Trusted Information for Healthy Pregnancies
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High-dose vitamin D safe during pregnancy
May 3rd
Taking high doses of vitamin D during pregnancy is safe and appears to reduce the risk of preterm birth and infections, say the authors of a study that compared different amounts of supplementation in expectant mothers.
But their recommendation that pregnant women should take 4,000 international units of vitamin D daily -- at least 10 times the standard recommended amount -- is sure to generate controversy.
"When we first proposed the study in 2002, it was heresy to even think about giving more than 400 international units a day of vitamin D," co-principal investigator Dr. Carol Wagner said from Vancouver, where the two-part study is being presented at an international pediatrics meeting.
"Diet doesn't provide enough vitamin D, and we don't go in the sun as much as we need (to)," said Wagner, adding that her research team set out to determine the optimal dose of vitamin D supplements for pregnant women that would promote health without doing harm.
The researchers enrolled 494 pregnant women at 12 to 16 weeks' gestation in the study and assigned them to three groups: one group received 400 IUs of vitamin D a day until delivery; the second got 2,000 IUs; and the third 4,000 IUs. The women were tested monthly to ensure they were not suffering any negative effects.
Neither the women nor the researchers knew what dose of vitamin D they were receiving in the study, a "blinded," randomized controlled trial whose methodology is considered the gold standard of medical science.
"What we found was that 2,000 was better than 400, and 4,000 was the best, without any adverse events that were associated with vitamin D," said Wagner. "And then ... we found fewer infections in the 4,000 group and fewer preterm labors and-or preterm birth deliveries in the 4,000 group compared to the 400 group."
Analysis of the data also showed that the women taking 4,000 units of vitamin D had half the rate of pregnancy-related disorders, such as gestational diabetes and preeclampsia, compared to expectant mothers taking 400 units.
However, Wagner conceded that the notion of pregnant women taking a daily dose of 4,000 IUs of vitamin D will likely stir some debate, especially within the medical community. The current recommended daily dose is 200 to 400 IUs daily.
Dr. Gideon Koren, head of the Motherisk Program at Toronto's Hospital for Sick Children, said the study is too small to provide such a definitive recommendation and to "declare therapeutic superiority" of 4,000 units of vitamin D.
"I think for now women should be sure that they get the recommended dose. I don't know that this study by itself should send women to buy 4,000. No, no way. I don't think this is sufficient."
"The study's important to show that it doesn't cause side-effects, but I think to tell women that they need 4,000 - to go from 400 to 4,000 - is huge."
However, Dr. Reinhold Vieth, head of the Bone and Mineral Laboratory at Mount Sinai Hospital in Toronto, has long argued that recommended daily amounts (RDAs) for vitamin D are outdated and woefully inadequate.
Vieth, who has conducted numerous studies on vitamin D in different patient populations, said the Canadian Pediatric Society has been advocating 2,000 units during pregnancy since 2007.
"The next step, 4,000, well, I bet you they'll come up with that in a couple of years, because this (the Wagner-group study) has to get published first," he said, adding that he agrees that pregnant women should be taking that level of vitamin D daily.
Dr. Robert Gagnon, a spokesman for the Society of Obstetricians and Gynecologists of Canada (SOGC), said the study was well-designed and its findings are important.
The Montreal specialist said SOGC is in the process of reviewing the medical literature before deciding on its official recommendation for expectant mothers.
"We need to see all the details of the study before we come to the recommendation," he said. "To say (pregnant women) should take 4,000, I think it's a little premature for that."
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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".
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Less sunlight in first trimester of pregnancy linked to MS
Apr 30th
Region of birth and lower levels of exposure to ultraviolet radiation during the first trimester of pregnancy were both independently associated with an increased risk of multiple sclerosis (MS) in adult life, shows research published in the BMJ.
The study was conducted across five states and one territory in Australia, among people born between 1920 and 1950 who were still alive at the time of the 1981 population census. A prevalence survey of MS had also been carried out in 1981.
There were 1524 patients with multiple sclerosis born in Australia 1920-50 from a total population of 2 468 779. Researchers analyzed their data by sex, month and year of birth and region of birth.
As expected, MS was more than twice as common among women as among men.
Overall, people born in November-December (first trimester in the Australian winter) had a third higher risk of subsequently developing MS than those born in May-June (first trimester in the summer).
When researchers analyzed their data by region of birth, they found that people born in regions with the lowest average levels of ambient ultraviolet radiation had a more than four times greater risk of subsequently developing MS than those born in the sunniest regions.
The association with month of birth was accounted for by the month- and region-specific ambient ultraviolet radiation during the first trimester – the effect of month of birth did not persist after adjustment for first trimester ultraviolet radiation.
The authors discuss the implications for prenatal care, and conclude: “Vitamin D supplementation for the prevention of multiple sclerosis might also need to be considered during in utero development.”
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Vaginal birth can be OK after multiple C-sections
Feb 18th
Women who attempt vaginal childbirth after having several babies by cesarean section may not have a greater risk of complications than women who've had only one prior C-section, a new study suggests.
Still, the American College of Obstetrics and Gynecology (ACOG) does not currently recommend vaginal delivery for women who have had three or more C-sections, as their risk of uterine rupture has generally been thought to be higher.
In the new study, however, researchers found that women with at least three prior C-sections showed no increased risk of uterine rupture during vaginal delivery.
In fact, none of the 89 women who opted to try vaginal childbirth had the complication, according to findings published in the British obstetrics journal BJOG.
Based on past research, the expected rate of uterine rupture among women with one prior C-section would be less than 1 percent; a large 2004 study of U.S. women, for example, found a rate of 0.7 percent.
These latest findings suggest it would be "reasonable to reconsider" the current ACOG recommendations for women with three or more prior C-sections, according to lead researcher Dr. Alison G. Cahill of Washington University School of Medicine in St. Louis.
For their study, Cahill and her colleagues reviewed the records of 25,000 women at 17 U.S. hospitals who gave birth after having at least one prior C-section. The group included 860 women with at least three prior C-sections, 89 of whom attempted a vaginal delivery; the remaining 771 elected to have a repeat C-section.
There were no cases of uterine rupture in either group, the researchers found.
The 89 women who chose to try labor also had no instances of bladder or bowel injury, or lacerations of the uterine artery -- the other main complications the researchers assessed. That compared with just over 2 percent of the women who had a repeat C-section -- though that difference, the researchers say, is not significant in statistical terms.
When it came to successful delivery -- meaning the doctor did not have to switch to a C-section during labor -- the chances were similar regardless of the number of prior C-sections.
Just over 13,600 women with one or two prior C-sections elected to try vaginal delivery, with a success rate of about 75 percent. That rate was 80 percent among women with a history of three or more C-sections.
Cahill pointed out that all of the women in the study had had C-sections done with what is called a low transverse incision -- a horizontal cut across the lowest part of the uterus. These types of incisions have a lower risk of rupture compared with the "classical" high vertical incision, an up-and-down incision made higher on the uterus.
Another factor to consider in the decision to try vaginal delivery after cesarean, according to Cahill, is whether a woman has ever had a previous vaginal birth. Previous vaginal deliveries increase the chances of success with a post-cesarean attempt at vaginal birth.
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Sterilization surgery not linked to sexual problems
Feb 18th
Women who have their "tubes tied" to prevent future pregnancies do not seem to have an increased risk of sexual dysfunction afterward, according to a new study.
In fact, researchers found, women in their study who'd had the procedure showed lower risks of certain sexual problems and tended to be happier with their sex lives than other women.
The surgery, known as tubal ligation, involves blocking the fallopian tubes that connect the ovaries with the uterus. It is done either right after childbirth -- through the vagina or during a cesarean section -- or via laparoscopic surgery, where one or two small incisions are made in the abdomen.
There are no physiological reasons to believe tubal ligation would cause sexual problems, but there has been little research on the subject, said Dr. Anthony Smith of La Trobe University in Melbourne, Australia, the lead researcher on the current study.
What studies there are have generally only asked women about their general sexual satisfaction, Smith told Reuters Health in an email.
For their study, Smith and his colleagues surveyed 2,721 Australian women about various sexual dysfunction symptoms and their overall satisfaction with their sex lives. Of those women, 447 -- or about 16 percent -- had had a tubal ligation, most of whom were between the ages of 40 and 64.
Overall, women who had had the procedure were less likely to report sexual problems and more likely to say they were happy with their sex lives, according to findings published in BJOG, a British medical journal.
Just over 42 percent said they lacked interest in sex, for example, compared with 51 percent of women who had not had a tubal ligation. And while 17 percent of the latter group said they "did not find sex pleasurable," only 14 percent of women in the tubal-ligation group said the same.
When the researchers accounted for other factors -- like age, education and marital status -- women who'd had a tubal ligation were roughly one-third less likely to lack interest in sex, take "too long" to reach orgasm, have vaginal dryness during sex or find sex unpleasant.
In addition, the study found, women in the tubal-ligation group generally gave higher marks to their sex lives. Thirty-six percent reported "extremely high sexual satisfaction," compared with 30 percent of women who had not had the procedure; when the researchers considered the other factors, women in the tubal-ligation group were two-thirds more likely to give such high ratings to their sex lives.
It's possible, Smith's team notes, that the women and their partners were enjoying sex more because they were free of anxiety over a potential unplanned pregnancy.
Of course, tubal ligation is only one method of birth control. In general, experts recommend it only for women who are sure they do not want to become pregnant in the future. And like any surgery, it carries some risks -- including bleeding or infection during the procedure, and incomplete closing of the tubes; about one in 200 women who have a tubal ligation later become pregnant.
Studies have also found that anywhere from 6 percent to 20 percent of women who have the procedure later regret their decision -- with younger women being more likely to express regrets.
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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.
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Two languages in womb makes bilingual babies: study
Feb 17th
Babies who hear two languages regularly when they are in their mother's womb are more open to being bilingual, a study published this week in Psychological Science shows.
Psychological scientists from the University of British Columbia and a researcher from the Organization for Economic Cooperation and Development in France tested two groups of newborns, one of which only heard English in the womb and the others who heard English and Tagalog, which is spoken in the Philippines.
To determine the babies' preference for a language, the researchers studied the newborns sucking reflex; increased sucking by a neonate indicates interest in a stimulus.
In the first experiment, infants heard 10 minutes of speech, with every minute alternating between English and Tagalog.
The English-only infants were more interested in English than Tagalog -- in other words, they "exhibited increased sucking behavior" when they heard English than when they heard Tagalog being spoken.
The infants exposed to two languages, on the other hand, showed an equal preference for both English and Tagalog, suggesting to the researchers that prenatal bilingual exposure prepares infants to listen to and learn about both of their native languages.
The researchers also tested the newborns to see if they could tell the differences between two languages -- key to becoming bilingual.
The infants listened to sentences being spoken in one of the languages until they lost interest, and then heard sentences in the other language or heard sentences in the same language, but spoken by a different person.
The infants exhibited increased sucking when they heard the other language being spoken, but their sucking did not increase if they heard additional sentences in the same language.
"These results suggest that bilingual infants, along with monolingual infants, are able to discriminate between the two languages, providing a mechanism from the first moments of life that helps ensure bilingual infants do not confuse their two languages," the authors of the study said.
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Wanted: Volunteers, All Pregnant
Feb 16th
The woman sent by government scientists visited the Queens apartment repeatedly before finding anyone home. And the person who finally answered the door - a 30-year-old Colombian-born waitress named Alejandra - was wary.
Although Alejandra was exactly what the scientists were looking for - a pregnant woman - she was "a bit scared," she said, about giving herself and her unborn child to science for 21 years.
Researchers would collect and analyze her vaginal fluid, toenail clippings, breast milk and other things, and ask about everything from possible drug use to depression, At the birth, specimen collectors would scoop up her placenta and even her baby’s first feces for scientific posterity.
She ultimately decided that participating would “help the next generation.”
Chalk one up for the scientists, who for months have been dispatching door-to-door emissaries across the country to recruit women like Alejandra for an unprecedented undertaking: the largest, most comprehensive long-term study of the health of children, beginning even before they are born.
Authorized by Congress in 2000, the National Children’s Study began last January, its projected cost swelling to about $6.7 billion. With several hundred participants so far, it aims to enroll 100,000 pregnant women in 105 counties, then monitor their babies until they turn 21.
It will examine how environment, genes and other factors affect children’s health, tackling questions subject to heated debate and misinformation. Does pesticide exposure, for example, cause asthma? Do particular diets or genetic mutations lead to autism?
But while the idea is praised by many experts, the study has also stirred controversy over its cost and content.
In August, the Senate committee overseeing financing for the study accused it of “a serious breach of trust” for not disclosing that the initial price tag of $3.1 billion would more than double, and said the study needed to release more information if it wanted to get “any” financing in the next budget year.
And an independent panel of experts and some members of the study’s own advisory committee say it misses important opportunities to help people and communities — emphasizing narrower medical questions over concerns like racial and ethnic health differences, leaving unresolved crucial ethical questions concerning what to tell participants and communities about test results.
“This study is of the magnitude of the accelerator in CERN, or a trip to the moon — a really big science issue,” said Milton Kotelchuck, a professor at the Boston University School of Public Health and a member of the independent panel. “But if you have a flawed beginning, then you’ve got 20 years of working on a flawed study.”
Officials are making changes, putting all but the pilot phase, to involve 37 locations, on hold while conducting an inquiry into the cost and scientific underpinnings, Dr. Collins said. Some data may no longer be collected if “we can’t afford” it, he said, and every aspect will receive “the closest possible scrutiny.”
The study is far from its plan of recruiting 250 babies a year for four or five years in each community. By December, 510 women were enrolled and 83 babies were born in the first seven locations, including Orange County, Calif., and Salt Lake County, Utah.
That was after knocking on nearly 64,000 doors, screening 27,000 women and finding 1,000 who were pregnant and in their first trimester (and therefore eligible).
The time and information required from families could also make the study “too burdensome to be conducted the way it is,” said Dr. Susan Shurin, former acting director of the National Institute of Child Health and Human Development, part of the National Institutes of Health and the study’s supervising agency. The fear is women will “go ‘Oh no, you again,’ and slam the door in your face.”
Specimens include blood, urine, hair and saliva from pregnant women, babies and fathers; dust from women’s bedsheets; tap water; and particles on carpets and baseboards. They are sent to laboratories (placentas to Rochester, N.Y., for example), prepared for long-term storage, and analyzed for chemicals, metals, genes and infections.
Participants provide the names and phone numbers of relatives and friends, so researchers can find them if they move. As children grow, scientists, including outside experts, can cross-reference information about their medical conditions, behavioral development and school performance.
Besides looking at widespread conditions, like diabetes, the study will consider regional differences. Maureen Durkin, principal investigator in Waukesha County, Wis., wonders if radium in the county’s water, and houses built on “farm fields that may be contaminated with nitrates and atrazine,” have different health consequences than pollution or industrial chemicals in Queens.
But study officials are trying to determine what information to give participants and when. Some experts say people should get results of their chemical or genetic tests only if medical treatments exist because otherwise it only causes anxiety. Others agree with Patricia O’Campo, a member of the study’s advisory committee and the independent panel, who says the study should be “less ivory towerish” and disclose more information to families and communities.
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Migraine drugs don’t up birth defect risk: study
Feb 16th
A study in nearly 70,000 pregnant women has found no link between migraine drugs called triptans and the risk of birth defects.
However, the researchers did find a "slight increase" in the risk of excessive bleeding during labor, and the failure of the uterus to contract normally after delivery, for women who used the drugs while pregnant.
Triptans are among the most powerful drugs used for migraine; others include aspirin, Excedrin, and ibuprofen.
While as many as three in 10 women may develop migraines during their childbearing years, women often shy away from using such drugs during pregnancy because of safety concerns, according to study co-author Katerina Nezvalova-Henriksen of the University of Oslo in Norway and her colleagues.
However, the authors of the study in Headache note, untreated migraine may itself carry risks for mother and child; some studies have linked it to pre-eclampsia, a potentially deadly pregnancy complication.
"While it is important to exert caution when using any medications during pregnancy, this study indicates" that pregnant women can either start or continue taking triptans without "any major risk" of miscarriage, premature delivery, or other bad outcomes, the authors conclude.
Nezvalova-Henriksen and her team studied nearly 70,000 women. Two percent, or 1,535, had used sumatriptan (Imitrex), rizatriptan (Maxalt), zolmitriptan (Zomig), or eletriptan (Relpax) in pregnancy.
Less than one percent -- 373 women -- had used the drugs before getting pregnant but not during pregnancy.
The overall birth defect rate, which encompasses everything from large birthmarks to serious heart problems, was the same among women who had taken triptans during pregnancy and those who didn't have migraines: 5 percent. Among those who had used triptans in the past but not during pregnancy, it was slightly higher: 6 percent.
The women who used triptans were also more likely than non-triptan users to take other drugs during pregnancy, including acetaminophen (Tylenol) with codeine and non-steroidal anti-inflammatory drugs such as ibuprofen.
However, the rate of major birth defects - such as serious problems of the limbs or internal organs -- was 3 percent for all three groups. That rate - about one in 33 births - is about what would be expected for all birth defects in the general population.
The researchers did find that women who used triptans in their second or third trimester were more likely to develop a condition called atonic uterus, in which the uterus fails to contract back to its normal size after delivery. This is the leading cause of excessive bleeding after delivery. They were also more likely to lose significant amounts of blood during labor and delivery.
And during pregnancy, they were more likely to suffer from vomiting than women who had never used the drug; they were also more likely to develop pre-eclampsia or eclampsia, and more likely to have deficiencies in the B-vitamin folate.
While many women who suffer migraines will experience improvements in their symptoms after their first trimester, Nezvalova-Henriksen and her team note, those whose symptoms don't improve by then aren't likely to get better.
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Excess weight raises pregnancy risks: study
Feb 12th
Being overweight or obese increases a woman's chances of having an extra-big baby, even after the effects of pregnancy-related, or "gestational," diabetes are taken into account, new research shows.
Excess weight in and of itself also sharply increased a woman's risk of pre-eclampsia, a potentially deadly pregnancy complication, Dr. Boyd E. Metzger of Northwestern University Feinberg School of Medicine in Chicago and his colleagues found.
Women have more difficulty delivering very large babies, while these newborns are also at risk of suffering injury during birth, including shoulder dislocation. While women who are overweight or obese are known to run a greater risk of having very large babies and experiencing other pregnancy complications, it has been difficult to separate out the effects of a mother's weight from those of gestational diabetes, Metzger and his colleagues note in the British Journal of Obstetrics and Gynecology.
This led them to investigate whether body mass index (BMI) -- a standard measure of weight in relation to height used to gauge how fat or thin a person is -- might influence pregnancy risks and fetal and newborn health, independently of a woman's blood sugar levels.
The study involved 23,316 women from 15 different medical centers in nine different countries. All had undergone an oral glucose tolerance test, which is used to identify women with, or at risk for, pregnancy-related diabetes; at that time, their height and weight were measured, too.
The researchers then used statistical techniques to control for women's oral glucose tolerance test results. Even after this adjustment, they found that the women with BMIs of 42 or greater, denoting severe obesity (for example, a 5-foot-5-inch tall woman weighing at least 250 pounds), were at more than triple the risk of having an excessively large baby, compared to the thinnest women in the study, who had BMIs of 22.6 or less (a 5'5" woman weighing less than 138 pounds).
The heaviest women's risks of having a C-section were more than doubled, while their likelihood of pre-eclampsia was 14-fold greater than for the leanest women. However, the heaviest women's risk for delivering a preterm baby was actually cut in half.
These findings help sort out the role BMI and gestational diabetes each play in the risk of complications of pregnancy and delivery, Metzger told Reuters Health in an interview.
He noted that recent studies have shown that dietary changes can effectively treat gestational diabetes for more than 90 percent of women with the condition.
"We're pretty confident that treating gestational diabetes going forward is going to continue to be beneficial," the researcher said. "We have much less evidence at this point as to how to neutralize or reduce the impact of overweight on pregnancy outcome."
What is becoming clear, he added, is that it's probably a woman's weight before she gets pregnant, rather than how much she gains during pregnancy, that's important in determining risk.
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