Monday, September 19, 2005

Study: Men's Tobacco Chewing May Harm Sperm

Study: Men's Tobacco Chewing May Harm Sperm

Sept. 16 (WEBMD) - A new study notes a possible link between tobacco chewing and sperm problems.

Infertile men "should be counseled about the adverse effects of tobacco chewing on sperm," write the researchers in Fertility and Sterility.

Chewing Tobacco and Sperm

The study included 638 men at an infertility clinic in Mumbai, India. All of the men had been tobacco chewers for four to 10 years.

"A large population of Indian men is addicted to tobacco chewing," write the researchers.

The men were split into three groups based on their tobacco chewing habits:

  • Mild: Chewing tobacco less than three times daily.
  • Moderate: Chewing tobacco three to six times daily.
  • Severe: Chewing tobacco more than six times daily.

Men in the "severe" tobacco chewing group had the fewest, worst quality sperm. The more tobacco the men chewed, the poorer their sperm were, the study shows.

The study didn't include any men who weren't tobacco chewers. Thus, the researchers can't say that it's actually the chewing tobacco for sure that caused the sperm problems.

The scientists who worked on the study included Ashok Agarwal, PhD, HCLD. Agarwal works at the Center for Advanced Research in Human Reproduction, Infertility, and Sexual Function at The Cleveland Clinic's Glickman Urological Institute.

Other Factors?

The study didn't pinpoint why the men were infertile. In India, tobacco chewing is more common among disadvantaged people, the researchers note.

Hardship can affect health in many ways; tobacco chewing probably doesn't paint the whole picture.

"Men addicted to tobacco chewing also have the least access to infertility medical services," write the researchers.

Efforts should be made to "direct the attention of the general public towards the possible relationship between tobacco chewing and the incidence of male infertility," write Agarwal and colleagues.

They note that an earlier study by other researchers didn't find a link between male infertility and tobacco chewing. That study was smaller and was designed differently, Agarwal's team writes.

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More First-Time Moms Opting For C-Sections

More First-Time Moms Opting For C-Sections
Patient-choice cesareans up nearly 40 percent, report finds

MONDAY, Sept. 12 (HealthDay News) -- More and more first-time mothers are choosing to deliver their babies by Cesarean section, even when there's no medical need for the procedure, researchers report.

A new report from HealthGrades found that patient-choice C-sections for first-time mothers with no medical need for a cesarean increased 36.6 percent from 2001 to 2003. While the absolute numbers are still low, accounting for only about 2.5 percent of U.S. births, the decision still remains a controversial one.

Some doctors support the idea of patient choice, while others feel it's nearly impossible for women without medical training to truly comprehend the risks involved with Cesarean births.

"I think women understand more now than they ever did, but do they understand the real risk? Probably not," said Dr. Samantha Collier, author of the report and vice president of medical affairs for HealthGrades, in Golden, Colo.

"The bottom line is that patient-choice C-section is an unnecessary surgery. And, there's an alternative to it, which women have been doing since the beginning of time. Plus, it may or may not be covered by insurance since it's not necessary," said Collier.

Collier said she wasn't against patient-choice C-sections -- just that women need to be as informed as possible. And, she added, women need to understand that their physicians will likely have a bias either for or against a patient-choice C-section, and it's important for women to know how their doctor feels about the issue.

Having a C-section is considered major abdominal surgery, according to Collier. The risks for the mother include hemorrhage, pain, infection and placenta-implantation problems in subsequent pregnancies. For the baby, risks include respiratory problems, accidental surgical cuts and an increased risk of breastfeeding problems and asthma, according to the report.

The risk of complications from a C-section has decreased dramatically, even in the last 10 to 20 years, said Collier. "While C-section complications are higher than for vaginal delivery, they're still so, so low," she said.

That reduction in complication rates may be one of the driving forces in the increase. Collier said women are also more educated on the issue and are demanding patient-choice C-sections. Plus, they're getting support from medical groups such as the American College of Obstetrics and Gynecology, she said.

In 2001, the rate of patient-choice Cesareans was 1.87 percent. That number rose to 2.55 percent in 2003, according to the HealthGrades report. These figures come from 1,500 hospitals in 17 states. Over the three years the report encompasses, 267,340 patient-choice C-sections were performed, according to the report.

There was significant variability in the patient-choice C-section rate from state to state. Nevada had the largest increase (56.7 percent), followed by Washington (53.6 percent) and Florida (47.6 percent) in elective first-time C-sections.

The states with the lowest change in the percentage of elective C-sections performed were Iowa (28.2 percent), New York (26.3 percent) and Arizona (15.7 percent).

Florida, New Jersey, New York and Nevada had the highest rates of patient-choice C-section, with each state having slightly more than 3 percent of births performed by elective cesarean.

Collier said she's not sure why there's such a difference from state to state, but said it may have something to do with physician training, or it could be more culturally accepted in some areas.

Dr. Kim Warner, an obstetrician/gynecologist for Kaiser Permanente in Denver, said, "The numbers of patient-choice C-sections probably are increasing, but I haven't seen it much here in Denver."

"We're very stringent in our indications for patient choice C-section and convenience is never one of them," she said.

Warner, incidentally, had an elective C-section for her first birth, and said that as many as one in three obstetricians chooses this option, hoping to prevent later problems, such as urinary or fecal incontinence. She is quick to point out, however, that there's no solid proof that vaginal delivery can cause such problems.

"For the majority of women, vaginal delivery is still the standard of care and is usually indicated, but you can definitely have a discussion about how you want to deliver your child with your doctor," said Warner.

Collier advised that, "if you decide that patient-choice C-section is something you're very, very interested in, collect information and talk to your doctor. Make sure you really understand the risks. It's often a tradeoff -- do you want pain now or later?"

"While you might get out of labor pain, later, when you're caring for your baby, you'll have a harder time picking up and caring for the baby because you're recovering from major abdominal surgery, which can impact bonding with the baby during the perinatal period," she said.

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More Research Needed Into Preemie Births

More Research Needed Into Preemie Births
March of Dimes experts say premature delivery up 30 percent since the 1980s

FRIDAY, Sept. 15 (HealthDay News) -- Targeted research to prevent premature birth is needed in order to save the lives of thousands of babies each year, according to a March of Dimes expert panel report released Friday.

"Preterm birth is a complex disorder, like heart disease or diabetes, with no single cause, and it requires a multifaceted approach," report lead author Dr. Nancy S. Green, March of Dimes medical director, said in a prepared statement.

"We need to stimulate more funding for research in six promising areas that may lead to new clinical strategies for identifying who is at greatest risk for premature birth and how to prevent it," Green said.

The six priority areas are:

  • Epidemiological studies that examine the risk of extremely preterm births to spot factors that predispose women to very early labor and delivery.
  • Genes and their interaction with the environment that, combined, result in preterm birth.
  • Racial and ethnic differences that may explain why non-Hispanic black American women have the highest rate of premature babies in the U.S.
  • The impact of infection and immune response to infection.
  • The effects of stress on the mother and fetus.
  • Clinical trials to assess the effectiveness of potential treatments.

More than 12 percent (about 500,000) of babies born each year in the United States are born prematurely and the rate of premature births in the country has increased by more than 30 percent since 1981. Premature birth is the leading cause of death among U.S. newborns, and preterm babies who survive often suffer lifelong health problems.

The recommendations appear in the current issue of the American Journal of Obstetrics and Gynecology.

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Wednesday, September 14, 2005

Use of Antidepressants While Pregnant Can Affect Baby

THURSDAY, Feb. 3 (HealthDay News) -- Women who take antidepressants like Paxil or Prozac while pregnant may have babies who experience withdrawal syndrome in the first few days of life, a new study finds.
Spanish scientists, using a worldwide drug alert system, found a higher-than-expected incidence of neonatal withdrawal syndrome, consisting of convulsions, irritability, abnormal crying and tremors, among babies of women who took selective serotonin reuptake inhibitors (SSRIs), the class of drugs that includes Paxil and Prozac.
Their report, which is published in the Feb. 5 issue of The Lancet, found the association seemed to be highest among women who used Paxil.
"There is an association in some cases, not in every single case," said Dr. Emilio Sanz, the lead author of the paper and a clinical pharmacology professor at the University of La Laguna School of Medicine in Tenerife. "If you have a pregnant woman that is depressed and is treated with anti-depressants, you should use the lowest effective dose or psychotherapy or other approaches if you can."
"Doctors should be more careful in prescribing SSRIs, especially paroxetine [Paxil] during pregnancy," added Dr. Vladislav Ruchkin, an associate research scientist at Yale University School of Medicine and the author of an accompanying editorial in the journal.
SSRIs, which first hit the market in 1988, are widely used to treat depression, anxiety and other mood and behavioral disorders in adults as well as children. But the drugs have been the subject of much recent controversy.
Reports last year of suicidal thinking in adolescents who use them led to a U.S. Food and Drug Administration review of clinical trials of antidepressants, which confirmed the association. That, in turn, led to the FDA's ordering a "black box" warning on the labels.
There has also been concern that SSRIs triggers manic behavior in 10 to 14 year olds, although a study released just this week found that the benefits of antidepressants appeared to outweigh the risk of suicide.
Several smaller studies, however, have already shown an increased risk of complications for pregnant women taking SSRIs.
For this latest research, investigators screened an international drug surveillance system maintained by the World Health Organization (WHO). The database contains three million records from 72 countries dating back to 1968. A signaling system sends alerts when there are more cases than there should be.
The investigators found a total of 93 cases of neonatal convulsions or withdrawal syndrome associated with SSRI use. About two thirds of the cases (64) were associated with Paxil, 14 with Prozac, nine with Zoloft and seven with Celexa, they said.
The database had incomplete information on dosage and duration of treatment and also doesn't include information on how many people were or are using these drugs.
Although those babies who experienced withdrawal syndrome appear to recover within a short period of time, Ruchkin is concerned that there may be a developmental impact on the infant brain, a subject on which there is little research.
"A number of studies suggest that SSRIs may have a long-term impact on the child's brain," he said, adding, however, that most such studies have been done with mice and that human studies need to be done.
For the moment, there is no clear guidance other than to exercise caution, Sanz said, with doctors assessing the severity of each woman's case before prescribing antidepressants.

For more up-to-date articles on pregnancy-related issues, visit our parent site

For more on this drug monitoring system, visit the World Health Organization.
SOURCES: Emilio Sanz, M.D., professor of clinical pharmacology, University of La Laguna School of Medicine, Tenerife, Spain; Vladislav Ruchkin, M.D., Ph.D., associate research scientist, Yale Child Study Center, Yale University School of Medicine, New Haven, Conn.; Feb. 5, 2005, The Lancet

Childbirth at Home as Safe as Hospital Delivery: Study

THURSDAY, June 16 (HealthDayNews) -- Women who choose to give birth at home with the help of a certified midwife have deliveries that are as safe as those done in a hospital, Canadian researchers report.
"Home birth is a reasonable option for low-risk women," said lead researcher Kenneth C. Johnson.
"In this low-risk group of women who had births with midwives at home, we found that the overall safety was similar to what you would find in a hospital in a similar low-risk group," added Johnson, a senior epidemiologist with the Center for Chronic Disease Prevention and Control at the Public Health Agency of Canada, in Ottawa.
Moreover, evidence from the study supports the American Public Health Association's recommendation that home deliveries with certified midwives should be increased in the United States, he said.
The study appears in the June 18 issue of the British Medical Journal.
Johnson and colleague Betty-Anne Daviss collected data on over 5,400 women who had planned to deliver their babies at home in 2000. These women all had the help of a certified midwife.
When it came time to deliver, 655 of the women transferred to the hospital instead at the start of labor, the researchers reported. "Only about 3 percent of these women had what the midwife perceived as an urgent transport," Johnson said. "The outcomes of these transfers turned out to be fine, by and large."
For the remaining women who had a home delivery, the death rate of newborns was 1.7 per 1,000 planned home births. This rate is similar to that of low-risk home and hospital births shown in other studies done in North America, the researchers noted.
Johnson pointed out that in Canada and Europe, midwives deliver most babies. "It's only in the United States among developed countries that midwives are still involved in only a very small percent of deliveries, and that home birth is rare and unacceptable to the obstetric and gynecology profession," he said.
Despite these findings, one expert thinks home delivery is not a good idea. "I am not a big fan of home deliveries," said Dr. Rachel Masch, an assistant professor of obstetrics and gynecology at New York University School of Medicine.
"I understand why women want to have them," she said. "And I understand that the literature we have today supports that there isn't any worse outcome for them versus the low-risk hospital delivery if you are screened properly. Although, as an obstetrician who sees a lot of things that happen bad quickly, I think that I have somewhat of a jaded view," Masch said.
Masch is concerned that when complications set in, they do so quickly and need immediate attention. Women who appear to be at low-risk can fall prey to problems during birth that weren't anticipated, or may have conditions that were not known, which can affect the delivery. Being in a hospital allows these women to get immediate care, which can save their lives and their babies' lives, she said, adding, "There are examples that I see frequently."
But another expert finds nothing but positives in increasing the numbers of home deliveries.
"The data we have so far suggests that over-medicalizing the process of labor and delivery adds cost without improving outcomes," said Dr. David L. Katz, director of the Prevention Research Center and an associate clinical professor of epidemiology and public health at Yale University School of Medicine.
"Building the option of home birth into the routine of obstetrical care for women at low risk of complications is worthy of serious consideration," he added.

To learn more about midwives, visit the Midwives Alliance of North America.

For more up-to-date articles on pregnacy-related issues, visit our parent site

SOURCES: Kenneth C. Johnson, Ph.D., senior epidemiologist, Surveillance and Risk Assessment Division, Center for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa; Rachel Masch, M.D., assistant professor of obstetrics and gynecology, New York University School of Medicine, New York City; David L. Katz, M.D., M.P.H., director, Prevention Research Center, associate clinical professor of epidemiology and public health, Yale University School of Medicine, New Haven, Conn.; June 18, 2005, British Medical Journal

More DNA Damage to Older Men's Sperm

TUESDAY, June 21 (HealthDay News) -- Older men have much more sperm DNA damage than young men do, which reduces their chances of fathering children, a Canadian study finds.
The study of over 2,100 men found that injury to sperm DNA was significantly higher in men over 45 years old than in all younger age groups. Men over 45 years had double the sperm DNA damage compared with men younger than 30 years old.
The research was presented Tuesday at the annual conference of the European Society of Human Reproduction and Embryology in Copenhagen.
The findings are particularly important given the societal increase in the average age of men and women first attempting to have children, noted researcher Dr. Sergey Moskovtsev of Mount Sinai Hospital in Toronto.
"Older men tend to reproduce with older women and the combination of increased female factor infertility, increased sperm DNA damage, low levels of DNA repair, and increased abnormalities in conventional semen parameters present in this [older male] population will have a pronounced impact on their reproductive potential," Moskovtsev said in a prepared statement.
"We need to investigate the possibility of developing techniques to identify and select sperm without DNA damage for use in assisted reproductive technologies," the Toronto expert said.

For more up-to-date articles on pregnancy-related issues, visit our parent site

SOURCE: European Society of Human Reproduction and Embryology, news release, June 21, 2005

Many Dads Unknowingly Raising Others' Kids

THURSDAY, Aug. 11 (HealthDayNews) -- Calling it a Pandora's Box with broad health implications, British researchers say genetic testing is informing about 4 percent of fathers that a child they are raising is not their own.
The implications are huge, the study authors noted, because such revelations often lead to divorce and increased mental health problems for both the man and woman involved, including the threat of violence by the man.
In addition, children whose lives are changed by this genetic information can struggle with low self-esteem, anxiety, and increased antisocial behavior, such as aggression.
And the problem will only grow more serious as genetic testing is used for more and more purposes, including screening for organ donations and checking for genetic-based diseases such as cancer, cystic fibrosis and heart disease, the researchers said. In addition, such testing is becoming more common in police investigations.
What's needed, the researchers said, is clearer guidance on when and how to disclose such information. They believe individual and family support services and counseling should become part of paternity-testing procedures.
"At the moment, people are often receiving the results of paternity testing through e-mail and post," said lead researcher Mark Bellis, a professor of public health at the Centre for Public Health at Liverpool John Moores University.
"People are receiving what can be pretty dramatic information without being linked into health or counseling or support services," he added. "In addition, people are coming forward in more and more numbers each year to have paternity testing done."
The report appears in the August issue of the Journal of Epidemiology and Community Health.
The authors said they based their findings on international published scientific research and conference abstracts released between 1950 and 2004.
The study found that rates of "paternal discrepancy" range on average from less than 1 percent to as high as 30 percent, depending on the group of people looked at. For women, those who are younger, poorer or have multiple sex partners are more likely to bear a child who wasn't fathered by a long-time partner, the researchers said.
An average paternal discrepancy rate of 4 percent means about one in 25 families could be affected, the researchers said.
To determine the extent of the problem, Bellis and his colleagues collected data on increasing rates of paternity testing in North America and Europe. For example, in the United States, rates more than doubled to 310,490 between 1991 and 2001, they noted.
In Great Britain, about one-third of pregnancies are unplanned, and about one in five women in long-term relationships has had an extramarital affair, the researchers reported. These are similar to figures in other developed countries, they noted.
Yet there is a lack of support services to help people who find out about a parental discrepancy from a paternity test. "Finding out a child does not belong to them [the fathers] can have effects in terms of breakup of families and issues of safety and well-being of the child and women," Bellis said.
Bellis believes that giving counseling and support to these families needs to be considered. "We need to think about how that can be delivered," he said.
He added, "In genetic testing for health conditions, in police investigations, all these can identify discrepancies in family genetics, but there is no consideration if it is a good thing or a bad thing to let the families know about those [discrepancies]."
One expert thinks the study highlights the social downside of emerging technologies.
"Not surprisingly, the disclosure of information about unsuspected paternity comes with potentially devastating effects," said Dr. David L. Katz, an associate clinical professor of public health and director of the Prevention Research Center at Yale University School of Medicine.
"But does that mean such information should be concealed when it is a byproduct of testing for other reasons? When should paternity testing be permissible, and at the request of whom?" he added.
New knowledge means new power, but not necessarily the power to use it correctly, Katz said.
"Bellis and colleagues suggest that genetic testing has provided the power to lift a lid off Pandora's Box," he said. "As they rightly point out, it will take something other than power -- namely wisdom -- to respond productively, fairly and compassionately to all that comes flying out."

For more up-to-date articles on pregnancy-related issues, visit our parent site

SOURCES: Mark Bellis, Ph.D., professor, public health, Centre for Public Health, Liverpool John Moores University, Liverpool, England; David L. Katz, M.D., M.P.H., associate clinical professor, public health, director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; August 2005 Journal of Epidemiology and Community Health

Researcher Stands by Fetal Pain Findings

WEDNESDAY, Aug. 24 (HealthDay News) -- A controversial new research article questioning whether early-term fetuses feel pain has triggered a heated debate on how the research might influence the flash-point realm of abortion politics.
But a neuroscientist who helped write the paper, published Wednesday, said there's no doubt about the conclusion: Humans only feel pain if they have a properly functioning brain, and fetuses in the early stages of development don't.
"The circuitry is not there," at least in the first 20 weeks, said Dr. Henry Ralston, a professor of anatomy and neuroscience at the University of California, San Francisco. "Without the connections, the sensation can't take place."
The report, a review of known research by four doctors and a researcher at UCSF, goes even further: In examining the effectiveness of giving anesthesia to a fetus for therapuetic procedures or abortion, the researchers concluded that fetal perception of pain is unlikely before the third trimester, at 29 to 30 weeks.
Other doctors disagree, however, as do anti-abortion activists who criticized the findings, which appear in the Aug. 24/31 issue of the Journal of the American Medical Association.
Dr. K. S. Anand, a pediatrician at the University of Arkansas for Medical Sciences, told The New York Times, "There is circumstantial evidence to suggest that pain occurs in the fetus."
Anand said premature babies only 23 or 24 weeks old cry when their heels are pricked for blood tests and become conditioned to cry when someone nears their feet.
"In the first trimester, there is very likely no pain perception," Anand said. "By the second trimester, all bets are off, and I would argue that in the absence of absolute proof we should give the fetus the benefit of the doubt if we are going to call ourselves compassionate and humane physicians."
The study is also raising eyebrows, according to a Philadelphia Inquirer report, because one of its authors is the head of an abortion clinic. Her affiliation was not disclosed in the study, nor was that of the lead author, a medical student who once worked for an abortion-rights organization, the newspaper said.
The researcher, UCSF obstetrician-gynecologist Eleanor A. Drey, is medical director of the abortion clinic at San Francisco General Hospital. She told the Inquirer: "We thought it was critical to include an expert in abortion among the authors. I think my presence ... should not serve to politicize a scholarly report."
JAMA editor-in-chief Catherine D. DeAngelis told the newspaper she had been unaware of that.
"This is the first I've heard about it," she said. "We ask them to reveal any conflict of interest. I would have published" the disclosure if it had been made.
The issue of fetal pain, once fairly obscure, has taken an increasingly prominent position in the public consciousness in recent months. More than a dozen state legislatures -- including those in New York and California -- have debated whether to require doctors to tell women getting abortions about the potential pain felt by fetuses during the procedures. The proposed laws would require doctors to offer anesthesia for the fetus.
Arkansas, Georgia and Minnesota have already passed such laws.
And Congress is considering whether to require doctors to provide anesthesia to fetuses in all cases of abortion after 22 weeks of gestational age. (The new study noted that only 1.2 percent of abortions in the United States are performed at or after 21 weeks.)
Ralston said he and his colleagues launched their study, an analysis of previous research, to provide some perspective on the debate.
The researchers examined studies that looked at feelings of fetal pain before the age of 30 weeks. They found that while there hasn't been much research, the evidence suggests that fetuses aren't able to sense pain before the third trimester. They also report that "little or no" research provides guidance about the use of anesthesia on fetuses.
Advocates of anesthesia legislation have pointed to medical reports that fetuses shy away from painful stimuli, like the stick of a needle, in operations during pregnancy. Some doctors argue that infants between 20 and 30 weeks actually suffer pain more intensely than older fetuses and babies because their neural systems aren't set up to adequately process the sensations.
But Ralston said early fetal reactions are simply reflexes stemming from the spinal cord, not a matter of brain response to pain. The spinal cord develops earlier than the brain, as early as eight weeks, he said.
So when do fetuses actually start feeling pain? Ralston said it's not clear, but the lack of feeling before 20 to 22 weeks is "open and shut."
However, Dr. David A. Grimes, a former head of abortion surveillance at the U.S. Centers for Disease Control and Prevention who now delivers babies and also performs abortions in Chapel Hill, N.C., told the Times, "This is an unknowable question."
"All we can do in medicine is to infer," he added.
Still, he said, the new research makes a compelling case that fetuses younger than 29 weeks have no perception of pain.

For more articles on pregnancy-related issues, visit our parent site

SOURCES: Henry Ralston, M.D., professor of anatomy and neuroscience, University of California, San Francisco; Aug. 24/31, 2005, Journal of the American Medical Association; Philadelphia Inquirer; The New York Times

C-Sections Linked to Higher Cavity Risk in Babies

FRIDAY, Aug. 26 (HealthDay News) -- Women with dental cavities who deliver their babies by Caesarean section should pay close attention to their babies' dental health later on, a new study suggests.
Researchers from New York University found that a cavity-causing bacterium that grows on tooth surfaces appeared much earlier in babies delivered by C-section than in those delivered vaginally. The study evaluated 156 mother-infant pairs.

"We are the first to report that there is a link between C-sections and the acquisition of cavity-causing bacteria in the baby," said Dr. Yihong Li, an associate professor of basic science and craniofacial biology at the New York University College of Dentistry.

Li, who is lead author of the study, added that the researchers did not study whether the babies delivered by C-section actually got more cavities later, but only that they had more cavity-causing bacterium earlier.
The study appears in the September issue of the Journal of Dental Research.

The reason for the findings? Li suspects that vaginally delivered infants, because of exposure to a greater variety and intensity of bacteria from their mothers and the surrounding environment at birth, develop more resistance to the cavity-causing germ than do C-section babies, who have less bacterial exposure at birth.

The women in the study were mostly black women from an inner-city area of Birmingham, Ala. In all, 127 of the women had vaginal deliveries and 29 had C-sections. Their mean age was approximately 21 years, and about 75 percent of the women had cavities. Li and her team then started collecting saliva and plaque samples from the babies to evaluate them for bacterium.

The bacterium, Streptococcus mutans, was detected in 55 of the 156 infants, on average at 22.3 months of age. But the C-section infants acquired the germ at 17.1 months of age, compared to 28.8 for the vaginally delivered babies. Dr. Edmond Hewlett, an associate professor of dentistry at the University of California, Los Angeles School of Dentistry and a consumer advisor for the American Dental Association, called the study sound.

"What's new here is the association between the time of infection with bacteria that cause cavities and the type of delivery," he said. It has been known that the primary route of infection for cavity-causing bacteria is mother to infant, he said.

Even so, the new study findings "shouldn't affect the decision for women to have a C-section," Hewlett added.
The take-home message for mothers, Li said, is this: "If the mother has very poor oral health, she really needs to pay attention to her [baby's oral health] if she delivers C-section."

"Don't share spoons with your baby," Hewlett tells mothers, especially those who have cavities. "Chewing gum with Xylitol in it after eating is a good way to clear the mouth of bacteria."

For more articles on pregnancy-related issues, visit our parent site

SOURCES: Yihong Li, Dr.P.H., D.D.S., M.P.H., associate professor of basic science and craniofacial biology, New York University College of Dentistry, New York City; Edmond Hewlett, D.D.S., associate professor of dentistry, University of California, Los Angeles, and consumer advisor, American Dental Association; September 2005, Journal of Dental Research

Exercise: The Right Stuff for Moms-to-Be

SUNDAY, Aug. 28 (HealthDay News) -- There was a time when pregnant women weren't expected to lift a finger in their 'delicate' state, much less exercise.

Today, the same exercise recommendations that apply to most of the rest of the country -- 30 minutes or more of moderate exercise on most if not all days of the week -- also apply to pregnant women, if they are in relatively good health and their doctors approve.

"It's good for pregnant women to exercise if they would like to do so," said Dr. Richard P. Frieder, a clinical instructor of obstetrics and gynecology at the University of California, Los Angeles, and an obstetrician-gynecologist at Santa Monica UCLA Medical Center.

"Generally women feel better and are fitter if they exercise during pregnancy," Frieder added.
But he cautioned that pregnant women shouldn't expect miracles from exercise: "It doesn't make labor any easier," he said. "That's a marketing myth that sells exercise classes."

Physical activity during pregnancy does have benefits, however. It may help with weight control, allowing the mom-to-be to avoid too much weight gain during pregnancy. And a regular workout may help a woman avoid pregnancy-related health risks, said pregnancy expert Michelle Williams of the University of Washington, Seattle.

In her research, Williams has found that physical activity during pregnancy reduced the risk of gestational diabetes by half, and the risk of pre-eclampsia -- a potentially dangerous condition marked by high blood pressure and other problems -- by 35 percent.

"The most common exercises were walking and jogging and aerobics. Even stair-climbing as part of a daily active lifestyle was associated with reduced risk of pre-eclampsia," said Williams, who is also associate director of the Center for Perinatal Studies at Swedish Medical Center, in Seattle.

"On the basis of our data, we can say that any activity is better than no activity. Much more research is needed to determine the optimal 'dose' amount, frequency and type of activity that is associated with the best pregnancy outcomes," she said.

Another study by researchers at the University of North Texas found that Cesarean delivery was 4.5 times more likely for sedentary women than for active women. The researchers compared 93 non-exercising women with 44 active women.

The American College of Obstetricians and Gynecologists issued revised recommendations for exercise during pregnancy. The guidelines say that while participation in a wide range of activities appears to be safe, each activity should be reviewed by a woman's doctor for potential risk.

According to the American Academy of Family Physicians, the most comfortable exercises during pregnancy are those that don't require you to bear extra weight, such as swimming and stationary cycling. Walking and low-impact aerobics are other good choices. Women should consult with their doctor about the best exercise.
If you didn't exercise before pregnancy, the advice to get individual instruction about exercise is especially crucial.

As the pregnancy progresses, "listen to your body," Frieder tells his patients. "Make allowances for tiredness. Don't exercise at the level you are used to if you are too tired."

Be sure your heart rate is lower than 140 beats per minutes, he said. And drink plenty of fluids before and after your workout.

Avoid exercise on extremely hot or humid days. And stop a workout if you have pain, bleeding or faintness or other symptoms -- and call you doctor.

Also, be aware that your center of gravity is lower during pregnancy and that may affect your ability to do exercises that seemed easy before. And your ligaments and joints are looser and more flexible when pregnant, so you're more likely to get sprains and strains.

For more articles on pregnancy-related issues, visit our parent site

SOURCES: Richard P. Frieder, M.D., staff obstetrician-gynecologist, Santa Monica UCLA Medical
Center, Santa Monica, Calif., and clinical instructor, David Geffen School of Medicine, University of California, Los Angeles; Michelle Williams, Sc.D., professor of epidemiology, University of Washington, Seattle

Folic Acid Is Helping Reduce Birth Defects

TUESDAY, Sept. 6 (HealthDay News) -- Folic acid fortification of foods, mandated since 1998 in the United States, continues to help reduce the incidence of severe birth defects such as spina bifida, researchers report.
The study, which appears in the September issue of Pediatrics, included a look at the effects of the B vitamin on children born to black and Hispanic women.

"We wanted to see if all racial and ethnic groups are having decreases, or is it only, for example, in one group?" explained study co-author Dr. Sonja Rasmussen, a clinical geneticist with the U.S. Centers for Disease Control and Prevention.

Her team analyzed data from 21 population-based birth defect surveillance systems. They examined trends in neural tube defects -- serious malformations such as spina bifida, a leading cause of childhood paralysis, and anencephaly, a condition in which parts of the brain and skull cap are missing. Both can be prevented through maternal intake during pregnancy of folate, which is thought to be important to embryonic development.
Looking at the years 1995 to 2002, the team divided births into pre-fortification, optional- and mandatory-fortification periods, and then evaluated associations between maternal folate levels and birth defects.
The study included data on 4,468 cases of spina bifida and 2,625 cases of anencephaly.

The CDC team concluded that folic acid fortification accounted for a 36 percent decline in the birth defects among the Hispanic population, and 34 percent in the non-Hispanic white population. The decline among blacks was not significant.

Before fortification, about 4,000 pregnancies annually were affected by neural tube defects, according to the March of Dimes. Now, about 1,000 fewer babies a year develop one of these conditions.
But some experts believe the fortification level, while helpful, needs to be set higher. In an editorial accompanying the study, Dr. Godfrey Oakley Jr., of the CDC, says the U.S. Food and Drug Administration should at least double the amount of folic acid required in enriched grain foods, currently set at 140 micrograms per 100 grams of grains.

The March of Dimes is also calling for higher fortification levels, said Dr. Jennifer Howse, president of the organization. She called the decline found in the Rasmussen study "very significant," but thinks higher levels of fortification are needed.

In a note of caution, however, Dr. Tsunenobu Tamura, author of a second Pediatrics study on folate status and child development, said more study is needed before that recommendation should be enacted.
"We should be extremely careful in increasing the fortification level because we do not know the consequences of high-dose fortification," said Tamura, a professor of nutrition science at the University of Alabama at Birmingham.

In his study, Tamura's team evaluated the maternal blood folate levels of black women at 19, 26 and 37 weeks of pregnancy. They then evaluated the neurological development of 355 of the women's children at 5 years of age using memory, motor skills and other tests.

"The mothers' folate nutritional status during pregnancy does not appear to affect psychomotor development of the children at 5 years of age," he said. Still, he said, he believes it's crucial that women get adequate folate during pregnancy.

Women of childbearing age are advised to take in 400 micrograms a day of folate, which can be obtained through vitamin pills or foods such as leafy green vegetables and citrus fruits.

More information
To learn more about folic acid and birth defects, visit the March of Dimes.

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SOURCES: Sonja Rasmussen, M.D., clinical geneticist, U.S. Centers for Disease Control and Prevention, Atlanta; Tsunenobu Tamura, M.D., professor, nutrition science, University of Alabama at Birmingham; Jennifer Howse, president, March of Dimes, White Plains, N.Y.; September 2005 Pediatrics

Rate of Premature Birth Hits New High in U.S.

Sept. 9, 2005 - (WebMD) The U.S. premature-birth rate has hit a record high, the latest CDC figures show.
The new figures cover the year 2003. They show that premature babies now make up 12.3% of all births -- a 30% increase since detailed record keeping began in 1981.

Most of the increase comes from white babies. Their preterm rate hit 11.5%. But that record high is dwarfed by the preterm rate for black babies: 17.6%, a rate that's barely changed since 1981.
Of even more concern is the "very preterm" rate for blacks. Nearly 4% of black babies are born at less than 32 weeks of pregnancy -- almost two and a half times the rate for white babies.

The new data are "troubling," says Joyce A. Martin, MPH, lead statistician for the CDC's division of vital statistics. Martin is the lead author of the CDC's newly released Births: Final Data for 2003.
"It is of concern nationally that this important indicator of child health continues to deteriorate," Martin tells WebMD.

Going in the Wrong Direction
March of Dimes president Jennifer L. Howse, PhD, says premature birth often has devastating consequences for babies and their families.

"It will break your heart: 25% of those babies have serious lifelong health consequences," Howse tells WebMD. "Learning disabilities, mental retardation, cerebral palsy, blindness or vision impairment -- these are infants who have been damaged and will have a lifetime of disability."
Howse notes that the U.S. Public Health Service has set a goal of reducing the premature birth rate to 7.6% by 2010. But the figures show we're steadily going in the wrong direction.

What's going on? Nobody is sure.

"We cannot say from our data what is driving the increase," Martin says. "Some studies suggest that changes in the management of labor and delivery may be driving some of the change. That is the rate of [medically] induced preterm births and the rate of cesarean delivery for preterm births."

Howse says C-sections and induced labor aren't the whole story. Another factor is the increase in multiple births.Are Fertility Drugs to Blame?

Are Fertility Drugs to Blame?
There's certainly been an increase in the number of women using fertility drugs. These drugs increase the number of multiple births -- and twins, triplets, and other multiple babies are much more likely to be premature than singleton babies. But that's far from the whole answer.

"The preterm birth rate has been increasing fairly steadily for the last couple of decades for singleton births," Martin says. "Although multiple births have driven the preterm rate up somewhat, it is not responsible for the overall rise."

Howse notes that obese women are much more likely to have a premature baby than normal-weight women. As America's obesity epidemic continues, premature birth is yet another way the health effects are visited on a new generation.

Another cause of premature birth, Howse says, is the increasing lack of health insurance by women of childbearing age.

"One in five women of childbearing age lacks health insurance," she says. "That is a factor, and it is on the rise."

The X Factor
But the biggest cause of premature birth is something Howse calls factor X.
"Factor X is a mother who does everything right in her pregnancy. She has no known risks during her pregnancy. And yet she delivers preterm," Howse says. "Factor X accounts for one half of premature births. We do not know the reasons."

What's needed, Howse says, is vastly more research. Doctors don't know the full molecular biology of normal pregnancy. That black box may very well hold the key to reducing premature births and the death and disability premature birth leaves in its wake

Teen Births Down, More Unmarried Moms
Not all the news from the CDC report is bad. The teen birth rate continues to drop. It fell by 3% to 41.6 births per 1,000 women aged 15-19. That's one-third of the peak rate seen in 1991.

The drop in teen births has been particularly dramatic among black teens. Their overall birth rate dropped by nearly half since 1991.

Other statistics from the new treasure trove of birth data:
There was a steep increase in childbearing among unmarried women. After eight years of little change, the birth rate for unmarried women aged 15-44 went up 3% to 44.9 births per 1,000. More than 1.4 unmarried U.S. women gave birth in 2003 -- the most in 60 years.

Moms are getting older. The birth rate for women aged 20-24 went down, while the birth rate for women aged 30-34 and 35-40 went up. The birth rate for women 40-44 soared by 5% to 8.7%. That's the highest it's been since 1969.

Low birth weight -- babies weighing 5.5 pounds or less -- went up to the highest level since 1970.
Cigarette smoking by pregnant women went down. But more than one in 10 pregnant women still smoke -- and about 25% of them smoke a half-pack or more per day.

SOURCES: Martin, J.A. National Vital Statistics Reports, Sept. 8, 2005; vol 54: pp 1-116. Joyce A. Martin, MPH, lead statistician, division of vital statistics, CDC. Jennifer L. Howse, PhD, president, March of Dimes.

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