Wednesday, December 21, 2005

Health Tip: Preparing For Your Pregnancy

(HealthDay News) -- Women can take many precautions to promote a health pregnancy before they become pregnant.

Here's a list of pre-pregnancy planning tips, courtesy of the Palo Alto Medical Foundation:

  • Stop smoking to reduce the risk of a low birth weight baby, a miscarriage or a stillbirth.
  • Avoid drinking alcohol.
  • Talk to your doctor about how prescription medications may affect your pregnancy. Some of these medications include the birth control pill, Accutane, and seizure and cancer medications.
  • Take a multivitamin with at least 400 micrograms of folic acid each day.
  • Maintain good health by eating healthy, exercising and maintaining a healthy weight.
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SIDS Linked to Subsequent Preemie Births

FRIDAY, Dec. 16 (HealthDay News) -- Women who've suffered the death of a baby due to sudden infant death syndrome (SIDS) are at increased risk of premature delivery and complications in subsequent pregnancies, British researchers report.

Writing in this week's issue of The Lancet, they noted these complications are also risk factors for SIDS. The finding may explain why some women have a family history of recurrent SIDS.

The University of Cambridge researchers analyzed data collected from more than 258,000 women who had consecutive births in Scotland between 1995 and 2001.

They found that women whose previous infant died were two to three times more likely than other women to have a premature baby, and two to three times more likely to deliver a small baby.

The study also found that women who had a premature delivery or a small baby had a twofold increased risk of SIDS occurring in infants they had in subsequent years. The association held true even after the researchers factored in other possible SIDS risk factors such as smoking, age and marital status.

"Our findings suggest a mechanism that would predispose women to recurrent cases of SIDS, and provide direct evidence that the risk of SIDS after a given birth is not statistically independent of whether the previous infants died," the study authors noted.

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It's (Often) a Boy! -- If Conception Takes Longer

THURSDAY, Dec. 15 (HealthDay News) -- The longer a woman takes to get pregnant, the more likely she is to have a baby boy.

That's the conclusion of a new Dutch study that appears in the Dec. 17 issue of the British Medical Journal.

Researchers analyzed data on 5,283 women who gave birth to single babies over a two-year period. They found that the 498 women who took longer than 12 months to conceive had a 58 percent chance of having a baby boy, compared with 51 percent for women who took less time to get pregnant.

For couples who conceive naturally, each additional year of trying to get pregnant is associated with a nearly 4 percent greater expected probability of having a baby boy, the study authors calculated. This was true even after the researchers adjusted for factors such as age, smoking status, alcohol use and menstrual cycle variability.

The study found no relation between a baby's gender and length of time getting pregnant among couples who had medical help in conceiving.

The researchers said their findings support the idea that sperm bearing the Y (male) chromosome swim faster in viscous fluids than sperm bearing the X (female) chromosome. They said women who have relatively viscous cervical mucous would have more difficulty getting pregnant and would be more likely to have a male baby if they do get pregnant.

The study may also explain why more boys than girls are born worldwide (105 boys to 100 girls in most countries), even though human semen contains equal amounts of X and Y bearing sperm, the researchers at Maastricht University said.

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Male Preemie Babies at Higher Risk for Hypertension As Adults

MONDAY, Nov. 21 (HealthDay News) -- Male infants born prematurely are at increased risk of developing high blood pressure decades later, Swedish researchers report.

The reasons for this rise in risk are unclear; however, the researchers don't think it can be explained by family history or genetics. Rather, they believe environmental challenges linked to prematurity may explain an increased risk for high blood pressure later in adulthood.

"Preterm-born men have an increased risk of high blood pressure and the risk is inversely proportional to the degree of prematurity -- the more premature, the higher the risk," noted lead author Dr. Stefan Johansson, a neonatologist at Karolinska University Hospital in Stockholm.

The study only included male babies -- experts note that a similar study in females might turn up similar trends.

The report appears in the November 29 edition of Circulation: Journal of the American Heart Association.

In their study, Johansson's team collected blood pressure and birth data on nearly 330,000 Swedish men born between 1973 and 1981.

They found that, compared with males born full-term, males who were born extremely preterm -- less than 29 weeks -- have almost twice the risk of developing high systolic blood pressure in adulthood. Systolic pressure refers to the first number in a blood pressure reading.

In addition, those who were very preterm -- 29 to 32 weeks -- had a 45 percent increased risk of high systolic blood pressure, while those born moderately pre-term -- 33 to 36 weeks -- had a 24 percent higher risk.

"The risk associated with preterm birth is most probably not explained by familial factors," Johansson said. "Our study further supports the concept that diseases in adulthood are associated with very early exposures [to environmental challenges]," he added.

Johansson thinks more research is needed on why preterm birth is associated with this risk of high blood pressure and recommends intervention as early as possible. "I think that clinical follow-up programs of children born more than three months before term should include blood pressure checks during their visits," he advised.

Another expert pointed out that these findings were confined to males only.

"At the present time, the study cannot be extrapolated to women born preterm because only men were included in this study," said Dr. Nieca Goldberg M.D., chief, Cardiac Rehabilitation and Prevention Center, Lenox Hill Hospital, and assistant clinical professor, medicine, New York University School of Medicine, in New York City.

"Other studies should be done to see if this relationship can be applied to women and people of various racial and ethnic backgrounds," she said. "Work like this will help us to identify risk factors earlier in life and apply preventive strategies that will ultimately reduce risk of heart disease and stroke."

Another expert said the study may shed more light on the causes of high blood pressure.

"This is a very interesting study," said Dr. Roger S. Blumenthal, an associate professor of medicine and director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease in Baltimore. "It shows that what happens to us when we are born can affect the development of high blood pressure 40 plus years later, which is quite fascinating. This may help to shed light on some of the other causes of high blood pressure."

Blumenthal adds that knowing this makes it even more important to make the lifestyle changes that help fight high blood pressure.

"People need to remember that the best way to prevent or control hypertension and type 2 diabetes is to exercise more and follow better dietary habits," he noted. "For now, that should be the focus of our efforts in America and elsewhere."

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Preterm Birth: The Nation's Leading Killer of Newborns

FRIDAY, Nov. 18 (HealthDay News) -- Stephanie Smith, a 41-year-old New Yorker, was a model mother-to-be when she became pregnant three years ago.

A dancer and massage therapist, she'd always been extremely fit and health conscious and was diligent in her pre-natal care.

So she was stunned when her son, Max, was born premature at 29 weeks and six days and weighed 2 pounds, 13 ounces.

"I was shocked. I never expected to go into premature labor," Smith said. "I did everything right."

Normal gestation is approximately 40 weeks, and a birth before 37 weeks is considered premature.

Max, now 3, was born with multiple health problems as a result of his prematurity. And Stephanie and her husband, Bernie Yee, struggled to take care of him through months of at-home care that initially included oxygen supplementation and tube feeding, a re-hospitalization for respiratory distress and a collapsed lung, with an induced coma needed to stabilize him.

"Everything that saved his life also caused other problems," Smith said.

Now Max is in school, and Smith is pleased with his progress, but noted that he lags behind other children his age in stamina.

Smith spoke Tuesday St. Mary's Healthcare System for Children in Queens, N.Y., a stop on a March of Dimes tour throughout New York City to highlight Prematurity Awareness Month.

March of Dimes President Dr. Jennifer L. Howse said Max's problems highlight the importance of focusing attention on the debilitating and often ongoing problems resulting from premature delivery, the cause of which is largely unknown.

On Tuesday, the U.S. Centers for Disease Control and Prevention reported that the number of preterm births increased by 2 percent from 2003 to 2004. More than 500,000 babies were born before 37 weeks of gestation in 2004, and there has been an 18 percent increase in preterm births since 1990, the agency said.

"We are so saddened by the increase because it means that more babies are going to have to struggle and more families will have a lifetime of health consequences to deal with," Howse said.

The CDC report was released on the third annual Prematurity Awareness Day, which the March of Dimes hopes will serve as a springboard for passing federal legislation to coordinate efforts on finding the causes for premature births and decreasing their numbers, the nation's leading killer of newborns.

According to Howse, there's no known cause for approximately half of the nation's preterm births.

"A mom can do everything right -- nutrition, diet, exercise and have no previous history of prematurity," Howse said, and still deliver a baby too soon.

Known reasons for preterm births include obesity; a lack of pre-conception and pre-natal care, which is common among women with no health insurance; and the use of fertility drugs, she said.

Howse said that twins have a 50 percent greater chance of being born prematurely, and that triplets and higher numbers of babies born together have a 90 percent chance of a too-early birth that brings high risks of often severe health problems. Those problems include neurological, learning, hearing and vision problems and cerebral palsy.

When women take fertility drugs, Howse said, it's very important that they get good medical advice. Often with assisted-reproduction technology, women will have four or five eggs implanted, raising the risk of multiple births, she said.

"It's a delicate area," Howse said, because a woman wants to have a baby, and if her doctor advises her that more eggs will increase the likelihood of success, she might do that without understanding the medical risks of premature delivery.

Another issue is that technology has enabled doctors to save the lives of ever-younger premature babies, resulting in more complex medical problems facing these infants and the doctors who treat them. St. Mary's offers long-term care for the continuing health problems of premature babies as they grow. Smith's son has been treated there.

"We've never had such tiny babies," said St. Mary's president Dr. Burton Grebin, who reported that the hospital's preterm baby population has doubled since its nursery opened in 1984.

"We have seen a dramatic impact because we have to adapt with increased technology, new equipment and more staffing. Some of these problems are subtle and go on for years," he said.

Howse said the federal government presently has no concerted plan to address the problems of premature births. She urged passage of a bill now before Congress that would create a federal agenda to research prematurity.

"We need to raise public awareness and gain the political will to focus on this problem," she said.

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Placenta Problems Predict Early Heart Trouble

THURSDAY, Nov. 17 (HealthDay News) -- Pregnant women with abnormal placentas appear to be at a twofold risk of developing early cardiovascular disease compared to women without these problems, Canadian researchers report.

Maternal placental syndromes include preeclampsia (high blood pressure during pregnancy) and conditions where the placental blood vessels become blocked. These include placental abruption and placental infarction, where the placenta becomes detached from the wall of the uterus.

Risk factors for placental syndromes include obesity, insulin resistance, high blood pressure and high cholesterol. These same conditions are also independent risk factors for cardiovascular disease.

"We looked at more than 1 million women who delivered," said study author Dr. Joel G. Ray, an assistant professor of obstetrics and gynecology at St. Michael's Hospital of the University of Toronto. "We examined whether they experienced a problem with their placenta or not."

In the CHAMPS (Cardiovascular Health After Maternal Placental Syndromes) study, Ray and his colleagues found that of the 1.03 million women in the study, 75,380 were diagnosed with maternal placental syndrome. The average age of the women in the study was 28 years.

Reporting in the Nov. 19 issue of The Lancet, the researchers compared the health outcomes of women who had placenta problems with women who didn't. "We looked at their future risk of having heart disease or stroke or blockage of one of the arteries to the legs," Ray said.

"We found that women who had placental syndromes had double the risk of developing premature cardiovascular disease, compared with women who didn't have one of those maternal placental syndromes," Ray said.

He believes that obesity before pregnancy is largely responsible for developing these syndromes. Many of the women who develop maternal placental syndromes have an abnormal metabolic state long before pregnancy, during pregnancy and after delivery, he said.

"We think that a lot of the risk for maternal placental syndromes is coming from the presence of obesity before pregnancy," Ray said. Conditions closely related to obesity, such as diabetes and high blood pressure, "create an environment that is unhealthy for the placenta and remains an unhealthy environment after the women delivers," he said.

Ray believes women can change their lifestyle and reduce their chances of maternal placental syndromes and premature heart disease.

"It isn't that hopeless," he said. "The metabolic state, to a degree, is determined by their body weight and what they eat. This study shows that there is a window for women to modify their health while they are young."

Another expert sees the study as important research into the special heart disease risks faced by women.

"We are now starting to think about things that are unique to women that can also give us clues to their risk of cardiovascular disease in the future," said Dr. Nieca Goldberg, chief of women's cardiac care at Lenox Hill Hospital, New York City and author of Women Are Not Small Men. "Before, we were looking at the traditional risk factors that predict cardiovascular disease in men."

Goldberg believes that any woman who has had a maternal placental syndrome should be watched carefully for the onset of cardiovascular disease. "Women who have had preeclampsia or other pregnancy problems shouldn't get lost to the health-care system," she said.

"We really need to make sure that we instill the advice of healthy lifestyle behavior in these young women," Goldberg said.

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Placenta Size May Affect Breast Cancer Risk

TUESDAY, Nov. 15 (HealthDay News) -- The heavier the placenta during pregnancy, the greater a woman's risk of breast cancer before menopause, a new Swedish study suggests.

"Compared with mothers whose placenta at first delivery weighed less than 500 grams, women whose placenta weighed equal to or greater than 700 grams had a 38 percent increase in risk of breast cancer," said study author Dr. Sven Cnattingius, a professor at the Karolinska Institute in Stockholm.

Results of the study are published in the Nov. 16 issue of the Journal of the American Medical Association.

While scientists don't know the exact cause of breast cancer, hormones clearly play a role in risk, according to Cnattingius. And during pregnancy, he added, hormone levels surge.

"Hormones during pregnancy are primarily produced by the placenta. And the levels of, for example, estriol -- the most potent estrogen -- are reported to increase with placental weight. We therefore hypothesized that a mother's risk of breast cancer may increase with placental weight," said Cnattingius.

The placenta is the temporary organ that supplies nourishment to the fetus.

To test this hypothesis, the researchers reviewed data from more than 300,000 Swedish women included in the Sweden Birth Register from 1982 through 1989. The study included follow-up information on the women through 2001, or until they had been diagnosed with breast cancer or died.

Fewer than 1 percent of the women -- 2,216 -- developed breast cancer. Almost all of the women -- 95 percent -- were diagnosed before the age of 50.

The study confirmed the researchers' hypothesis. Women whose placentas weighed 700 grams or more had a 38 percent increased risk of breast cancer, compared to women whose placentas weighed less than 500 grams, according to the study. A woman with a placenta weighing between 500 and 699 grams in one pregnancy and 700 grams or more in another pregnancy had an 82 percent increased risk of breast cancer, compared to women who had two pregnancies with placentas weighing less than 500 grams.

When compared to women with two pregnancies with placentas weighing under 500 grams, women whose placentas weighed 700 grams or more in two pregnancies had double the risk of breast cancer, the researchers said.

"The risk of (predominantly premenopausal) breast cancer among mothers increase with placental weight," Cnattingius concluded.

The researchers also confirmed previous findings that an earlier maternal age was somewhat protective against breast cancer. Those whose first pregnancies occurred when they were 19 or younger had about a 10 percent reduced risk of breast cancer, while those who waited until they were 35 or older to have their first child faced 20 times the average breast cancer risk.

Commenting on the placenta findings, Debbie Saslow, director of breast and gynecological cancer control for the ACS, said, "This is an interesting study, but it's not cause-and-effect, it's an association. The risk reported is a really small relative risk, and it's not going to change any lifestyle recommendations."

The only women who might want to consider these findings are those who have tested positive for breast cancer genes, Saslow added.

If you know you're already at a high risk for breast cancer, and if you don't feel strongly about when in your life you have children, it might be better to have them earlier, she said. But, that doesn't mean you couldn't have children later in life either, she added.

What women can do to help prevent breast cancer is get enough exercise, eat right and don't drink alcohol excessively. Besides potentially lowering your breast cancer risk, you'll also lower your risk of heart disease and diabetes by taking these steps, she said.

More than 200,000 American women are diagnosed with breast cancer each year, according to the ACS. Over a lifetime, 13 percent of U.S. women will develop the disease, according to the society.

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U.S. Preemie Births, Caesareans Reach Record Highs

U.S. Preemie Births, Caesareans Reach Record Highs
Fear of lawsuits may be driving surge in C-sections, experts say

TUESDAY, Nov. 15 (HealthDay News) -- The number of premature births in the United States and the rate of Caesarean delivery are the highest they've ever been, according to new government figures released Tuesday.

The report, by the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics, showed that the C-section delivery rate rose to 29.1 percent in 2004, an increase of more than 40 percent since 1996. And more than half a million babies were born preterm last year, the highest number ever recorded.

"Measures of maternal and infant health are not improving in the country," said lead author Joyce A. Martin, lead statistician at the reproductive statistics branch of the National Center for Health Statistics in Hyattsville, Md.

"We don't have a good sense of why that is, quite frankly," she added.

"Preterm births increased for the first time in at least two decades to more than 500,000 births in 2004," Martin said. "The rate increased 2 percent between 2003 and 2004, and has risen more than 18 percent since 1990."

One factor responsible for the dramatic increase in preterm birth rates is the increase in multiple births, Martin said.

"Multiple births are much more likely to be born too early and too small," she said. "But there is also an increase in single preterm deliveries, and the reasons for that are less clear."

Martian noted that low birth weight has followed a similar path. The low birth weight rate increased from 7.9 percent in 2003 to 8.1 percent in 2004. Since 1990, the percentage of infants born with low birth weight has risen 16 percent, according to the report.

In addition, the rate of C-section deliveries rose 6 percent in 2004 to 29.1 percent of all births, the highest rate ever reported in the United States. "It's up 40 percent since 1996," Martin said. "It had declined in the 80s until 1996, and there has been a strong upswing since."

Other findings in the report, which includes data from birth certificates processed through May 2005, include a slight decrease in tobacco use among pregnant women and no change in the number of women seeking prenatal care.

One expert sees several factors as responsible for these trends.

"The increase in the Caesarean births is due to three things -- malpractice, malpractice, malpractice," said Dr. Joshua A. Copel, director of Maternal and Fetal Medicine at Yale University School of Medicine.

Copel believes that the decision to do cesarean deliveries is largely based on doctors' fear of litigation. "Not that much has changed about the American population to account for such an increase in Caesarean birth rates except the fear of obstetricians of being sued," he said.

In terms of the increase in premature delivery, the reasons for the increase are not clear, Copel said. "I would speculate that you would find an interaction between multiple birth and premature delivery and obesity," he said. "Women who have higher body mass have higher insulin resistance, and are more likely to ovulate infrequently and take medication to ovulate more frequently."

Copel also noted that birth certificate data are spotty. "They must be taken with some skepticism," he said. "The only things you can rely on in birth certificates are date of birth, the gender and the weight."

Another expert blames current priorities in U.S. medical care.

That preterm and low birth weight babies were more common in 2004 than in the years preceding reflects a widening of health-care disparities, as these outcomes are more common among ethnic minorities, said Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine. "Efforts to address such disparities have apparently failed, as the timely delivery of prenatal care was no higher in 2004 than in previous years," he said.

"Most disturbing are data showing a steady increase in the rate of Caesarean delivery," Katz added. "While the so-called C-section can be invaluable when used to address complications of labor and delivery, it appears to be used increasingly for mere convenience, or to avoid liability associated with the natural risks of birthing."

"That we are doing more surgery, but not delivering more prenatal care, is quite concerning," Katz said. "Pregnancy-related care should be a national priority, and delivery a matter of Nature's timing, not the obstetrician's convenience. The trends in this report call for a reassessment of our priorities."

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Lupus, Rheumatoid Arthritis Raise Pregnancy Risks

TUESDAY, Nov. 15 (HealthDay News) -- Pregnant women with lupus or rheumatoid arthritis may experience more pregnancy complications and longer hospitalizations than other women, a new study finds.

Stanford University researchers analyzed 2002 data from the Nationwide Inpatient Sample, which contains discharge records from representative U.S. hospitals. The researchers compared delivery outcomes and hospitalizations for nearly 3,300 women with lupus and more than 1,400 women with rheumatoid arthritis to women in the general population.

Reporting at this week's annual scientific meeting of the American College of Rheumatology in San Diego, they found that women with lupus had twice the rate of hypertensive disorders, compared to women with rheumatoid arthritis. Women with either lupus or rheumatoid arthritis had higher rates of hypertensive disorders than pregnant women in the general population.

Women with lupus or rheumatoid arthritis also faced higher rates of intrauterine growth restrictions and Cesarean delivery, the study said.

"Women with either lupus and/or rheumatoid arthritis are typically somewhat older when they become pregnant," researcher Dr. Eliza F. Chakravarty, assistant professor of medicine with Stanford's division of immunology and rheumatology, noted in a prepared statement.

"However, even after adjusting for maternal age, they run a higher risk for adverse outcomes and generally experience longer hospital stays than other women. As a result, they should be monitored carefully for the length of their pregnancies," Chakravarty said.

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