Sunday, April 23, 2006

Conceiving again too soon or too late boosts risks, study shows

Researchers Seek 'Optimal' Pregnancy Interval

TUESDAY, April 18 (HealthDay News) -- Pregnancies spaced less than 18 months or more than 59 months apart carry a higher risk of low birth weight, preterm birth and small size for gestational age.

"This sort of upholds the conventional wisdom that you want to wait between pregnancies, and you want to plan your pregnancies," said Dr. Jennifer Wu, an obstetrician/gynecologist at Lenox Hill Hospital in New York City. "The conventional wisdom is to try to space the births two years apart at least. A family needs to recover physically, emotionally and financially between babies. It needs to be able to devote enough time to each child."

Wu was not involved in the study, which appears in the April 19 issue of the Journal of the American Medical Association.

"Having these accumulating studies adds strength to the conclusion," added Dr. Peter Bernstein, an associate professor of obstetrics and gynecology at Montefiore Medical Center/Albert Einstein College of Medicine in New York City. Bernstein was on a select panel making recommendations to the U.S. Centers for Disease Control and Prevention for guidelines on preconception care coming out this Friday.

Although experts were hesitant to suggest an optimal interval, Wu said that ideally a couple would want to wait 20 to 40 months between pregnancies, with the earliest interval being nine months after the first delivery. Eighteen months is considered optimal by many.

Previous research had suggested that both short and long intervals between pregnancies increased the rates of adverse outcomes, but it wasn't clear if other factors (for example, socioeconomic status or mother's health) also played a role.

For this study, researchers at Fundacion Santa Fe de Bogota in Colombia conducted a meta-analysis of studies published between 1966 and 2006. Sixty-seven articles met the criteria for inclusion in the study, representing more than 11 million pregnancies.

The evidence showed that babies born to women who had an interval of less than six months between pregnancies had a 40 percent increased risk of preterm birth, a 61 percent increased risk of low birth weight and a 26 percent increased risk of being small for their gestational age, compared to children of mothers with an interval of 18 to 23 months between pregnancies.

Babies born to mothers with pregnancy intervals longer than 59 months had a 20 percent to 43 percent increased risk of these outcomes.

For each month that the pregnancy was shortened from 18 months, the risk for preterm birth, low birth weight and small for gestational age increased by 1.9 percent, 3.3 percent and 1.5 percent, respectively.

For each month that the time between pregnancies was lengthened beyond 59 months, the risk for increased by 0.6 percent, 0.9 percent and 0.8 percent, respectively.

It's not clear why short intervals make for worse outcomes, although several theories have been put forth. One is the maternal nutritional depletion hypothesis, which suggests that the mother doesn't have time to recover from one pregnancy to the next. Nutritional deficiency in the mother means the child doesn't get enough nutrients either.

It's even less clear why extra-long intervals run into more problems. "It may be related to the fact that women who have long intervals are getting older, and women of advanced maternal age have an increased risk of some of these things," Bernstein said.

The paper is, in a sense, an argument for family planning.

"You don't want to do it too soon," Wu said. "You want to plan a pregnancy."

"I don't know that providers are out there telling their patients at their postpartum visit you really should really try and not have another pregnancy for 18 months," Bernstein added. "Health-care providers need to start identifying this as a high-risk problem, and they need to counsel patients about planning."

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Younger Moms' Kids Get Longevity Edge

Children of women under 25 twice as likely to live to 100, study finds

MONDAY, April 17 (HealthDay News) -- Society's oldest members are most likely to be born to its youngest mothers, new research suggests.

The odds of living to 100 and beyond double when a person is born to a woman under 25 years of age, compared to those people born to older mothers, according to one of the most rigorous studies on the subject yet conducted.

The finding may also help clear up a statistical mystery -- three years ago, the same husband-and-wife team of researchers found that being the first-born child in a family also boosted longevity, although no one knew why.

"It turns out that the whole phenomenon of first-born order and longevity is driven by young maternal age," said study co-author Leonid Gavrilov, a research associate at the Center on Aging at the University of Chicago.

In other words, he said, first-born children are simply more likely than their siblings to have been born when mom was in her teens or early 20s.

The study, which was funded by the U.S. National Institute on Aging (NIA) and the Society of Actuaries, was presented recently at the Population Association of America annual meeting, in Los Angeles.

As nutrition and health care continue to improve, so too does the number of Americans whose years extend into the triple-digits.

"Certainly there were more [centenarians] in the 2000 census than there were in 1990, and most people think this population will grow," said Georgeanne Patmios, acting chief of the Population and Social Processes Branch of the NIA's Behavioral and Social Research Program.

According to the Census Bureau, there were 37,000 Americans aged 100 years or older in 1990, and by 2000 that population had risen to 55,000. According to experts, women are three to five times more likely to live beyond 100 than men.

But what other factors encourage "extreme" old age? Previous research by Gavrilov and his wife/co-researcher, Natalia Gavrilova, has uncovered some clues. For example, in research published over the past few years, they found that U.S. centenarians were more likely to come from farming families in the Midwest than from any other demographic.

They also discovered that being the first-born in a family meant a lot, boosting the odds of making it to 100 by nearly 80 percent.

"But nobody knew why that was -- sometimes in research you get answers, but you also get new questions," Gavrilov said.

So, he and his wife set out to solve that puzzle. They selected 198 centenarians from across the United States, checking and double-checking their ages using every form of documentation available. Comparing the centenarians' histories to those of their siblings, the researchers then analyzed the data to help explain the "first-born effect."

One theory -- that first-born children might have been relatively protected from pediatric illness because they weren't surrounded by disease-bearing siblings in infancy -- didn't pan out. "We found that even at age 75 it still matters that one is first-born," Gavrilov said. "It's a late-life phenomenon."

A second theory -- that first-born kids reaped the benefit of a relatively young, strong and productive father -- also fell flat. "We got the very clear result that the father's age wasn't important," the Chicago researcher said.

That wasn't the case for mothers. In fact, statistical analysis revealed that young maternal age at birth completely accounted for the first-born effect.

"It is very rare in science that you have such clear-cut results. But here, when we saw the results, we went 'Wow,'" Gavrilov said. Overall, children born to an under-25 mother had double the odds of living to 100 and beyond, compared to offspring of women who delivered at a later age.

So, why do young moms tend to bear more long-lived children? "At this point all we have is hypotheses," Gavrilov said. "One is biological -- that maybe the eggs are different in their quality, and the best ones, the most vigorous eggs, go first to fertilization."

He said his wife Natalia came up with a competing theory: That young moms haven't had time to pick up the latent, chronic infections that might in some way impede the long-term health of their offspring. "This might interfere with normal development," Gavrilov said. "So, when the children are born they are superficially healthy but maybe they are not really strong enough to survive to 100."

Patmios said the question of why younger mothers might bear more resilient offspring remains "open, but it's worthy of additional research." She stressed that it has proven extremely tough to get in-depth, reliable data for events that happened over a century ago. "There are a lot of other factors that probably contribute to exceptional longevity which, given the dataset that Dr. Gavrilov has to use, he can't assess," she said.

And what about the longevity of children born to today's moms, who are often postponing first pregnancy to their 30s or even 40s? According to Gavrilov, advances in diet and health care mean American newborns still have a better chance of living out a century than their great-grandparents did.

"The data shows that there is a steady increase in living to age 100, despite the fact that women are tending to postpone their childbearing years," he said.

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Fetus Cannot Feel Pain, Expert Says

British commentary calls abortion-linked U.S. legislation into question

FRIDAY, April 14 (HealthDay News) -- Fetuses cannot feel pain, therefore U.S. legislation requiring doctors to tell women that the fetus will feel pain, or to provide pain relief during abortions, has no scientific basis and may harm the women involved, a leading expert contends.

"This is an unwarranted piece of legislation because there is good evidence that the fetus cannot feel pain at any stage of gestation," said Stuart Derbyshire, senior lecturer in psychology at the University of Birmingham, U.K.

He authored an review of the available data on the subject in the April 15 issue of the British Medical Journal.

"I don't think the question of pain resolves the argument about abortion," said Derbyshire, who said abortion remains a social, moral and political question. However, he said that, based on the evidence, "it's illegitimate to use the possibility of pain as a way of trying to prevent abortion from occurring, because the possibility of pain doesn't exist."

Some other experts agreed.

"No one wants to inflict pain in fetuses unnecessarily, nor do physicians want to put the mother at risk by the unnecessary administration of analgesics to treat her fetus, not her," said Dr. Henry J. Ralston, a professor of anatomy and neuroscience at the University of California School of Medicine, San Francisco. "I agree with Dr. Derbyshire's primary conclusion, that 'Legal or clinical mandates to prevent pain in fetuses are based on limited evidence and may put women seeking abortion at unnecessary risk.'"

Pro-life representatives took issue with Derbyshire's findings.

"This is a bit more propaganda than science," said David Christensen, director of congressional affairs for the Family Research Council in Washington, D.C.

Specifically, Christensen faults the author for being selective in the research he chose to include and for presenting a "circular argument."

"He redefines pain such that not even a newborn could experience pain in the way he defines it, and then concludes that fetuses can't experience pain and that's absurd," Christensen said.

"The purpose behind the legislation is to make sure women are informed about the possibility that an unborn child from 20 to 25 weeks on could experience pain," Christensen said. "This author wants to maintain the choice of abortion but not allow women to make an informed choice and I think that's pretty telling."

The U.S. government is presently considering legislation that would require doctors to inform women seeking abortions that "there is substantial evidence that the process of being killed in an abortion will cause the unborn child pain."

The legislation would additionally require that a fetus of more than 22 weeks' gestational age receive anesthesia before the abortion procedure. Doctors who refuse to comply could be fined $100,000 while also losing their license and their Medicaid funding.

More than a dozen state legislatures -- including those in New York and California -- have debated such bills. Several states have already passed laws.

Congress is also considering whether to require doctors to provide anesthesia to fetuses in all cases of abortion after 22 weeks of gestational age.

But is there enough evidence to conclude that fetuses actually experience pain?

After examining the available neurological and psychological literature, Derbyshire says "no."

The neural circuitry needed to process pain is complete, if not mature, by 26 weeks' gestation, he said. "From about 26 weeks you can talk about there being a complete system in terms of biology, a link from the skin to the spinal cord to the brain, and we know that set-up is reasonably functional," Derbyshire explained.

But to properly experience pain, the mind must also be developed, something which cannot happen until after birth. The mind permits the subjectivity of pain, said the U.K. expert, who has previously served as an unpaid consultant to Planned Parenthood of Virginia and Planned Parenthood of Wisconsin, as well as the U.K.-based Pro-Choice Forum.

"The key thing is representational memory," Derbyshire explained. "If you want to discriminate pain from hunger, from vision, or from any other sensational experience, you need to be able to label it in some way, and that will come from interactions with the primary caregiver," -- in other words, after birth.

"I agree that pain is a complex sensory experience that requires activation of many regions of the cerebral cortex and that 'Without consciousness there can be nociception [response to noxious events] but there cannot be pain,'" Ralston said. "I do not know when that necessary neural circuitry is fully developed and functional, but it certainly is not established by 20 weeks gestational age, as encoded in legislation in several states in laws penalizing physicians for not informing mothers about pain in their fetuses."

The problem with the actions encoded in the legislation is that it could put the mother at risk, according to Derbyshire.

"It does introduce risks to the mother if we start to inject drugs to the fetus and increase the time of the procedure," Derbyshire said. "That would be unnecessary and involve unnecessary costs and risks."

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German Measles Fades as Birth Defect Threat

The disease is nearly eradicated in the U.S., experts say

FRIDAY, April 7 (HealthDay News) -- German measles may no longer be the frightening threat to pregnant American women it once was, experts say.

According to a statement in the April issue of the journal Birth Defects Research Part A, congenital rubella syndrome -- a birth defect caused by German measles (rubella virus) -- has been nearly eradicated in the United States.

Rubella can cause birth defects such as blindness, deafness, and congenital heart disease. A rubella epidemic in the U.S. in the early 1960s resulted in more than 11,000 fetal deaths and the birth of 20,000 infants with congenital rubella syndrome. A more effective vaccine was introduced in the 1970s, and helped eliminate the transmission of rubella from pregnant women to their unborn babies.

But the experts that crafted the new statement believe rubella is no longer an endemic disease in the U.S. and that, "congenital rubella syndrome has been nearly eradicated from the United States."

Fewer than 10 cases of rubella were reported in the U.S. last year, and there have only been four cases of congenital rubella syndrome reported in the past five years. Only one of those cases involved a child whose mother had been born in the U.S.

The statement was endorsed by the Teratology Society, the Organization of Teratology Information Specialists, the Neurobehavioral Teratology Society, and the Behavioral Toxicology Society.

Maintaining high rubella vaccination rates is crucial to the continued success of the efforts to eliminate rubella, the experts warned.

"Effective strategies, such as continued universal childhood and adolescent immunization, must be secured to extend this success worldwide," the statement concluded.

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Ethnicity Plays Role in Obstetric Risks

Ethnicity Plays Role in Obstetric Risks
It could affect odds for underweight newborn, U.S. study suggests

FRIDAY, April 7 (HealthDay News) -- Ethnicity-linked differences between U.S.-born women of varying backgrounds can affect pregnancy outcomes, a new study finds.

For example, even though U.S.-born Asian-Indian women have fewer risk factors, they're more likely to deliver low birth weight babies than Mexican-American women.

"Now we see that the daughters of foreign-born women have similar issues and that the indicators we have traditionally used to predict pregnancy outcomes -- maternal educational level and age, and access to early prenatal care, for example -- aren't reliable for every population," researcher Dr. Ashima Madan of Lucile Packard Children's Hospital and Stanford University School of Medicine, said in a prepared statement.

The study confirms previous research that found a similar pattern in more recent immigrants and also suggests that doctors need to factor in their patients' ethnic backgrounds when planning pregnancy care.

The findings appear in the March issue of the Journal of Pediatrics.

Madan's team analyzed data on more than six million births in 11 states between 1995 and 2000 to white, foreign and U.S.-born Asian-Indian and Mexican women.

Asian-Indian women were more than twice as likely as white women to have low birth weight infants. Mexican-American women fared a bit better than Asian-Indian women.

The study also found that Asian-Indian women were more likely than either Mexican-American or white women to have diabetes, which, in severe cases, can restrict fetal growth.

Other factors that may affect fetal growth include maternal birth weight; stress, attitudes toward pregnancy; family support; and other biological risk factors in addition to diabetes.

Low birth weight babies often require more intensive medical care and longer stays in hospital after birth. They're at increased risk for a number of medical problems in adulthood, including diabetes, high blood pressure, and heart disease.

"Our findings point out how much more we have to learn about fetal growth and well-being. Hopefully by continuing to study these populations, we may identify new interventions that improve perinatal outcomes for women of all ethnic backgrounds," Madan said.

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Fetal Environment May Influence Adult Cancer Risk

In mice, boosting uterine antioxidant levels also raised offspring's lifetime odds for cancer

WEDNESDAY, March 29 (HealthDay News) -- Molecular changes in the fetal environment, including altered levels of antioxidants, may affect cancer risk later in life in mammals, Canadian researchers report.

"We know that cancer-causing agents can travel across the placenta and harm the developing embryo or fetus," lead researcher Peter Wells, of the Leslie Dan Faculty of Pharmacy at the University of Toronto, said in a prepared statement. "This study provides the first direct evidence that changing the uterus's molecular environment -- in this case, by increasing the presence of antioxidants by adding vitamin E to the mice's diet -- alters the carcinogenic process in adult life."

The researchers studied pregnant mice genetically altered to lack one or both copies of the p53 gene, which causes a high rate of cancers in their offspring. Before and during pregnancy, the mice were given either a normal diet or a diet with a high dose of vitamin E.

The study also included two control groups of pregnant mice with both copies of the p53 gene intact. One control group received a normal diet and the other control group received a diet supplemented with a high dose of vitamin E.

The offspring off all the groups were observed for DNA damage and signs of cancer.

"Increased levels of vitamin E reduced in utero deaths among the offspring from 40 percent in the control groups to 5 percent in the test groups. In contrast, surprisingly, it also increased the onset of cancer in the offspring," Wells said. "Offspring that were exposed to vitamin E and lack one or both copies of the (p53) gene developed cancers 9 percent to 21 percent faster than the equivalent control groups."

Preliminary studies using a much lower dietary dose of vitamin E found a protective effect against cancer. This suggests that making certain adjustments to the molecular environment in the uterus may provide a fetus with increased protection from oxidative stress and delay or slow the onset of some cancers later in life.

The study appears in the current issue of Carcinogenesis.

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New Infant Screen Detects Metabolic Disease

Blood-based method catches rare but sometimes deadly disorders

TUESDAY, March 28 (HealthDay News) -- Scientists have developed a screening technique to detect harmful enzyme deficiencies in newborns.

Enzyme deficiencies in newborns can cause rare metabolic diseases such as Tay-Sachs, Fabry and Gaucher syndromes that can have crippling or deadly consequences.

"All of the damage from these diseases is permanent, so if you can start treatment early, in a few weeks or months, you can begin to minimize the damage," Frantisek Turecek, a University of Washington, Seattle, chemistry professor, said in a prepared statement.

He and his colleagues designed a screening method that uses a spot of blood drawn from a baby's heel and dried on a paper card. After rehydration, target enzymes are incubated and measured using a high-tech method called tandem mass spectrometry that gauges a substance's chemical composition and quantity.

A sample can be screened for about 15 enzyme deficiencies at the same time, and the entire process takes less than two days.

So far, the UW team has found that this screening method is effective at detecting seven diseases -- Krabbe, Pompe, Niemann-Pick, Gaucher, Fabry, Tay-Sachs, and Hurler syndromes. These diseases are all associated with enzyme deficiencies within structures called lysosomes, which break down large molecules in most cells. The enzyme deficiency causes waste material to accumulate in cells.

In the worst cases, these diseases can cause mental retardation, blindness and death by age five or six.

The research was expected to be discussed Tuesday at a meeting of the American Chemical Society in Atlanta.

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Most New Moms Exhausted: Study

C-sections, breast-feeding especially linked to postpartum woes

TUESDAY, March 28 (HealthDay News) -- Many new mothers may underestimate the toll giving birth and caring for a baby can take on their health, new research shows.

At five weeks postpartum, a majority of new moms were fatigued, had breast discomfort and a decreased desire for sex, the study found.

"This study highlights the need for ongoing rest and recovery beyond four to six weeks postpartum, and the need for more support for women," said study author Pat McGovern, an associate professor in the division of environmental health sciences at the School of Public Health at the University of Minnesota.

"Moms that have just delivered have a great need for support. In other parts of the world, help for new moms and maternity leave is more generous than in this country," said Dr. Nicholas Klein, director of obstetrics and gynecology at Nyack Hospital in Nyack, N.Y.

Under the federal Family Medical Leave Act (FMLA), women who work for companies with more than 50 employees can take 12 weeks of unpaid medical leave for the birth of a child, explained McGovern.

However, she pointed out that many women can't afford to take unpaid leave, and the law only covers employees of relatively large companies. That means a lot of women may end up going back to work sooner than they'd like.

According to the study, 76 percent of working mothers return to work within a year after the birth of their child. Forty-one percent of working mothers are back within three months, and nearly one in six is back within the first month after delivery.

McGovern and her colleagues suspected that many of these women were still experiencing delivery-related symptoms or symptoms associated with the demands of caring for a newborn.

To see if this was the case, they interviewed more than 700 women five weeks after they had given birth. Most of the women were white and married. About half had a college education. The average age was nearly 30.

Not surprisingly, about two out of three women reported feeling fatigued. Sixty percent said they had breast discomfort, and 52 percent said they had a decreased interest in sex. Fifty percent of the women said they had sore or irritated nipples, and almost as many women said they were experiencing headaches. Forty-three percent said they had back or neck pain.

Women who delivered by Caesarean section and women who were breast-feeding reported more postpartum symptoms.

McGovern said it wasn't surprising that women who'd had C-sections had more postpartum difficulties, but she was somewhat surprised that women who were breast-feeding had more symptoms, even when the researchers factored out problems specifically associated with breast-feeding, such as sore nipples.

"Breast-feeding babies digest food more rapidly and need to feed more frequently. That's tiring for mom," said McGovern.

McGovern said there's no one "ideal" time for women to head back to work, though she said most women who can afford to take 12 weeks will do so.

"It's really individual to each woman because it's a constellation of so many factors, such as what's the health of the baby and the mother? How much help does she have at home? Is she married or single? What's the nature of her work? Does she like it or hate it? And, is the job flexible?" she said.

McGovern said there needs to be more education for expectant mothers so they know what to expect in the postpartum period, and that workplaces should be more flexible.

"The postpartum period for the woman and for her family can be rough. The woman needs all the help and support she can get," said Klein.

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Typical U.S. Pregnancy Now Just 39 Weeks

Typical U.S. Pregnancy Now Just 39 Weeks
That's a week shorter than the traditional full-term pregnancy, report finds

THURSDAY, March 23 (HealthDay News) -- The average length of a pregnancy in the United States is getting shorter, with the most common duration now 39 weeks, rather than 40 weeks, which is considered full term, a new report found.

Babies born close to full term -- five to six weeks early, called "late preterm" -- now account for the lion's share of premature births in the United States. And those babies, like very premature babies, face greater health risks.

"Most of the rise in prematurity is related to these so-called late preterm babies," said Dr. Nancy Green, medical director of the March of Dimes in White Plains, N.Y. "In terms of numbers, it's enormous," she said.

About one in eight babies is born premature and 70 percent of those are late preterm, accounting for more than 355,000 births a year, said Michael Davidoff, manager of informatics, research and development at the March of Dimes and lead author of the paper, which appears in a special supplement of the journal Seminars in Perinatology. The paper was also presented at a July 2005 symposium sponsored by the National Institute of Child Health and Human Development.

The proportion of all preterm births in the United States has been rising steadily, from 9.4 percent of live births in 1981 to 12.3 percent in 2003, a 31 percent increase. Healthy People 2010, a federal health initiative, has established a target rate of no more than 7.6 percent.

But, during this period, the rate of very preterm births has stayed relatively constant at 1.8 percent to 2 percent. These very-early babies have been the focus of much attention in the past, because they have high complication rates. Prematurity and low birthweight are the leading cause of infant mortality among black infants and the second leading cause of mortality among all infants.

Attention is now shifting to the "later preterm" babies because they, too, can suffer complications such as respiratory distress syndrome, hypoglycemia and longer stays in the neonatal intensive care unit (ICU).

"They certainly have more complications at birth and end up anywhere from a few days to a few weeks in the neonatal ICU," Green said.

"Nobody has been focusing on the babies at more than 34 weeks -- are we doing the right thing by not bringing them to full-term ?" added Dr. Amanda Cotter, assistant professor of obstetrics and gynecology at the University of Miami Miller School of Medicine.

And although the impact on a single infant may not be huge, the public health ramifications are considerable. "The total hospital cost for these infants is about the same as it is for the extremely preterm babies because there are fewer of the extremely preterm infants," Green said.

According to the new report, 25 percent of all singleton babies were born full term at 39 weeks in 2002. Between 1992 and 2002, births at or after 40 weeks declined by nearly 21 percent while births occurring between 34 and 36 weeks increased 12 percent.


The study authors speculated that the rise of Caesarean sections and induced labor, as women become more focused on controlling their delivery dates, may be a part of it. But that is far from the whole picture, Green said, adding, "There's no hard data."

And early delivery isn't always a bad thing.

"Some of this is a success story, better maternal and fetal monitoring, detecting problems early and intervening before calamities happen," Green said. "We know that mortality rates have gone down over time, which largely reflects better management," she added.

On the other hand, she continued, "Some of the late preterm babies who have complications and who spend a few days in the neonatal ICU, we suspect, [the early delivery] may not be medically necessary."

What should expectant parents do?

Make your pregnancy as healthy as can be, starting, if possible, before conception with proper nutrition and lifestyle habits, Green advised. Detect and treat underlying maternal health conditions whether it's hypertension, asthma or diabetes.

Finally, Green said, "if everything is going well for a singleton pregnancy, and everything is uncomplicated, go to term. Don't deliver early, because there are consequences."

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Pregnancy Complications May Signal Long-Term Heart Trouble

Obstetric problems may put women at cardiovascular risk, study finds

MONDAY, March 13 (HealthDay News) -- Pregnant women who experience numerous complications, such as preeclampsia, gestational diabetes, or preterm birth, may also be at an increased risk of developing heart disease and early death, new research suggests.

Pregnancy complications were associated with an independent 60 percent increased risk for development of cardiovascular disease and a more than two-fold increased risk for death from any cause, according to analyses done by a team from Duke University Medical Center and Durham Veterans Affairs Medical Center.

They presented the findings Monday at a meeting of the American College of Cardiology, in Atlanta.

The researchers also concluded that women who continue to smoke during pregnancy not only harm the health of their fetus, they also more than double their risk of all-cause death and nearly triple their risk of cardiac death. Smoking also close to doubles a woman's risk of developing coronary artery disease.

"The complications during pregnancy that we studied could have lasting effects on the cardiovascular system and can be seen as novel early warning signs of future heart disease or mortality risk," Duke cardiologist Dr. Mimi Biswas said in a prepared statement.

The findings suggest a new group that could benefit from targeted heart disease prevention efforts.

"Typically, younger women tend not to be closely followed for cardiovascular disease -- based on the results of our analyses, those with difficult pregnancies should be," Biswas said. "Knowing that these complications may have ramifications later in life gives us a unique opportunity to catch women early. When women are young, they may tend to focus on the care of their babies and gloss over going to the doctor for their own care."

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Tuesday, March 21, 2006

Calcium Cuts Pregnancy Complications

Calcium Cuts Pregnancy Complications
Supplements eased preeclampsia-linked trouble but not its incidence, study found

FRIDAY, March 10 (HealthDay News) -- Boosting the calcium intake of pregnant women with low dietary calcium can help prevent complications from a dangerous condition known as preeclampsia, in which a woman's blood pressure rises dramatically, a new global study found.

However, the extra calcium did not significantly reduce the number of women who got preeclampsia, according to Dr. Jose Villar of the World Health Organization, lead author of the study that appears in the March issue of the American Journal of Obstetrics & Gynecology.

"It was not as positive as one would like," Dr. Marshall Lindheimer, professor emeritus of medicine and obstetrics and gynecology at the University of Chicago, said of the calcium-preeclampsia prevention link. He is a co-author on the study.

The 1.5 gram calcium supplement taken daily by women in the study "didn't prevent the disease, all it did was to decrease the severity," Lindheimer said. But it did decrease the rate of maternal and newborn deaths, he said.

Preeclampsia affects about 9 percent of pregnancies worldwide, according to Villar. It can lead to premature delivery and the need for a Caesarean section. If it progresses to a more serious condition, eclampsia, the woman can suffer seizures or coma. In the worst cases, preeclampsia can cause disability or death of mother or fetus.

In the study, Villar and his team assigned more than 8,300 women who were receiving health care from one of eight centers in six countries to either the calcium-supplementation group or a placebo group. Before the study, all the women took in less than 600 milligrams a day of dietary calcium, or about half the amount recommended during pregnancy.

When the researchers followed up, they found the rate of preeclampsia was not statistically different between the groups. But eclampsia was lower in those treated, with 17 women in the calcium group stricken with eclampsia compared to 25 in the placebo group. Severe gestational high blood pressure was higher in the placebo group, too, with 59 of the women developing hypertension vs. 43 in the calcium-treated group.

Newborn death was also less likely in the supplementation group, with 0.9 percent infant deaths in the calcium group compared to 1.3 percent in the placebo group.

Finally, the risk of early preterm delivery -- before 32 weeks -- was 2.6 percent in the calcium group, but 3.2 percent in the placebo group.

Women in the study received health care at centers in Argentina, Egypt, India, Peru, South Africa and Vietnam. Each center is part of the World Health Organization's Maternal and Perinatal Research Network.

The cause of preeclampsia is still unknown, and there's no way to prevent it. A relationship between calcium deficiency and preeclampsia has long been suspected.

Lindheimer said it's not clear how calcium may help. "It may affect the contractability of the blood vessels," he said. "Intracellular calcium is very important in muscle physiology." Insufficient calcium consumption may lead to more constriction of the vessels, he said. "When you replenish the calcium, they [vessels] are in a more dilated state. It may be that effect which makes the disease less severe."

The study results are of greatest value mostly outside the United States, Lindheimer said, where calcium deficiency is a bigger problem.

But the study might also serve as a useful reminder for U.S. doctors to urge their pregnant patients to get enough calcium, he said.

While the study results don't necessarily apply to American women, the findings are interesting, said Dr. Ashley Roman, an assistant professor of obstetrics and gynecology at the New York University School of Medicine.

"It helps us to understand the process of preeclampsia better," she said. "When it comes to preeclampsia, we are still in the dark ages. We have been studying it for years, and we don't know what causes it, how to predict it well, and we really don't know how to prevent it."

Roman tells her pregnant patients to be sure to take in 1,200 milligrams of calcium daily, if not from diet, then from a calcium supplement.

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Postpartum Depression Impacts Infant Care

Postpartum Depression Impacts Infant Care
Depressed moms less likely to breast-feed, play with new baby, study finds

WEDNESDAY, March 8 (HealthDay News) -- Mothers who suffer symptoms of depression after childbirth are less likely to breast-feed, play with, read to, or otherwise interact with their newborns, new research shows.

The nationwide study, by researchers from the Johns Hopkins Bloomberg School of Public Health and Columbia University, included nearly 4,900 mothers from 15 pediatric care centers.

It found that about 44 percent of mothers with postpartum depressive symptoms were likely to be breast-feeding at two to four months after the birth of their baby, compared with nearly 57 percent of mothers without depressive symptoms.

Other findings included:

  • At two to four months following birth, 87.4 percent of mothers with depressive symptoms were likely to play with their infants at least once a day, compared with 91.9 percent of mothers with no symptoms of depression;
  • At the same point in time, 22.4 percent of mothers with depressive symptoms were likely to show their newborns books, compared with 28.2 percent of mothers without symptoms of depression.

However, depressive symptoms did not seem to affect a mother's baby-related safety practices, such as placing the infant in the correct sleeping position or lowering the temperature of the home water heater. Overall, adherence to safety practices was high among all the mothers in the study.

"Maternal depressive symptoms are very common in early infancy. We found nearly 18 percent of the mothers in our study reported experiencing some symptoms of depression two to four months after the birth of their children," study corresponding author Dr. Cynthia S. Minkovitz, a professor in the department of population and family health sciences at Bloomberg, said in a prepared statement.

"These symptoms clearly have an unfavorable impact on a mother's parenting practices, particularly those that involve active engagement with the child. Our results highlight the importance of screening new mothers for depressive symptoms," Minkovitz said.

The study appears in the March issue of the Archives of Pediatrics and Adolescent Medicine.

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Kids' Asthma Linked to Maternal Nutrition

Kids' Asthma Linked to Maternal Nutrition
Researchers find Vitamin D could make a difference

SATURDAY, March 4 (HealthDay News) -- The link between maternal health and childhood asthma is becoming clearer.

Researchers presenting new studies at the annual meeting of the American Academy of Allergy, Asthma and Immunology in Miami Beach have recorded associations between maternal nutrition and stress with asthma in children.

One study found that expectant mothers who take higher amounts of vitamin D may decrease their child's risk for asthma.

Vitamin D deficiency is common in areas where asthma is also widespread, raising the suspicion that the two are linked, said Dr. Carlos Camargo, senior author of the study and an associate professor of medicine and epidemiology at Harvard Medical School in Boston.

Camargo and his team followed 1,300 mother-child pairs for more than three years.

By the time the children were 2 years old, there was already a clear association between higher vitamin D intake when the mother was pregnant and lower risk of wheezing and asthma in the children, he said at a news conference Saturday in Miami Beach.

And, he added, the three-year link was even stronger.

The results of previous studies suggest that vitamin D may have an effect on a fetus's developing immune system.

"Doctors should understand that vitamin D insufficiency is real," Camargo said. "It's important to get it from diet or supplements and the way to do that is through fortified milk, fish and supplements. And that is totally independent of our findings."

A Canadian study found that pregnant women who have asthma are more likely to have premature babies and to have babies with low birth weight.

This survey of 13,980 children born in Manitoba found that mothers who suffered from asthma were, on average, 2.77 times more likely to have a baby born at less than 28 weeks' gestation and 3.04 times more likely to have a baby born at less than 32 weeks' gestation than a non-asthmatic mother.

"Maternal asthma is a risk factor for prematurity and low birth weight in babies, and physicians and other health-care professionals need to assess present and past asthma even up to five years prior in order to properly assess risk for premature labor," said lead author Dr. Joel Liem, a research fellow in pediatric allergy and clinical immunology at the University of Manitoba.

Another research group at the same university found that children of mothers who experienced stress (defined as visiting a doctor or getting a prescription for depression or anxiety) were 1.3 times more likely to develop asthma. "The highest risk was in children with repeat exposure to mother's stress," said Anita Kozyrskyj, lead author of the study and associate professor of pharmacy and medicine at the university.

Kozyrskyj could only speculate on the possible mechanisms behind this association. "It may be related to the fact that stress alters mom's behavior, and there is some evidence that stress in the first year of life can cause some changes to the gastrointestinal system," she said.

Asthma affects more than 18 million people in the United States, with total direct medical expenditures reaching into the billions.

Not surprisingly, researchers are fast in the pursuit of causes as well as better ways to treat the disease.

Other studies presented this week in Miami Beach found that children and parents of children were under-reporting how much asthma medication the child was taking. By one measure, only one-third of the medicine was actually being used.

The study was undertaken to try to understand why people don't adhere to medication guidelines.

"Most patients don't follow daily treatment regimens no matter how good their doctor is," said Bruce Bender, lead author and head of pediatric behavioral health at National Jewish Medical and Research Center in Denver. "That disconnect is huge, and it's a large factor in how well we control asthma in kids and adults."

Finally, another study done at the VA Greater Los Angeles Healthcare System found that patients with intermittent (as opposed to persistent) asthma accounted for nearly half of all asthma-related emergency department visits.

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Some Pregnant Women at Higher Risk of Gestational Diabetes

Health Tip: Some Pregnant Women at Higher Risk of Gestational Diabetes
May require careful monitoring

(HealthDay News) -- Gestational diabetes is diabetes that is found for the first time when a woman is pregnant.

Diabetes means that a woman's blood sugar is too high, a condition that isn't good for her or her baby, according to the National Diabetes Information Clearinghouse.

Of every 100 pregnant women, three to eight develop gestational diabetes.

Women are at higher risk if they are overweight or have a family history of diabetes.

If a woman is at higher risk, it's recommended that she be checked for the condition during one of her first prenatal visits.

If she is found to have gestational diabetes, doctors will recommend exercise and changes in diet, and in some cases, will prescribe insulin.

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Tuesday, February 28, 2006

Health Tip: Paxil and Pregnancy Don't Mix

Health Tip: Paxil and Pregnancy Don't Mix
Pregnant women should avoid the drug, FDA says

(HealthDay News) -- Researchers have found that taking Paxil, a popular antidepressant, in the first three months of pregnancy can increase the risk of birth defects, the U.S. Food and Drug Administration said in a December 2005 news release.

"FDA is advising patients that this drug should usually not be taken during pregnancy, but for some women who have already been taking Paxil, the benefits of continuing may be greater than the potential risk to the fetus," the agency said.

The FDA recommends that expectant mothers who are taking -- or considering taking -- Paxil and similar antidepressants discuss with their doctors the potential risks and benefits.

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The Fight Against Birth Defects Starts Early

The Fight Against Birth Defects Starts Early
Women should take measures to ensure a healthy pregnancy before conceiving

WEDNESDAY, Feb. 22 (HealthDay News) -- Alicia Clendennin of Quaker Hill, Conn., was 18 weeks' pregnant when routine blood tests revealed her unborn child had a high risk of suffering some sort of birth defect.

Clendennin, now 47, went for an ultrasound, and doctors described what they were seeing as they ran the device over her belly.

"That's when they saw the opening in his back and determined that he did have spina bifida," Clendennin said of the test, performed 11 years ago. "They explained to me right then what they were finding."

Clendennin, a nurse by training and these days an administrator for a home care company, said she couldn't believe what she was hearing. She'd been taking folic acid for years. She'd avoided alcohol. She's not overweight and doesn't smoke.

But her instincts told her the diagnosis was true.

Spina bifida is a neural tube defect, or a birth disorder involving incomplete development of the brain, spinal cord or their protective coverings, according to the U.S. National Institutes of Health. It is caused by the failure of the fetus's spine to close properly during the first month of pregnancy, and at its most extreme can cause paralysis and mental retardation.

Birth defects form, in most cases, extremely early, so the steps a woman can take to try to ensure a healthy pregnancy should be taken far in advance of conception, experts say.

"Many birth defects form during the embryonic period, before a woman even realizes she's missed her first period," said Amy Case, who represents a program that monitors birth defects for the Texas Department of State Health Services.

"Before she can say, 'Oh I'm pregnant, I need to take of myself,' the damage may be done," added Case, who also serves as secretary/treasurer of the National Birth Defects Prevention Network.

It's a tough concept to grasp and keep in mind, studies have shown.

For example, the number of American women taking folic acid supplements -- one of the easiest ways to prevent serious birth defects of the brain and spine -- decreased from 40 percent in 2004 to 33 percent in 2005, according to a March of Dimes study.

But half of all pregnancies in the United States are unplanned, Case said. That means all women of childbearing years owe it to themselves -- and their potential offspring -- to do what they can to prevent birth defects.

"Women who can become pregnant should take very good care of their bodies," she said. "Many of the things they can do need to be done really before they conceive."

About one in 33 infants in the United States is born with a birth defect, and the causes of most defects remain a mystery.

Folic acid has been associated with the prevention of neural tube defects like spina bifida and anencephaly, or incomplete brain formation.

Doctors recommend that women take a vitamin containing 400 micrograms of folic acid every day to prevent these defects from occurring. Again, for the folic acid to work most effectively, it should be in a woman's diet prior to conception.

"You really need to have the folic acid taken on a regular basis three months prior to conception," DaSilva said. "Pregnancy is not a nine-month event. It should be considered a one-year event, with the first months spent preparing your body."

The number of women taking folic acid shot up when the March of Dimes conducted a public campaign for the supplement's use in the late 1990s, DaSilva said. But those numbers have slowly slipped over time.

"Like with everything, unless it's always in the spotlight people have short memories," DaSilva added.

"Someone who plans to have a baby should see a pediatrician, discuss her medical status and review what medication she is taking so the baby won't have birth defects," DaSilva said.

DaSilva also urges women to educate themselves about the ways they can better care for themselves and, as a result, their child-to-be.

Clendennin's pregnancy was difficult: she went into premature labor three times, and spent the last 10 weeks of the pregnancy in bed, resting, trying to give her unborn son a chance to grow as big as possible before she delivered him.

Three hours after Morgan was born, he underwent surgery to close his back.

He's had 14 surgeries since, 12 of them before he was 2 years old. Most of the surgeries dealt with neurological issues caused by hydrocephalus, a secondary defect discovered after his birth that causes excessive fluid in the brain. Shunts were placed in his head to drain off the excess fluid.

Because of these surgeries, and aggressive action taken by his doctors early on, Morgan now is living a mostly normal life.

Morgan has no signs of mental retardation, Clendennin said. He's in braces from the ankles down, but is able to walk without any assistive equipment at all.

The boy is an avid skier, hitting icy, expert slopes without fear, his mother said. He's also shown an artistic side, enjoying theater and art and singing.

Clendennin said knowing what was in store for her son before he was born helped her plan for the good care he's gotten since.

"I really believe it's important to have the prenatal testing done so you know what's going on with the child and you can make important decisions," she noted. "If you know in advance, you can pick your hospitals. You can pick your surgeons. You can pick your method of delivery."

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Moms' Genetics Might Help Produce Gay Sons

Moms' Genetics Might Help Produce Gay Sons
Women with multiple gay sons make a key chromosomal choice, study suggests

TUESDAY, Feb. 21 (HealthDay News) -- New research adds a twist to the debate on the origins of sexual orientation, suggesting that the genetics of mothers of multiple gay sons act differently than those of other women.

Scientists found that almost one fourth of the mothers who had more than one gay son processed X chromosomes in their bodies in the same way. Normally, women randomly process the chromosomes in one of two ways -- half go one way, half go the other.

The research "confirms that there is a strong genetic basis for sexual orientation, and that for some gay men, genes on the X chromosome are involved," said study co-author Sven Bocklandt, a postdoctoral researcher at the University of California at Los Angeles.

The link between genetics and sexual orientation has been a hot topic for more than a decade as a few scientists have tried to find genes that might make people gay or straight. In the new study, Bocklandt and colleagues examined a phenomenon called "X-chromosome inactivation."

While females have two X chromosomes, they actually require only one and routinely inactivate the other, Bocklandt said. "That way, both men and women have basically one functional X chromosome," he added. Men have both an X and Y chromosome, but the Y chromosome plays a much smaller role, he said.

Women typically inactivate one of their two X chromosomes at random. "It's like flipping a coin," Bocklandt said. "If you look at a woman in any given (bodily) tissue, you'd expect about half of the cells to inactivate one X, and half would inactivate the other."

In the new study, researchers looked at 97 mothers of gay sons and 103 mothers without gay sons to see if there was any difference in how they handled their X chromosomes. The findings appear in the February issue of the journal Human Genetics.

"When we looked at women who have gay kids, in those with more than one gay son, we saw a quarter of them inactivate the same X in virtually every cell we checked," Bocklandt said. "That's extremely unusual."

Forty-four of the women had more than one gay son.

In contrast, 4 percent of mothers with no gay sons activated the chromosome and 13 percent of those with just one gay son did.

The phenomenon of being more likely to inactivate one X chromosome -- known as "extreme skewing" -- is typically seen only in families that have major genetic irregularities, Bocklandt said.

What does this all mean? The researchers aren't sure, but Bocklandt thinks he and his colleagues are moving closer to understanding the origins of sexual orientation.

"What's really remarkable and very novel about this is that you see something in the bodies of women that is linked to a behavioral trait in their sons," he said. "That's new, that's unheard of."

Still, there are caveats. Dr. Ionel Sandovici, a genetics researcher at The Babraham Institute in Cambridge, England, pointed out that most of the mothers of multiple gay sons didn't share the unusual X-chromosome trait. And the study itself is small, which means more research will need to be done to confirm its findings, Sandovici said.

Ultimately, Sandovici added, the origins of sexual orientation remain "rather a complicated biological puzzle."

And this line of research does have its critics. Some have worried that, in the future, manipulation of a "gay gene" or genes might be used as a method of preventing homosexuality in utero, or perhaps even after. But Bocklandt said these kinds of fears shouldn't stand in the way of legitimate scientific research.

"We're trying to understand one of the most critical human traits: the ability to love and be attracted to others. Without sexual reproduction we would not exist, and sexual selection played an essential role in evolution," he said. "Yet, we have no idea how it works, and that's what we're trying to find out. As with any research, the knowledge you acquire could be used for benefit or harm. But if [scientists] would have avoided research because we were afraid of what we were going to find, then we would still be living in the stone age."

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Drug Might Help Prevent Fetal Alcohol Syndrome

Drug Might Help Prevent Fetal Alcohol Syndrome
Mice exposed to nicotinamide appeared to be protected, scientists say

TUESDAY, Feb. 21 (HealthDay News) -- Nicotinamide, a drug commonly used to treat certain autoimmune diseases, may also help prevent fetal alcohol syndrome, mouse studies suggest.

Fetal alcohol syndrome refers to a number of health problems suffered by babies born to mothers who drank alcohol during pregnancy.

In this study, researchers at Weill Medical College of Cornell University, New York, injected alcohol into mouse pups shortly after they were born. Since mouse brain development happens a bit later than it does in humans, the brain development in newly born mice is about equivalent to that of human fetuses in the third trimester of pregnancy.

This single injection of alcohol into the newborn mice was comparable to levels a human fetus is exposed to during a bout of excessive drinking by a pregnant mother, the researchers explained. The alcohol caused the death of brain cells in the baby mice, who exhibited a number of behavioral abnormalities when they became adults.

In another group of baby mice, the researchers injected nicotinamide two hours after they injected the alcohol.

In this group of mice, the amount of brain cell death appeared to be no greater than that seen during normal brain development. The mice also showed no behavioral abnormalities in adulthood, the researchers add.

A weaker protective effect was noted when nicotinamide was injected eight hours after the alcohol injection.

While this research is in the early stages, it does suggest that nicotinamide may help protect a fetus against alcohol damage if the mother takes the drug soon after she drinks. However, the authors emphasized that the best way to prevent fetal alcohol syndrome is for pregnant women, or those who may become pregnant, to avoid drinking.

The study was published in the Feb. 20 issue of the Public Library of Science.

More Studies on Everything Pregnant

Stress in Early Pregnancy Linked to Miscarriage
Ease anxieties before you get pregnant, experts advise

TUESDAY, Feb 21 (HealthDay News) -- Pregnant women who are stressed out during the first three weeks after conception are nearly three times as likely to miscarry, a new study finds.

"Try to provide yourself with what you consider a good environment. The less stress, the better," advised lead researcher Pablo Nepomnaschy, a postdoctoral fellow at the National Institute of Environmental Health Sciences of the National Institutes of Health in Research Triangle Park, N.C.

His team published its findings in this week's issue of the Proceedings of the National Academy of Sciences.

The NIH team evaluated 61 women over 12 months, collecting each woman's urine three times a week to check for pregnancy status and levels of cortisol, a stress-linked hormone.

"This study is special in the sense that we include cortisol data," said Nepomnaschy, He added that they did this testing very early in the pregnancy because "most pregnancy losses take place in the first three to four weeks after conception."

Of the 61 women, 22 got pregnant. Nine carried to term and 13 miscarried. Women with increased cortisol levels during the first three weeks of pregnancy were 2.7 times more likely to miscarry, the researchers found.

In all, miscarriages occurred in 90 percent of pregnancies in which the women had increased cortisol levels and in 33 percent of those with normal cortisol levels.

Nepomnaschy said it's unclear why a boost in cortisol might raise miscarriage risks, but he offered a hypothesis: "The body might interpret that [increased cortisol level] as conditions deteriorating, and maybe that might trigger an abortion mechanism."

The women studied were all residents of a rural area of Guatemala. "This population is more alike than any population in the United States," Nepomnaschy said, explaining that he was trying to get a sample of women who were similar in lifestyle, ethnicity and culture to rule out other factors linked to miscarriage. The women studied had similar diets and activity levels, and were all of the same ethnicity.

Another expert, Dr. Mary Stephenson, an obstetrician-gynecologist who runs the Recurrent Pregnancy Loss Program at the University of Chicago, said, "It's an intriguing article. Certainly more research is needed. But it is a potential mechanism by which miscarriage may occur."

Other studies have looked at the cortisol/miscarriage link, Stephenson said. "The results have been conflicting. There are some studies in animals that suggest that stress increased the risk of miscarriage. And doctors have long suspected that stress does the same in people."

About 15 percent of recognized pregnancies end in miscarriage, according to the March of Dimes. But Stephenson said that statistic usually includes pregnancies that made it to six weeks. "When you count the ones that occur before six weeks, up to half of pregnancies end in miscarriage," she noted.

The best advice for women trying to get pregnant is to de-stress your life before you conceive, she said.

"I talk about this a lot with my patients," Stephenson said. "I recommend that before they get pregnant, they take a serious look at their lifestyle."

And that includes getting enough sleep, so fatigue isn't an issue. "Fatigue is a type of stress," Stephenson said.

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Health Tip: Avoid Needless Ultrasounds of Fetus
FDA says they could be dangerous

(HealthDay News) -- The U.S. Food and Drug Administration has warned against taking a picture of a developing fetus merely as a keepsake.

These images can show facial features, hair and even the developing baby's sex.

But the FDA says while ultrasounds are generally safe, they can affect developing tissues and may cause a rise in fetal temperature.

Also, prenatal images being marketed for non-medical reasons are often done by less-experienced personnel and may expose a fetus to a longer period of imaging than one performed by a medical technician.

The FDA recommends that women limit ultrasounds to those done for medical reasons only.

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Preemie Babies Have Reduced Lung Function
The problem is especially pronounced in boys, researchers say

THURSDAY, Feb. 16 (HealthDay News) -- Many healthy but premature infants younger than 12 weeks old have reduced lung function, a new Brazilian study finds.

"Preemie" boys are more likely to experience impaired lung capacity than girls, the researchers added, as are babies that quickly put on weight.

"There was a noticeable reduction in expiratory flows in the preterm groups compared with control infants and reference values," researcher Dr. Marcus H. Jones, of the Hospital Sao Lucas in Porto Alegre, said in a prepared statement.

The findings appear in the current issue of the American Journal of Respiratory and Critical Care Medicine.

The study involved 62 premature infants with no significant neonatal respiratory disease and 27 full-term infants.

Previous studies on full-term infants have noted reduced lung function in boys. After adjusting for gestational age and weight, Jones and his colleagues found that expiratory flows were 30 percent lower in the preterm male infants. The findings could help explain why preemie male babies have a higher risk of death from respiratory illness than girls, the researchers said.

Even premature infants who appear to have a healthy lung capacity may have some reduced function, the team noted. "The increased risk of wheezing, chronic cough and hospital readmissions early in life suggests that some degree of airway obstruction is present even in preterm infants without neonatal respiratory distress," Jones said.

He said the findings indicate that gestational age does have an independent effect on expiratory flows -- the amount of breath expelled by the lungs.

"There is up to a 7 percent increase [in expiratory flow] per week of gestation. It also reinforces the hypothesis that prematurity alone has an important role in the development of persistent airway obstruction," Jones said.

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Science Reveals Secret to Sperm's Success
Key protein helps them penetrate an egg

WEDNESDAY, Feb. 15 (HealthDay News) -- Successful sperm use their tails to make one final jump into the egg -- and new research is revealing just how it happens.

A protein called CatSper1 is crucial to the ability of sperm to suddenly switch their tail movement from a smooth swimming motion to the sharp snap that thrusts them into the ovum, U.S. researchers report in the current issue of the journal Nature.

The discovery could lead to new avenues of research into male infertility or contraceptives that might block sperm from entering an egg, say the researchers at the Howard Hughes Medical Institute in Chevy Chase, Md.

Using an analytical technique to study electrical currents inside sperm, the researchers discovered that CatSper1 was a major component of the cellular calcium ion channel -- a mechanism that's largely responsible for proper sperm movement and male fertility.

"It's like opening a chamber in an ancient pyramid, because no one had ever seen inside sperm cells to measure all the currents that control their activity," researcher David E. Clapham said in a prepared statement.

"We are already measuring many of these currents and beginning to answer questions about what they are and what they do," he said.

Clapham said he and his colleagues plan to do further studies examining electrical currents and other inner workings of sperm.

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Overweight Women Risk Problem Pregnancies
Some simple steps can reduce likelihood of high blood pressure, gestational diabetes

SATURDAY, Feb. 11 (HealthDay News) -- With one-third of American women heavy enough to be termed obese, and many others at a weight deemed unhealthy, it's no surprise doctors are becoming more concerned about women who are too heavy before they get pregnant.

The reason: They -- and their babies -- are at higher risk for health problems.

So last August, the American College of Obstetricians and Gynecologists issued an opinion on obesity during pregnancy, cautioning women and doctors about the risk that obesity poses to pregnant women and their babies.

For women who are obese before becoming pregnant, there is a heightened risk of miscarriage, blood-pressure problems, pregnancy-related diabetes and, perhaps, a greater need for Caesarean-section delivery, said Dr. Laura Riley, an obstetrician-gynecologist at Massachusetts General Hospital and former chairwoman of ACOG's obstetric practice committee.

"There's also a higher risk of the baby being overweight," she said, adding that a baby of about 10 pounds at birth is deemed overweight. Babies of heavy mothers are at greater risk of stillbirth, prematurity, neural tube defects and higher rates of childhood obesity, according to ACOG.

Women who aren't obese but are heavy -- with a body mass index (a ratio of weight to height) of between 25 and 30 -- are also at increased risk of diabetes, high blood pressure and a C-section if they gain too much weight during pregnancy, Riley said. A BMI of 18.5 to 24.9 is considered normal; a BMI of 25 to 29.9 is considered overweight; a BMI higher than 30 is deemed obese.

Ideally, "women should get down to their ideal body weight before they get pregnant," Riley said. "But it is not always easy." And not always feasible. "If you are 41, do you want to wait a year to lose the weight? Probably not," she added.

"But if you could get to your ideal body weight, that is what you should do," Riley said. "At the very least, you should see a nutritionist and figure out how you can minimize your weight gain" during pregnancy.

According to the ACOG recommendations, women of normal weight before pregnancy should gain 25 to 35 pounds while expecting; overweight women 15 to 25 pounds; and obese women, 15 pounds.

Netty Levine, a registered dietitian at the Nutrition Counseling Center at Cedars-Sinai Medical Center in Los Angeles, often works with pregnant women who are heavy. She cautions them not to diet, which is not recommended during pregnancy, but to focus on making "lifestyle changes for you and your future family."

For instance, Levine recommends that overweight women sit down and complete a food diary of what they eat for several days. Then she evaluates that record to see if the women are getting enough protein and calcium, and if they are eating too much fat or sugar. She also looks to see if portion sizes are too large -- one of the most common weight-control mistakes.

"This is no time to lose weight," Levine tells women who were too heavy when they got pregnant. "But you can keep it to a minimum." For obese women, that means 15 pounds or so.

For women who are heavy and hoping to get pregnant, Levine agreed with Riley -- the best idea is to slim down first. That might not require drastic changes, she tells women. Make small changes. "Get off those smoothies, drink more water. If you like waffles, top them with strawberries, just pass on the butter and syrup," she said.

Levine evaluates a woman's entire day -- and lifestyle -- and decides where the problem spots are when it comes to overeating. "Some people eat healthfully at home but have a business lunch every day. Or they eat healthfully at work and get home at night and overeat." Zeroing in on the trouble spots can help women fix the problem, she said.

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Wednesday, January 18, 2006

Smoking During Pregnancy Raises Risk for Finger, Toe Deformities

Smoking During Pregnancy Raises Risk for Finger, Toe Deformities
Odds rise with number of cigarettes smoked per day, study finds

WEDNESDAY, Jan. 11 (HealthDay News) -- Smoking during pregnancy greatly increases the risk of having a baby with finger or toe deformities, according to a study covering more than 6.8 million births in the United States during 2001 and 2002.

The study identified 5,171 children with either extra, webbed or missing fingers and toes born to mothers who smoked during pregnancy. The mothers did not report other health risk factors such as heart disease, diabetes or high blood pressure.

Women who smoked one to 10 cigarettes a day during pregnancy had a 29 percent increased risk of having a baby with finger or toe deformities, the study found. Smoking 11 to 20 cigarettes a day raised the risk by 38 percent, while smoking 21 or more cigarettes a day raised the risk by 78 percent.

The study appears in the January issue of the journal Plastic and Reconstructive Surgery.

"The results of this study were interesting. We suspected that smoking was a cause of digital anomalies but didn't expect the results to be so dramatic," study author Dr. Benjamin Chang, of the University of Pennsylvania, said in a prepared statement.

"Smoking is so addictive that pregnant women often can't stop the habit, no matter what the consequences. Our hope is this study will show expectant mothers another danger of lighting up," Chang said.

In the United States, webbed fingers or toes occur in one of every 2,000 to 2,500 live births and excess fingers or toes occur in one in every 600 live births, the researchers said.

Chang said these kinds of abnormalities are the most common kinds of problems he treats.

"Parents would ask why this happened to their child, but I didn't have an answer. This study shows that even minimal smoking during pregnancy can significantly increase the risk of having a child with various toe and finger defects."

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Vitamin D Levels During Pregnancy Predict Kids' Bone Health

Vitamin D Levels During Pregnancy Predict Kids' Bone Health
Moms who take extra supplements may protect offspring from osteoporosis, study suggests

FRIDAY, Jan. 6 (HealthDay News) -- Mothers who take extra vitamin D while pregnant could be protecting their children from osteoporosis later in life.

A study appearing in the Jan. 7 issue of The Lancet reports that children born to mothers with insufficient vitamin D during pregnancy had weaker bones when they were 9 years old.

"It's not the holy grail, but it's another piece of information that suggests that events beginning from gestation influence ultimate bone health and bone strength," said Dr. Stephen Honig, director of the Osteoporosis Center at the Hospital for Joint Diseases in New York City. "This is easily correctable, and seems to be something that comes at no particular cost, either economic or from an adverse-effect standpoint."

"It's very interesting and very suggestive," added Dr. Loren Wissner Greene, a clinical associate professor of medicine at New York University School of Medicine and co-director of the Bone Density Unit at New York University.

Many people show a vitamin D deficiency, and this includes otherwise healthy women during pregnancy.

Vitamin D is required for optimal calcium absorption, which is critical to bone growth. The main source of vitamin D is sunlight, and most people don't get enough of that.

"There has been a recognition that a lot of people in the United States are vitamin D-deficient in these days of sunscreen," Greene said.

At the same time, accumulating evidence suggests that environmental factors early in life can influence a person's chance of developing osteoporosis. For instance, birth weight can predict bone mass later on, while poor intrauterine and childhood growth are associated with double the risk of hip fracture 60 years later. A mother's build, nutrition, smoking and physical activity level during pregnancy can also influence bone mass of the baby at birth.

No one has yet looked at a relationship between the mother's vitamin D status during pregnancy and skeletal growth of their children. The authors of this study hypothesized that maternal vitamin D insufficiency during pregnancy had a long-lasting effect on childhood bone mass.

The researchers studied 198 children born in 1991 and 1992 at a hospital in Southampton, England. They assessed mothers' body build, nutrition and vitamin D status during pregnancy; children's body size and bone mass were measured nine years later.

Women who had reduced levels of vitamin D during the later part of their pregnancies had children with reduced bone-mineral content at 9 years of age.

Women who took vitamin D supplements and who were exposed to more sunshine were less likely to have a vitamin D deficiency. Reduced concentration of calcium in the umbilical cord blood was also associated with a reduced bone mass in the offspring.

"Their point is that there may be a programming effect that goes on in utero that effects calcium and bone accrual," Honig said. "Something happens in the last trimester that influences the transport of calcium across the placenta, and somehow that situation changes the developmental period over a prolonged timeframe."

The findings need to be confirmed, but they fit in well with other studies that have shown that issues early in life, such as low birth weight, can impact osteoporosis risk later in life.

"These are all things that are lending credibility to the need to think about bone growth and development as starting from gestation onward, rather than just thinking about this as diseases that occur after menopause," Honig said. "That's a significant thing."

The authors suggested that giving vitamin D supplements to pregnant women, especially if the third trimester occurs during the winter when there is less sunlight, could contribute to stronger bones in their children.

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Healthy Aging: The 30s -- And Baby Makes Three

Healthy Aging: The 30s -- And Baby Makes Three
As women age, they must take extra care to ensure a healthy pregnancy

TUESDAY, Dec. 27 (HealthDay News) -- In 1970, the average American woman was 21.4 years old when she gave birth to her first child. By 2000, that figure had climbed to 25, according to federal statistics.

The increase in age reflects the fact that many couples today are postponing childrearing until their 30s and 40s.

But as women age, they must take extra care to ensure a healthy pregnancy, experts say.

"That means, first and foremost, getting proper prenatal care," said Dr. Thomas Weida, a spokesman for the American Academy of Family Physicians.

"In some cases, experts are even advocating a preconception visit -- either to the family doctor or an ob-gyn, to look for any risk factors that might complicate pregnancy, things like smoking, drinking, drug use," he said. Every woman knows -- or should know -- that drinking, smoking and pregnancy don't mix, but studies show that a significant percentage of women still ignore these warnings.

Fertility in women begins a gradual decline in the mid-30s, Weida said, while men's fertility remains stable until much later in life. Once conception has occurred, regular visits to the doctor can reassure moms- and dads-to-be that all's well.

"There's regular ultrasound, of course, as well as tests for certain genetic defects," said Weida, who is also a professor of family and community medicine at Pennsylvania State College of Medicine in Hershey. "As women get older -- say, from 35 into their 40s -- you also have the possibility of doing amniocentesis to look for defects."

Weida always advises women to take a multivitamin during their pregnancy, as well as folic acid, which protects against severe neural tube defects such as spina bifida.

Then there's delivery. The most common, serious complication is preeclampsia, where the mother's blood pressure suddenly soars. "It's tough to predict this, because you can get preeclampsia and be of average weight and never have had high blood pressure," Weida said. "Certainly though, if you do have medical problems such as diabetes, that puts you at slightly higher risk. Those things are usually looked for during prenatal visits," he said.

A healthy delivery means a newborn needing lots of nourishment to grow. "Experts now agree that breast-feeding is the 'formula' of choice," Weida said, with hundreds of studies confirming breast milk's power in speeding development and boosting infant immune systems. "During this period, moms obviously need to hydrate themselves and keep up their nutrition," he added. "So, sometimes I'll continue vitamin supplements after delivery, too."

New moms and those who love them also need to be on the lookout for postpartum depression. "It's all about duration and intensity," Weida said. Short-term "blues" shouldn't be of great concern, "but severe depression that goes on for a couple weeks -- that's certainly an issue that needs to be looked at," he said.

And what about Dad? According to Weida, his role in this family drama is basically as key supporting player -- with Mom and Baby the stars. "As most new fathers know, this means a lot of getting up at night," he said.

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Friday, January 13, 2006

Britney Spears Give Birth to a Baby Boy

THURSDAY, Sept. 15 (CNN) -- The singer underwent a caesarean at Santa Monica's UCLA Medical Center, near Los Angeles, according to the magazine US Weekly and television show "Access Hollywood."

Britney, 23, and her husband Kevin Federline announced the pregnancy in April.

Reports suggest that they will call the baby either London Preston or Preston Michael. Her top name for a girl was Addison Shye.

It is the first child for Britney, while Kevin, 27, has two young children -- Kori, three, and one-year-old Kaleb -- with ex-girlfriend, Shar Jackson.

Last month, the singer revealed: "I have a feeling I'm going to have an operation. I don't know why but I hope so.

"My mom said giving birth was the most excruciating thing she's ever gone through in her life. So if a caesarian doesn't happen, I'll be like, 'Epidural, please.' "

The star, who has sold more than 60 million albums, has made no secret of her wish to start a family and has said she can see herself as a mother.

Shortly after tying the knot in a private ceremony last September, she announced she would be taking a break from music to enjoy married life and focus on motherhood.

"I've had a career since I was 16, have traveled around the world and back and even kissed Madonna," she wrote on her Web site.

"The only thing I haven't done so far is experience the closest thing to God and that's having a baby. I can't wait."

Britney hosted a Moroccan-themed baby shower at her Malibu home last month.

Presents included a white wrought-iron bassinet from her mother, Lynne, a car seat, a stroller, an infant bathtub and lots of stuffed animals.

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