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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