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.

Going to be a dad? Pregnant partner? Visit www.thefunkystork.com for more info on pregnancy and life as an expectant dad!

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."

Going to be a dad? Pregnant partner? Visit www.thefunkystork.com for more info on pregnancy and life as an expectant dad!

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."

Going to be a dad? Pregnant partner? Visit www.thefunkystork.com for more info on pregnancy and life as an expectant dad!

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.

Going to be a dad? Pregnant Partner? Visit www.thefunkystork.com for more information on pregnancy and life as an expectant father.

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.

Going to be a dad? Pregnant partner? Visit www.thefunkystork.com for more info on pregnancy and life as an expectant dad!

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.

Going to be a dad? Pregnant partner? Visit www.thefunkystork.com for more info on pregnancy and life as an expectant dad!

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.

Going to be a dad? Pregnant partner? Visit www.thefunkystork.com for more info on pregnancy and life as an expectant dad!

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.

Going to be a dad? Pregnant partner? Visit www.thefunkystork.com for more info on pregnancy and life as an expectant dad!

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."

Going to be a dad? Pregnant partner? Visit www.thefunkystork.com for more info on pregnancy and life as an expectant dad!

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.

Going to be a dad? Pregnant partner? Visit www.thefunkystork.com for more info on pregnancy and life as an expectant dad!

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.

Going to be a dad? Pregnant partner? Visit www.thefunkystork.com for more info on pregnancy and life as an expectant dad!

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.

Going to be a dad? Pregnant partner? Visit www.thefunkystork.com for more info on pregnancy and life as an expectant dad!

Health Tip: Preparing For Your Pregnancy

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

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

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

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SIDS Linked to Subsequent Preemie Births

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Male Preemie Babies at Higher Risk for Hypertension As Adults

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Preterm Birth: The Nation's Leading Killer of Newborns

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Placenta Problems Predict Early Heart Trouble

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Placenta Size May Affect Breast Cancer Risk

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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U.S. Preemie Births, Caesareans Reach Record Highs

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

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

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

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

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

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

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

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

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

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

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

One expert sees several factors as responsible for these trends.

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

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

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

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

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

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

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

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

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Lupus, Rheumatoid Arthritis Raise Pregnancy Risks

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

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

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

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

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

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

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Gene May Spur ADHD Antisocial Behaviors

Gene May Spur ADHD Antisocial Behaviors
Mutation might also be tied to problems stemming from low birth weight, researchers say

WEDNESDAY, Nov. 9 (HealthDay News) -- Antisocial behavior in children with attention deficit hyperactivity disorder (ADHD) may be associated with a variant gene involved in brain signaling, British researchers report.

This variant of the "catechol O-methyltransferase" (COMT) gene may also increase a child's susceptibility to the effects of lower birth weight, the study said.

Researchers at Cardiff University in Wales looked for the COMT variant in 240 children, ages 5 to 14, with ADHD who were at high risk for early onset antisocial behavior.

The study found a significant association between the COMT variant and antisocial behavior and between birth weight and antisocial behavior.

The researchers also concluded that interaction between this COMT variant and low birth weight could be associated with antisocial behavior.

"Early onset antisocial behavior in a high-risk clinical group was predicted by a specific COMT gene variant previously linked with prefrontal cortical [brain] function and birth weight," the study authors concluded.

The findings appear in the November issue of the journal Archives of General Psychiatry.

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Test Detects Down Syndrome Early

WEDNESDAY, Nov. 8 (HealthDay News) -- Researchers say that by using a test called first-trimester combined screening, they can now detect Down syndrome earlier in pregnancy than ever before.

The combined screen includes an ultrasound test called a nuchal translucency test, plus tests that look for two proteins in maternal blood.

"This test is a big step forward for pregnant women because, on its own, it picks up 87 percent of cases of Down syndrome, and does so extremely early in pregnancy -- 11 or 12 weeks -- which is sufficiently early that women can find out important pregnancy information before being visibly pregnant," said Dr. Fergal Malone, chairman of the department of Obstetrics and Gynecology at the Royal College of Surgeons in Dublin, Ireland.

Malone was lead author of the study, which compared the new test to standard second-trimester screening, called quadruple screening. His team published their findings in the Nov. 10 issue of the New England Journal of Medicine.

According to the March of Dimes, the average 25-year-old American woman has about a one-in-1,250 chance of giving birth to a baby with Down syndrome. That risk climbs with age, so that by the time a woman reaches 40, her odds of giving birth to a Down baby has risen to about one in 100.

Second-trimester quadruple screening is currently the standard Down syndrome screening test used in the United States, according to the study. This test, which focuses on maternal blood proteins, is generally performed 15 weeks to pregnancy. If test results are abnormal, many women choose to undergo amniocentesis, which can diagnose Down syndrome. This means that a woman is often 18 or 19 weeks pregnant when she gets her amniocentesis results, Malone said.

He said the nuchal translucency test was first developed in the early 1990s and can only be done at between 11 and 13 weeks' gestation. Using ultrasound, a technician measures the thickness of the back of the fetus' neck. A difference of just a fraction of a millimeter, along with the presence of two proteins -- pregnancy-associated plasma protein A and the free beta subunit of human chorionic gonadatropin -- can signal the presence of Down syndrome.

If this combined screening test is positive, many women follow-up with chorionic villus sampling (CVS), which like amniocentesis can diagnose Down syndrome, but does so at an earlier stage of pregnancy. The optimal time for this test is 11 weeks. Before then, the fetus is too small, and after 13 weeks, the fetus is too large for the ultrasonographer to get an accurate picture.

To compare combined screening to standard quadruple screening, Malone and colleagues from centers in the United States, Ireland and the U.K. performed both tests on more than 38,000 pregnant women. One hundred and seventeen women in this group had babies with Down syndrome.

Both tests had an overall 5 percent false-positive rate, meaning that they picked up "cases" of abnormality that were in fact normal. The first-trimester combined screening was more effective in detecting Down syndrome, the researchers report.

Rates of detection for combined screening were 87 percent, 85 percent and 82 percent for tests done at 11, 12 and 13 weeks, respectively. Traditional quadruple screening had a detection rate of 81 percent.

The researchers stressed that the nuchal translucency test is very difficult to perform, and requires special training.

"Typical measurements in most women are only about 1 millimeter, and fractions of a millimeter differences in this measurement can make a huge difference to the risk of Down syndrome quoted to the woman," said Malone, who added that even the best-trained sonographers can't obtain measurements in 7 percent to 8 percent of cases.

Still, Malone said he is offering combined screening to his patients.

"The major benefit is that women can now get a great degree of reassurance about the health of their baby, and the likelihood that they are going to have a normal pregnancy, much earlier than previously. Additionally, if bad news is discovered, and a patient decides to undergo a pregnancy termination, such terminations are much safer for the woman at 12 weeks compared with 20 weeks," said Malone.

"This study confirms that first-trimester combined screening is a very precise way to screen for Down," said Dr. Allen Hogge, chairman of the department of obstetrics and gynecology and a geneticist at Magee-Women's Hospital at the University of Pittsburgh Medical Center.

"The problem at this point is that it's not going to be widely available for a while," he said. "It's also just a screening test. It's not a yes or no answer."

Malone added that while the combined screening test isn't widely available, it is being performed in many major medical centers in the United States and Europe. However, he pointed out that many insurers, including Medicaid, aren't currently reimbursing for this test yet.

"Patients may have to pay for this screening test themselves, or they and their doctors may have to get involved with complex claims procedures. Hopefully, the data provided in [our] trial will convince more insurers that not only is this a valid test, but it is probably the single most efficient screening test for Down syndrome that is available today," said Malone.

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