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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Health Tip: Risk Factors for Miscarriage

FRIDAY Nov. 11 (HealthDay News) -- Up to one in five pregnancies ends in miscarriage, a devastating result for the prospective parents and their families.

Here are some risk factors for miscarriage, courtesy of the Baystate Health system of New England:

• Infection.
• Hormonal imbalance.
• Exposure to lead or radiation.
• Drinking, drugs and smoking.
• Sexually transmitted diseases.
• Diabetes.
• Poor nutrition.

The first signs of miscarriage often are vaginal bleeding and cramping. If you're pregnant and have either of these symptoms, talk to your doctor immediately.

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Health Tip: Pregnancy Test Kit Must Be Used Correctly

Health Tip: Pregnancy Test Kit Must Be Used Correctly
Or you may skew the result

(HealthDay News) -- Home pregnancy tests are fairly reliable, but their accuracy can be compromised if not used correctly, the Mayo Clinic says.

Possible causes of a false-positive result may be using an unclean urine collection cup, using an old or damaged kit, having an impure urine sample because of blood or excessive protein, and taking prescription drugs such as diuretics and anticonvulsants.

False-negative results may stem from taking the test too early, timing the test incorrectly, and using diluted urine.

If the results of a home pregnancy test are questionable, read the directions, call the toll-free number usually located on the test box, or take the test a second time.

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Maternal Blood Test Might Reveal Fetal Health

Maternal Blood Test Might Reveal Fetal Health
Early research points the way to safe, accurate prenatal screen

FRIDAY, Oct. 7 (HealthDay News) -- New research is moving scientists closer to the holy grail of prenatal medical care: a maternal blood test that could reveal health problems in an unborn child.

Researchers from Hong Kong reported this week that they've discovered a potential new way to differentiate the DNA of the mother from that of the fetus in a maternal blood plasma sample. The key, they say, lies in a DNA trait that's much more common in maternal genetic material.

Specialists couldn't predict how long it may take for the findings to translate into a routine fetal DNA screening test available in the doctor's office. And the study results don't appear to have any bearing, at least for now, on controversial fetal DNA tests that promise to predict a baby's gender early in pregnancy.

Still, the research is promising, said Dr. Siobhan Dolan, associate medical director at the March of Dimes. "This study is a step in the right direction," she noted.

Currently, the best screening tests for fetal medical problems -- including amniocentesis -- are also potentially dangerous to the unborn child. Doctors and researchers have been looking for a noninvasive test, and a test using the mother's blood would certainly fit the bill (current blood tests for pregnant mothers don't directly measure the health status of the fetus).

The good news is that a small bit of fetal blood does blend in with the mother's blood. "The trick is to find a way to sort out in the blood what came from the fetus and what came from the mother," Dolan said.

Only about 3 percent of DNA in maternal blood plasma comes from the fetus, said study author Dennis Lo, a professor of chemical pathology at the Chinese University of Hong Kong. There are ways to differentiate the fetal DNA, such as looking for the male Y chromosome, he said, but that only works for male fetuses.

In the new study, Lo and his colleagues report that they can differentiate maternal from fetal DNA by looking for a specific gene that acts differently in mothers and fetuses. They also used their technique to accurately detect cases of pregnancy-associated hypertension, also known as preeclampsia, in pregnant women.

The findings appear in this week's early online edition of the Proceedings of the National Academy Sciences.

Earlier this year, researchers reported that they were able to more easily analyze fetal DNA by boosting its levels in blood samples. Scientists have also found a way to separate bits of maternal and fetal DNA by analyzing their size.

The new research may have implications for existing fetal DNA tests, such as those that detect potentially dangerous blood group incompatibilities between mother and fetus, Lo said. It's not yet known if the tests will help pick up other diseases like Down syndrome, but researchers are hopeful, Lo said.

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New Insights into Preemie Infant Brain Injury

New Insights into Preemie Infant Brain Injury
Neurological damage once considered harmless may not be, study suggests

MONDAY, Oct. 3 (HealthDay News) -- A part of the brain called the cerebellum -- previously believed to be principally involved in motor coordination -- also plays an important role in the development of behavior and cognition, new research reveals.

Experts at Children's Hospital Boston used MRI to study the brains of 47 premature babies. Cerebellar injury is increasingly recognized as a potentially serious complication of premature birth.

Reporting in the October issue of Pediatrics, they found that cerebellar injury can have a major impact on development, and that the cerebellum and another part of the brain, the cerebrum, are tightly interconnected. It's long been believed that the cerebrum is the primary location of higher cognitive functions such as language and visual processing.

The Boston team found that when the cerebrum was injured, the cerebellum failed to grow to a normal size. And when the cerebellar injury was limited to one side, the opposite cerebral hemisphere did not grow to normal size.

"There seems to be an important developmental link between the cerebrum and the cerebellum. We're finding that the two structures modulate each other's growth and development. The way the brain forms connections between structures may be as important as the injury itself," study author and neurologist Catherine Limperopoulos said in a prepared statement.

"Until recently, cerebellar injury was underrecognized. Doctors downplayed it, saying 'Oh, maybe Johnny will be a little clumsy,'" she said. "Our research has made us aware that cerebellar injury is not a benign finding. We now know to look for it, and can counsel families that their children are likely to have deficits that extend beyond motor, and that may benefit from early intervention."

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Vaccine Might Shield Newborns from Infection

Vaccine Might Shield Newborns from Infection
Study will examine whether vaginal bacteria can be suppressed during childbirth

THURSDAY, Sept. 29 (HealthDay News) -- U.S. researchers are conducting a study to determine if a new vaccine can protect newborn babies from potentially lethal infection.

The infection is caused by common bacteria called group B strep that live harmlessly in the gastrointestinal tract and vagina of 25 percent of women. Exposure to these bacteria during birth can trigger potentially lethal infections in newborns, however.

"If we could give a vaccine to prevent women from harboring group B streptococcus in the vagina, then babies are not going to get it," Dr. Daron Ferris, a family medicine physician at the Medical College of Georgia and principal investigator of the U.S. National Institutes of Health study, explained in a prepared statement.

The 18-month study of 600 healthy, non-pregnant women will compare the effectiveness of the vaccine -- which was developed at Harvard University -- with a standard tetanus toxoid vaccine in controlling group B infections in the study participants.

Group B strep is the most common infectious cause of death in newborn babies, according to the U.S. Centers for Disease Control and Prevention. Infection-related problems typically occur in the first week of life when a baby's immune system is immature and unable to fight off infection. The bacteria can cause septicemia, meningitis, pneumonia and long-term hearing and vision damage in infants, as well as developmental problems.

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Immune Drug May Prevent Fetal Infection

Immune Drug May Prevent Fetal Infection
Hyperimmune globulin cut rate of mom-to-child transmission of cytomegalovirus

THURSDAY, Sept. 29 (HealthDay News) -- A drug that boosts a woman's immune system during pregnancy may help prevent her from passing along a common but dangerous virus to her unborn baby, Italian researchers report.

The drug, called hyperimmune globulin, cut rates of mother-to-child transmission of cytomegalovirus (CMV) to just 3 percent of babies born to women infected with the virus.

In contrast, 50 percent of infected mothers who did not receive the treatment passed on the potentially harmful pathogen to their newborn.

"Hyperimmune globulin was effective in treating and preventing mothers from transmitting the infection," said study co-author Dr. Stuart Adler, a professor of pediatrics and chairman of infectious disease at the Medical College of Virginia Campus of Virginia Commonwealth University in Richmond.

His team published their findings in the Sept. 29 issue of the New England Journal of Medicine.

Cytomegalovirus is a very common infection that is usually harmless for adults and children, according to experts at the March of Dimes. About half of the U.S. population will have contracted CMV by the time they're 30.

But the virus can cause grave harm to newborns. About 1 percent of all babies born in the United States are born with congenital cytomegalovirus, an infection that varies in severity from causing no symptoms to causing severe neurological problems and even death.

There's currently no effective treatment for the infection, and if a mother is infected with the virus during pregnancy, there's about a 40 percent chance that she'll pass the infection on to her offspring.

Hyperimmune globulin is a type of immunotherapy designed to boost the maternal immune system. For the current study, CMV-specific hyperimmune globulin was used to ramp up the immune system against this particular threat.

Adler said the researchers suspected the CMV-specific hyperimmune globulin would work in humans because of prior research in human cell cultures and animals. The therapy is considered very safe, and no adverse effects have been noted.

Because the therapy is considered so safe for women and the consequences of an active CMV infection can be so severe for newborns, the study was not randomized and women were offered the option to receive treatment.

Pregnant women were recruited for the study from eight Italian cities. Women with active CMV infection were then separated into either a therapy group or a prevention group.

The therapy group included 45 women who had an active CMV infection, as did their babies. All babies were tested via amniocentesis. Thirty-one of these women elected to receive treatment with hyperimmune globulin, and 14 chose not to receive the therapy.

Only one woman (3 percent) in the therapy group gave birth to an infant with CMV disease, defined as a displaying symptoms of infection at birth and being in some way handicapped at 2 years or older.

In contrast, seven women (50 percent) of the women who weren't treated gave birth to babies with CMV disease.

The "prevention" group included 84 women with CMV infection who chose not to undergo amniocentesis, so the researchers didn't know whether or not these babies were infected. Thirty-seven of these women chose to receive hyperimmune globulin, compared to 47 women who declined.

Six out of the 37 women (16 percent) who received treatment delivered babies with congenital CMV vs. 19 out of 47 women (40 percent) who did not receive the treatment.

"This new therapy is very exciting because there has been no effective therapy for protecting babies from CMV," said Dr. Patrick Duff, from the University of Florida College of Medicine in Gainesville, and author of an accompanying editorial.

However, Duff added, "There's still room for caution here. This study didn't include a huge number of patients, and it wasn't randomized." He also noted that screening tests for CMV aren't 100 percent accurate and therapy with hyperimmune globulin is expensive. "There are still some loose ends," he said.

Both Adler and Duff said additional studies need to be done to confirm these findings.

In the meantime, Adler believes women who are pregnant or thinking of becoming pregnant should be screened for CMV -- especially if they are at high risk for infection. High-risk groups include women who spend a lot of time with young children, such as a teacher or day-care worker or a mother of a young child under the age of 2 or 3, he said.

Women who test seronegative -- meaning they've never had the disease -- need to take precautions to lessen the chance of getting infected with CMV while they are pregnant. This means frequent and thorough hand washing and avoiding intimate contact with youngsters -- no kissing on the lips or sharing eating utensils. Women who test seropositive -- meaning they've had the infection at some point in the past -- are at extremely low risk of passing any active infection onto their baby, however.


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Fewer Women Taking Folic Acid Supplements

Fewer Women Taking Folic Acid Supplements
The B vitamin helps prevent birth defects, researchers say

THURSDAY, Sept. 29 (HealthDay News) -- The number of American women taking folic acid supplements to prevent serious birth defects of the brain and spine decreased from 40 percent in 2004 to 33 percent this year, according to a new report from the March of Dimes.

The report appears in the Sept. 30 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

"We have found that over the years the percentage of women reporting taking a vitamin containing folic acid every day has gone back down to 33 percent in 2005," said report co-author Heather Carter, a CDC nutrition epidemiologist.

The researchers also found that the percentage of women who were aware of folic acid increased from 78 percent in 2004 to 84 percent in 2005.

While awareness increased, the percentage of women who know that folic acid prevents birth defects remained unchanged at 25 percent. And the percentage of women who know that folic acid should be taken before pregnancy dropped from 12 percent in 2004 to just 7 percent in 2005, the lowest percentage since 1997, according to the survey.

There are number of reasons why women don't take folic acid supplements, Carter noted. "The most common reason for not taking a vitamin is forgetting to take it," she said. "Twenty-eight percent say they forget to take a vitamin."

Many women also think they don't need to take a vitamin, Carter said. "Some women also believe that they can get the vitamin from the food they eat," she said. "We need to motivate women to take either a vitamin supplement or get folic acid from fortified foods."

Women of childbearing age are advised to take folic acid, a B vitamin, every day. Folic acid can also come from vitamin pills or foods such as enriched breads and cereals, leafy green vegetables and citrus fruits.

"Every women of childbearing age needs to be consuming a vitamin containing 400 micrograms of folic acid every day to try to prevent serious birth defects of the brain and spine," Carter stressed.

These birth defects most often include the neural tube defects spina bifida and anencephaly (incomplete brain formation). These birth defects, occurring in an estimated 3,000 pregnancies in the United States each year, can cause lifelong disability or death, according to the CDC.

One expert agrees with the importance of getting enough folic acid, and thinks that women can get the folic acid they need by eating vitamin-enriched foods.

The difficulty in getting all women of childbearing age to get enough folic acid owes to a combination of education and economics, said Tsunenobu Tamura, a professor of nutrition science at the University of Alabama.

"However, if women are eating enriched grain products like bread and cereal, they should get folic acid in addition to the folic acid they are getting from regular food," Tamura said.

Tamura encourages women to get folic acid from foods. "If you go to the grocery story you should select items that contain enriched flour to get folic acid," he said. "If women get folic acid through enriched foods, they may not need to take folic acid supplementation."

But another expert thinks that taking a supplement is the best way to guarantee that women are getting enough folic acid.

"To ensure that women get 400 micrograms of folic acid daily, the most assured way is though a multivitamin supplement," said report co-author Joanne Petrini, director of the perinatal data center at the March of Dimes Birth Defects Foundation.

There are probably not a lot of women getting the required amount of folic acid through diet, Petrini said. "Only a third are getting it through supplements, which means that 70 percent don't," she added.

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Study: Men's Tobacco Chewing May Harm Sperm

Study: Men's Tobacco Chewing May Harm Sperm

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

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

Chewing Tobacco and Sperm

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

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

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

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

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

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

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

Other Factors?

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

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

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

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

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

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More First-Time Moms Opting For C-Sections

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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More Research Needed Into Preemie Births

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

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

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

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

The six priority areas are:

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

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

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

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Use of Antidepressants While Pregnant Can Affect Baby

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

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

Childbirth at Home as Safe as Hospital Delivery: Study

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

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

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

More DNA Damage to Older Men's Sperm

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

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

Many Dads Unknowingly Raising Others' Kids

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

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

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

Researcher Stands by Fetal Pain Findings

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

For more articles on pregnancy-related issues, visit our parent site www.thefunkystork.com

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

C-Sections Linked to Higher Cavity Risk in Babies

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

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

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

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

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

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

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

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

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

For more articles on pregnancy-related issues, visit our parent site www.thefunkystork.com

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

Exercise: The Right Stuff for Moms-to-Be

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For more articles on pregnancy-related issues, visit our parent site www.thefunkystork.com

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

Folic Acid Is Helping Reduce Birth Defects

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

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

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

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

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

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

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

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

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

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

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

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