March 17, 2010, 7:45 PM CT

Stress during pregnancy and asthma in offspring

Stress during pregnancy may raise the risk of asthma in offspring, as per scientists at Brigham and Women's Hospital and Harvard Medical School in Boston. The scientists investigated differences in immune function markers in cord blood between infants born to mothers in high stress environments and those born to mothers with lower stress and found marked differences in patterns that appears to be linked to asthma risk during the later part of life.

"This is the first study in humans to show that increased stress experienced during pregnancy in these urban, largely minority women, is linked to different patterns of cord blood cytokine production to various environmental stimuli, relative to babies born to lower-stressed mothers," said Rosalind Wright, M.D., M.P.H., associate doctor at Brigham and Women's Hospital.

The findings have been published online ahead of print publication in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine

Asthma is known to be more prevalent among ethnic minorities and among disadvantaged urban communities, but the disparity is not completely explained by known physical factors. Urban women living in the inner-city also experience significant stress, especially minority women......... Posted by: Emily      Read more         Source

March 10, 2010, 8:21 AM CT

Elective removal of ovaries during hysterectomy

Removal of the ovaries (bilateral oophorectomy) while performing a hysterectomy is common practice to prevent the subsequent development of ovary cancer. This prophylactic procedure is performed in 55% of all U.S. women having a hysterectomy, or approximately 300,000 times each year. An article in the March/recent issue of The Journal of Minimally Invasive Gynecology suggests that this procedure may do more harm than good.

William H. Parker, MD, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, provides a comprehensive analysis of the medical literature relating to the benefit of oophorectomy at the time of hysterectomy. His investigation includes studies of post-hysterectomy cancer incidence, all cause mortality, cardiovascular disease, osteoporosis and hip fractures, coronary artery disease, and many other conditions. He concludes that, on balance, removal of the ovaries is not generally warranted for all women undergoing hysterectomy. In women not at high risk for development of ovarian or breast cancer, removing the ovaries at the time of hysterectomy should be approached with caution.

Dr. Parker states, "Presently, findings based on observation suggest that bilateral oophorectomy may do more harm than good. Given that 300 000 U.S. women a year undergo elective oophorectomy, the findings of increased long-term risks have important public health implicationsPrudence suggests that a detailed informed consent process covering the risks and benefits of oophorectomy and ovarian conservation should be conducted with women faced with this important decision."........ Posted by: Emily      Read more         Source

March 9, 2010, 8:26 AM CT

Exposure to BPA may cause permanent fertility defects

Scientists at Yale School of Medicine have discovered that exposure during pregnancy to Bisphenol A (BPA), a common component of plastics, causes permanent abnormalities in the uterus of offspring, including alteration in their DNA. The findings were published in the recent issue of Journal of the Federation of American Societies for Experimental Biology (FASEB J.).

Led by Hugh S. Taylor, M.D., professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale, the study is the first to show that BPA exposure permanently affects sensitivity to estrogen.

Taylor and his team used two groups of mice, one exposed to BPA as a fetus during pregnancy and another exposed to a placebo. They examined gene expression and the amount of DNA modification in the uterus. They observed that the mice exposed to BPA as a fetus had an exaggerated response to estrogens as adults, long after the exposure to BPA. The genes were permanently programmed to respond excessively to estrogen.

"The DNA in the uterus was modified by loss of methyl groups so that it responded abnormally in adulthood," said Taylor. "The gene expression waccording tomanently epigenetically altered and the uterus became hyper-responsive to estrogens."

Taylor said that exposure to BPA as a fetus is carried throughout adulthood. "What our mothers were exposed to in pregnancy may influence the rest of our lives. We need to better identify the effect of environmental contaminants on not just crude measures such as birth defects, but also their effect in causing more subtle developmental errors"......... Posted by: Emily      Read more         Source

February 18, 2010, 9:54 PM CT

Depression in Low-income Urban Mothers

More than half of low-income urban mothers met the criteria for a diagnosis of depression at some point between two weeks and 14 months after giving birth, as per a research studyled by University of Rochester Medical Center scientists and published online by the journal Pediatrics.

This is the first study to describe the prevalence of depression among low-income urban mothers, who were attending well-child care visits, through the use of a diagnostic interview. It also is the first study of this population group to test the accuracy of three depression screening tools routinely used by physicians.

The screening tools have high accuracy in identifying depression, the scientists concluded, but cutoff scores may need to be altered to identify depression more accurately among low-income urban mothers.

The study involved 198 mothers who were 18 years of age or older and whose children were no older than 14 months. The mothers attended well-child visits at the outpatient pediatric clinic at Golisano Children's Hospital at the Medical Center.

The scientists observed that 56 percent of the mothers, after a diagnostic interview, met the criteria for a diagnosis of a major or minor depressive disorder.

"This is an unexpected, very high proportion to meet diagnostic criteria for depression," said Linda H. Chaudron, M.D., associate professor of Psychology, Pediatrics and of Obstetrics and Gynecology. "This appears to be a group at high risk for depression. The message of this study is that pediatricians and other clinicians who work with low-income urban mothers have multiple screening tools that are easy to use and accurate. These tools can help clinicians identify mothers with depression so they can be referred for help"......... Posted by: Emily      Read more         Source

February 8, 2010, 8:04 AM CT

Stillbirth in women with fibroids

In a study to be presented today at the Society for Maternal-Fetal Medicine's (SMFM) annual meeting, The Pregnancy Meeting , in Chicago, scientists will unveil findings that show that there is an increased risk of intrauterine fetal death (IUFD), usually known as stillbirth, in women who have fibroids.

IUFD, or still birth, is rare and affects only six to seven out of every thousand births.

The study, conducted by scientists at Washington University in St. Louis, Mo., identified women who had fibroids detected during their routine second trimester ultrasound for anatomic survey at 16-22 weeks.

"Fibroids are very common," said Dr. Molly J. Stout, one of the study's authors. "We think they occur in 5% to 20% of all women, but most women are asymptomatic and don't even know they have them".

The study was a retrospective cohort study of 64,047 women. Data were extracted on maternal sociodemographics, medical history, and obstetric outcomes. Pregnancies with any fetal anomalies were excluded. Women with at least one fibroid detected at the time of fetal anatomic survey were in comparison to women without fibroids. The primary outcome was IUFD after 20 weeks gestation. Univariate and multiple logistic regression analyses were used to estimate the risk of IUFD in women with fibroids, and subgroup was conducted by presence or absence of fetal growth restriction (IUGR)......... Posted by: Emily      Read more         Source

February 8, 2010, 7:56 AM CT

Estrogen-only HRT may increase risk of asthma

Oestrogen-only hormone replacement treatment (HRT) may increase the risk of developing asthma after the menopause, suggests a large scale study published ahead of print in the journal Thorax

The authors base their findings on 57, 664 women, who were quizzed about their use of HRT and development of asthma symptoms every two years between 1990 and 2002.

All the women were taking part in the French E3N study, which includes almost 100, 000 women born between 1925 and 1950, and is the French component of the European Prospective Investigation into Cancer and Nutrition (EPIC).

None of these women had asthma when menopausal symptoms began.

The monitoring period equated to 495,448 person years in all, of which over a third was accounted for by women who had not used HRT (35.7%).

Prior users made up 4.5% while information on how long HRT was used was not known for a further 4%. Of the remainder, just under 56% were recent users of HRT.

Between 1990 and 2002, 569 women were newly diagnosed with asthma, corresponding to a rate of 1.15 cases per 1000 women a year.

Compared with women who had never used any form of HRT, those who did use it were 21% more likely to develop asthma, after adjusting for factors likely to influence the results......... Posted by: JoAnn      Read more         Source

February 4, 2010, 8:11 AM CT

Mother's exposure to bisphenol

For years, researchers have warned of the possible negative health effects of bisphenol A, a chemical used to make everything from plastic water bottles and food packaging to sunglasses and CDs. Studies have linked BPA exposure to reproductive disorders, obesity, abnormal brain development as well as breast and prostate cancers, and in January the Food and Drug Administration announced that it was concerned about "the potential effects of BPA on the brain, behavior and prostate gland of fetuses, infants and young children".

Now, mouse experiments by University of Texas Medical Branch at Galveston scientists have produced evidence that a mother's exposure to BPA may also increase the odds that her children will develop asthma. Using a well-established mouse model for asthma, the researchers observed that the offspring of female mice exposed to BPA showed significant signs of the disorder, unlike those of mice shielded from BPA.

"We gave BPA in drinking water starting a week before pregnancy, at levels calculated to produce a body concentration that was the same as that in a human mother, and continued on through the pregnancy and lactation periods," said UTMB associate professor Terumi Midoro-Horiuti, main author of a paper on the study appearing in the recent issue of Environmental Health Perspectives........ Posted by: Emily      Read more         Source

February 4, 2010, 7:42 AM CT

Waiting for birth or inducing

In a study to be presented today at the Society for Maternal-Fetal Medicine's (SMFM) annual meeting, The Pregnancy Meeting , in Chicago, scientists will unveil findings that show that waiting for birth is as effective as inducing labor in cases of intrauterine growth restriction (IUGR).

Intrauterine growth restriction means that the fetus is substantially smaller than normal. The condition affects about 10% of pregnant women.

At birth the babies are more likely to have low blood sugar, trouble maintaining their body temperature, and an abnormally high red blood cell count. They're also prone to jaundice, infections, and Cerebral Palsy. During the later part of life growth restricted babies appears to be prone to executive and behavioral disorders, obesity, heart disease, type II diabetes, and high blood pressure.

Because of lack of evidence, obstetricians follow two main policies for pregnancies with suspected fetal growth restriction at term. Some doctors may induce labor out of concern for complications, while others will await spontaneous delivery to prevent higher operative delivery rates. Scientists in the obstetric research consortium in the Netherlands conducted a randomized controlled trial of 650 women in 52 hospitals to compare both strategies......... Posted by: Emily      Read more         Source

February 4, 2010, 7:41 AM CT

Sutures cause fewer complications than staples

In a study to be presented today at the Society for Maternal-Fetal Medicine's (SMFM) annual meeting, The Pregnancy Meeting , in Chicago, scientists will present findings that there were less complications for women, after having a cesarean delivery, if sutures were used instead of staples to close the wound.

When Suzanne Basha, M.D. began her career as an obstetrician/gynecologist, she was surprised to find nothing in the literature that provided evidence about which method was better to close a wound after a cesarean.

"It seemed to me that I was seeing more patients return with complications after a cesarean birth when staples were used instead of sutures but I couldn't find any studies that supported a recommendation for the use of either method," Basha said.

Basha and her colleagues at the Lehigh Valley Health Network in Allentown, Pa., conducted a study of 425 patients who were randomized. Women undergoing cesarean delivery in labor as well as scheduled cesarean delivery were eligible. Surgical and postpartum care was otherwise at the discretion of the provider. Wound complication data was complete for 98% of subjects (219 suture and 197 staples) and included wound separation, wound infection, antibiotic use, need for a wound-related doctor visit, and readmission. Data were collected via telephone interview two to four weeks postoperatively by a single investigator......... Posted by: Emily      Read more         Source

February 4, 2010, 7:39 AM CT

Genes and premature labor

New evidence that genetics play a significant role in some premature births may help explain why a woman can do everything right and still give birth too soon.

Research presented today at the 30th Annual Society for Maternal-Fetal Medicine (SMFM) meeting ― The Pregnancy Meeting ― showed that the genes of both the mother and the fetus can make them susceptible to an inflammatory response that increases the risk of preterm labor and birth.

Silent, undetected infections and inflammation are major risk factors for preterm labor and birth, says SMFM member Roberto Romero, MD, Chief of the Perinatology Research Branch at the National Institute of Child Health and Human Development. One of every three preterm births occurs to a mother who has an infection in her uterus, but has no symptoms.

Dr. Romero led a team of physicians and researchers studying a large number of genes involved in the control of labor that could help explain the complex process that triggers preterm birth. They found DNA variants in genes involved in fighting infection in the pregnant woman and the fetus. Eventhough these variants increased the risk of preterm labor and birth, they have been preserved by evolution because they are needed to fight infection, Dr. Romero said......... Posted by: Emily      Read more         Source

February 4, 2010, 7:33 AM CT

Treating depression during pregnancy with acupuncture

In a study to be presented today at the Society for Maternal-Fetal Medicine's (SMFM) annual meeting, The Pregnancy Meeting , in Chicago, scientists will unveil findings that show that acupuncture appears to be an effective therapy for depression during pregnancy.

"Depression during pregnancy is an issue of concern because it has negative effects on both the mother and the baby as well as the rest of the family," said Dr. Schnyer, one of the study's authors.

About 10% of pregnant women meet criteria for major depression and almost 20% have increased symptoms of depression during pregnancy. The rates of depression in pregnant women are comparable to rates seen among similarly aged non-pregnant women and among women during the postpartum period, but there are far fewer therapy studies of depression during pregnancy than during the postpartum period.

Dealing with depression is difficult for pregnant women because the use of anti-depressants poses concerns to the developing fetus and women are reluctant to take medications during pregnancy.

In the study, an evaluator-blinded randomized trial, 150 participants who met the Diagnostic & Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for Major Depressive Disorder were randomized to receive either acupuncture specific for depression (SPEC, n=52) or one of two active controls: control acupuncture (CTRL, n=49) or massage (MSSG, n=49). Treatments lasted eight weeks (12 sessions). Junior acupuncturists masked to therapy assignment needled participants at points prescribed by senior acupuncturists. Massage therapists and patients were not blinded. The primary outcome was the Hamilton Rating Scale for Depression, administered by blinded raters at baseline and after four and eight weeks of therapy. Data were analyzed using mixed effects models and by intent-to-treat......... Posted by: JoAnn      Read more         Source

February 3, 2010, 7:59 AM CT

Women should be allowed to eat, drink during labor

The traditional practice of restricting food and fluids during labour does not provide any benefits, finds a new review co-authored by a Queen's University Associate Professor.

"Based on our review, there is no convincing and existing evidence to support restriction of fluids, and perhaps food, for women during labour. Women should be able to choose for themselves," says Dr. Joan Tranmer of the Queen's School of Nursing.

Practitioners have been concerned about eating and drinking during labour since the 1940s. The restriction is thought to prevent Mendelson's syndrome (named after work by Dr. Carl Mendelson), a rare, but sometimes fatal, condition caused by regurgitation of acidic stomach contents into the lungs when a general anaesthetic is given.

"With medical advances over the past 60 years, including the increase use of epidural anesthesia, we thought it was time to question the widespread ban on food and drink now that we are in the 2000s," says Professor Tranmer. "The use of general anesthesia during C-sections is low. And even when used, the techniques have improved since the 1940s, so the risk of maternal death or illness is very, very low" .

There is tremendous variation in the practice of fluid and food restriction across birth settings (home births versus hospitals)......... Posted by: Emily      Read more         Source

January 26, 2010, 8:50 AM CT

Antidepressants and lactation difficulties

As per a newly released study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM), women taking usually used forms of antidepressant drugs may experience delayed lactation after giving birth and may need additional support to achieve their breastfeeding goals.

Breastfeeding benefits both infants and mothers in a number of ways as breast milk is easy to digest and contains antibodies that can protect infants from bacterial and viral infections. The World Health Organization recommends that infants should be exclusively breastfed for the first six months of life. This newly released study shows that certain common antidepressant drugs appears to be associated with a common difficulty experienced by new mothers known as delayed secretory activation, defined as a delay in the initiation of full milk secretion.

"The breasts are serotonin-regulated glands, meaning the breasts' ability to secrete milk at the right time is closely correlation to the body's production and regulation of the hormone serotonin," said Nelson Horseman, PhD, of the University of Cincinnati and co-author of the study. "Common antidepressant drugs like fluoxetine, sertraline and paroxetine are known as selective serotonin reuptake inhibitor (SSRI) drugs and while they can affect mood, emotion and sleep they may also impact serotonin regulation in the breast, placing new mothers at greater risk of a delay in the establishment of a full milk supply"......... Posted by: JoAnn      Read more         Source

January 6, 2010, 8:10 AM CT

Increasing sonogram use in pregnant women

Current use of prenatal ultrasounds in women with singleton pregnancies is 55% greater than in 1996, even in low-risk pregnancies. More than one-third (37%) of pregnant women now receive 3 or more ultrasound tests in the second and third trimesters of a given pregnancy, found an article http://www.cmaj.ca/embargo/cmaj090979.pdf in CMAJ (Canadian Medical Association Journal) www.cmaj.ca. The increase in the use of multiple ultrasound scans per pregnancy has been more pronounced in low-risk than high-risk pregnancies, suggesting a need to review current practices.

Current guidelines recommend two ultrasounds in an uncomplicated pregnancy one in the first trimester and one in the second to screen for fetal and genetic anomalies.

The study included almost 1.4 million singleton pregnancies between 1996 and 2006 in Ontario, Canada's most populous province. It included both low-risk and high-risk pregnancies, the latter defined by the presence of a maternal comorbidity, need for genetics counselling or a previous complicated pregnancy. The study accounted for the recent introduction of first trimester nuchal translucency scanning.

The authors observed that almost 1 in 5 of all pregnant women including those at low-risk of complications now receive 4 or more ultrasounds in the second and third trimesters......... Posted by: Emily      Read more         Source

December 1, 2009, 8:14 AM CT

Glucose intolerance in pregnancy

Women who have gestational glucose intolerance (a condition less severe than gestational diabetes) exhibit multiple cardiovascular risk factors as early as three months after birth, as per a newly released study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).

Scientists in this study sought to evaluate the relationship between gestational glucose intolerance and postpartum risk of metabolic syndrome (defined as the clustering of several cardiometabolic risk factors including obesity, high blood pressure and low HDL cholesterol). Metabolic syndrome, like gestational diabetes itself, is linked to increased risk of developing type 2 diabetes and cardiovascular disease.

Scientists followed 487 women who underwent oral glucose tolerance testing during pregnancy. Each subject was classified as either having normal glucose tolerance, gestational glucose intolerance or gestational diabetes. At three months postpartum, scientists reviewed each subject's cardiometabolic characteristics, such as blood pressure, weight, waist measurement and lipid levels.

Findings support that even mild glucose intolerance during pregnancy predicts an increased likelihood of the metabolic syndrome at 3 months postpartum. The presence of cardiovascular risk factors as early as three months postpartum indicates that these risk factors appears to be longstanding and contribute to the long-term risk of cardiovascular disease in this patient population......... Posted by: Emily      Read more         Source

November 13, 2009, 8:16 AM CT

Exercising up to the end of pregnancy

Contrary to more conservative customs, exercising up to the end of pregnancy has no harmful effect on the weight or size of the foetus. This is what has been indicated in a study carried out by scientists of the Universidad Politcnica de Madrid (Polytechnic University of Madrid), which also shows the positive relationship between the weight of sedentary mothers before pregnancy and the body size of their babies. The conclusions appear in the International Journal of Obesity

"Partaking in low-level physical activity has beneficial effects on materno-foetal health". These findings have recently been reported in the International Journal of Obesity and highlight the benefits for the health of the baby and the mother when a physically-active lifestyle is maintained throughout pregnancy.

"An exercise regime carried out during the second and third trimester of pregnancy does not harm the health of the foetus", Jonatan R. Ruiz, researcher at the Karolinska Institute, Sweden, and principal author of this study, who has coordinated a team from the Polytechnic University of Madrid in collaboration with the Swedish centre, explains to SINC.

160 healthy women between the ages of 25 and 35 participated in the study, all of whom had sedentary habits and no risk of premature birth. Of this group of women, half followed an exercise regime under the supervision of experts in Physical Activity and Sports Science in collaboration with the Gynaecology and Obstetrics Unit of Hospital Severo Ochoa in Madrid......... Posted by: Emily      Read more         Source

November 11, 2009, 8:18 AM CT

Healthy Babies by the Numbers

When a fetus is smaller than expected for the number of weeks of pregnancy, due to associated problems like a poorly developed heart, health concerns as severe as brain damage can result.

The condition, known as Intra-uterine growth restriction (IUGR), prompts doctors to use ultrasound to track a baby's health and determine the best time for delivery. But these measurements are often incomplete, and obstetricians have had to rely on educated guesses about the strength of a fetus's circulatory system.

Now, thanks to new research from Tel Aviv University, IUGR babies will have a better chance for a healthy life.

Prof. Ofer Barnea of TAU's Department of Biomedical Engineering, in collaboration with Prof. Jacob Bar from the Wolfson Medical Center, couples mathematical models with information about a baby's physiology inside the womb. Combining ultrasound with powerful algorithms based on real-life data, pediatricians get critical data on the development of the fetal circulatory system, so they can determine when the baby is strong enough to survive on its own.

"Babies with IUGR experience stress and growth restrictions inside the womb," says Prof. Barnea. "Doctors need to assess their growth, but currently have to rely on partial data from ultrasound systems. If they leave the baby inside too long, she may suffer from brain damage. Conversely, we need to be sure her heart is strong enough to survive outside the womb"......... Posted by: Emily      Read more         Source

November 5, 2009, 8:22 AM CT

Women with asthma may benefit from oral contraceptives

New research shows that during natural menstrual cycles, women with asthma who were not taking oral contraceptives (OC) had lower exhaled nitric oxide levels (eNO), a marker of airway inflammation linked to asthma, than women who were taking OC.

Scientists from McMaster University in Hamilton, ON, Canada, studied 17 women with asthma during their menstrual cycles. Results showed that individuals not using oral contraceptives (OC) had higher mean eNO levels than women using OC.

Furthermore, among women not using oral contraceptives, an increase in estrogen levels was linked to a decrease in eNO, while an increase in progesterone was significantly linked to an increase in eNO. Scientists speculate that OC may have a potential role in the management of premenopausal women with asthma......... Posted by: JoAnn      Read more         Source