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Parenting

Why Moms-To-Be Might Want to Hire a Doula

2:00

Ever heard of a doula?  You’re not alone if the answer is no.  The word “doula” comes from the ancient Greek meaning “ a woman who serves.”

According to DONA International, a doula is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.

A recent study found that women with doula care had 22% lower odds of giving birth prematurely, and were less likely to have a C-section. (Among the women with doulas, 20.4% gave birth via cesarean, compared to 34.2% of women without doulas.)

For pregnant women, doulas can offer emotional and physical support throughout the pregnancy and labor; either in a hospital setting or at home.  There are also doulas that are certified to help mothers postpartum.

While many people may not have heard of doulas, they are beginning to gain some recognition.  TIME Magazine recently published an article on the 4 reasons why moms-to-be should consider hiring one.  The author spoke with Jada Shapiro, founder of the doula referral service, Birth Day Presence, in New York City.

1. They provide extra care and support:

Although every doula has a unique approach, their main role is to care for the mom-to-be. 

“Doulas offer continuous support to women both during pregnancy and after childbirth,” Shapiro explains.

“In a way, we are trying to recreate what was typical in old-world communities when women were surrounded by a vast support system of female friends and relatives during pregnancy.”

And while doulas are not medical professionals, they possess a wealth of knowledge about pregnancy and childbirth that can be extremely helpful for expectant moms.

“We work closely with our clients to de-mystify pregnancy terminology and help women interpret their options,” says Shapiro. 

That said, one of the most common misconceptions about doulas is that they interfere with a woman’s obstetrician. Shapiro says it’s important to note that this is not the case. “Doulas complement the care a woman receives from her doctor,” she says. “We don’t get in the way of medical decisions.”

She also adds that while many people believe you can only work with a doula if you want a medicine-free birth, this is also untrue: Women with all kinds of birth plans can find it helpful to consult a doula during their pregnancy.

2. They can assist with pain management:

Moms-to-be are well aware of the stories of pain during labor and delivery as well as the growing physical un-comfortableness that comes with being pregnant.

“Doulas are well-trained in physical comfort and can offer a wide range of pain relief techniques and tools,” says Shapiro, including acupressure, hydrotherapy, birthing balls, massage, and suggesting position changes during labor. Doulas can also help moms relax with soothing imagery, music, and breathing exercises.

This individualized level of care can help moms feel a little calmer during one of the most physically and emotionally challenging days of their lives. “I believe that many mothers just feel generally more cared for and less alone during the experience of childbirth with the help of a doula,” Shapiro says.

 

3.They provide support to both moms and their partners:

“Something I hear from many of my clients is that they can’t believe how intimate their childbirth experience was, even with a doula there,” says Shapiro.

She adds that because childbirth can be such an overwhelming experience for families, having the support of a third party can be just as useful for partners as it is for moms-to-be: 

“Doulas can help recall important information from midwife or doctor appointments, lend a helping hand if mom needs a massage, or just generally absorb some of the stress from the partner,” she says. “In this way, a doula can allow partners to be fully present in the experience.”

4. They’re there for you on the big day:

“Doulas are typically on-call 24/7 during a client’s ‘due window’ of 36 to 42 weeks,” says Shapiro.

When a woman goes into labor, her doula will be available for physical and emotional support both while she’s laboring at home as well as accompanying her to the hospital.

And in addition to the aforementioned relaxation and pain relief techniques, doulas know a lot about childbirth (Shapiro, for example, has attended “more than 350” births in her 13 years as a professional doula).

“During labor, doulas might suggest alternate positions; encourage different non-medical techniques to potentially help speed up dilation, such as walking around; and just generally act as a sounding board for difficult medical decisions,” she says.

If you’re interested in learning more about doulas, you can check out the DONA International website at www.dona.org. It has information on where you can find a certified doula and how the process works.

Sources: Kathleen Mulpeter, http://news.health.com/2016/01/28/what-is-a-doula-4-reasons-pregnant-women-might-want-one/

Daily Dose

Is Cord Blood Banking Worth It?

New parents often ask "is cord blood banking worth it?"During some recent “pre-natal” interviews with couples who are expecting their first baby, I have been asked about cord blood banking.  This question often comes up as prospective parents are given information by either their obstetricians or via the mail regarding private companies that will “bank” a baby’s umbilical cord blood.

In theory, the storage of cord blood is being touted as “biological insurance” in case the child (or possibly another full sibling) may need a stem cell transplant due to a malignancy, bone marrow failure, or certain other metabolic diseases during their lifetime. The chance of this even happening is remote, and at the same time, most conditions that might be helped by cord blood already exist in the infant’s cord blood stem cells and therefore would not be used. (premalignant changes can be found in stem cells). But, when parents are told that the cord blood may someday help their still unborn child, and then look at the financial commitment which may be hundreds to thousands of dollars, they are also caught thinking, “it is only money” and this might one day save my child’s life. Of course, when put that way we would all say, “go for it, money does not matter”. But, in reality the investment is not at all guaranteed and to date there is not much scientific data to support autologous (a baby’s own) stem cell transplantation. (Duke University is currently doing some studies on the use of cord blood stem cells for infant brain injuries and I have a patient who is partaking in these studies.) With this being said, private self-storage programs should be discouraged and umbilical cord blood banking should be encouraged when banked for public use via The National Marrow Donation Program or via state run cord blood banks.  In this way, cord blood stem cells are available to anyone that might need a transplant and could possibly be a match with your child.  The cells may also be used for ongoing research purposes at major medical centers and universities across the country. When using a public donor cord blood bank, the bank pays for the collection and storing of the baby’s cord blood, and there is not an initial or yearly bill for storing the cord blood. The cord blood is also stored in a consistent manner which complies with national accreditation standards. There is not the need to worry about a financial conflict of interest that may occur when using a private company. Lastly, research continues to look at the storage life of cord blood units, and paying a yearly fee for a child until 18, 21 or into perpetuity may not even guarantee the stem cells viability. I would talk to my OB-Gyn about donating an infant’s cord blood to the public bank if that is possible in your area. The cord blood bank will need to be notified 4–6 weeks before the baby is due. Once the cord blood is donated, parents will be notified of any abnormalities found in the cord blood (genetic or infectious etc), so that is a bonus too! Lastly, put the money you would have spent with a private cord blood banking company in your child’s college savings plan and add to it each year, like you were paying for the banking.  You have a much better chance of needing that “bank account”! That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Parenting

Uterus Transplant May Bring Hope to Women That Cannot Get Pregnant

1:45

The first U.S. uterus transplant at the Cleveland Clinic may offer a future option for women who have Uterine Factor Infertility (UFI).  UFI includes women who had had a hysterectomy, fibroids or scarring and cannot get pregnant. The revolutionary procedure may also give hope to women with a rare genetic syndrome called Mayer-Rokitansky-Küster-Hauser (MRKH).

MRKH syndrome, which occurs in 1 in 4,500 newborn girls, is a disorder that affects the reproductive system and can cause the vagina and uterus to be underdeveloped or absent from birth, according to the National Institutes of health.

“Women who are coping with UFI have few existing options,” Dr. Tommaso Falcone, an obstetrician-gynecologist and Cleveland Clinic Women’s Health Institute chairman, said in a statement last year. “Although adoption and surrogacy provide opportunities for parenthood, both pose logistical challenges and may not be acceptable due to personal, cultural or legal reasons.”

Dr. Jennifer Ashton, ABC News' Chief Women's Health Correspondent and board-certified obstetrician and gynecologist, said the uterus transplant was a major breakthrough in women's health and huge advance for helping women with MRKH.

"The really important thing for this story is it speaks to the incredibly powerful drive that some woman have to carry their own baby," Ashton said. "Even though uterine surrogacy is legal in the U.S. for some women, it’s not enough, it’s not the same thing. This is, I think, a really exciting important step for women’s health in this country."

While this is the first time the surgery has been performed in the U.S., nine women in Sweden have had the operation and four of those women have now given birth.

There is a wait time between the surgery and when a woman should start trying to conceive.  Women who receive the transplant will likely have to take anti-rejection drugs for a long time to ensure the procedure is successful. The Cleveland Clinic transplant was performed with a uterus from a deceased organ donor.

The hospital says that it is continuing to screen possible transplant candidates. For more information on the procedure you can check out the Cleveland Clinic website  at http://my.clevelandclinic.org/services/uterus-transplant.

In vitro fertilization and insemination was also considered revolutionary when the first “test tube” baby was born in 1978. Now, these procedures are commonplace for couples having difficulty conceiving.  It will be interesting to see how the uterine transplant changes future options.

Story source: Gillian Mohney, http://abcnews.go.com/Health/uterus-transplant-us-hope-women-rare-condition/story?id=37224525

Alexandria Sifferlin, http://time.com/4238596/uterus-transplant-cleveland-clinic/

 

Your Baby

Which Fish is Healthier for Pregnant Women?

1:45

New federal nutrition guidelines say that pregnant and breastfeeding women should eat 2 to 3 servings of fish every week. However, there are certain fish that should be eaten only once per week and other fish that should be avoided entirely by pregnant and nursing women.

One reason for the differentiation between certain types of fish is its likelihood of containing either very low or high levels of mercury.

Nearly all fish and shellfish contain traces of mercury. But some contain high levels.  A type of mercury called methylmercury is most easily accumulated in the body and is particularly dangerous.

Eating large amounts of these fish and shellfish can result in high levels of mercury in the human body. In a fetus or young child, this can damage the brain and nervous system.

The highest mercury concentration belongs to fish that typically live a long time. Pregnant and breastfeeding women should avoid King mackerel, Marlin, Orange roughy, Shark, Swordfish, Tilefish from the Gulf of Mexico and Bigeye Tuna. These are fish that usually contain high levels of mercury.

The new guidelines come with a handy chart that gives you the best choices of fish, good choices and fish to avoid.

Naturally, many pregnant women are concerned about eating fish after hearing about the possibility of consuming any mercury whatsoever. It’s important to remember that most of the fish consumed by Americans falls into the safe category.

Studies show that fish provide an array of nutrients that are important for your baby's early development. Most experts agree that the key nutrients are two omega-3 fatty acids – DHA and EPA – that are difficult to find in other foods. Fish is also low in saturated fat and high in protein, vitamin D, and other nutrients that are crucial for a developing baby and a healthy pregnancy.

How do fish end up consuming mercury? Some of the sources (such as volcanoes and forest fires) are natural. It's also released into the air by power plants, cement plants, and certain chemical and industrial manufacturers, landfills and farming runoff.

When mercury settles into water, bacteria convert it into a form called methylmercury. Fish absorb methylmercury from the water they swim in and the organisms they eat. Methylmercury binds tightly to the proteins in fish muscle and remains there even after the fish is cooked. Fish that live a long time consume more mercury.

There are many benefits to eating fish; you just need to be aware of the kinds of fish you eat. To help you make the best choices, the new chart released by the FDA and EPA is shown below.

Story sources: Megan Thielking, https://www.statnews.com/2017/01/19/fda-guidelines-fish/

http://www.babycenter.com/0_eating-fish-during-pregnancy-how-to-avoid-mercury-and-still_10319861.bc

http://www.fda.gov/downloads/Food/FoodborneIllnessContaminants/Metals/UCM536321.pdf

Daily Dose

The Flu Vaccine For Moms-To-Be

I have the opportunity to see (not treat) a lot of pregnant women in my practice and they have been asking me my opinion about flu vaccine during pregnancy.

They were inquiring about both seasonal flu vaccine and H1N1 (swine) flu vaccine. The statistics surrounding pregnancy, influenza and secondary infections or other complications have been documented for several years. Retrospective studies done in the late 1990s showed that healthy pregnant women were more likely to have complications from influenza and had higher death rates than expected. This was especially noted in women in the last trimester of their pregnancies. Due to these studies the CDC and ACOG (American College of Obstetrics and Gynecology) recommended that all pregnant women receive seasonal influenza vaccine. Despite these recommendations, more than 50 percent of OB’s recently surveyed do not routinely recommend flu vaccine and do not provide vaccine in their offices. I see many expectant mothers who are totally surprised when I ask them if they have received a flu vaccine from their OB. In fact only 1 in 7 pregnant women are being vaccinated. This may be partially due to the fact that OB’s have not routinely been vaccine providers, as we pediatricians have been, and are now becoming more aware about universal recommendations for flu vaccine in pregnancy and are ordering vaccine for their patients to receive during routine obstetrical visits. Flu vaccine is safe throughout pregnancy. This year is especially significant in that the H1N1 (swine) flu has also caused serious complications and deaths in pregnant women. The data shows that a disproportionate number of the deaths seen from swine flu (about 6 percent) were in pregnant women. Pregnant women are four times more likely to be hospitalized than other flu sufferers. This may be due physiological changes in lung function during pregnancy, as well as to differences in immune function. Regardless of the reasons, pregnancy in and of itself puts a woman at increased risk of serious complications, hospitalization and even death. Pregnancy is typically a time that we see the “the glow of pregnancy”, not complications or even death from having the flu. As an added benefit of vaccination, the antibodies that a pregnant woman will produce after vaccination will then be transported across the placenta to help protect the newborn. Passive transport of maternal antibodies may be the best protection for a newborn in the first two months of life. This is especially important for those infants being born during the height of the flu season. As you know we cannot give an infant flu vaccine until they are six months of age. With both H1N1 influenza currently circulating throughout the U.S. and seasonal flu yet to come, now is the time to make sure that you are vaccinated, especially if you are pregnant. Lastly, pregnant women should not receive live –attenuated flu vaccine (Flu-mist), but should receive the injectable flu vaccine for both seasonal flu and H1N1. You may receive both flu vaccines on the same day.  It is equally important for the father of the baby to be immunized against both types of flu to minimize the newborn’s risk of exposure as well. The best protection for a newborn is vaccination of those who will be caring for the infant during the flu season!! That’s your daily dose, we’ll chat again soon.

Your Baby

Gap Between Pregnancies Linked to Autism

2:00

Does it make a difference how long a woman waits between pregnancies in the health of her newborn?  According to a new large study, the closer the pregnancies, the higher the risk that her child will have autism or other neurodevelopmental disabilities.

"Based on the current best available evidence, it appears that the ideal inter-pregnancy interval -- the time elapsed between the birth of the immediate older sibling and the conception of the younger sibling -- is 2 to 5 years, in order to reduce the risk of autism," said study author Dr. Agustin Conde-Agudelo. He is a researcher at the World Health Organization Collaborating Center in Human Reproduction at the University of Valle in Cali, Colombia.

Researchers looked at existing studies involving more than 1.1 million children and also found that waiting too long between pregnancies (5 years or more) could raise the odds of autism.

The reasons for the link between short pregnancy spacing and autism are not known noted Conde-Agudelo. He said that scientists believe nutrition and other factors may play a role.

The study doesn’t prove that either long or short intervals between pregnancies actually causes autism, just that there seems to be an association between the two.

Conde-Agudelo and his team reviewed seven large studies reporting a link between short birth spacing and autism. The investigators found that children born to women with less than 12 months between pregnancies were nearly twice as likely to develop autism as children born to women with three years or longer between pregnancies.

Three of those studies also reported a significant link between long pregnancy spacing and autism, especially for two milder types, which were formerly called Asperger's syndrome and pervasive developmental disorder.

Meanwhile, the findings also suggested that shorter pregnancy spacing was associated with an increased risk of developmental delays and cerebral palsy, which can affect body movement, muscle coordination and balance.

Conde-Agudelo and other researchers conjectured that the mother’s depleted levels of folic acid between closely spaced pregnancies might play a role in the rise of autism risk.

The B vitamin folic acid is necessary for proper brain and spinal cord development in fetuses, and women are typically advised to take folic acid supplements during pregnancy.

As for longer pregnancy intervals also potentially linked to autism, Conde-Agudelo said it's been hypothesized that related factors such as infertility, unintended pregnancy and maternal inflammation levels may affect autism possibility.

Most neurodevelopmental disabilities, including autism, are thought to be caused by a complex mix of factors. These include genetics, environment, parental health and behaviors during pregnancy, and complications during birth, the researchers said in background notes.

The study was published in the April online edition of the journal Pediatrics, and will appear in the May print issue.

Story source: Maureen Salamon,  http://consumer.healthday.com/cognitive-health-information-26/autism-news-51/pregnancies-close-together-may-raise-autism-risk-study-says-709733.html

Your Baby

Eating During Labor May Speed Up Delivery

1:45

In many hospitals, when a woman is in labor, all she is allowed to eat are a few ice chips. That rule may need updating, according to a new study that finds women who were allowed to eat before delivery had a slightly shorter labor than those who were restricted to ice chips or sips of water - although the study can't prove that eating caused deliveries to happen sooner.

The practice of limiting food during labor goes back a study in the 1940s in which women who delivered under general anesthesia were at risk of inhaling their stomach contents and choking in it, writes senior author, Dr. Vincenzo Berghella, of Thomas Jefferson University in Philadelphia, and his colleagues in Obstetrics and Gynecology.

“We really don’t know how much if anything people can eat or drink in labor," said Berghella,.

Whether women can have more than water or ice chips as they labor to give birth is a common discussion among healthcare providers, he told Reuters Health.

General anesthesia is not commonly used during delivery these days, but the old guidelines are still in use.

For the new study, the researchers compiled data from randomized controlled trials that compared the labor outcomes of women who were allowed to eat only ice chips or water and those who were allowed to eat or drink a bit more.

For example, one study allowed women to drink a mixture of honey and date syrup. Another study allowed all types of food and drinks. A few others allowed women to drink liquids with carbohydrates.

Overall, the researchers analyzed 10 trials that included 3,982 women in labor. All were only delivering one child - not twins or triplets - and were not at risk for cesarean delivery.

The women with the less restrictive diets were not at increased risk for other complications, including vomiting or choking, during the use of general anesthesia.

And women who were allowed to eat and drink more than the traditional ice chips and water had labors that were shorter, by an average of 16 minutes, compared to women with the more restrictive diets.

Speaking from experience, 16 minutes less of labor pains is a real bonus. How does adding more liquid or food during delivery help reduce the time before delivery? The researchers presented some ideas.

"If we’re well hydrated and have adequate carbohydrate in our body, our muscles work better," said Berghella. A woman's uterus is largely made of muscle.

Another of his studies, which found women who received more fluid than normal delivered faster than other women, reinforces the finding.

Berghella said it's still common practice for women with uncomplicated births to be restricted to water or ice chips during labor.

"The evidence from well-done studies is they can have more than that," he said.

Do women really want to eat much during labor? Probably not, there’s a lot going on in the body as labor progresses.  But more liquids and some light carbohydrates during the early part of labor may be welcomed – especially if they shorten the time between labor and when baby enters the world.

Story source: Andrew M. Seaman, http://www.reuters.com/article/us-health-pregnancy-labor-food-idUSKBN15O2ZR

 

Parenting

Laughing Gas to Ease Labor Pains?

2:00

Like many Americans, you may think laughing gas (Nitrous Oxide) is something that is only used in a dentist’s office to ease the fear of dental work.  But if you live outside the U.S., you’re more likely to associate the pain reducing gas with childbirth.

A recent U.S. survey based on interviews with a representative sample of nearly 1,600 women who gave birth in American hospitals in 2005, showed that only about 1% of American women used nitrous oxide for pain relief during labor, as compared to 69 % of British women and 70% of New Zealanders.

However, U.S. doctors say that these figures may already be starting to shift in favor of using laughing gas in the delivery room.

Laughing gas used to be given to women during delivery quite often - but was replaced in the 1930s by the epidural for controlling pain. Today in the delivery room, epidurals are used almost exclusively for medically- induced pain relief.

In 2011, the Food and Drug Administration approved new laughing gas equipment to be used in American delivery rooms, and this resulted in a resurgence of use in America.

"Maybe 10 years ago, less than five or 10 hospitals used it [for women in labor]," Dr. William Camann, director of obstetric anesthetics at Brigham and Women's Hospital, told ABC News. "Now, probably several hundred. It’s really exploded. Many more hospitals are expressing interest."

Why should a woman consider using laughing gas during labor?  There are actually quite a few pros.

Laughing gas is regarded as a less extreme pain relief option during labor, when compared to the traditional epidural. It’s recommended for women who opt for a natural delivery but simply need a bit of help along the way.

"It's a relatively mild pain reliever that causes immediate feelings of relaxation and helps relieve anxiety," Camman explained. "It makes you better able to cope with whatever pain you’re having."

According to an article published in the journal Birth, “Although nitrous oxide provides much less complete pain relief than an epidural, it is enough for many women. It is eliminated through the lungs rather than the liver, and so does not accumulate in the mother’s or baby’s body. Unlike opioids, it does not depress respiration.”  

Another advantage is the cost. Nitrous oxide is a lot less expensive than an epidural. The average cost for a woman choosing laughing gas during labor may be less than a $100, compared to an epidural, which may run as high as $3,000 according to some experts.

One of the biggest complaints for women who undergo an epidural is the numbness they experience far after labor. It can take sometimes hours for women to regain complete sensation in the lower half of their body, but with laughing gas the effects wear off nearly as soon as inhalation ceases.

There are cons associated with laughing gas as well. It doesn’t completely alleviate the pain and many women feel it just isn’t strong enough. It can also cause some disorientation and a change in awareness.

Laughing gas is also known to have side effects such as nausea, dizziness, and drowsiness. Although these are not experienced by all women who use the gas for pain relief, for those that do, it can blemish the birthing experience.

Ultimately, the choice whether or not to use laughing gas is completely up to the mom’s comfort level. She can also opt to have an epidural if she finds she does not like the effects of the gas or feels that it is not providing enough relief from the pain. Unfortunately, at this point many hospitals in America do not even offer laughing gas as an option, but perhaps due to this recent surge in popularity more delivery rooms will become stocked with the pain relief option in time. 

Having gone through the birthing experience myself, I vote for as many safe pain-relieving options as possible!

Sources: Dana Dovey, http://www.medicaldaily.com/laughing-gas-pain-relief-when-giving-birth-becoming-popular-option-among-new-moms-319180

Judith P. Rooks, CNM, MPH, MS http://onlinelibrary.wiley.com/doi/10.1111/j.1523-536X.2006.00150.x/full

Your Baby

Can More Fruit Consumed During Pregnancy Raise Baby’s IQ?

1:30

The USDA recommends that women consume 2 cups of fruit daily. This can include fruits that are fresh, canned, dried or frozen, as well as 100-percent fruit juice.

Fruit not only contains important vitamins, minerals and fiber but may also provide benefits for the children of moms-to-be who consume more fruit during pregnancy.

According to a new study from Alberta, Canada, the children of mothers that consumed higher levels of fruit during pregnancy, had better cognitive development by the time they were one-year-old.

Researchers said the effects of eating more fruit on test scores were significant.

"It's quite a substantial difference," Dr. Piush Mandhane, an associate professor of pediatrics at the University of Alberta, said in a press release.  "We know that the longer a child is in the womb, the further they develop -- and having one more serving of fruit per day in a mother's diet provides her baby with the same benefit as being born a whole week later."

For the study, researchers analyzed data on 688 one-year-old children collected as part of the Canadian Healthy Infant Longitudinal Development study, and considered the amount of fruit their mothers consumed during pregnancy, gestational age at birth, parental lifestyle factors, including income and education, and cognitive tests given to the children.

Two-thirds of the population falls between 85 and 115 on the traditional IQ scale, with the average at about 100. The researchers found if pregnant mothers ate six or seven servings of fruit or fruit juice per day, their children scored six or seven points higher on IQ tests at one year old. There was no improvement in learning when only the babies were fed fruit.

The researchers noted that future studies will explore longer-term benefits of increased fruit consumption during pregnancy beyond one year of life, as well as whether higher intake of fruit affects development of other parts of the brain.

"We found that one of the biggest predictors of cognitive development was how much fruit moms consumed during pregnancy. The more fruit moms had, the higher their child's cognitive development," Mandhane said.

Experts recommend that pregnant women eat a variety of foods throughout the day to make sure they and their baby get the nutrients they need. A balanced diet contains fruits and vegetables, breads and grains, protein and dairy. Doctors often prescribe prenatal vitamins just in case a mom-to-be isn’t able to get all the nutrients she needs by diet alone.

While fruit is important to one’s overall diet, pregnant women should consult with their OB/GYN about their intake if they are diabetic or susceptible to gestational diabetes.

The study was published in the online edition of EBioMedicine,

Story source: Stephen Feller, http://www.upi.com/Health_News/2016/05/26/Eating-fruit-while-pregnant-helps-babys-cognitive-development-study-says/3311464273928/?spt=sec&or=hn

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