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Your Baby

Eating Fish During Pregnancy Benefits Baby’s Brain Development

2:00

Can eating more fish during pregnancy help babies’ brains function better as they grow older? Yes, according to a new study from Spain. The researchers say that mothers who eat three substantial servings of fish – each week- during pregnancy may be giving their children an advantage as they mature.

Researchers followed nearly 2,000 mother-child pairs from the first trimester of pregnancy through the child’s fifth birthday and found improved brain function in the kids whose mothers ate the most fish while pregnant, compared to children of mothers who ate the least.

Even when women averaged 600 grams, or 21 ounces, of fish weekly during pregnancy, there was no sign that mercury or other pollutants associated with fish were having a negative effect that offset the apparent benefits.

“Seafood is known to be an important source of essential nutrients for brain development, but at the same time accumulates mercury from the environment, which is known to be neurotoxic,” lead author Jordi Julvez, of the Center for Research in Environmental Epidemiology in Barcelona, said in an email to Reuters Health.

This important health concern prompted the U.S. Food and Drug Administration (FDA) to come up with a guideline for pregnant women in 2014. It encourages women to eat more fish during pregnancy, but limit the intake to no more than 12 ounces per week.

For this study, researchers analyzed data from the Spanish Childhood and Environment Project, a large population study that recruited women in their first trimester of pregnancy, in four provinces of Spain, between 2004 and 2008.

Julvez and colleagues focused on records of the women’s consumption of large fatty fish such as swordfish and albacore tuna, smaller fatty fish such as mackerel, sardines, anchovies or salmon, and lean fish such as hake or sole, as well as shellfish and other seafood.

Women were tested for blood levels of vitamin D and iodine, and cord blood was tested after delivery to measure fetal exposure to mercury and PCB pollutants. At ages 14 months and five years, the children underwent tests of their cognitive abilities and Asperger Syndrome traits to assess their neuropsychological development.

On average, the women had consumed about 500 g, or three servings, of seafood per week while pregnant. But with every additional 10 g per week above that amount, children’s test scores improved, up to about 600 g. The link between higher maternal consumption and better brain development in children was especially apparent when kids were five.

The researchers also saw a consistent reduction in autism-spectrum traits with increased maternal fish consumption.

Mothers’ consumption of lean fish and large fatty fish appeared most strongly tied to children’s scores, and fish intake during the first trimester, compared to later in pregnancy, also had the strongest associations.

“I think that in general people should follow the current recommendations,” Julvez said. “Nevertheless this study pointed out that maybe some of them, particularly the American ones, should be less stringent.”

Julvez noted that there didn’t appear to be any additional benefit when women ate more than 21 ounces (about 595 g) of fish per week.

“I think it's really interesting, and it shed a lot more light on the benefits of eating fish during pregnancy,” said Dr. Ashley Roman, director of Maternal Fetal Medicine at NYU Langone Medical Center in New York.

“I think what's interesting about this study compared to some data previously is that they better quantify the relationship between how much fish is consumed in a diet and then the benefits for the fetus and ultimately the child,” said Roman, who was not involved in the study.

Roman also noted that pregnant women should avoid certain fish such as tilefish, shark, swordfish and giant mackerel. These are larger fish with longer life spans that may accumulate more mercury in their tissue.

While fish may be a great source of protein and benefit brain development in utero, most experts agree that women should consult their obstetrician about what fish are safer to eat and how much they should eat during pregnancy.

The study was published online in the January edition of the American Journal of Epidemiology

Source: Shereen Lehman, http://www.reuters.com/article/us-health-pregnancy-fish-idUSKCN0UW1S4

 

 

 

Your Baby

High-Sugar Intake During Mom’s Pregnancy May Double Child’s Risk of Asthma

2:00

It’s no secret that moms-to-be often develop a sweet tooth during pregnancy, but new information suggests high-sugar foods and drinks may double their child’s risk for developing asthma and allergies later in life.

Researchers from Queen Mary University of London used data gathered from nearly 9,000 mother-child pairs in the Avon Longitudinal Study of Parents and Children, an ongoing research project that tracks the health of families with children born between April 1, 1991, and December 31, 1992.

During the study, the participating pregnant women were asked about their weekly intake of certain foods and specific food items including sugar, coffee and tea. Their responses were used to calculate their intake of added sugar.

The researchers only saw weak evidence to suggest a link between women’s added sugar intake and their children’s chances of developing asthma overall. But when they looked specifically at allergic asthma—in which an asthma diagnosis is accompanied by a positive skin test for allergens—the link was much stronger. Children whose moms were in the top fifth for added sugar during pregnancy were twice as likely to have allergic asthma when compared to children whose moms were in the bottom fifth.

Children of mothers with the high-sugar diets were 38% more likely to test positive for an allergen and 73% more likely to test positive for more than one allergen, compared to those kids whose moms stayed away from added sugar.

"The dramatic 'epidemic' of asthma and allergies in the West in the last 50 years is still largely unexplained -- one potential culprit is a change in diet," said Annabelle Bedard, lead author and a postdoctoral fellow at Queen Mary's Centre for Primary Care and Public Health Blizard Institute. "Intake of free sugar and high fructose corn syrup has increased substantially over this period."

As with most studies, a cause and effect was not established, only an association. The study’s authors believe that the association is strong enough to warrant further investigation.

Lead researcher Professor Seif Shaheen  said: "We cannot say on the basis of these observations that a high intake of sugar by mothers in pregnancy is definitely causing allergy and allergic asthma in their offspring.

"However, given the extremely high consumption of sugar in the West, we will certainly be investigating this hypothesis further with some urgency.”

There are many health reasons why pregnant women should limit their intake of high-calorie and sugary foods and drinks. This research suggests that it may be prudent for the health of their unborn child as well.

Story sources: Susan Scutti, http://edition.cnn.com/2017/07/05/health/sugar-pregnancy-child-allergy-asthma-study/index.html

 Henry Bodkin, http://www.telegraph.co.uk/science/2017/07/06/high-sugar-intake-pregnancy-linked-double-risk-child-asthma/

Parenting

Taking Anti-Depressants During Pregnancy

2:30

There have been several studies examining the health risks to babies when moms-to-be take anti-depressants during pregnancy. Research is showing that many antidepressants, especially the selective serotonin reuptake inhibitors (SSRIs) and older medications, are generally safe. Birth defects and other problems are possible. But the risk is very low.

One concern pregnant women have had is; will taking anti-depressants harm my baby’s intellectual, neurological and social development development?

Recently, in a first-of its kind study, researchers from the Icahn School of Medicine at Mount Sinai found a slight elevated risk of intellectual disability (ID) in children born to mothers treated with antidepressants, but the risk was not statistically significant and is likely due to other factors, including parental age and the parents' psychiatric history.

While other studies have examined the risk of autism in mother's who took antidepressants during pregnancy, this is the first study to examine the risk of ID in this population.

What is intellectual disability? According to the American Association of Intellectual and Developmental Disabilities (AAIDD), intellectual disability is a disability characterized by significant limitations both in intellectual functioning (reasoning, learning, problem solving) and in adaptive behavior, which covers a range of everyday social and practical skills. This disability originates before the age of 18. The term intellectual disability covers the same population of individuals who were diagnosed previously with mental retardation. It’s now the preferred term of use.

For the study, researchers examined the risk of ID in 179,000 children born in Sweden in 2006 and 2007. Approximately 4,000 of those children were exposed to antidepressants and other psychotropic medications during pregnancy. The researchers compared the risk in these children with a subsample of 23,551children whose mothers were diagnosed with depression or anxiety prior to childbirth but did not use antidepressants during pregnancy.

The results showed that the risk of ID after exposure to antidepressant medication was not much different between both groups. ID was diagnosed in about 0.9% of exposed children and 0.5% of unexposed children.

"Our study provides more information for clinicians to evaluate the risks in pregnant women taking antidepressants," said co-author Abraham Reichenberg, PhD, Professor of Psychiatry, Icahn School of Medicine at Mount Sinai. "It should be factored into other considerations such as the increased risk for the mother if not medicated, the drug's side effects, and other medical conditions."

The study will be published online in JAMA Psychiatry.

Webmd.com makes some good points about pregnancy and anti-depressants and offers tips for mothers-to-be that suffer from depression. Both psychiatric experts and ob-gyn experts agree that if you have mild depression and have been symptom-free for at least six months, you may be able to stop using antidepressants under a doctor’s supervision before getting pregnant or while you are pregnant. Psychotherapy, along with lifestyle measures, may be all that you need to manage your depression. You may be able to get through your pregnancy without antidepressants if you:

  • Talk with a therapist on a regular basis
  • Exercise more
  • Spend time outside
  • Practice yoga and meditation
  • Minimize your stress

But, the experts point out, it will be better for both you and your baby to stay on antidepressants while pregnant if any of the following is true:

  • You have a history of severe or recurrent depression
  • You have a history of other mental illnesses, such as bipolar disorder
  • You have ever been suicidal

Few, if any, medications are considered absolutely safe during pregnancy. Research findings on the effects of antidepressants on the growing baby are mixed and inconclusive. One study may find a particular antidepressant causes one type of risk. Another one, though, may find that it doesn’t. Also, the risks to the baby may be different depending on the type of antidepressant and when in the pregnancy it is taken. Regardless, most risks found by researchers have been low.

Story sources: https://www.sciencedaily.com/releases/2017/07/170712110441.htm

http://www.webmd.com/baby/pregnancy-and-antidepressants#1

Your Toddler

Does Parents’ Obesity Impact Toddlers’ Developmental Skills?

2:00

Children, whose parents are obese, may show signs of developmental delays by the time they are 3 years old, according to a new study.

The specific developmental problems seem to differ depending on whether the mother, father or both parents are obese, according to researchers from the U.S. National Institute of Child Health and Human Development.

"Specifically, mothers' obesity was associated with a delay in achieving fine-motor skills, and fathers' obesity in achieving personal and social skills -- that includes skills for interacting with others," said lead researcher Edwina Yeung. She's an investigator in the institute's division of intramural population health research.

"When both parents were obese, it meant longer time to develop problem-solving skills," she added.

Not everyone agrees with the researchers’ conclusion. At least one pediatric neurologist suggests that the results don’t necessarily prove a direct cause and effect.

And Yeung acknowledges the same. "We used observational data, which doesn't allow us to prove cause and effect, per se," she explained.

What the researchers found was interesting though. Compared with children of normal-weight mothers, children of obese mothers were 67 percent more likely to fail a test of fine-motor skills (using their hands and fingers) by age 3.

In addition, children of obese fathers were about 71 percent more likely to fail tests of personal and social skills, which may indicate how well they relate to and interact with others, by age 3, the researchers said.

Children whose mother and father were both obese were nearly three times more likely to fail tests of problem-solving ability by age 3, according to the researchers’ findings.

Most research into understanding child health and development has focused on mothers and their pregnancies. "Our findings suggest that factors from fathers may also play a role and deserve attention," Yeung said.

One child health expert doesn't think obese parents should be overly concerned by this study.

"Children of obese parents are not doomed to have developmental problems," said Dr. Ian Miller. He is a pediatric neurologist and director of Neuroinformatics at Nicklaus Children's Hospital in Miami.

There’s a long list of other conditions that can also impact the brain such as lead-poisoning, sickle cell disease, iron-deficiency anemia, autism, epilepsy or cerebral palsy—any of which can cause developmental problems, Miller said. He isn't ready, however, to add obesity to that list.

But, obesity may increase the risks of these health problems, Miller says. The probability for developmental problems is low among all children, including those of obese parents. "It's not a 'sky is falling' type of scenario," he said.

For the study, Yeung and her colleagues collected data on more than 5,000 women and their children who were part of the Upstate KIDS study, which sought to determine if fertility treatments could affect child development from birth through age 3.

The women were enrolled in the study about four months after giving birth in New York state, excluding New York City, between 2008 and 2010.

About one in five pregnant women in the United States is overweight or obese, Yeung said.

To check the children's development, parents completed the Ages and Stages Questionnaire after doing a series of activities with their children, Yeung said.

The test doesn't diagnose specific problems, but is a screen for potential problems, so that children can be referred for further testing, she explained.

The children were tested at 4 months and six more times through age 3 years. Mothers also gave information on their health and weight, both before and after pregnancy, and the weight of their partners, Yeung said.

More studies are needed to further examine if there is a link between obese parents and their offspring’s developmental skills, Yeung said.

The report was published online Jan. 2 in the journal Pediatrics.

Story Source: Steven Reinberg, http://www.webmd.com/children/news/20170103/can-parents-weight-hinder-toddlers-development#1

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

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DR SUE'S DAILY DOSE

Are vaccines safe for pregnant moms?

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