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Your Baby

Pregnant? Exercise is Good For You!

2:00

For years, the prevailing thought has been – if you didn’t exercise before, during pregnancy wasn’t the time to start. That’s no longer the case says, Alejandro Lucia, a professor of exercise physiology at the European University of Madrid.

A group of researchers want women to know that when it comes to exercise, there is a strong consensus of benefit for both the mother and developing fetus.

"Within reason, with adequate cautions, it's important for [everyone] to get over this fear," said Lucia.

According to the American College of Obstetricians and Gynecologists (ACOG), which updated its recommendations in 2015, women without major medical or obstetric complications should get at least 20 to 30 minutes of moderate-intensity aerobic exercise — enough to get you moving, while still being able to carry on a conversation — on most days of the week.

Lucia noted that evidence now suggests that starting an exercise program while pregnant can provide health benefits to both the mother and the growing fetus. Obviously, though, if you're new to exercise, take it slowly — you can work up to that 20 or 30 minutes.

The authors of the study say physical activity can prevent excessive weight gain, which can complicate the pregnancy and contribute to obesity. A review of existing research published in 2015 by the Cochrane Library found "high-quality evidence" that exercise during pregnancy can help prevent gaining too much weight, and may possibly lower the likelihood of a cesarean section, breathing problems in newborns, maternal hypertension and a baby that is significantly bigger than average. And of course, exercise promotes general cardiovascular and muscular health.

Other health problems can be helped such as chronic high blood pressure, gestational diabetes and women who are overweight or obese. Researchers say women with these conditions should be encouraged to exercise.

However, there are some health conditions in pregnancy where exercise should be avoided. According to the ACOG guidelines, women should avoid aerobic exercise if they have significant heart disease, persistent bleeding in the second or third trimester, severe anemia and risk of premature labor, among other conditions. And certain symptoms, such as contractions or dizziness during exercise, should be checked out quickly.

The bottom line is that women need to make a plan with their physician, taking into account their exercise history, their health, and the risk of pregnancy complications, says James Pivarnik, a professor of kinesiology and epidemiology at Michigan State University. He wasn't an author of the viewpoint but has conducted research on exercise and pregnancy.

Moderation is the goal during any exercise program. Long distance running and heavy weight lifting are not recommended. ACOG also recommends against contact sports, hot yoga, and exercises done in the supine position, i.e. lying face up, starting in the second trimester.

There are always exceptions to the rule, particularly with women who are highly trained athletes before they become pregnant. These women should still form plan with their OB/GYN on how much and what kinds of exercises are safe for them.

Among the general population and pregnant women specifically, people will respond differently to an exercise program. "But we know if you do the kind of things they're talking about here, the odds are your risk will be lower," says. Pivarnik.

Story source: Katherine Hobson, http://www.npr.org/sections/health-shots/2017/03/21/520951610/exercising-while-pregnant-is-almost-always-a-good-idea

Your Baby

Choosing the Safest Fish to Eat During Pregnancy

2:00

As a parent or an expectant mom, you may have travelled down the same path as many others- searching for the healthiest diet for your family or soon-to-be newborn.

Fish is one of the foods that rank high on the healthy food chart. It’s frequently referred to as a “brain food” because of its brain-boosting nutrients, particularly omega-3 fatty acid. Certain fish are an excellent choice while others may contain high levels of mercury; a known toxin than can harm a developing child.

Mercury is a common seafood pollutant. This neurotoxic chemical can harm a baby’s developing brain in utero, even at very low levels of exposure.

Seas are increasingly polluted by toxic chemicals from 2 major sources: small gold mines and coal fired power plants, according to a recent report by Healthy Babies Bright Futures (HBBF.)

Mercury in a mother’s body can be transferred to her fetus during pregnancy, exposing the developing fetus to the potent neurotoxin.

The report states that millions of women of childbearing age who eat mercury -contaminated fish have enough of the toxic chemicals in their bodies to harm a developing child. “55% of the global sample of women measured more than 0.58ppm of mercury, a level associated with the onset of fetal neurological damage.” This is the finding of a new, first of its kind report on mercury levels in women of childbearing age in 25 countries by HBBF partner, IPEN: the International POPs Elimination Network

While these findings may make you wonder if any fish are safe to eat, many health experts recommend that women who are pregnant should not give up eating fish out of fear of mercury toxins, but should focus on eating fish found to be very low in mercury. These include: wild Alaska salmon, sardines from the Pacific, farmed mussels, farmed rainbow trout, and Atlantic mackerel (not trawled).  

High mercury risk fish to avoid include shark, swordfish, orange roughy. bigeye tuna, king mackerel and marlin.

The FDA and the EPA joined forces this year and released new guidelines on fish consumption for pregnant women or those who might become pregnant, breastfeeding mothers and parents of young children. To governmental agencies created a chart to help these consumers more easily understand the types of fish to select. The agencies have an easy-to-use reference chart that sorts 62 types of fish into three categories:

  • “Best choices” (eat two to three servings a week)
  • “Good choices” (eat one serving a week)
  • “Fish to avoid”

Fish in the “best choices” category make up nearly 90 percent of fish eaten in the United States. The chart can be found online at https://www.fda.gov/Food/ResourcesForYou/Consumers/ucm393070.htm

The HBBF report also includes a warning about canned tuna. Limit your intake of canned tuna. While tuna is higher in Omega 3s and nutrients than most fish, the mercury levels can vary in individual tuna. Light canned tuna is recommended over white tuna; however, HBBF notes in their report that scientists found that for both types, the potential harm to a baby’s brain exceeds the fish nutrients’ brain-boosting assets.

One tip to remember is that larger fish tend to absorb more mercury than smaller types of fish. Fish should not be eliminated from any family’s diet; the benefits far outweigh the dangers. However, it’s important to choose fish that are known to be lower in mercury for a healthier outcome.

Story sources:  Charlotte Brody, RN, http://blog.hbbf.org/toxic-mercury-and-your-babys-ability-to-learn/

https://www.fda.gov/Food/ResourcesForYou/Consumers/ucm393070.htm

 

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

Your Baby

Can Prenatal Supplements Reduce Baby’s Risk of Autism?

2:00

According to the Centers for Disease Control and Prevention (CDC), 1 in 68 U.S. children have been identified with autism spectrum disorder.  

While there is no one cause attributed to the developmental disability, a new study suggests that taking folic acid and multivitamins during pregnancy may reduce your child's risk of developing autism.

 “Reduced risk of [autism] in offspring is a consideration for public health policy that may be realized by extended use of folic acid and multivitamin supplements during pregnancy," the researchers concluded in the report.

The international team of scientists, led by Stephen Levine from the University of Haifa in Israel, gathered data on tens of thousands of children born in Israel between 2003 and 2007, and followed their progress until 2015.

Researchers gathered prescription data, to see whether the kids' mothers had been prescribed folic acid or multivitamin supplements either prior to or during pregnancy.

Results showed that women who took supplements prior to pregnancy were 61 percent less likely to have a child diagnosed with autism, compared with moms who didn't take supplements.

In addition, taking supplements during pregnancy was linked to a 73 percent reduced risk of an autism diagnosis, the findings showed.

These study results indicate that taking folic acid and multivitamins could be a way to protect babies against the development of autism, said Tom Frazier, chief science officer for Autism Speaks, a group that promotes advocacy and support for individuals with autism and their families.

"The study suggests this is not a trivial recommendation. This is something that people really should pay attention to," Frazier said. "The reduction in risk isn't huge, but it isn't small either."

Pregnant women are advised to take folic acid to prevent abnormal fetal neural development. A lack of the vitamin could possibly set the stage for later onset of autism, Frazier said. He's not sure how the protective effect of multivitamins might work.

The study is not without its’ critics. The study cannot prove a direct cause-and-effect link between supplements and autism due to its design, and suffers from some major limitations, said Dr. Ruth Milanaik, director of the neonatal neurodevelopmental follow-up program at Cohen Children's Medical Center, in New Hyde Park, N.Y.

"I don't have a problem with saying folic acid is good for pregnant women. You should not only take folic acid during pregnancy, you should also take folic acid before pregnancy," Milanaik said. "But this study does not show that [not taking supplements] is a cause of autism in any way, shape or form."

Prescription records can't show whether women follow through and take their supplements, she said. Supplements also are available over-the-counter, and some of the moms could have purchased and taken them without waiting for a prescription, Milanaik notes.

The study was published online in January, in the journal JAMA Psychiatry.

Story source: Dennis Thompson, https://consumer.healthday.com/cognitive-health-information-26/autism-news-51/prenatal-vitamins-tied-to-lower-autism-risk-in-kids-study-finds-729864.html

Parenting

Flour with Added Folic Acid Is Reducing Birth Defects

2:00

Folic acid is a B vitamin that is known to help prevent certain types of birth defects in newborns. In January 1998, the FDA added a requirement that folic acid be added to breads, cereals, and other products that use enriched flour. These fortified foods include most enriched breads, flours, corn meals, rice, noodles, macaroni, and other grain products.

Since then, a new report shows that serious birth defects have fallen 35 percent. While that is certainly wonderful news, a 2014 study found that as many as 25 percent of American women are still not receiving even the minimum amount of recommended folic acid from either their diet or through supplements.

Women who don't get enough folic acid have an elevated risk of giving birth to a child with conditions called neural tube defects, the best known of which is spina bifida, which often causes paralysis.

Health experts began recommending that women of childbearing age take folic acid in 1992 because studies showed that taking 400 micrograms a day could reduce spina bifida and related birth defects by up to 70%.

Doctors now recommend that women who are considering having children start taking folic acid before trying to get pregnant. Since some pregnancies are not necessarily planned, many doctors recommend that women of childbearing age take a daily multivitamin that contains folic acid.

The benefits of folic acid have been researched for quite some time and since food producers began adding folic acid to grains, that simple step has prevented more than 1,300 babies a year from being born with spina bifida or related conditions, according to a report from the Centers for Disease Control and Prevention.

Authors of the new study found that Hispanic women are more likely to have a baby with spina bifida or a similar birth defect.

That's partly because the "masa harina" corn flour used in tortillas and other Hispanic foods isn't fortified with folic acid, the study says. The March of Dimes has petitioned the FDA to require that folic acid be added to corn flour. Adding folic acid to corn flour would prevent another 40 cases of spina bifida or related conditions each year, the report says.

"Even with fortification, there will be some women that do not get the recommended amount of folic acid every day," says Candice Burns Hoffmann, of the CDC's National Centers for Birth Defects and Developmental Disabilities. "We still have more work to do."

If you’re considering having a baby, talk to your doctor before becoming pregnant about the benefits of folic acid and how much you may need.

Sources: Liz Szabo, http://www.usatoday.com/story/news/nation/2015/01/15/folic-acid-birth-defects/21784019/

http://www.spinabifidaassociation.org

Your Baby

Obese During Pregnancy Linked to Obesity in Offspring

2:00

Not every time, but often, you’ll see obese couples and their kids are either obese or on the threshold of obesity. While adults have the power and the life experience to understand the health issues associated with obesity, their children – depending on their age- are reliant on on their parents making healthy choices for them.  

 Is generational obesity inherited or a case of families making poor choices where food and exercise are concerned – or both?

Researchers from the University of Colorado School of Medicine wondered if children born to obese moms might be predisposed to being obese due to their womb environment.

The team of scientists analyzed stem cells taken from the umbilical cords of babies born to normal weight and obese mothers. In the lab, they coaxed these stem cells to develop into muscle and fat. The resulting cells from obese mothers had 30% more fat than those from normal weight mothers, suggesting that these babies’ cells were more likely to accumulate fat.

No cause and effect was established, but the scientists noted that further research was needed. “The next step is to follow these offspring to see if there is a lasting change into adulthood,” says the lead presenter, Kristen Boyle, in a statement.

She and her colleagues are already studying the cells to see whether they use and store energy any differently from those obtained from normal-weight mothers, and whether those changes result in metabolic differences such as inflammation or insulin resistance, which can precede heart disease and diabetes.

Other studies have found a high correlation between parents’ Body Mass Index (BMI) numbers and their children ‘s BMI, particularly between mothers and their kids. Further, the BMI of grandmother’s and their grandchildren is also high.

What is a healthy weight gain for a pregnant woman? It depends on how much you weigh before getting pregnant.

The guidelines for pregnancy weight gain are issued by the Institute of Medicine (IOM); most recently in May 2009. Here are the most current recommendations:

•       If your pre-pregnancy weight was in the healthy range for your height (a BMI of 18.5 to 24.9), you should gain between 25 and 35 pounds, gaining 1 to 5 pounds in the first trimester and about 1 pound per week for the rest of your pregnancy for the optimal growth of your baby.

•       If you were underweight or your height at conception (a BMI below 18.5), you should gain 28 to 40 pounds.

•       If you were overweight for your height (a BMI of 25 to 29.9), you should gain 15 to 25 pounds. If you were obese (a BMI of 30 or higher), you should gain between 11 and 20 pounds.

•       If you're having twins, you should gain 37 to 54 pounds if you started at a healthy weight, 31 to 50 pounds if you were overweight, and 25 to 42 pounds if you were obese.

These recent findings point out again, how important it is for pregnant women to consider the possible long - term health affects on their unborn offspring when making decisions about their own health.

The report was presented in May to the American Diabetes Association.

Sources: Alice Park, http://time.com/3906135/obese-moms-wire-kids-obesity-during-pregnancy/

http://www.babycenter.com/0_pregnancy-weight-gain-what-to-expect_1466.bc

 

Daily Dose

Zika Warning in United States

1:30 to read

The Zika virus is now here….that is, in the continental United States and specifically Miami, Florida.  There are now 4 confirmed cases of Zika infections in Florida, all thought to have been contracted from the bite of mosquitoes in early July. The cases are clustered in a northern area of Miami.  Although there have not been any mosquitoes in Miami that have tested positive for the Zika virus, epidemiologists do not think that is unusual, as the mosquitoes that were presumably infected may have already died (they have a short life cycle). Large scale testing of trapped mosquitoes in Florida is continuing.

Because the Zika virus only causes symptoms in about 20% of those infected (80% of people will never show symptoms although being infected) the health department is working to see if there may be even more cases in the Miami area. They are doing door to door surveillance in some zip codes and obtaining screening urine specimens checking for the virus….there should be more information available in the near future. At the same time, due to the fact that the Zika virus may be spread from blood and body fluids, the donated blood supply in Miami is being screened for Zika prior to being used. 

So…many of the families I care for vacation in Florida in the summer, especially along the Gulf Coast. I have received a number of phone calls in the last week from expectant mothers, as well as some who are trying to conceive, asking if they should even go to Florida?  This is a tough question, but for the time being, seeing that Texas does not YET have any locally acquired Zika virus I told them that I would probably err on the side of caution and change my beach travel plans. (England has recommended that their pregnant citizens “delay or postpone” all non essential travel to Florida).  

Here is my rationale.  Why risk going to the beach, with your family and children (who are going to spend most of their time outside), in a state known to have the Aedes aegypti mosquito and now confirming the first cases of locally acquired Zika?  The anxiety that is associated with the possibility of getting a mosquito bite ( despite using insect repellent and trying to wear protective clothing - which is difficult at the beach??), is just not worth it. Worrying for weeks after returning from vacation and never truly knowing if you might have been exposed (remember most people will not become ill when infected), and wondering if you should not conceive? Or worrying at every OB appointment that your fetus is developing normally…..because you went to the beach in Florida a month ago….? I just can’t think of a reason to go through all of that…for a week at the beach.

With that being said, I now have 4 mothers who have decided to cancel their vacation plans at the beach, and to stay home and not “take any chances”. The effects of the Zika virus on a developing fetus are life long and a vacation is just a fun filled week - so why not make a few  memories this summer with a stay-cation?  No anxiety…right?  Let’s see what happens in Florida and other southern states over the next few weeks and months as this situation continues to evolve. 

In the meantime - get rid of standing water and use your insect repellent wherever you live!

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 Child

Will 60% of U.S. Children be Obese by Age 35?

2:00

As many as six in ten U.S. children could be obese by the time they are 35 years old. That sobering news comes from a study conducted by "Childhood Obesity Intervention Cost-Effectiveness Study" (CHOICES).

The numbers are a result of data entered into a computer. The investigators first combined height and weight data from five studies involving about 41,500 children and adults. The computer then generated a representative sample of 1 million "virtual" children up to the age of 19, living in the year 2016. The model then predicted how obesity rates would unfold until all the virtual children turned 35.

The model indicated that being overweight or obese early in life bumped up the risk for being obese later in life. In addition, the more overweight or obese someone was as a child, the greater the person's chance of being obese by age 35.

According to the U.S. Centers for Disease Control and Prevention (CDC), roughly 20 percent of American children between the ages of 6 and 19 years of age are currently obese. That reflects a tripling of the number since the 1970s.

The study’s lead author, Zachary Ward, a doctoral candidate in health policy with the Harvard T.H. Chan School of Public Health's Center for Health Decision Science, in Boston, noted that the results were not unexpected.

"It should not be surprising that we are heading in this direction. We are already approaching this level of adult obesity for certain subgroups [and] areas of the country." Ward said.

Still, Ward expressed some surprise at how strongly being obese at a very young age predicted obesity decades down the road. 

"For example, we found that three out of four 2-year-olds with obesity will still have obesity at age 35," he said. "For 2-year-olds with severe obesity, that number is four out five."

Lona Sandon, an assistant professor of clinical nutrition at the University of Texas Southwestern Medical Center in Dallas, was also not surprised at the findings.

"Trends show obesity occurring earlier in adulthood, and [the] current level of childhood obesity suggests that the trend will continue," said Sandon, who was not involved with the analysis. 

Because "obesity is difficult to reverse at any age," she said, prevention is key. Parents should not rely solely on public school nutrition and activity programs to do the job.

Earlier studies have suggested that obesity in children may begin in the womb if the mother is obese when she becomes pregnant, and develops gestational diabetes. This combination can produce a large child at birth. Studies have shown that babies born with higher amounts of fat at birth tend to continue having more body fat in childhood and on into adulthood.

Experts recommend that overweight women that are considering becoming pregnant, first lose the extra weight and be tested for type2 diabetes. If they are found to have type2 diabetes before they're pregnant, they should be treated beforehand; this will help their pregnancy and prevent complications.

Sandon also notes that there are other things parents can do to help insure a healthier child. "Concerned parents can make efforts to prepare and provide healthier foods at home, plan regular scheduled mealtimes, limit screen time, encourage participation in sports, encourage participation in active leisure time activities instead of more sedentary activities and, most of all, set an example by being active, having a healthy relationship with their own food choices and having regular mealtimes as well."

The study by Ward and his colleagues appears in the November issue of the New England Journal of Medicine.

Story sources: Alan Mozes, https://www.webmd.com/children/news/20171129/60-percent-of-us-kids-could-be-obese-by-age-35#1

Lucilla Poston, Professor, https://www.news-medical.net/news/20170111/Childhood-obesity-starts-in-the-womb.aspx

 

 

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