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Your Baby

Pregnancy: Too Much, Too Little Weight Gain Adds to Health Risks

2:30

If you’re thinking about becoming pregnant, starting your pregnancy at a normal weight is best for baby and you, according to new study.

The study found that too much or even too little weight, increases an expectant mom's risk for severe illnesses and death. 

"Not only for baby's sake, but also for your own sake, have a healthy diet and get regular exercise before pregnancy," said study lead author Dr. Sarka Lisonkova. She's an assistant professor in the department of obstetrics and gynecology at the University of British Columbia and the Children's and Women's Health Centre in Vancouver. 

"It's never too late, even if you're already pregnant," Lisonkova said, adding that weight gain during pregnancy can also increase the risk for severe illnesses and even death in expectant mothers.

The study was large, including information on three-quarter of a million women. The average age of the women was 28 years old.

The researchers found that the more a woman weighed, the more likely she was to have a severe illness or to die during pregnancy. Underweight women also had an increased risk for these outcomes. Severe illness included such conditions as eclampsia (convulsions or coma brought on by high blood pressure), sudden kidney failure, sepsis, hemorrhage and respiratory problems.

While the results sound scary, the risk to any one particular woman is low. For instance, the study found that, compared with normal-weight pregnant women, there were about 25 more cases of either severe illness or death for every 10,000 pregnant women if the woman was obese.

"The chance that any one woman dies in pregnancy is about 1 in 6,000 in the United States," said Dr. Aaron Caughey, who chairs the department of obstetrics and gynecology at Oregon Health and Science University in Portland

However, what's especially concerning about this study's findings, he said, is that more and more women are entering pregnancy obese or super-obese. With higher levels of obesity, "there's an incredibly high inflammatory state that increases the risk of rare outcomes, like thromboembolism," a blood clot, Caughey said.

He said that underweight women likely had a chronic illness that increased their risk. 

Both Caughey and Lisonkova said that ideally, women should be at a normal weight before getting pregnant. If a woman isn't at her ideal weight, pregnancy is a good time to start focusing on things such as eating a healthy diet and getting regular exercise, they said. 

Pregnancy can be a "focusing event for affecting behavior change in women," Caughey said, because once pregnant, a woman often focuses on doing what she can to have a healthy baby.

"Pregnancy is a great time to think about diet and exercise, especially because women often drive health behaviors in the family, so there's no time like the present to make healthy changes," he said. 

Lisonkova also emphasized the importance of good prenatal care. "Clinicians can catch signs of potential complications earlier with regular checkups," she said. 

A woman will naturally gain weight while pregnant and that’s as it should be, but if you begin a pregnancy overweight it’s more difficult to keep the weight gain within the normal range. It’s healthier for mom and baby to begin a pregnancy at or close to a normal weight.

The study was published in the November edition of Journal of the American Medical Association.

Story source: Serena Gordon, https://consumer.healthday.com/vitamins-and-nutrition-information-27/overweight-and-underweight-health-news-516/weighing-too-much-or-too-little-when-pregnant-can-be-risky-728505.html

 

 

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

Parenting

Pregnancy May Actually Modify a Mom’s Brain

Baby, motherhood, health

Moms often feel like they have a “sixth sense” when it comes to their newborn’s needs and survival. What they may really be experiencing are the physical changes that pregnancy can have on the brain.

Researchers in Spain wanted to know if pregnancy could actually change the structure of a woman’s brain, impacting how she reacts to her newborn. What they found was that long-term changes to the brain do occur and that they may have evolved over time to improve a mother’s ability to protect and nurture her child.

The researchers used information gathered from MRI scans that compared the brain structures of 25 women before and after their first pregnancies.

After giving birth, the women had significant reductions of gray matter in areas of the brain associated with social interactions, the findings showed. Those brain regions overlapped with ones that activated when mothers watched images of their own babies.

“The changes concern brain areas associated with functions necessary to manage the challenges of motherhood," study co-lead author Erika Barba said in a news release from the Autonomous University of Barcelona.

Some women feel like they have trouble remembering things during and after their pregnancy, sometimes referred to as having “baby brain.” The good news is that researchers reported the participants had no changes in memory or other thinking functions during pregnancy. That means the loss of gray matter does not lead to problems in those areas. The brain changes, which lasted for at least two years after the women gave birth, probably help them adapt to motherhood, the study authors suggested.

According to study co-director Oscar Vilarroya: "The findings point to an adaptive process related to the benefits of better detecting the needs of the child, such as identifying the newborn's emotional state. Moreover, they provide primary clues regarding the neural basis of motherhood, perinatal mental health and brain plasticity in general."

Researchers also found that they were able to use the brain changes to predict a mother’s attachment to her baby. The changes were similar whether women got pregnant naturally or through fertility treatments.

This is the first research to show that pregnancy involves long-lasting changes -- at least for two years postpartum.

The term “mama bear” has often been used to describe the fierceness that some mothers’ exhibit when they feel their child is in danger or has been wronged. Now science may have found out why that is.

The study was published in the journal Nature Neuroscience.

Story source: Robert Preidt, http://www.webmd.com/baby/news/20161219/pregnancy-may-spur-mothering-changes-in-a-womans-brain

Your Baby

Babies in 3D Virtual Reality

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3D imaging of fetuses has been around for a while, but the images are typically static and lacking in depth. That may change however, with a new virtual reality technique that can be rotated 360 degrees, according to a team of researchers from Brazil.

The researchers said that they hope that these enhanced fetal models are the next step in not only allowing parents to visualize their future children, but also in helping researchers to better understand fetal anatomy.

In their research, the researchers were able to use the technique to visualize and make 3D models of 25 fetuses. There were two cases in which the technique didn't work In those, the levels of amniotic fluid were too low for the researchers to get images of the fetus that were high enough in their resolution to make the 3D model, Werner told Live Science.

But in the cases where the technique worked, "we found these images more real, and the possibility that we can see in 360 degrees presents us with a greater interaction with the exam," said study co-author Dr. Heron Werner Jr., who is from a company called Clinical Diagnostic Imaging that is based in Rio de Janeiro. Heron and his colleagues recently presented the technique at the annual meeting of the Radiological Society of North America.

The technique involves creating a 3D model of the fetus using MRI and ultrasound, or a combination of the two. A pregnant woman would undergo an imaging exam similar to a regular obstetric ultrasound or MRI. Next, the researchers would use frames of these images, in sequence, to begin to make a 3D model of the fetus, the researchers said.

The most exciting part is that the parents would then be able to view the final image - which can include the inside of the womb, the umbilical cord and the placenta along with the fetus — through a virtual reality device like a headset.

Werner and his team used a virtual reality headset in their research. They found that women could not only experience what it would look like if they were flying through and around their fetus by merely looking around, but also they could hear the fetal heartbeat, by way of the ultrasound.

Another benefit of this new technology is in its ability to allow medical professionals new options for evaluating the health and development of a fetus, the researchers said.

For example, the researchers said, a doctor could zoom through the entire length of a fetus’s airway to look for masses that could block it and to better determine delivery options.

What once seemed like science fiction is well on its way to being a part of everyday science.

Story source: Taylor Kubota, http://www.livescience.com/57221-vrtual-reality-shows-unborn-babies-in-3d.html

 

Your Baby

Mom’s Blood Pressure May Determine Sex of Baby

1:45

Parents-to-be have been looking for signs that predict the sex of their baby for thousands of years.  Carrying high? You’re having a girl! Is your baby bump round like a basketball? Congratulations, you’re having a boy! While these “old wives tales” have never been reliable, scientists can now make an educated guess at about four and half months, during pregnancy, with an ultrasound. Another test, amniocentesis, can be used to check the baby’s chromosomes. This tests is usually reserved for older mothers to identify possible genetic problems.

A new study from China, may offer another alternative for determining the sex of a pre-born baby  - tracking the mother’s blood pressure.

Researchers began their study in 2009, with just over 1,400 newly married women in Liuyang, China. All the women had the intention of becoming pregnant within 6 months.

Before becoming pregnant, all the women underwent full lab tests to record their blood pressure, cholesterol, triglycerides and glucose levels.

Once the women became pregnant, their health was tracked. All received routine obstetric care, including continual monitoring of blood pressure shifts, as well as the diagnosis of any complications throughout their pregnancies.

Ultimately, the study participants gave birth to 739 boys and 672 girls.

Researchers found that women who gave birth to boys had registered a higher pre-pregnancy systolic blood pressure (the upper number in a blood pressure reading) than women who gave birth to girls. Mothers of boys averaged about 113 mm Hg, versus mothers of girls who had an average near 110 mm Hg.

After making adjustments for maternal age, educational background, smoking history, obesity and blood labs, they found the blood pressure numbers still held up.

"The only thing that was related was blood pressure, but blood pressure was strongly related," said study co-author Ravi Retnakaran, M.D., an endocrinologist at Mount Sinai Hospital in Toronto.

The findings add another link in the mystery of what determines the sex of a fetus in utero; however, researchers say more studies are needed to prove a mother’s blood pressure determines the sex of her child.

"One of the things we don't want is for people to look at this and think, 'Oh, we can manipulate the blood pressure before pregnancy and thereby change the chances of having a boy or a girl.' We definitely are not saying that, because we are not showing cause and effect," Retnakaran said. "I think the way to look at this is that it may be telling us something very new about [our] physiology."

The study was published in the American Journal of Hypertension.

Story sources: Alan Mozes, http://www.webmd.com/baby/news/20170112/could-moms-pre-pregnancy-blood-pressure-predict-babys-gender#1

Jessica Mattern, http://www.womansday.com/health-fitness/womens-health/news/a57553/blood-pressure-sex-of-baby/

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/

 

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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Your child has Coronavirus. Now what?

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