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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

Kids of Obese Mothers at Higher Risk for Autism, ADHD

1:45

A new study points out another reason that obesity and pregnancy can be a bad combination not only for the mother but for her future child as well.

Researchers found that six-year-olds whose mothers were severely obese before pregnancy are more likely to have developmental or emotional problems than kids of healthy-weight mothers.

The lead author of the study, Heejoo Jo of the Centers for Disease Control and Prevention (CDC), and her team reviewed data on 1,311 mother-child pairs collected between 2005 and 2012, including the mothers’ body mass index (BMI, a height-to-weight ratio) before pregnancy and their reports of the children’s psychosocial difficulties at age six.

The researchers also incorporated the children’s developmental diagnoses and receipt of special needs services.

Kids of moms who were severely obese, with a BMI greater than 35, were twice as likely to have emotional symptoms, problems with peers and total psychosocial difficulties compared to kids of moms who had a healthy BMI, between 18.5 and 25.

Their children were three times as likely to have a diagnosis of autism spectrum disorder and more than four time as likely to have attention-deficit/hyperactivity disorder (ADHD), as reported in the journal Pediatrics.

Previous studies have shown a connection with autism and maternal diabetes and obesity.

Researchers took into account pregnancy weight gain, gestational diabetes, breastfeeding duration, postpartum depression and infant birth weight. None of these explained the apparent association.

“We already do know that obesity is related to health problems during pregnancy and throughout the lifetime,” Jo said. “I think this adds to that by suggesting that not only does severe obesity affect a woman’s health but the health of her future children.”

This study could not analyze the mechanism linking severe obesity and later risk for developmental problems, Jo noted.

“One theory that we could not look at and needs further research was some small studies have linked maternal obesity to increased inflammation, which might affect fetal brain development,” she told Reuters Health by phone.

While it sounds cliché because we’ve heard it so much; obesity in America has reached epidemic status. Almost 30 percent of Americans are obese and the prevalence of maternal obesity has risen rapidly in the last two decades.

In the USA, approximately 64% of women of reproductive age are overweight and 35% obese.

Women’s health specialists recommend that obese women considering pregnancy lose weight before they conceive to help reduce health risks for themselves as well as their child.

The Academy of Pediatrics recommends that all children be screened for developmental delay or disability at nine, 18 and 24 or 30 months of age.

Health experts strongly suggest that women who were obese or severely obese when they became pregnant make sure that their children receive these developmental screenings.

Sources: Kathryn Doyle, http://www.reuters.com/article/2015/04/28/us-obese-pregnancy-adhd-kids-idUSKBN0NJ2FC20150428

James R. O'Reilly, Rebecca M. Reynolds, http://www.medscape.com/viewarticle/776504

Your Baby

Higher ADHD Risks Linked to Premature Births

2:00

The risk that a child will have Attention Deficit Hyperactivity Disorder (ADHD) is relatively low among the general population. However, a new study suggests that the more premature a baby is when born; the risk for ADHD increases significantly.

Finnish researchers led by Dr. Minna Sucksdorff of the University of Turku compared more than 10,000 children with ADHD against more than 38,000 children without ADHD but similar in terms of gender, birth date and place of birth.

The researchers used birth medical records to see how far along in the pregnancy the mother was when the child was born. They also looked at whether the children were underweight or overweight for what is expected at that gestational age.

The study results showed that the risk of ADHD increased for each week earlier that a child was born. A full-term pregnancy is considered to be 40 weeks.

The odds of children with ADHD were 10 times greater when they were born during the 23rd to 24th week of pregnancy. Children born between the 27th and 33rd week of pregnancy were twice as likely to have ADHD compared to those without ADHD.

Other factors that affect gestational age and ADHD were also taken in account such as the mother’s age and whether she smoked or used drugs or alcohol. After these considerations, the findings remained the same.

In regards to birth weight, researchers found that infants born at very low or very high weight percentages were also at a higher risk for ADHD.

These findings imply that the pathways in the fetal brain may develop differently in children who are not adequately nourished, or are over-nourished, in the womb, or once a child is delivered prematurely, said Dr. Glen Elliott, chief psychiatrist and medical director of Children's Health Council in Palo Alto, Calif.

However, he added, this type of study cannot show that premature birth or growth rate in the womb actually causes ADHD. Symptoms of the common brain disorder include inattention, impulsive behavior and hyperactivity, which can affect a child's ability to learn and make friends.

Most early cesarean births happen because a mother and / or her infant are in distress and surgery is needed to protect one or the other or both of their health. Planned cesareans are typically scheduled close to the original due date and are unlikely to be associated to ADHD risk. However, the findings may give doctors something to consider when making a decision about cesarean birth.

"Since both gestational weight and gestational age have marked effects, clinicians may face difficult choices if a fetus is not thriving in the womb at an early gestational age," Elliott said. "Does one deliver the child early to enhance nutrition or delay to minimize the effects of premature delivery?"

The risk is still low overall that a child will have ADHD, and these findings are based on a child's relative risk of having the condition compared to others, Elliott added. The study suggests that the chance for ADHD appears to be greatest among the very premature babies.

The findings were published in the August 24th online edition of  the journal Pediatrics.

Source: Tara Haelle, http://www.webmd.com/baby/news/20150824/adhd-risk-rises-for-each-week-a-preemie-is-born-early

Your Baby

Should Pregnant Women Buckle-Up?

2.00 to read

Should expectant mothers buckle up and make sure the air bag is turned on before driving or riding in a car?  Absolutely say researchers in a recent study by the Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC.

Many women are concerned that, in case of an accident, seat belts and /or air bags might harm their unborn child, but according to the study, expectant mothers who are not restrained during a car crash are more likely to lose the pregnancy than those who are.

According to the March of Dimes, nearly 170,000 pregnant women are involved in a motor vehicle accident each year.

"One thing we're always concerned about is (educating) patients on seatbelt use," said Dr. Haywood Brown, the chair of Obstetrics and Gynecology at Duke University Medical Center and senior author of the new study.

"Nonetheless, like all individuals, some choose and some do not choose to wear their seatbelt," he added.

For the study, Brown and his colleagues searched through the trauma registry at Duke University Hospital. They found 126 cases of women in their 2nd and 3rd trimesters that had been in a car crash and were cared for at the hospital between 1994 and 2010.

What they discovered was that 86 mothers were wearing a seat belt when the crash occurred. Of that group, 3.5 percent or (3) fetuses died.

12 mothers were not wearing a seat belt. Of the unrestrained group, 25 percent or (3) fetuses died. 

"The bottom line is, you've got to wear your restraint because it decreases the risk not only for your injuries but injury to your child," Brown told Reuters Health.

Where should the seat belt be placed? The American College of Obstetricians and Gynecologists recommends that the seat belt be fitted low across the hipbones and below the belly.

The March of Dimes offers more seat belt and air bag guidelines for pregnant women:

  • Always wear both the lap and shoulder belt.
  • Never place the lap belt across your belly.
  • Rest the shoulder belt between your breasts and off to the side of your belly.
  • Never place the shoulder belt under your arm.
  • If possible, adjust the shoulder belt height to fit you correctly.
  • Make sure the seat belt fits snugly.
  • Driving can be tiring for anyone. Try to limit driving to no more than 5-6 hours per day.
  • Never turn off the air bags if your car has them. Instead, tilt your car seat and move it as far as possible from the dashboard or steering wheel.
  • If you are in a crash, get treatment right away to protect yourself and your baby.
  • Call your health provider at once if you have contractions, pain in your belly, or blood or fluid leaking from your vagina.

Researchers found that first time mothers were the least likely to use a seat belt. Brown noted it's possible that the habit of buckling in children might prompt mothers to put on their own seatbelt.

Mothers-to-be also worry about airbags and whether they could harm the fetus if a crash causes deployment.

In the study, airbags came out in 17 of the accidents, and in those cases the mother was more likely to experience the placenta separating from the uterus - a condition that can be fatal for the mother or the fetus.

Another researcher, not involved in the study, suggested to Reuters Health that the severity of the accidents, and not the airbags, might have been the cause of the serious consequences.

Brown said some women will disarm the airbag for fear that it will damage the baby in case of a crash, but "it's not the smart thing to do because it will save your life if the airbag comes out."

A study, from researchers in Washington State, found that airbags did not increase the risk of most pregnancy-related injuries.

No one likes to think about the damage a car accident can cause, but the reality is that seat belts and air bags save lives. Mothers-to-be, like everyone else, should use theirs when driving or riding in a car. You may need to make some adjustments so that your seat belt fits safely and correctly and the air bag is not right up next to your stomach, but taking those few extra steps could mean the difference between life and death.

Sources: Kerry Grens, http://www.reuters.com/article/2013/03/08/us-buckle-up-during-pregnancy-idUSBRE92710P20130308

http://www.marchofdimes.com/pregnancy/stayingsafe_seatbelts.html

Your Baby

Could higher cigarette taxes save babies lives?

1:45

A new study says that when the cost of cigarettes increase, fewer babies die.  The study links rising cigarette taxes to a decline in infant deaths.

Specifically, researchers said that each $1 per pack increase in the overall tobacco tax rate over the years 1999-2010 may have contributed to two fewer infant deaths each day.

The dangers of smoking during pregnancy are well documented. Complications include infant nicotine addiction, lower oxygen for the growing baby, increased chances of miscarriage, an increase of a baby developing respiratory problems and sudden infant death syndrome to name just a few.

Fortunately, U.S. smoking rates have declined during the years examined in the study – 1999 to 2010.

The research doesn't directly prove that higher taxes translate into fewer infant deaths. Still, "we found that increases in cigarette taxes and prices were associated with decreases in infant mortality," said study author Dr. Stephen Patrick, an assistant professor of pediatrics and health policy at Vanderbilt University in Nashville.

In the new study, researchers tracked infant death rates and tobacco taxes from 1999-2010, when inflation-adjusted tobacco taxes on the state and federal levels rose from 84 cents a pack to $2.37 per pack. During the same time period, the number of infant deaths per 1,000 live births fell from 7.3 to 6.2 overall, and from 14.3 to 11.3 among African-Americans.

Other factors were also considered that might influence infant mortality including family income and education. Researchers still found an association with the rising cigarette taxes.

Patrick acknowledged that it's possible that factors other than cigarette taxes contributed to the decline in the infant death rate. One possibility is that medical care improved over that time, leading to fewer deaths. But Patrick said that prospect is unlikely since such a change would presumably be seen in all states, and the study didn't reveal that kind of trend.

The researchers also examined the effect of tobacco prices, and found that increases appeared to have the same level of impact on infant mortality as tax hikes.

What about the prospect that pregnant women and new mothers might choose to spend money on tobacco -- including higher taxes -- instead of on their children? "That would only occur if smoking is a large share of the household expenditures," Levy said. And, he said, it's important to note that research has shown that higher taxes are especially likely to lead to less smoking among the poor.

While there may be other contributing factors that reduce the number of infant mortality during the research dates, researchers noted that the higher cost of cigarettes means more pregnant women will smoke either not at all or less and that’s a good thing for the babies they deliver.

The study was published online in the journal Pediatrics.

Sources: Randy Dotinga, http://www.kfvs12.com/story/30638397/higher-cigarette-taxes-tied-to-fewer-infant-deaths

http://www.webmd.com/baby/smoking-during-pregnancy

Daily Dose

Jessica Simpson's Weight Gain

1.30 to read

Jessica Simpson has been getting a lot of press and TV time related to the amount of weight she gained during her recent pregnancy and the difficulty she is having “shedding” the pounds.  I just thought I needed to “WEIGH IN” on this subject as I don’t think the real issue is being discussed.  

As a pediatrician, I am not as concerned about when or how she loses the excessive weight that she packed on during her pregnancy.  I am more worried about the message that she is sending to other pregnant women.  Excessive weight gain during pregnancy may cause complications that could jeopardize an unborn baby’s health. It is not safe to gain all of that weight during a pregnancy. 

Jessica Simpson is quoted saying that she is a “southern girl” and enjoys fried foods, macaroni and cheese and cream gravy. Most obstetricians recommend that a woman of average weight gain between 25-35 lbs during a pregnancy. If a woman is overweight prior to becoming pregnant she may only need to gain 15-20 lbs during the 9 months. Being pregnant does not mean that you can forget all about nutrition, eat excessively and gain 100 lbs. (educated guess on my part). 

A woman who gains excessive weight during a pregnancy may have complications and is more likely to develop high blood pressure as well as gestational diabetes.  Gestational diabetes is typically controlled with dietary changes alone, but in some cases a pregnant woman may even require insulin. Gestational diabetes puts the baby at risk for having blood sugar problems at birth. At the same time, blood pressure problems may be dangerous for the mother and put the baby at risk for premature birth and all of the problems that are related to prematurity. 

At the same time, excessive weight gain during pregnancy typically causes the newborn to be what is termed, “large for gestational age”.   These big babies are often delivered by C-section either electively or emergently and again there are more complications seen after a C-section than a vaginal delivery. 

So.....I wish that the media would not put the focus on how Jessica Simpson is going to lose the weight or how much she is going to be paid to lose all of those pounds, but rather on the fact that she jeopardized the health of her newborn. She was fortunate that she had a beautiful and healthy newborn daughter. 

We all have had cravings while pregnant, but healthy eating and regular exercise are still recommended to ensure the health of the unborn baby.  Jessica Simpson’s weight gain and diet is not the role model we pediatricians want for pregnant moms to follow! 

Daily Dose

More Zika Virus Cases

1:15 to read

I have been receiving a lot of phone calls from patient families, especially from mothers who are either pregnant or thinking about becoming pregnant, with their concerns and confusion over the Zika virus.  Several of these women have trips scheduled to Mexico and the Caribbean in the coming weeks, and called to ask what they should do?

While I don’t want to be an alarmist, I do think there is real concern that this virus seems ia spreading amid new reports of countries who have identified the Zika virus and associated microcephaly in newborns.  The list of countries grows daily, and in fact, the CDC website has being updated with a new map showing the distribution of the virus.  

The Zika virus is transmitted to humans by the bite of an Aedes mosquito that has been infected by the virus.  There is no human to human transmission, but a mosquito could bite an infected person and then become infected itself and go on to bite another human.  It is a cycle.  Travelers to Zika-affected countries will ultimately bring the virus back to the United States where it is expected to spread to states with warmer and humid climates (such as TX, FL, MS, LA and HA) as summer approaches.

The CDC has already issued a warning for pregnant women and those who are planning to become pregnant to avoid travel to the 20 countries ( and growing) who have known Zika virus. As I told my patients, is it worth it to go on vacation or to attend a wedding and risk ( even the slightest risk) becoming infected with this virus and having a child who is born with microcephaly (small head) and abnormal brain growth??? Short of wearing mosquito netting to cover yourself from head to toe, copious amounts of DEET insect repellent and staying inside (which is not foolproof) …I  just think it may be time to re-think plans to travel to these areas while more research and data is being gathered.  The World Health Organization and the CDC have researchers investigating all aspects of Zika virus, including trying to develop a vaccine, but all of this takes time. 

While for most people the Zika virus causes a mild illness with headache, fever, pink eye and joint aches, the effects on the unborn baby may be devastating. The CDC has also just issued guidelines for OB/Gyns who may see women who are pregnant that have returned from a trip to one of these areas with Zika and show signs of a “viral infection” with symptoms as above. In this case, the recommendation is that a blood test is done to confirm Zika virus and if the mother is positive she should have serial ultrasounds (every 3-4 weeks)  performed to monitor the baby’s head growth. Unfortunately, not all pregnant women who may be infected with the virus will have symptoms ( p to 80% of people may not feel ill ), and their babies could possibly be affected as well.  While it seems that the virus may be more likely to affect a fetus during the first trimester, it is difficult to pick up microcephaly on ultrasound before the second trimester.

So….this story continues to evolve and new recommendations should be expected as more information is gathered. But my advice continues to be…”why risk it?” . To have any concern, doubt,  or worry about exposure is enough for me to advise my patients to change their plans!

Stay tuned. This story is not going away…..

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!

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

 

 

 

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