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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/

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

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

Eating During Labor May Speed Up Delivery

1:45

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Your Baby

Babies in 3D Virtual Reality

1:45

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

 

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

Fish Oil During Pregnancy May Reduce Baby’s Asthma Risk

2:00

A Danish study’s results suggests pregnant women that take a fish oil supplement during the final 3 months of pregnancy may reduce their baby’s risk of developing asthma or persistent wheezing.

The study involved 736 pregnant women, in their third trimester. Half the women took a placebo containing olive oil and the other group was given 2.4 grams of fish oil. The women took the supplements until one week after birth.

Among children whose mothers took fish-oil capsules, 16.9 percent had asthma by age 3, compared with 23.7 percent whose mothers were given placebos. The difference, nearly 7 percentage points, translates to a risk reduction of about 31 percent.

In the study, the researchers noted that they are not ready to recommend that pregnant women routinely take fish oil. Although the results of the study were positive, several experts have noted that more research needs to be done before higher doses of fish oil supplements are recommended over eating more fish.

Researchers found no adverse effects in the mothers or babies, the doses were high, 2.4 grams per day is 15 to 20 times what most Americans consume from foods.

One in five young children are affected by asthma and wheezing disorders. In recent decades, the rate has more than doubled in Western countries. Previous research has shown that those conditions are more prevalent among babies whose mothers have low levels of fish oil in their bodies. The new large-scale test, reported in The New England Journal of Medicine, is the first to see if supplements can actually lower the risk.

Before doctors can make any recommendations, the study should be replicated, and fish oil should be tested earlier in pregnancy and at different doses, Dr. Hans Bisgaard, the leading author of the study, said in an email to the New York Times. He is a professor of pediatrics at the University of Copenhagen and the head of research at the Copenhagen Prospective Studies on Asthma in Childhood, an independent research unit.

Dr. Bisgaard said it was not possible to tell from the study whether pregnant women could benefit from simply eating more fish. Pregnant women are generally advised to limit their consumption of certain types of fish like swordfish and tuna because they contain mercury. But many other types are considered safe, especially smaller fish like sardines that are not at the top of the food chain and therefore not likely to accumulate mercury and other contaminants from eating other fish.

“It is possible that a lower dose would have sufficed," the Bisgaard team said.

The supplements didn't seem to affect the odds of a baby or toddler developing the skin condition eczema, or an allergy such as a reaction to milk or egg products, or a severe asthma attack.

An editorial in the same journal by an expert who was not part of the study praised the research, saying it was well designed and carefully performed. The author of that editorial, Dr. Christopher E. Ramsden, from the National Institutes of Health, said the findings would help doctors develop a “precision medicine” approach in which fish-oil treatment could be tailored to women who are most likely to benefit.

If the findings are confirmed in other populations, doctors could test to see who would mostly likely benefit from fish oil supplements. "The health care system is currently not geared for such," Bisgaard said. "But clearly this would be the future."

If you are considering taking fish oil supplements during pregnancy, be sure and check with your OB/GYN for a recommended dose.

All fish oils are not the same. Some brands of fish oil are of higher quality than others. A reputable fish oil manufacturer should be able to provide documentation of third-party lab results that show the purity levels of their fish oil, down to the particles per trillion level. Also, if the supplements smell or taste fishy, they shouldn’t. High quality fish oil supplements don’t. Avoid fish oils that have really strong or artificial flavors added to them because they are most likely trying to hide the fishy flavor of rancid oil.

Story sources: Denise Grady, http://www.nytimes.com/2016/12/28/health/fish-oil-asthma-pregnancy.html?WT.mc_id=SmartBriefs-Newsletter&WT.mc_ev=click&ad-keywords=smartbriefsnl

Gene Emery, http://www.reuters.com/article/us-health-asthma-fish-oil-idUSKBN14H1T3

http://americanpregnancy.org/pregnancy-health/omega-3-fish-oil/

 

Parenting

Laughing Gas to Ease Labor Pains?

2:00

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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