Smoking Part 1: Pregnancy and young children
A number of studies have been reported lately that link various health problems in babies and children to pre-natal or 2nd hand cigarette smoke. It is well established that women who smoke or are exposed to smoke while pregnant have a greater chance of having babies with low birth weight, pre-mature birth, SIDS and lung problems, etc. Some recent studies present additional evidence of cardiovascular and pulmonary problems due to smoking.
In Hypertension: Journal of the American Heart Association a study of 456 babies show that mothers who either smoked or were exposed to smoke while pregnant had babies with significantly higher systolic blood pressures than babies born to women who did not smoke or were not exposed to 2nd hand smoke.
In another study of 244 kids 4-12 years old it was found that kids whose parents smoked had reduced lung function similar to that of people who smoke themselves. Children whose parents smoke also have lowered endothial function in their arteries - a sign of damage (Circulation).
A nicotine byproduct called cotinine can be found in the urine of babies who have even one parent who smokes. Compared to babies without parents who smoke, babies with a smoking parent have 5.58 times as much cotinine (Archives of Disease in Childhood: Fetal and Neonatal Edition).
Additional recent research tying health problems to women smoking include women having a 59% greater chance of begining menopause before age 45 (BMC Public Health). Other research shows a connection between smoking and stillbirths - women who smoked during their 1st and 2nd pregnancy had a 35% greater chance of still birth (BJOG: An International Journal of Obstetrics and Gynecology).
Considering all the evidence indicating how damaging cigarette smoke is to babies and young children it surprises me that there are still women with children who smoke. Of course it can be difficult to avoid 2nd hand smoke sometimes - especially if family members smoke or if someone works in a place that allows smoking.
Even if someone doesn’t care about the health of people around them - I would have thought the threat to one’s own health would be enough to convince more people to stop.
– More on that thought in Smoking Part 2 (coming soon).
March 9, 2007
Smoking and other pregnancy perils
At a recent conference of the American Heart Association research was presented that shows more evidence of the damage that smoking can do. Children of women who smoked while they were pregnant had carotid arteries with thicker walls than those whose mothers did not smoke. Thicker artery walls increases the risk of strokes and heart attacks.
Another study published in the European Respiratory Journal found that kids who have a certain variant of a gene called interleukin-1 receptor antagonist (IL1RN) are harmed more by their mothers’ smoking while pregnant with them. More specifically, they were over 4 times as likely to get asthma compared to those with other variants of the gene - but only if their mothers’ smoked.
According to the American Journal of Obstetrics and Gynecology pregnant women are more likely to have injuries that they need to be hospitalized for than was previously believed. Fractures, strains, sprains, dislocations, crushing injuries, poisoning and bruises were the most common reasons for the hospitalizations. Car accidents and falls were the most common reasons for the injuries.
Pregnant women with gum disease have a greater chance of delivering their babies prematurely according to a study in American Journal of Obstetrics and Gynecology.
Researchers publishing in the The Journal of Nutrition have found that pregnant women and their newborn babies in the northern part of the United States have vitamin D levels that are too low. In their study 80% of AA women and almost half of the caucasian women had levels that were too low when they delivered even though almost all of them had been taken prenatal vitamins.
February 6, 2007
Prenatal health
According to a report in The Lancet there is now a potential new test to check for genetic abnormalities like Down’s syndrome. Currently testing for these types of things involves using chorionic villus sampling (CVS) or amniocentesis. This new test is non-invasive and analyzes DNA from the fetus taken from the mother’s blood samples. More trials and testing will need to be done with it before it will be approved for medical care.
In the Archives of Pediatrics and Adolescent Medicine there is a paper presenting evidence that women taking antidepressants, such as SSRI’s like Prozac and Zoloft, while pregnant doesn’t have an effect on the behavior of the child later on. Four year old children were observed and no statistically significant behavior differences were seen. However, the mother’s moods and stress levels seemed to have an effect on the kids behavior and development.
Drinking alcohol while pregnant - especially during the first two months when many women don’t know they are pregnant - can result in birth defects, can negatively effect normal development of the nervous system and cause fetal alcohol syndrome. In a study published in American Journal of Preventive Medicine over 800 women who drank often and didn’t use reliable birth control were placed randomly into either a group to get counseling or not. It was found that even 5 short sessions with a counselor were enough to reduce their drinking and get them to use birth control.
(Technorati Tags: pregnancy, antidepressants, Prozac, Zoloft, alcohol)
January 30, 2007
Pregnancy and newborn health part 2
A recent study in Radiology shows that around 25% of babies born vaginally have a small amount of bleeding in their brains. Likely it is normal and has always happened but newer techniques using high-resolution magnetic resonance imaging are now able to detect it. It is likely related to their heads being squeezed through the birth canal as it is not seen in babies delivered by Caesarean section.
According to recent research published in the American Journal of Obstetrics and Gynecology using transdermal nitroglycerin in women who go into labor prematurely can prolong their pregnancy. It may also decrease the occurance of some illnesses associated with premature births such as chronic lung disease, inflammation of the intestines, intraventricular hemorrhage, and periventricular leukomalacia. The mechamism is not known but may involve the relaxation of the smooth muscles of the uterus.
Earlier this month in Obstetrics and Gynecology a paper was published which indicates that women who are taller and who do regular exercise while pregnant may have babies that weight less but are still in a weight range that is considered to be normal. A higher birth weight can sometimes be related to labor problems so being tall and sedentary while pregnant for taller women could negatively affect the health of the baby and mother. Of course any exercise routine should be discussed with a doctor first, especially if pregnant.
The CDC issued a report concerning birth defects and infant deaths a while back. About 3-4% of babies in the US are born with some type of birth defect such as common ones like hypospadias, Down syndrome, cleft lip, pulmonary valve stenosis and hypoplastic left heart syndrome. Birth defects are the main reason really young babies are hospitalized or die.
Obstructive sleep apnea syndrome (OSAS) is the most common type of sleep apnea. Sleep apnea is characterized by episodes of stopped breathing during sleep. Kids with OSAS tend to have more respiratory tract illnesses and have around 40% more hospital visits compared to other kids during their first of life, often before they are officially diagnosed with OSAS. Early diagnosis and intervention is recommended by researchers who published their findings about the costs of OSAS in children in the American Journal of Respiratory and Critical Care Medicine.
Still not done - but once again I’m out of time!
January 29, 2007
Pregnancy and newborn health
Lots of news concerning pregnancy and early childhood health to catch up on today:
A study in the American Journal of Epidemiology shows evidence of a connection between the reactivation of the virus (Epstein-Barr) that causes mononucleosis and the development of acute lymphoblastic leukemia in young children, especially those under one year old. The research was headed by Dr. Matti Lehtinen from the National Public Health Institute, Oulu, Finland.
Research by Vivette Glover of Imperial College London indicates a possible effect of maternal stress while pregnant on the mental and emotional development of her child. The mechanism is not known yet but may involved increased levels of cortisol in the mother and in the amniotic fluid.
Reduced intake of folic acid, a form of the water-soluble vitamin B, has long been linked to a higher chance of a child to be born with neural tube disorders like spina bifida. It can be found naturally in green leafy vegetables. There is now some evidence that folic acid supplements taken in early pregnancy can also decrease the chance of cleft lip by about 40%. This research appeared in the British Medical Journal.
Also in the British Medical Journal is a study showing that up to 3 cups of caffeinated coffee (considered to be a moderate amount) a day while pregnant doesn’t raise the risk of premature births or underweight babies. Eight or more cups of caffeinated coffee a day however may increase the chance of stillbirth. In this study over 1000 pregnant women were put into a group to drink a moderate amount of coffee either with or without caffeine and no difference was found between the average birth weights.
According to a report in American Journal of Respiratory and Critical Care Medicine women who are treated for some illnesses and disorders during pregnancy have children who have a greater chance of having wheezing problems. These include pregnancy-induced hypertension (PIH), preeclampsia, maternal diabetes and antibiotics given during delivery for urinary tract infections and respiratory infections.
An interesting story in the American Journal of Physiology - Regulatory, Integrative, and Comparative Physiology presents some evidence that babies who are born with low sodium levels tend to prefer saltier foods later on. Micah Leshem and his team at the University of Haifa in Israel observed 41 kids who had been born premature and found that those who were born with sodium deficiencies tended to choose salty over sweet foods when given a choice. Kids who had been born premature were chosen for the study because they have a greater chance of being born with lower sodium levels.
I still have lots more to write about - but I am out of time again! I’ll continue first chance I get.
(Technorati Tags: mononucleosis, leukemia, stress, pregnancy, cleft lip, folic acid, sodium, salt)
January 9, 2007
Pregnancy and child birth (Part 2)
Yesterday I ran out of time to write about research topics about pregnancy and childbirth - so here is part 2:
Archives of Pediatrics and Adolescent Medicine reports that when pregnant women get a flu shot and then give birth during the flu season the babies do not seem to be protected from respiratory disease as newborns. The research studied 3160 babies from mothers who were vaccinated and 37,969 who weren’t.
New data from the Centers for Disease Control and the National Center for Health Statistics show that around 30% of babies born in the US are through a C-section. This is a record high (in 2005), while the number of teenagers giving birth has gone down dramatically. The 2005 rate of teen (15-19) births was 40.4 out of 1000. In 1991 it was 61.8 in 1000 births.
A study in Obstetrics & Gynecology prevents evidence that amniocentesis during the 4-6th months ”midtrimester” of pregnancy does not raise the rate of a miscarriage. Amniocentesis is of course the procedure in which a needle is inserted through the abdomen to the uterus to get a sample of amniotic fluid for purposes of diagnosing genetic diseases, gender, etc. This study by Dr. Keith A. Eddleman from Mount Sinai School of Medicine, New York examined a large amount of data - from around 3000 women who had amniocentesis and 31,000 who didn’t. One of the interesting things they noticed was that in women over 35 the rate of miscarriage after amniocentesis was 1.06% and for women of that age range who didn’t have it was higher - 1.92%.
A few other odd and ends related to pregnancy and childbirth - metformin - given to women for polycystic ovary syndrome and type 2 diabetes does not seem to increase the risk of birth defect when given during the first trimester (Fertility and Sterility). Women who are given drugs to induce labor have nearly double the chance of an amniotic fluid embolism (Lancet). New guidelines suggest reducing the number of embryos implanted for in-vitro fertilization to 2 or less for women under age 35, 2 or 3 from 35 to 37, 4 for 38 to 40 and 5 for women over the age of 40. Research in the The Cochrane Library suggests that hypnosis, acupuncture, massage, relaxation, aromatherapy and acupressure may help to reduce labor pain.
And finally, a report from a Czech journal, Naturwissenschaften, suggests that women who are infected with the parasite that causes toxoplasmosis are more likely to have boys. Usually 51% of babies are boys, but in women with this parasite it was found that 61 percent of babies were boys. People can become infected with it from eating undercooked meat or exposure to the feces of cats. Pregnant women exposed to the parasite have a greater chance of having a baby with birth defects which is the reason pregnant women are recommended to have someone else clean their cat’s litterbox. The data also showed that the more antibodies the woman had to the parasite the more likely she was to have a boy - with the women who had the highest amount having a 72% chance of having a boy.
(Technorati Tags: amniocentesis, pregnancy, miscarriage, toxoplasmosis, childbirth)
January 8, 2007
Pregnancy - diet, weight gain and diabetes
I haven’t written much here about pregnancy and childbirth, mostly because it is not something I’ve had experience with. However, it is obviously a women’s health issue, so here is a summary of the topic from the past few months.
Pregnancy and Diet
The International Journal of Obstetrics and Gynecology reports that eating too much fish during pregnancy is dangerous because of the mercury levels. This isn’t new, but this most recent study was in women in Taiwan. Methylmercury - the form of mercury usually found in fish - can pass through the placenta and then to the fetus. Fish with higher levels of mercury like shark, swordfish, king mackerel and tilefish and are not recommended for pregnant women according to the FDA. Tilapia and shrimp has lower levels of mercury and are safer.
Diabetes and Pregnancy
The November issue of the Journal of Pediatrics includes research showing that babies whose mothers had diabetes while pregnant and needed to be treated with insulin had immature sucking abilities, possibly due to a less mature nervous system, than women whose diabetes was managed with diet.
Increasing levels of hemoglobin A1C early in pregnancy is associated with a poor outcome, although it was not as useful to predict the outcome of any individual pregnancy. The American Diabetes Association recommends the level of A1C to be 7.0 or lower. Research was in the journal Diabetes Care.
Many women of Mexican descent tend to have babies with high infant birth weights. This can be explained in part by the weight of the mother before and during pregnancy. This weight gain is sometimes associated with blood sugar levels that are excessive and abnormal according to the American Journal of Public Health.
On the other hand, a paper published in BJOG: An International Journal of Obstetrics and Gynecology indicates that women with a BMI less than 18.5 before pregnancy have a 72% higher chance of having a first trimester miscarriage. A higher intake of fresh fruits and vegetables can help as can taking vitamins especially those with folic acid or iron. Women in the study who had morning sickness were nearly 70% less likely to have a miscarriage.
Related to the above stories an article in Diabetes Care presents evidence that women who have given birth to 5 or more kids have a greater chance of getting type 2 diabetes later in life. The study looked at data from 7000 African-American and Caucasian women. It is not known if the effect is due to biology or lifestyle, but is independent from obesity and socioeconomic status.
Women with type 1 diabetes that keep their blood sugar under control have a lower chance of developing preeclampsia - published in BJOG.
(Technorati Tags: pregnancy, diabetes, childbirth, mercury, fish)
June 14, 2006
The New England Journal of Medicine had a recent article about how the use of angiotensin-converting–enzyme (ACE) inhibitors by women in their first trimester of pregnancy can result in major congenital malformations.
Previously it had been shown that the use of ACE inhibitors during the 2nd and 3rd trimesters of pregnancy could result in an increased chance of fetopathy.
ACE inhibitors are used to treat hypertension and cardiovascular disorders. They work by lowering arteriolar resistance and increasing venous capacitance; increasing cardiac output and cardiac index, stroke work and volume, lowering renovascular resistance, and leading to increased natriuresis (from Wikipedia)
The study looked at 29,507 babies born between 1985 and 2000 . Of these 209 were exposed to ACE inhibitors in just the first trimester and 202 were exposed to other antihypertensive drugs in just the first trimester. The rest were not exposed to any medications for hypertension during gestation.
Based on vital records and hospitalization claims while they were under a year old it was determined the ones exposed to the drugs during the 1st trimester had a greater chance of major congenital malformations. The authors of the study suggest that ‘exposure to ACE inhibitors during the first trimester cannot be considered safe and should be avoided’. Reference: New England Journal of Medicine Volume 354:2443-2451 June 8, 2006 Number 23
(Technorati Tags: pregnancy, ACE inhibitors, trimester, hypertension, NEJM)
May 22, 2006
Got twins?
A new study by Dr. Gary Steinman shows that women who drink milk are 5 times more likely to have twins than women who don’t eat or drink any animal products.
The study compared the number of twins born to women who ate a regular diet, vegetarians (who do consume dairy products), and vegans (no animal products).
Gary Steinman believes that levels of IGF (insulin-like growth factor) may be involved. IGF is released from the liver in response to growth hormone. It results in ovaries being more sensitive to follicle stimulating hormone - which increases ovulation.
Since IGF enters milk, including cow’s milk, this may be why milk drinkers have a greater chance of having twins. Vegans have a 13% lower level of IGF in their blood.
Some women just naturally have higher levels of IGF. Black women have higher rates of twin births and they also have higher levels of IGF in their blood. Asian women tend to have much lower IGF levels and also the lowest rate of twin births. Caucasian women have levels some where in between.
Also, in cows, genes that influence the chance of having twins are near the gene for IGF.
Possible explanations for the number of twins has increased in the last 30 years include fertility treatments, women delaying pregnancy and hormones fed to cows.
Gary Steinman works at the Long Island Jewish Medical Center in New Hyde Park, New York and this study appears in the Journal of Reproductive Medicine, in the May 2006 issue.
What genetic disorders does prenatal genetic testing detect?
Hsien Hsien Lei at Genetics and Health asks ‘What genetic disorders does prenatal genetic testing detect?’ in her most recent genetics quiz.
The answer?
‘Down syndrome, trisomy 13, trisomy 18, sex chromosomal abnormalities, and other rare genetic disorders resulting in mental retardation and/or physical problems.’
See more of her genetics quizzes here!
