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Study: Vitamin D Supplements During Pregnancy Doesn’t Impact Infants Growth

Posted on August 14, 2018

Even in a population of women with vitamin D deficiency, supplementation of high-dose vitamin D from mid-pregnancy until birth and for 6 months postpartum shows no benefits on measures of fetal or infant growth compared with prenatal supplementation only, or placebo, according to a study of more than 1100 women and their infants.

“Vitamin D supplementation given to women during the latter half of pregnancy and in the postpartum period improved biochemical markers of vitamin D status and reduced the risk of vitamin D deficiency, as expected. However, even at higher than conventional doses, vitamin D supplementation did not have effects on infant growth up to 1 year of age,” first author Daniel Roth, MD, PhD, an associate professor in the departments of pediatrics and nutritional sciences at the University of Toronto, Ontario, told Medscape Medical News.

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Scientists Discover Pregnant Women Have an Immune System Clock

Posted on September 2, 2017

Scientists at the Stanford University School of Medicine have completed the first-ever characterization of the meticulously timed immune system changes in women that occur during pregnancy.

The findings, which will be published Sept. 1 in Science Immunology, reveal that there is an immune clock of pregnancy and suggest it may help doctors predict preterm birth.

“Pregnancy is a unique immunological state. We found that the timing of immune system changes follows a precise and predictable pattern in normal pregnancy,” said the study’s senior author, Brice Gaudilliere, MD, PhD, assistant professor of anesthesiology, perioperative and pain medicine.

Although physicians have long known that the expectant mother’s immune system adjusts to prevent her body from rejecting the fetus, no one had investigated the full scope of these changes, nor asked if their timing was tightly controlled. “Ultimately, we want to be able to ask, ‘Does your immune clock of pregnancy run too slow or too fast?'” said Gaudilliere.

The new research comes from the March of Dimes Prematurity Research Center at Stanford University, which aims to understand why preterm births happen and how they could be prevented. Nearly 10 percent of U.S. infants are born prematurely, arriving three or more weeks early, but physicians lack a reliable way to predict premature deliveries.

“It’s really exciting that an immunological clock of pregnancy exists,” said the study’s lead author, Nima Aghaeepour, PhD, instructor in anesthesiology, perioperative and pain medicine. “Now that we have a reference for normal development of the immune system throughout pregnancy, we can use that as a baseline for future studies to understand when someone’s immune system is not adapting to pregnancy the way we would expect.”

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CDC Issues New Guidance on Zika and Pregnant Women

Posted on July 26, 2017

Yesterday, the Centers for Disease Control and Prevention (CDC) updated its interim guidance on caring for pregnant women who may have been exposed to the Zika virus. The updated guidance is published online July 24 in Morbidity and Mortality Weekly Report.

“CDC has updated the interim guidance for U.S. health care providers caring for pregnant women with possible Zika virus exposure in response to 1) declining prevalence of Zika virus disease in the World Health Organization’s Region of the Americas (Americas) and 2) emerging evidence indicating prolonged detection of Zika virus immunoglobulin M (IgM) antibodies,” state Titilope Oduyebo, MD, from the Zika Response Team, CDC, and colleagues.

The agency updated the guidance given the fact that it is difficult to accurately interpret the current available tests for Zika, and the fact there is new evidence showing that antibodies to Zika virus can be detected more than 12 weeks after a person is infected.

Ugh!

The CDC kept the definition of possible Zika virus exposure: If a woman has traveled to or is living in an area where mosquitoes carry the virus or is having sex with an individual who has traveled to or lives in such an area.

All practitioners and medical facilities that see pregnant women should take heed to the following recommendations:

Ask all pregnant women in the United States and US territories about possible Zika virus exposure before and during their current pregnancy at every prenatal visit. Providers should also ask about symptoms of Zika (eg, fever, rash, joint pain, conjunctivitis).
Pregnant women should not travel to areas at risk for Zika transmission. If their sexual partner lives in such an area, pregnant women should use condoms or abstain from sex during pregnancy.
Pregnant women with recent Zika virus exposure and symptoms of Zika should undergo Zika virus nucleic acid test (NAT) of serum and urine and IgM testing as soon as possible, through 12 weeks after symptom onset.
For pregnant women without symptoms but with ongoing possible exposure to Zika, IgM testing is no longer routinely recommended; offer Zika NAT testing three times during pregnancy, although optimal timing and frequency of NAT alone are unknown.
For asymptomatic pregnant women with recent possible Zika exposure, routine Zika testing is not recommended but can be considered using shared-decision making.
Pregnant women with recent possible Zika exposure whose fetus has ultrasound findings suggesting congenital Zika syndrome should undergo maternal testing with NAT and IgM.
For nonpregnant women with ongoing Zika exposure, Zika IgM testing is not warranted to establish baseline IgM levels as part of preconception counseling.

The guidance includes an updated comprehensive approach for testing placental and fetal tissues in certain cases, such as in a mother with laboratory-confirmed Zika whose fetus or infant has possible Zika-associated birth defects.

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STUDY: Smoke While Pregnant and Your Kid May Become Schizophrenic

Posted on February 7, 2017

A study by researchers at Columbia University’s Mailman School of Public Health, Columbia University Medical Center (CUMC), New York State Psychiatric Institute and colleagues in Finland reports an association between smoking during pregnancy and increased risk for schizophrenia in children.

Results show that a higher maternal nicotine level in the mother’s blood was associated with an increased risk of schizophrenia among their offspring.

Findings are published online in the American Journal of Psychiatry.

The paper evaluated nearly 1,000 cases of schizophrenia and matched controls among offspring born in Finland from 1983-1998 who were ascertained from the country’s national registry.

Heavy maternal nicotine exposure was associated with a 38-percent increased odds of schizophrenia.

The findings persisted after adjusting for factors, including maternal and parental psychiatric history, socioeconomic status, and maternal age.

“To our knowledge, this is the first biomarker-based study to show a relationship between fetal nicotine exposure and schizophrenia,” said Alan Brown, MD, MPH, senior author and Mailman School professor of Epidemiology and professor of Psychiatry at CUMC.

“We employed a nationwide sample with the highest number of schizophrenia cases to date in a study of this type.”

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Study: Pregnancy loss linked to heart disease later

Posted on July 19, 2014

Miscarriages and stillbirths might be a marker for women at higher risk of developing heart disease later in life, an observational study suggested.

The study suggests that physicians should now include stillbirth or miscarriage on their list of items to ask about in screening for cardiovascular disease.

Coronary heart disease risk was 27% higher for women who had a history of stillbirth compared with none (multivariate adjusted odds ratio 1.27, 95% CI 1.07-1.51), Donna R. Parker, ScD, of Memorial Hospital of Rhode Island in Pawtucket, and colleagues found.

That risk was a significant 18% to 19% elevated among women with one or two prior miscarriages compared with none in an analysis of the Women’s Health Initiative (WHI) observational cohort appearing in the July/August issue of the Annals of Family Medicine.

“Women with a history of one or more stillbirths or one or more miscarriages appear to be at increased risk of future cardiovascular disease and should be considered candidates for closer surveillance and/or early intervention,” they urged.

The American Heart Association guidelines already include pregnancy complications as a risk factor for cardiovascular disease in women due to growing evidence for an association, but these don’t address long-term cardiovascular implications of pregnancy loss, the group pointed out.

Physicians should now include stillbirth or miscarriage on their list of items to ask about in screening for cardiovascular disease, argued Roxana Mehran, MD, of Mount Sinai School of Medicine in New York City, who was not involved in the study.

“This is so important because the prevalence of pregnancy loss is increasing as the [average] age of women who are becoming pregnant is increasing,” she told MedPage Today.

Women with a history of pregnancy loss perhaps should be screened earlier, agreed Mehran, the founding and immediate past chair of the Society for Cardiovascular Angiography and Interventions’ Women in Innovations program, working with ob/gyns to promote screening women for cardiovascular risk factors.

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Trying to Conceive: Questions to Ask Your Doctor

Posted on April 5, 2014

Congratulations! You’ve decided to have a baby and that’s a very exciting time of your life. But remember, making a baby can take time. So be patient, especially when your friends seem to constantly be sharing their good news and the in-laws are asking, ‘Are you pregnant yet?’ every time they see you. Often, after years of painstaking birth control, it can be a tough realization that getting pregnant when you finally want to isn’t as easy as you thought it would be. Here are a few questions to ask your doctor when you are ready to conceive:

1. How long should it take for me to get pregnant? This depends on a great number of factors. But realize that making a baby takes time, often up to 12 months. If you’ve been trying for longer than a year, see your doctor to begin an infertility evaluation. If you’re older than 35, it can take longer because of aging impact on your eggs, so start your evaluation after 6 months if you have not conceived . Don’t panic, try to be patient and have fun in the process. After all, stress will only exacerbate the challenge.

2. How much will my age really affect my chances? The chances of a woman naturally having a baby after age 35 decline by about 50 percent, and they decline by about 90 percent after age 40. So if having a baby is in your future plans, get started sooner rather than later. If you’re under 35, see an infertility expert after one year of trying without success. If you’re 35 or more, see an infertility expert if you don’t conceive naturally within six months. If you’re over 38, be seen after 3 months of unsuccessful trying. Though conceiving after 40 may be difficult, it’s not impossible, so ask your doctor what else you can do.

3. Should I take prenatal vitamins? What kind? Yes. Eating healthy will raise your chances of conceiving and having a healthy pregnancy (that means cutting out the junk food and loading up on greens), and prenatal vitamins help fill in any holes in the mother’s diet. Ask your doctor to recommend a good prenatal vitamin with calcium and lots of B6 when you first start thinking about having a baby. Rainbow Light Complete Prenatal System is one of the few prenatals that has enough vitamin B6, which has been shown to increase fertility. Also, take an Omega-3 fish oil. Look for those with a higher mg of DHA and EPA.

4. Does timing matter? You’re best bet is try to conceive just before and during ovulation, which happens anywhere from 13 to 20 days before your period. I recommend using an ovulation predictor kit to time intercourse. Then, have sex a few days leading up to and on the day of ovulation. Remember that sperm can live up to 6 days in your body, but your egg can only survive 12 to 24 hours. This timing gives you the best odds of the sperm and egg meeting. To be sure you’re getting the timing right, pick up a ClearBlue fertility monitor to help you map your fertility calendar. Use a digital thermometer, which is much faster and easier to use than a standard one, for basal temperature measurements. And to keep you on track, use a journal to keep track as a personal conception and pregnancy organizer.

5. Can I use a lubricant? If having timed relations is affecting your ability to be intimate, a lubricant is a great option. But many lubricants may actually negatively affect sperm motility. Try Pre-Seed. It’s the only FDA-cleared, clinically shown ‘Fertility-Friendly’ Lubricant developed by doctors and used by fertility clinics. Use the applicator to apply it near the cervix. Its pH balanced to match fertile cervical mucus as well as the pH of sperm, so it won’t harm your chances of conceiving.

6. When should I take a pregnancy test? And which one should I use? Home pregnancy tests work by detecting levels of the hormone human chorionic gonadotropin (hCG), that is produced during pregnancy. These tests can only detect hCG after implantation occurs, which is generally 10 days post-ovulation (dpo). But don’t freak out if a test comes up negative at 10 dpo, since it’s not an exact science and you may still get pregnant up to 15 dpo. 15 dpo is when a woman who is not pregnant will typically get her period, so it’s the ‘first day of a missed period.’

First Response Early Result is the only pregnancy test that can detect pregnancy up to 6 days before your missed period (9 dpo). That’s one day sooner than any other home pregnancy test in the market.

Gloria Richard-Davis, MD, from the University of Arkansas Medical Sciences (UAMS) Department of Obstetrics and Gynecology, is an educator and Educator author of Planning Parenthood.

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