Prenatal Care Articles

2006

Pregnancy & Childbirth | USA Today Examines Effect of Depression During Pregnancy [Mar 14, 2006]

      USA Today on Monday examined the risks pregnant women face when continuing or stopping treatment for depression during pregnancy. Two recent studies, one published in February in the New England Journal of Medicine and another published in the Feb. 1 edition of the Journal of the American Medical Association, led to "mixed conclusions" about the benefits and risks associated with taking antidepressants during pregnancy, USA Today reports. The NEJM study finds that women who take certain types of antidepressants, called selective serotonin reuptake inhibitors, during the second half of pregnancy are six times as likely as women not taking SSRIs to have an infant with a rare, but severe, heart and lung condition. Meanwhile, the JAMA study finds that 68% of pregnant women who stopped taking antidepressants during pregnancy relapsed compared with 26% of pregnant women who continued taking the drugs. "There are potentially risks on both sides of the fence," University of Michigan psychiatrist Sheila Marcus said, adding. "You really have to look at the severity of the maternal illness, the desire of the mother [and] the medicine you're thinking about using." Data suggest that more that 10% of pregnant women experience depression (Rubin, USA Today, 3/13).

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=35995

Pregnancy & Childbirth | Meeting To Determine Risks, Benefits of Pre-Planned C-Sections Begins [Mar 28, 2006]

      NIH on Monday opened a three-day meeting that aims to determine what is known about the risks and benefits of pre-planned caesarean sections and how to ensure that pregnant women receive appropriate information about the procedure, the AP/Seattle Post-Intelligencer reports (Neegaard, AP/Seattle Post-Intelligencer, 3/27). Preliminary results from a survey released last week by the not-for-profit maternity care group Childbirth Connection finds that many pregnant women are inadequately informed about potential complications relating to c-section delivery, and almost all women surveyed believed that there was a medical reason for having their c-section (Kaiser Daily Women's Health Policy Report, 3/21). A c-section can save the life of the pregnant woman, but there are infrequent but severe potential complications such as hemorrhages, infections and blood clots. According to the AP/Post-Intelligencer, women opt for c-section deliveries for a variety of reasons, including convenience, worries about a riskier emergency c-section if there are problems during vaginal delivery or complications that can result from a vaginal delivery. While there are no statistics showing precisely how many c-sections are elective, "more and more [women] seem to be choosing a surgical birth even when there's no clear medical need," according to the AP/Post-Intelligencer. Some recent studies looking at birth certificates and insurance claims estimate that about 80,000 women undergo elective c-sections annually, the AP/Post-Intelligencer reports. The lack of data on elective c-sections is in part because there is no exact definition of elective, Wendy Wilcox of the Montefiore Medical Center in New York City said, adding that obesity increases the risk of complications during labor but is not often listed as a reason for a c-section. In addition, there is little data comparing women who undergo elective c-sections and their infants with healthy women who undergo vaginal delivery.

*http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=36254

2005

Group B Strep

The management of group B strep is complicated, admitted Sharon Dalrymple, childbirth educator and maternity nurse in Calgary, Alberta, Canada. Group B streptococcus (GBS) bacteria are naturally present in the human bowel without causing symptoms of infection. They become a problem only when they are present in the vagina or rectum of a pregnant women. If passed to the fetus during delivery, the bacteria can cause potentially fatal sepsis, meningitis, or respiratory distress.

Fortunately, GBS infection in babies is relatively rare. About one in five pregnant women has a GBS colonization at any given time. Penicillin is given intravenously to the mother during labor to prevent transmission, but it is not completely effective. Every year in the United States, about 1,700 babies are born with a GBS infection, although fewer than 100 will die from it.

Pregnant women are usually tested for GBS by vaginal and rectal swabs at about 37 weeks of pregnancy. It's believed that test result are reliable for about five weeks. But what makes the presence of GBS problematic is that the bacteria are  transient. "So why treat for an organism that might be gone by delivery day?" Dalrymple wondered, particularly when the presence of the bacteria may mean that a woman should not stay at home early in labor.

Treatment options

The current recommendations from  the Center for Disease Control and Prevention in Atlanta is to give penicillin to women in a high-risk category who test positive, and to offer the antibiotic to women who test positive but are not at high risk for transmitting the infection to their babies. High-risk categories include labor beginning before 37 weeks, rupture of membranes with labor lasting longer that 18 hours, unexplained fever of 100.4 or higher, a  previous birth with GBS, and a bladder or kidney GBS infection during pregnancy.

American Baby, CBE reporter, page 3, Spring 2005.

Green Tea Not for Moms-to-Be

With its heart-healthy and cancer-preventive antioxidants, green tea is great for our body, but only after you have given birth. Why?

Past research by the CDC's National Center for Environmental Health found that women who consume one to two cups of tea per day within three months of conception, and in their first trimester, have double the risk of having a baby with spina bidfida, a neural tube defect associated with folic acid deficiency; those who have three or more cups have triple their risk.

The data and the findings were based on did not differentiate between types of teas. " This preliminary study that did not account for factor like the intake of folic acid and multivitamins," says lead author Adolfo Correa-Villaseñor, MD.

But a new study finds a closer link between green tea, specifically, and neural tube defects. Spanish and British researches found that an antioxidant in green tea inhibits folate activity, which is needed for all cell growth, and is critical for a developing embryo in early pregnancy.

American Baby. July 2005.Page 20

Receiving early prenatal care can help to reduce the incidence of perinatal illness

Receiving early prenatal care can help to reduce the incidence of perinatal illness, disability, and death by providing health care advice to mothers and identifying and managing any chronic or pregnancy-related risks. The percentage of mothers receiving prenatal care in their first trimester of pregnancy increased slightly from 2002 to 2003, from 83.7 percent to 84.1 percent. Overall this figure has risen 11 percent since 1990, when only 75.8 percent of women received first trimester care.

Although a positive trend was observed among most racial/ethnic groups, there are still great disparities among these groups in the likelihood of entering care early in pregnancy. In 2003, 89.0 percent of non-Hispanic White women entered care in the first trimester, followed by Asian/Pacific Islander women at 85.4 percent, Hispanic women at 77.4 percent, non-Hispanic Black women at 76.0 percent, and American Indian women at 70.9 percent. Since 1990 the total number of women receiving late or no care has dropped from 6.1 to 3.5 percent although the rate of late or no care remains high among American Indian/Alaska Native women (7.6 percent), non-Hispanic Black women (6.0 percent), and Hispanic women (5.3 percent).

http://mchb.hrsa.gov/whusa_05/pages/0424pc.htm. Women Health USA 2005

Eating for two, gaining too much

ith more than half of women already overweight, some doctors say pregnancy guidelines should be scaled back. August 22, 2005. Latimes.com: Health By Jacqueline Stenson.

Women who start their pregnancies at a normal weight are currently advised to gain at least 25 but no more than 35 pounds. Underweight women are told to gain more, overweight women less. But with the nation's overall waistline expanding, the guidelines that set these ranges are being criticized as too lenient.

As a result, they could be revised downward, dramatically so, if some doctors and women's health experts have their way. The concern is that it's almost recommending too much weight gain for an average pregnancy," says Dr. Michael Nageotte, president of the Society for Maternal-Fetal Medicine, who practices at Long Beach Memorial Medical Center.

More than half of women of childbearing age are overweight or obese even before pregnancy, federal statistics show. And some studies indicate that a third or more of women gain more than recommended during gestation.

Further, women who gain excess weight with two or three pregnancies may never get back to their starting point. Over time, those additional pounds contribute to diabetes, heart disease and other health problems.

The Institute of Medicine hopes to convene a committee later this year to explore how well the guidelines have been followed and whether there's a need to revisit them.

"Excessive weight gain in pregnancy is probably one of the biggest contributors to female obesity," says Dr. Sharon Phelan, a professor of obstetrics and gynecology at the University of New Mexico in Albuquerque.

And, Phelan adds, "It is exceptionally hard to lose that weight."

Weight gain during pregnancy is a source of growing concern for doctors. Not only does it raise the risk of gestational diabetes and high blood pressure, which could lead to a preterm delivery with complications, for example, but it also can lead to bigger babies that cause more difficult deliveries and require more C-sections.

Research also suggests babies born to overweight women may be more likely to have birth defects and become heavy themselves.

According to the current recommendations, women of normal weight should gain 25 to 35 pounds during pregnancy, underweight women should gain 28 to 40, overweight women should gain 15 to 25 and obese women should gain at least 15.The guidelines focus on weight gain associated with healthy babies. But now that obesity is such a problem in the United States, the effect of the weight gain on the mothers needs to be addressed, says Brenda Rooney, an epidemiologist at the Gundersen Lutheran Medical Center in La Crosse, Wis. Her research has shown that women who don't lose baby fat within six months are more likely to be carrying it with them 10 or 15 years later.

Rooney says recent research on weight gain in pregnancy seems to indicate that a gain of up to 25 pounds may be appropriate for normal weight to overweight women.

But Dr. Raul Artal, professor and chairman of obstetrics, gynecology and women's health at St. Louis University School of Medicine, would like to see women gain far less — no more than 10 to 14 pounds for a normal weight woman, up to 16 to 20 pounds for an underweight woman and "very little" for overweight women.

He says women should essentially gain only the weight accounted for directly by the pregnancy — which includes the fetus, placenta, amniotic fluid, increased blood volume and breast enlargement — but not additional fat that's usually included in estimates of healthy pregnancy weight gain.

"We're not bears," Artal says. "Pregnancy is not a time of hibernation."

Fat stores may be needed in times of starvation, but most women in our super-size-me nation are eating too much.

Although most doctors would never recommend dieting, per se, during pregnancy, Artal says he has no qualms about counseling overweight patients to eat less. "For them, less could still be the diet of another person for a whole week," he says.

One of his patients who recently gave birth weighed 520 pounds. The baby was so large that the mother had trouble in labor and needed a C-section, he says.

Other doctors say Artal's weight-gain recommendations are extreme, but they agree the Institute of Medicine guidelines, while a good general guide, may be too permissive and, if strictly adhered to by all women, could encourage some to gain more than they should.

"I don't want patients to feel pressure to gain weight in a healthy pregnancy," Nageotte says.

Most babies tend to do just fine whether their mothers gain within the current guidelines or several pounds outside of them, he says.

Though very low weight gain in some women may cause a baby to be underweight, even babies born to mothers who've endured famine have fared well, he says.

"The fetus, being a very efficient parasite, if you will, is able to survive and get what it needs from the mother," Nageotte says.

Several doctors, including Phelan and Nageotte, say a weight gain of 25 to 30 pounds is plenty for many women.

But even that upper limit can be too easily passed.

Gin Treadwell-Eng, a 33-year-old events coordinator, knows this firsthand. By the end of her first pregnancy, she had added 61 pounds to her 5-foot-5 frame.

Her blood pressure was normal and by all other accounts the pregnancy was healthy, but she hated the way she looked — "I had a real hard time with it," Treadwell-Eng says.
The Santa Clarita woman ultimately delivered a healthy baby girl, but it took her more than a year and a half to lose most of the weight — and she never regained her pre-pregnancy weight of 145. She began her second pregnancy eight pounds heavier than the first.

Linda Meyers, director of the Institute of Medicine's Food and Nutrition Board, which oversaw the 1990 guidelines, says her group thinks it's important to look into whether the guidelines need to be updated because they are 15 years old, newer research has been done on the subject and obesity rates are rising.

"I think any time there's active research in an area and new knowledge it pays to stop and take stock of whether it's time to look further," she says.

She notes that the Institute of Medicine's Board on Children, Youth and Families is in the preliminary stages of organizing a workshop to explore issues of weight gain in pregnancy.

Rosemary Chalk, director of the children's board, says that at the request of the federal Maternal and Child Health Bureau, she's working to convene the Institute of Medicine committee this fall to "begin raising questions" about pregnancy weight gain. The bureau is part of the U.S. Department of Health and Human Services, but the committee would be under the auspices of the Institute of Medicine.

Regardless of guidelines, though, many experts say what's most important is for pregnant women to focus on eating a healthy diet — with a mere 300 additional calories per day — than obsess about what the scales say.

"The weight gain is a proxy," Phelan says. "It's a clue to us about [a woman's] nutrient intake." Due in November, Treadwell-Eng isn't gaining as rapidly this time. She credits less nausea during her first trimester; she hasn't eaten as much bread and crackers as before. And she's trying to walk more. So far, she's put on 23 pounds — about 20 pounds less than she had gained at this point in her last pregnancy.
"It's better this time," she says.

Listeriosis

What you need to know:

Listeriosis is a form of food poisoning caused by bacteria called Listeria monocytogenes. If a pregnant woman has listeriosis, she may have a miscarriage or stillbirth, or her baby may become very ill or even die.

Foods that may be contaminated with Listeria include unpasteurized milk, foods made from unpasteurized milk, poultry, fish and ready-to-eat meats (such as cold cuts or deli meats). Symptoms of listeriosis can include a flu-like illness with fever, muscle aches and chills and sometimes nausea and diarrhea. It can progress to meningitis (an infection of the membranes surrounding the brain) and blood infection. A blood test can determine if a person has listeriosis.

What you can do:

The U.S. Centers for Disease Control and Prevention (CDC) recommends that all pregnant women take steps to protect themselves and their babies from listeriosis. You should:

• Cook all meats, poultry and seafood thoroughly.
• Avoid sushi made with raw fish.
• Avoid cold cuts or deli meats.
• Wash raw vegetables before cooking.
• Avoid unpasteurized milk and foods made from it.
• Avoid soft cheeses such as Brie, feta, Camembert, blue-veined and Mexican-style. (Hard cheeses, processed cheeses, cream cheese and cottage cheese are safe.)
• Cook leftover foods or ready-to-eat foods (like hot dogs) until steaming hot. Cook hot dogs to an internal temperature of at least 165°F.

http://search.marchofdimes.com/cgi-bin/MsmGo.exe?grab_id=578&page_id=2360576&query=listeriosis&hiword=listeriosis+

Fetal Alcohol Spectrum Disorders   (FASD). The only cause FASD is alcohol use during pregnancy. When a pregnant woman drinks, the alcohol crosses the placenta into the fetal blood system. THus, alcohol reaches the fetus, its developing tissues, and organs. This is how brain damege occurs, which can lead to mental retardation, and other challenges.

No alcohol consumption is safe during pregnancy. In addition, the type of alcohol does not make a difference.

Return to Articles    Pregnancy/Prenatal Care