Healthy Kids
Mom's Nicotine Patch May Raise Baby's Risk for Colic
MONDAY, Feb. 20 -- Infants of mothers who smoke or use nicotine replacement therapy during pregnancy are more likely to have colic, a new study finds.
Colicky babies cry inconsolably for several hours a day, and researchers in the Netherlands found that exposure to nicotine -- either from cigarettes or nicotine replacement therapy -- was associated with a significantly increased risk of colic, ranging from 30 to 60 percent.
"The theory is that there are nicotine receptors in the GI [gastrointestinal] system and nicotine receptors that alter serotonin, and these alterations affect the babies after birth, causing colic," Dr. Jennifer Wu, an obstetrician-gynecologist at Lenox Hill Hospital in New York City, said. Serotonin is believed to promote feelings of well-being.
The researchers looked at data on interviews with more than 63,000 mothers included in the Danish National Birth Cohort. Interviews were done during pregnancy and six months after they had their babies.
About 74 percent of the moms didn't smoke; 24 percent did smoke; 0.3 percent of women used nicotine replacement therapy, which can include patches, inhalers or gum; while 2 percent of women smoked and used nicotine replacement therapy.
About 8 percent of babies had colic. Colic, which usually starts when a baby is a few weeks old, involves crying excessively for at least three hours a day, more than three days a week, for more than three weeks.
The causes of colic aren't well understood, nor are the reasons why nicotine might raise the risk of colic, Wu said. Prior research has also shown smoking to be associated with colic. However, these studies do not prove cause and effect.
The study is published online Feb. 20 and in the March issue of Pediatrics.
In the United States, obstetricians don't often prescribe nicotine replacement in pregnant women, said Daniel Jacobsen, a nurse practitioner at North Shore-LIJ Health System's Center for Tobacco Control in Great Neck, N.Y.
According to the U.S. Centers for Disease Control and Prevention guidelines for treating tobacco dependence, "it is not recommended to use nicotine replacement therapy when treating pregnant women," Jacobsen said.
Instead, he tries counseling and behavioral therapy, even hypnosis, to help women overcome the addiction.
"A very small percentage of women continue to smoke throughout their pregnancy. Most women, when they find out they're pregnant, are able to quit," he said.
Wu agreed that there are cultural differences between Danish and American women. "It's very rare that you have a patient that smokes regularly, who is of childbearing age and who hasn't quit long before they're trying to have a baby," she said.
However, occasionally a woman just can't seem to stop. In that case, Wu and Jacobsen said they might turn to nicotine replacement.
Smoking during pregnancy is associated with low-birthweight babies, which can affect their growth and development throughout life. Smoking is also associated with spontaneous abortion, stillbirth and sudden infant death syndrome, Jacobsen said.
Colic, though frustrating and difficult, typically passes after a few weeks or months.
"Nicotine replacement is not the recommended treatment, but when women are still smoking in high amounts and are exposing themselves and their fetus to all these toxins, it is sometimes thought to be the lesser harm," Jacobsen said.
One of his patients, for example, tried behavioral therapy to no avail. While pregnant, she used a nicotine inhaler for about two weeks, and then was able to stop smoking, he said.
"Colic can be hard on the parents. It's a nuisance ... but the physical effects the tobacco causes on the fetus are worse," Jacobsen said. "They can cause death or severe problems throughout the lifespan."
SOURCES: Daniel Jacobsen, N.P., Center for Tobacco Control, North Shore-LIJ Health System, Great Neck, N.Y; Jennifer Wu, M.D, obstetrician-gynecologist, Lenox Hill Hospital, New York City; March 2012, Pediatrics
THURSDAY, Feb. 16 -- An alarming increase in ectopic pregnancy-related deaths among Florida women is likely caused by illicit drug use and delays in seeking medical care, a U.S. report released Thursday says.
The finding that deaths from ectopic pregnancies jumped fourfold in the past decade in Florida points to a need for improved access to health care and greater awareness of the importance of early pregnancy testing, officials from the U.S. Centers for Disease Control and Prevention said in a report published in the Feb. 17 issue of the agency's Morbidity and Mortality Weekly Report.
"This is the first report of an abrupt increase in ectopic pregnancy deaths identified in the United States in recent times," the CDC researchers said in the report.
Ectopic pregnancy is a life-threatening condition that occurs when an egg is fertilized outside of the uterus, usually in the fallopian tube. If undetected, the mother-to-be may die from hemorrhage due to tubal rupture.
From 1999 to 2008, Florida's death rate from ectopic pregnancy was similar to the national rate -- 0.6 deaths per 100,000 live births -- but it jumped dramatically in recent years to 2.5 per 100,000 births in 2009-2010. While 13 ectopic-related deaths were reported in Florida in the decade 1999 to 2008, nearly that number -- 11 -- were reported in just 2009-2010, the agency said. During that time, the proportion of deaths caused by ectopic pregnancies soared from 3.5 percent of all pregnancy-related deaths to 10.8 percent, the report noted.
Compared to the earlier period, the women who died from tubal pregnancy in 2009-2010 were more likely to be single, white or Hispanic, lack health insurance and have less than a high school education, the report found.
Officials said the women who died during 2009-2010 were more likely to have collapsed from hemorrhage before seeing a health care provider than the women who died during 1999-2008. And several women tested positive for illicit drug use, including cocaine.
Nationwide, between 1 percent and 2 percent of pregnancies are ectopic, but these abnormal pregnancies account for between 3 percent and 4 percent of pregnancy-related deaths. However, the death rate from ectopic pregnancies steadily declined nationally in the late 20th century through 2007, the latest year for which figures are available.
The study has several limitations, the researchers stressed. Full medical information was not available for the deceased women, and drug testing was not routine during much of the earlier period.
Efforts to educate women on the dangers of drug use before and during pregnancy are essential, the CDC researchers added.
-- Margaret Steele
SOURCE: Morbidity and Mortality Weekly Report, news release, Feb. 16, 2012
Women With the Autoimmune Diseases Often Have Fewer Children Than Desired, Study Finds
By Salynn Boyles
WebMD Health News
Reviewed by Louise Chang, MD
Feb. 16, 2012 -- More than half of women diagnosed with lupus or rheumatoid arthritis prior to completing their families end up having fewer children than they had planned for, new research suggests.
The study is among the first to examine infertility, pregnancy loss, and family planning choices in women with the autoimmune diseases.
Lupus, RA, and Childbirth
Rheumatoid arthritis (RA) and lupus are often diagnosed in younger women, yet their impact on childbearing is not well understood.
It is clear from earlier research that women with rheumatoid arthritis tend to have fewer children than healthy women and that women with lupus have more miscarriages.
But the reasons for this are not so clear, and prior studies have not examined how living with a chronic autoimmune disease impacts family size and family planning decisions, says Duke University Medical Center investigator Megan Clowse, MD, who runs the center's autoimmune disease pregnancy registry.
"We wanted to learn more about how having lupus or rheumatoid arthritis influenced these decisions," she says.
Clowse and colleagues surveyed 578 women with rheumatoid arthritis and 114 with lupus enrolled in a national autoimmune disease registry.
Among their findings:
- 55% of the women with rheumatoid arthritis and 64% of those with lupus who were interested in having children reported having fewer children than they had hoped to have.
- Rheumatoid arthritis patients who had fewer children than planned were one-and-a-half times more likely to report problems with infertility than patients who had as many children as they had hoped for.
- Lupus patients who had fewer children than they had planned to have had a three-fold higher miscarriage rate than lupus patients who had the number they had planned for. There was no significant difference in infertility rates.
WEDNESDAY, Feb. 15 -- Infants with birth defects who are born on weekends or at night do just as well as those delivered on a weekday, a new study says.
Both groups of infants stayed at the hospital for the same amount of time, had the same rates of admission to the neonatal intensive care unit, and required antibiotics or breathing assistance the same number of times, said the researchers from the University of Rochester Medical Center in New York.
The findings suggest that pregnant women carrying babies with birth defects should deliver when their bodies are ready, regardless of the day or time, the researchers said.
They analyzed data from 220 infants with known, non-lethal birth defects who were born between 2000 and 2010.
A number of studies have examined the association between delivery time and outcomes for healthy infants, but there was no current research on infants with birth defects, according to the authors of the new study.
"When we know that a baby will need further testing or surgical repair during the newborn period due to an identified abnormality, we typically try to arrange the delivery on a weekday," Dr. Eva Pressman, a professor and director of the high-risk pregnancy program at the medical center, said in a university news release.
"But the bottom line is that the timing of delivery isn't terribly important; if a woman goes into labor in the middle of the night or over the weekend her baby will do just as well," she added.
The findings suggest there is no reason to induce labor or perform a cesarean section solely to deliver an infant with a birth defect during the day, said senior study author Dr. Loralei Thornburg, an assistant professor of maternal-fetal medicine.
"If there is no medical reason for inducing labor it is best to let the baby come on its own time, because we know elective induction is associated with negative outcomes for mom, including increased rates of cesarean delivery, greater blood loss and an extended length of stay in the hospital, and is without significant benefits for the baby," she said in the news release.
The study was scheduled for presentation Friday at the annual meeting of the Society for Maternal-Fetal Medicine in Dallas.
Research and conclusions presented at medical meetings should be considered preliminary until published in a peer-reviewed medical journal.
-- Robert Preidt
SOURCE: University of Rochester, news release, Feb. 10, 2012
FRIDAY, Feb. 10 -- A new childbirth study says 39 weeks' gestation is the best time for elective Cesarean delivery for women who have previously delivered via C-section.
The research was slated for presentation Friday at a meeting of the Society for Maternal-Fetal Medicine in Dallas.
"Prior studies have compared the perinatal risks of elective delivery at 37 to 41 weeks' gestation, but didn't evaluate the hazard of delivery versus not delivering at a specific time point," Dr. Giuseppe Chiossi, who conducted the study for the U.S. National Institute of Child Health and Human Development, said in a society news release.
"We wanted to compare the risks of elective repeat Cesarean at each gestational age starting at 37 weeks with the cumulative maternal and neonatal risks of not delivering at that particular gestational age," Chiossi said.
The researchers found that elective repeat Cesarean deliveries at a later gestational age were associated with much lower rates of poor health results for infants compared to deliveries at 37 and 38 weeks.
They also found that poor infant results were much more frequent in pregnancies that continued beyond 39 weeks compared to those in which the baby was delivered through elective surgery at 39 weeks.
Mothers' health results tended to be better with continued pregnancy rather than elective Cesarean at 37 or 38 weeks, but the difference was significant only at 37 weeks. Mothers' results were much worse for later deliveries compared to elective Cesarean at 39 weeks.
Research presented at medical meetings should be considered preliminary until published in a peer-reviewed medical journal.
-- Robert Preidt
SOURCE: Society for Maternal-Fetal Medicine, news release, Feb. 7, 2012
FRIDAY, Feb. 10 -- Breast-feeding reduces the risk of obesity in children born to mothers with diabetes during their pregnancy, a new study indicates.
Researchers followed 94 children of diabetic mothers and 399 children of non-diabetic mothers from birth until age 13.
It's known that children of diabetic pregnancies are at increased risk for obesity. The Colorado School of Public Health researchers wanted to assess how breast-feeding affected the growth of body-mass index (BMI), an indicator of childhood obesity.
The study found that children of diabetic pregnancies who were breast-fed for at least six months had a slower BMI growth as they grew older than those who were breast-fed for less than six months. The study found similar results in children of non-diabetic pregnancies.
The study was published online recently in the International Journal of Obesity.
"Breast-feeding support represents an important clinical and public health strategy to reduce the risk of childhood obesity," study author and epidemiologist Tessa Crume said in a University of Colorado Denver news release.
The findings offer another reason to encourage and support mothers to breast-feed for at least six months, the time recommended by the American Academy of Pediatrics, the release said.
"We can work with pediatricians, obstetricians and the public health community to give these women targeted support immediately following birth," Crume said.
-- Robert Preidt
SOURCE: University Colorado Denver, news release, Feb. 8, 2012
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