Family Planning and Pregnancy
One of the most common treatments for unexplained infertility is ovulation induction, in which a woman takes drugs that will increase the number of eggs the ovary releases in the hope that at least one will result in a pregnancy. But when too many eggs are available for fertilization, the rates of high-risk multiple pregnancies go up. A recent study compared three drugs used for ovulation induction and found that the one more likely to result in a live birth was also more likely to result in a multiple pregnancy (twins, triplets, or more). The options for treating unexplained infertility remain less than ideal, but careful choices mean that the pregnancies that do result will be safer for moms and babies.
In a new study sure to raise hackles and controversy, an international team of researchers is reporting that pregnant women who drink alcohol during the first trimester of pregnancy and possibly beyond aren’t putting their babies at risk for premature birth or low birth weight, or themselves at risk for high blood pressure complications during pregnancy. This goes against recommendations for women to avoid drinking alcohol during pregnancy. The main reason for this is that heavy use of alcohol during pregnancy has been linked to a long-term and irreversible condition known as fetal alcohol syndrome that can cause long-lasting physical and developmental problems. The medical evidence supporting strict abstinence from alcohol during pregnancy is not very strong. Will there be consensus about whether it’s safe for a pregnant woman to have a glass of wine or a beer once or twice a week? I don’t think we will see that any time soon.
Drinking alcohol during pregnancy has been taboo for some time, largely because drinking too much can cause fetal alcohol syndrome (FAS). Because no one has been able to identify a clear threshold for “safe” drinking during pregnancy, doctors tell women to steer away from alcohol entirely. A series of five studies from Denmark published in BJOG An International Journal of Obstetrics and Gynaecology found that “low” (1-4 drinks per week) to “moderate” (5-8 drinks per week) alcohol consumption in early pregnancy did not harm the neuropsychological development of children evaluated at age five. Drinking more appears to be a different story. In one of the studies, five-year-olds whose mothers consumed higher levels of alcohol (9 or more drinks per week) during pregnancy were significantly more likely to have lower attention spans. The authors of the study do not argue that drinking alcohol during pregnancy is wise or to be encouraged. In fact, most doctors will continue to advise pregnant women not to drink alcohol. is there a middle ground? Perhaps. Deciding to have a sip (or glass) of champagne at a special occasion during pregnancy may not be an unreasonable or unsafe choice–one that each woman has to make for herself, ideally after talking with her obstetrician or midwife about this issue.
Heart disease, stroke, diabetes, asthma, osteoporosis and other common chronic diseases are often blamed on genes, pollution, or the wear and tear caused by personal choices like a poor diet, smoking, or too little exercise. An intriguing hypothesis is that these and other conditions stem from a developing baby’s environment, mainly the womb and the placenta. During the first thousand days of development, from conception to age 2, the body’s tissues, organs, and systems are exquisitely sensitive to conditions in their environment during various windows of time. A lack of nutrients or an overabundance of them during these windows, so the thinking goes, programs a child’s development and sets the stage for health or disease.