Pregnancy and Childbirth
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A study published in the July 2002 issue of the Archives of Pediatrics
and Adolescent Medicine confirms suspicions that a common antibiotic
can cause a serious condition in very young infants.
Infantile hypertrophic pyloric stenosis (IHPS) occurs when the muscle
surrounding the outlet from the stomach becomes overgrown and obstructs
the passage of food into the intestines. The condition, which usually
arises in the first three to five weeks of life, causes projectile vomiting.
This can lead to dehydration, weight loss, and electrolyte imbalances
that affect kidney function. Physicians have long believed that exposure
to the antibiotic erythromycin is related to the condition.
To investigate the link, researchers tracked the antibiotic use and
IHPS occurrence in over 314,000 infants between 1985 and 1997. Of the
7,138 infants given prescriptions for erythromycin within the first 90
days of life, 804 were diagnosed with pyloric stenosis. Further analysis
showed that while infants younger than two weeks old were rarely given
erythromycin, those who were exposed within the first two weeks of life
were eight times as likely to develop IHPS as an infant who had not received
the drug during this time. Babies who received erythromycin after the
first two weeks did not appear to have an increased risk for the condition.
Physicians commonly use erythromycin to treat infants with illnesses
such as respiratory and ear infections, whooping cough, and conjunctivitis.
The results of this study suggest the risks and benefits of erythromycin
need to be carefully weighed — and perhaps other antibiotics tried — before
it is prescribed for use in infants younger than two weeks.
October 2002 Update
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The Benefit of Magnesium
Eclampsia and preeclampsia are the leading causes of death for pregnant
women and their fetuses, particularly in developing countries. Physicians
believe the high blood pressure, swelling, and protein in the urine associated
with preeclampsia lead to the convulsions and coma of eclampsia.
Obstetricians generally use anticonvulsants to treat and prevent the
convulsions of eclampsia. In the U.S., magnesium sulfate has been the
drug of choice for nearly a century. Research confirms magnesium as the
most effective drug at preventing eclamptic seizures. Now magnesium sulfate
is being used increasingly to treat preeclampsia as well, with the hope
it will prevent eclampsia. A study published in the June 1, 2002, issue
of The Lancet confirms this hope.
The study, dubbed the Magpie Trial, was a large international effort
aimed at discovering the effects of magnesium sulfate on women with preeclampsia
and their children. Close to 10,000 women with preeclampsia from 33 developed
and developing countries were involved. Roughly half of the women were
randomly assigned to receive magnesium sulfate while the other half received
Use of magnesium sulfate resulted in a 58% decrease in risk of eclampsia
compared to use of the placebo. This translates to 11 fewer women in
1,000 suffering from eclampsia. The preventive effect of magnesium was
consistent regardless of the severity of the preeclampsia, the stage
of pregnancy, whether an anticonvulsant had been given prior to the trial,
and whether the woman had delivered before entry into the trial. Women
receiving magnesium sulfate also had a 45% lower risk of death than women
receiving the placebo. There appeared to be no difference in the risk
of fetal or infant death related to the use of either the drug or the
placebo. However, women receiving magnesium sulfate had a 27% lower risk
of premature detachment of the placenta.
While the benefits of using magnesium sulfate are evident, some non-serious
negative side effects were also apparent. Roughly 25% of the women receiving
the drug experienced flushing, nausea, or vomiting. Only 5% of the women
receiving the placebo experienced side effects.
Based on the results of this study, magnesium sulfate may become a mainstay
in the treatment for preeclampsia as well as eclampsia. The low cost
of the drug makes this even more likely, not only in the U.S., but also
around the world.
September 2002 Update
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Many women who deliver their first baby through cesarean section have
trouble deciding whether to use the same method to deliver a second child.
Some women have to balance their desire for a natural birth experience
with the risk to the baby presented by vaginal delivery. Researchers
now say that a second cesarean section is the safest childbirth method
for women who have already had one.
In cesarean sections, babies are delivered through surgical openings
in the uterus and lower abdomen. Vaginal deliveries after cesareans can
be dangerous because the labor and birth could rupture the scars and
uterus, possibly depriving the baby of oxygen and causing severe blood
loss in the mother.
A study of 313,238 births in Scotland found that for women with previous
cesareans, the delivery-related death rate for subsequent babies was
about 11 times higher in vaginal births than in planned repeat cesareans.
The study involved babies born between 37 weeks' and 43 weeks' gestation
and appears in the May 22/29, 2002, Journal of the American Medical
Still, the overall infant death rate for vaginal births after a prior
cesarean delivery (VBAC) was about equal to the death rate in first-time
vaginal births about 12.9 per 10,000 babies, lower than previously
thought. But the infant death rate associated with planned repeat cesareans
was only 1.1 per 10,000.
Current guidelines recommend limiting VBACs to full-term babies in the
headfirst position, those born to women with only one previous cesarean
that was done with a low horizontal incision (vertical scars put the
baby at higher risk than horizontal ones), and an otherwise healthy pregnancy.
While many insurers have sanctioned VBACs to cut costs and reduce hospital
stays, some doctors remain wary. However, it is ultimately up to the
patient the International Federation of Gynecology and Obstetrics
and the American College of Obstetricians and Gynecologists say that
the patient should decide on method of delivery. This, of course, after
the patient is advised on all risks and benefits of both procedures.
July 2002 Update
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may cause birth defects, low birth weight
It's been 24 years since the first baby was conceived with the help
of in-vitro fertilization (IVF), bringing hope to thousands of childless
couples. In 1999 alone, over 30,000 babies were born in America with
the help of artificial reproductive technologies (ART), including IVF.
Since then, an estimated 300,000 IVF babies have been born worldwide.
But this revolutionary way to overcome infertility is not risk-free.
Two new studies published in the March 7, 2002, issue of the New
England Journal of Medicine suggest that ART babies are more likely
to be born with birth defects and low birth weights than newborns conceived
In IVF the man's sperm and the women's egg are combined in a laboratory
dish. After fertilization, the resulting embryo is then transferred to
the women's uterus to develop naturally. A special IVF procedure called
intracytoplasmic sperm injection (ICSI), where the sperm is injected
directly into the egg, can also be used for severe male infertility.
ARTs, including IVF, increase the risk of multiple births because several
embryos are usually transferred to the uterus at one time to increase
the probability of a successful pregnancy. But this practice is controversial
because multiple births are associated with low birth weight, which puts
the newborn at an increased risk for short- and long-term disabilities
and even death. However, in one of the new studies, researchers with
the U.S. Centers for Disease Control found that even ART babies born
alone were 2.6 times as likely to have a low birth weight than a naturally
conceived single infant.
In the other study, Australian researchers found that about 9% of the
301 IVF babies studied had birth defects, such as heart trouble, stunted
limbs, Down syndrome, and cleft palate, compared to only 4.2% of the
4,000 naturally conceived babies studied. The risk was still more than
doubled when multiple births were not considered.
Neither these nor previous studies have been able to identify whether
the reason for the excess risk of low birth weight and birth defects
is related to the underlying infertility itself or to the procedures
and drugs used to overcome it.
To many advocates of assisted reproduction, the results of these studies
aren't necessarily frightening, but reassuring. They look at them and
celebrate that more than 90% of IVF babies are born healthy. But regardless
of the interpretation of the numbers, couples looking for help with fertility
should consider these risks.
May 2002 Update
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Timing of pregnancy tests affects accuracy
Pregnancy test instructions routinely approve testing "as early
as the first day of the missed period." However, a recent study
suggests such guidance could lead to inaccurate results.
Researchers in North Carolina evaluated the number of pregnancies that
were actually detectable on the first day of a woman's missed period.
The participants, women ages 2142, were planning to conceive. Of
the pregnancies conceived during the five-year study, 10% of the fertilized
eggs had not yet implanted in the woman's uterus on the day a period
was expected. Even one week after the first day of the missed period,
the test was only accurate 97% of the time.
In addition, due to natural fluctuation in the schedule of ovulation,
implantation does not necessarily occur before a woman's regular period
should. The timing of implantation varies widely in its relation to the
expected period. Many women will test positive a week or more before
their period is expected, while some will test positive only a week or
more afterward. As a result, women should avoid substances known
to harm a fetus (cigarette smoke, large quantities of alcohol) if they
are trying to conceive, even if a pregnancy test comes back negative
on the first day of a missed period.
March 2002 Update
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Birth Control Patch
The first skin patch approved for birth control by the U.S. Food and
Drug Administration will be available by prescription in 2002. Ortho
Evra works by slowly releasing progestin and estrogen, the same hormones
used in birth control pills, into the bloodstream. Its efficacy lies
in the prevention of ovulation and the thickening of the cervical mucus,
which makes it harder for sperm to enter the uterus.
Ortho Evra is 99% effective in preventing pregnancy. However, the side
effects include an increased risk of blood clots, heart attack, and stroke.
This risk is even higher for cigarette smokers. In three clinical trials
involving over 3,000 women taking Ortho Evra, 5% of participants had
at least one patch that detached from their skin and 2% withdrew from
the trial due to skin irritation. Also, the patch appeared to be less
effective in women weighing more than 198 pounds.
The regimen is similar to that of birth control pills. The patch is changed
once a week for three weeks. The patch-free fourth week allows for a
menstrual period. The small (less than two square inches) and paper-thin
design makes Ortho Evra easy to hide beneath clothing. It can be applied
to the buttocks, abdomen, upper torso (front or back), and the upper
outer arm, and be worn in a different place each week.
February 2002 Update
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Pregnancy and Anticonvulsant Drugs
"Do you have epilepsy or take any anticonvulsant drugs?" This
is a common question asked of pregnant women and women who are planning
to become pregnant. The cause for the concern is the risk of birth defects
associated with the disease. But whether birth defects are related to
the mother's epilepsy or caused by the drugs used to treat it remained
unknown until recently.
A study published in the New England Journal of Medicine examined
newborns for birth defects related to anticonvulsant drugs. Each newborn
belonged to one of three groups: newborns exposed to anticonvulsant drugs
in the womb; newborns of mothers with epilepsy who did not take anticonvulsant
drugs; and newborns of mothers without epilepsy or a history of seizures.
Results showed birth defects were more frequent in infants exposed to
anticonvulsant drugs (20% of infants exposed to one drug had birth defects
and 28% of infants exposed to two or more drugs had birth defects). However,
the infants of mothers with epilepsy who were not treated with anticonvulsant
drugs were at no greater risk of birth defects then infants of mothers
This study suggests birth defects are caused by anticonvulsant drugs
and not by epilepsy itself. A separate, earlier study based on data from
a number of different countries identified the types of birth defects
associated with common anticonvulsant drugs. Some of these findings are
||Related Anticonvulsant Drug
||Phenobarbital or methylphenobarbital
||Phenobarbital, methylphenobarbital, valproic acid,
|Brain and face abnormalities, shortened limbs
If you take anticonvulsant drugs and are pregnant, or are thinking of
becoming pregnant, consult your physician about the risks to your baby.
November 2001 Update
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Vaccine safety: no link between thimerosal
and neurodevelopmental disorders
Parents should feel confident and safe when having their children immunized.
No evidence exists that proves a link between thimerosal-containing vaccines
and neurodevelopemental disorders, such as autism, attention deficit-hyperactivity
disorder, or speech and language delay. The Institute of Medicine recently
reported these findings, consistent with the recommendations of the American
Academy of Pediatrics.
Thimerosal, a mercury-containing preservative, was used for many years
in vaccines to prevent contamination. Taking in a high dose of mercury
is toxic to the human nervous system. But because of the increasing number
of vaccines routinely recommended for infants, concern was raised in
1999 by the Food and Drug Administration that the total amount of mercury
contained in the vaccinations could be exceeding the recommended mercury
levels for infants.
Although there's no data to suggest thimerosal caused any harm, the American
Academy of Pediatrics and the U.S. Public Health Service have requested
manufacturers remove thimerosal from vaccines. As a result, most, if
not all, childhood vaccines are now thimerosal-free.
The Institute of Medicine's recommendations emphasized the importance
and continued safety of childhood vaccination. Parents should definitely
be reassured that all routine childhood immunizations are in their children's
best interests, as they clearly have been shown to prevent potentially
November 2001 Update
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Childhood Depression and Postpartum Psychiatric
In the United States, more than 2 million adults suffer from bipolar
manic depressive disorder, an illness of extreme moods. It is characterized
by deep depression followed by periods of hyperactivity and elation,
referred to as mania, with periods of normal mood in between.
Bipolar disorder often leads to substance abuse and one in four people
with the condition attempt suicide.
In a recent study published in the American Journal of Psychiatry,
researchers set out to determine how often major childhood depression
turns into bipolar disorder. The researchers followed up on 72 subjects
who, at an average age of 10.3 years, had been treated for major depressive
disorder with the tricyclic antidepressant drug nortriptyline. They also
studied 28 normal subjects.
At the time of follow-up, the average age of the subjects who had had
prepubertal major depressive disorder was 20.7 years. Of these subjects,
33.3% now had bipolar disorder, compared to none of the normal comparison
These results may, in part, be due to heredity. A large portion of the
prepubertal children who had been diagnosed with a major depressive disorder
had family histories of bipolar disorder. Because bipolar disorder tends
to run in families, these children may have been more vulnerable to developing
the condition. Another possibility is that the children who were originally
treated with nortriptyline already had bipolar disorder, but had not
yet experienced their first manic episode.
Clinicians treating children with antidepressants should be aware of
the risk that children with major depressive disorder may develop adult
bipolar manic depressive disease.
Another study, published in Psychology and Medicine, sought to
determine the long-term prognosis of women with postpartum psychiatric
disorders. 50-80% of women experience some degree of postpartum depression
within one month of delivering a child. Postpartum psychiatric disorders
are more extreme.
The study authors used standardized questionnaires to determine the long-term
outcome of 64 women who had been hospitalized with postpartum psychiatric
disorders 23 years earlier, and who had been interviewed for a 1982
study of women with diagnoses of schizophrenia, schizo-affective, bipolar,
or unipolar affective disorders.
The researchers found that 75% of the women had recurrent psychiatric
illness, and 37% of the women had at least three subsequent episodes.
However, only 29% of the 34 women who gave birth after the initial postpartum
psychiatric disorder had additional episodes of maternal psychiatric
illness. In addition, a majority of the 64 women were functioning well
in society; 71-73% were employed and in stable relationships.
The women with the best outcomes were those who had an initial diagnosis
of unipolar disorder, those who experienced psychiatric illness after
a first pregnancy, and those whose psychiatric illness started within
one month of delivery.
July 2001 Update
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Women have a new choice for birth control. Late last year the FDA approved
the intrauterine device (IUD) Mirena. Mirena is a T-shaped plastic device
placed in the uterus by a physician that releases small amounts of the
hormone levonorgesterel to block conception. Although not the first hormonal
IUD, Mirena only needs to be replaced once every five years. The others,
in contrast, must be changed yearly. The manufacturer, Berlex Laboratories,
reports less than 1% of women become pregnant while using Mirena.
Physicians can easily remove the IUD. And once its extracted,
a woman can again become pregnant. According to Berlex, eight out of
ten women who are trying to conceive will become pregnant within the
first year after Mirena is removed.
Mirena is not for everyone, however. Women with a history of pelvic inflammatory
disease or a previous ectopic pregnancy (when the embryo grows outside
the uterus) should not use IUDs. Furthermore, they dont protect
against sexually transmitted diseases. Possible side effects include
spotting or missed periods.
June 2001 Update
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Ginger for Morning Sickness
A new study suggests using ginger to relieve morning sickness may not
just be an old wives tale.
Researchers in Thailand recently evaluated the effectiveness of ginger
(Zingiber offinale) to alleviate nausea and vomiting during pregnancy.
A similar study had previously found the root helped pregnant women suffering
from severe morning sickness requiring hospitalization. But this severe
condition, called hyperemesis gravidarum, only occurs in approximately
0.3% of pregnancies. In contrast, milder nausea affects up to 85% of
pregnant women and about half experience vomiting. Its caused,
in part, by rising levels of the hormone estrogen during the first 3
months of pregnancy.
The study involved 70 pregnant women reporting nausea and vomiting. Three
times a day for four days, 32 of the women were given 250mg capsules
of fresh ginger that was chopped into pieces, then baked and ground into
powder. The remainder received a placebo. All of the women were advised
not to take other drugs.
The number of vomiting episodes decreased significantly for the women
taking ginger compared to the placebo group. Using two other scales,
the researchers also found the frequency of nausea symptoms decreased
significantly in the ginger group both during the trial and at a follow-up
seven days later. No side effects were observed in the women or their
fetuses. The previous study had warned of theoretical damage to fetal
brain development, but this studys treatment period was short just
four days and the dosage of 1g of ginger per day is far below
the amount used in many foods.
This study suggests ginger may be safe and beneficial in small doses.
Other helpful measures include eating frequent small meals and taking
vitamin B6 or a prescribed antiemetic. Ginger has also proven
effective for treating motion sickness, seasickness,and post-surgical
and chemotherapy-induced nausea.
June 2001 Update
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Ultrasound Not an Accurate Screening Test for Down
About 5,000 babies are born each year with Down syndrome, a condition
that causes varying degrees of mental disabilities and physical abnormalities.
Because of the difficulties associated with raising a child with Down
syndrome, some women choose to test for the condition.
The most reliable prenatal test for Down syndrome is amniocentesis, a
process in which the clinician inserts a needle through the woman's abdomen
to remove and analyze a sample of amniotic fluid. While the test is about
99% accurate, it increases the risk of miscarriage anywhere from 0.5-1%.
Because of the risks associated with amniocentesis, some clinicians have
suggested that ultrasound should be used as a screening test to determine
whether certain markers exist that suggest the baby may be born with
Down's and that an amniocentesis is warranted. Ultrasound is a painless,
non-invasive, general screening device that uses sound waves to view
the fetus. It is widely used during the second trimester of pregnancy
as a routine part of prenatal care.
While the idea of a non-invasive prenatal test is encouraging, ultrasound
is not an accurate method of screening for Down syndrome, according to
a study in the Journal of the American Medical Association. The
analysis of 56 studies published between 1980 and 1999 found that only
one of the markers found on an ultrasound, a thickening at the back of
the neck, was reliable enough for a physician to recommend amniocentesis.
Other markers present on an ultrasound, such as brain cysts and bright
spots on the bowel, were often harmless and not reliable indictors of
Down syndrome. The researchers concluded that the dangers associated
with an amniocentesis based on most ultrasound markers are greater than
the possibility of having a child born with Down's.
May 2001 Update
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Study Shows Fish Consumption Protects Against
Stroke, But FDA Suggests Pregnant Women Should Take Caution
A large study in the Journal of the American Medical
Association (JAMA) recently showed that regularly eating fish might
protect against ischemic stroke, which is the most common type of stroke.
Numerous studies have already shown an association between fish consumption
and a reduced risk of heart disease. But there is a caveat. The Food
and Drug Administration (FDA) recently warned that pregnant women and
women who are of childbearing age who may become pregnant, should avoid
certain types of fish that contain high levels of mercury, which may
be harmful to their unborn children.
Results of the Nurses' Health Study, published in the JAMA article,
involved nearly 80,000 women. It showed that women who ate fish two to
four times a week had a 48% lower risk of ischemic stroke the
kind caused by blood clots than women who ate fish less than once
per month. Even women who ate fish only once a week or less had a risk
reduction, but it was not statistically significant. These results held
true primarily among women who did not regularly take aspirin, which
prevents the formation of blood clots. Omega-3 fatty acids, the protective
substances found in fish, reduce levels of fats related to cardiovascular
disease and help prevent blood clotting. Dark, oily fish such as mackerel,
salmon, and sardines are a good source of omega-3 fatty acids.
Although pregnant women need not give up fish and its beneficial
health effects altogether, they should be careful about what types
of fish they eat. The FDA has advised that pregnant women and those who
may become pregnant stop eating shark, swordfish, king mackerel, and
tilefish. These large, long-living fish contain hazardous levels of methyl
mercury, a form of mercury that can accumulate in a woman's body
and affect the developing central nervous system of an unborn child.
This can lead to babies with slower cognitive development. As an extra
precaution, the FDA advised that nursing mothers and young children also
avoid these fish. Mercury gets into both fresh and salt water through
Some critics feel the FDA's mercury warnings are not strong enough. A
report by the National Academy of Sciences suggested the exposure limits
for mercury should be four times stricter.
While this controversy remains unresolved, the FDA encouraged pregnant
women to continue to eat a variety of other fish, containing very low
levels of mercury, as part of a balanced diet. Among other health benefits,
the fatty acids in fish enhance brain development. According to the FDA,
women can safely eat up to 12 ounces of fish per week. Fish that contain
low levels of mercury include shellfish, canned fish, smaller ocean fish,
and farm-raised fish. Women who eat fish caught by family or friends
should contact their local health department for advice on the safety
of fish from local waters.
May 2001 Update
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Does Aspirin Prevent Preeclampsia?
Preeclampsia, also known as toxemia, is a condition that
affects pregnant women and their unborn baby. It is characterized by
high blood pressure, water retention, and protein in the urine. The condition,
which usually occurs after the 5th month of pregnancy, can lead to seizures,
kidney and liver damage, slow fetal growth, and even fetal or maternal
death. Preeclampsia affects up to 8% of pregnancies, and is responsible
for 10-15% of maternal deaths. In the past decade, several studies have
looked at the effectiveness of aspirin in preventing preeclampsia.
Early studies showed promising results. But larger, more recent studies
failed to show any benefit.
In an effort to reconcile these conflicting results, British researchers
reviewed several studies involving over 30,000 women who were at increased
risk for preeclampsia. (Risk factors include preexisting high blood pressure,
diabetes, a first pregnancy, pregnancy as a teenager or over the age
of 40, and pregnancy involving multiple fetuses.) The women had been
randomized to receive an antiplatelet drug (usually low-dose aspirin),
a placebo, or no antiplatelet medication.
The researchers concluded that aspirin reduced the risk of preeclampsia
by 15%. Their review also showed that aspirin decreased the risk of premature
births by 8% and the risk of stillbirths or newborn deaths by 14%. Based
on these results acknowledged by the researchers as showing only
small to moderate benefits the researchers recommended the use
of aspirin. Several issues including the optimal dosage, the proper time
to start treatment, and which women are most likely to benefit, remain
Despite the results of this review, some leading experts are unconvinced
that aspirin is effective at preventing preeclampsia. However, even physicians
who doubt aspirin's efficacy agree that at doses of less than 80 milligrams
per day, aspirin is not harmful. If your physician prescribes aspirin
to prevent preeclampsia, it may or may not be effective but in
any case, it won't be harmful.
March 2001 Update
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Caffeine Intake Linked to Miscarriage in Early Pregnancy
Many doctors urge women to limit or avoid caffeine intake during pregnancy
because of a suspected link between caffeine and miscarriage. A recent
study published in the New England Journal of Medicine adds weight
to the cause and effect relationship. The study showed that the amount
of caffeine found in one to three cups of coffee increases the risk of
miscarriage by 30 percent. Three to five cups a day increases risk by
40 percent, and five or more cups of coffee per day more than doubles
the risk of miscarriage.
The researchers collected data from 562 women in Sweden who had had a
miscarriage during their first trimester of pregnancy and from 953 women
who did not miscarry. They questioned the women about their caffeine
intake as well as symptoms of pregnancy such as nausea, vomiting and
tiredness. They also performed additional tests to separate risk of smoking
and of genetic defects of the fetus from the risk associated with caffeine
intake. Even after accounting for these factors, they found that caffeine
increases risk of miscarriage. Although coffee is usually a primary source
of caffeine, the study suggests that caffeine found in tea, soda, and
other sources can also lead to miscarriage, if taken in comparable amounts.
Previous studies have been unable to separate the role of nausea from
the role of caffeine intake in relation to miscarriage. Nausea and vomiting,
which are more common in healthy pregnancies, naturally limit the amount
of coffee ingested. As a result, it has been difficult to establish whether
these women carried to term because they limited their intake of caffeine
or because their pregnancies were healthier to begin with. The researchers
in this study found a relationship between caffeine and miscarriage even
after controlling for nausea.
January 2001 Update
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Hormone Level Best Predictor of Drug Success in
Treating Ectopic Pregnancy
The prevalence of ectopic pregnancies has risen sharply since the 1970s.
Some women are at increased risk for an ectopic pregnancy for
example, women who smoke, or have had prior pelvic surgery, or have used
an IUD in the past, and those with a history of infertility. An ectopic
pregnancy occurs when an embryo starts to develop outside the uterus,
usually in a fallopian tube. This quirk of nature is difficult. The embryos
are rarely normal, and it is impossible for the pregnancy to continue.
This situation also threatens a woman's health. If an ectopic pregnancy
goes undetected, the fallopian tube could rupture and the woman could
suffer severe internal bleeding. If it is not detected early enough,
there can be damage to the woman's reproductive organs that can compromise
her fertility. Symptoms of an ectopic pregnancy may include vaginal bleeding,
sharp abdominal cramps, or pains on one side; however, ectopic pregnancy
can be painless or associated with only mild cramps.
An ectopic pregnancy is generally treated with surgery, which is invasive
and carries certain risks. Another approach is the use of a drug called
methotrexate. Methotrexate is traditionally used as part of cancer therapy
because it obstructs the metabolism of rapidly growing cells. In the
case of an ectopic pregnancy, the drug prevents embryonic cells from
multiplying. While there are clear advantages to medical treatment of
an ectopic pregnancy (no surgical risks, faster recovery time, and possibly
better preservation of fertility), it isn't always effective and sometimes
surgery is required.
Researchers from the University of Tennessee, Memphis, recently did a
study to determine what factors might help predict whether methotrexate
treatment will be successful. They monitored 350 women with ectopic pregnancies
who were given the drug; 320 of the women were treated successfully.
After comparing various factors, such as the size of the embryo and the
presence of fluid in the abdominal cavity, the researchers determined
that the level of a hormone produced during pregnancy was the single
most important factor in determining whether drug treatment would be
successful. The hormone, called human chorionic gonadotropin (HCG), is
produced by the placenta and helps ensure the production of progesterone,
thus preserving the pregnancy. (It is the hormone measured in home pregnancy
tests.) High levels of the hormone suggest an embryo that is still developing
and growing. Methotrexate treatment was more successful in women whose
HCG levels were 15,000 or less. It is important to keep in mind that
the women in this study had very early ectopic pregnancies and no signs
of internal bleeding.
Ectopic pregnancy can be a painful experience both emotionally and physically.
Medical treatment with methotrexate, rather than surgery, can be a somewhat
less traumatic way to handle this problem.
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Breast-Feeding May Protect Against Childhood
Another vote in favor of breast-feeding! Researchers in Western Australia
found that babies who are fed breast milk exclusively for their first
four months are less likely to develop asthma by age 6. Asthma is the
leading cause of hospital admissions for Australian youth. In the United
States, it affects about 17 million Americans and about a quarter of
all children under 18.
To determine whether there was a connection between asthma and breast-feeding,
the researchers compared questionnaires completed by parents when their
children were a year old with questionnaires completed when the children
were 6. The surveys asked about breathing problems, feeding (length and
exclusivity of breast-feeding), smoking in the home, and daycare (to
evaluate exposure to respiratory infections).
The age at which a child was fed soy or cow's milk was more positively
associated with asthma and wheezing. Introduction of milk other than
breast milk before four months was a significant risk factor for the
development of asthma by age 6. According to the Food and Drug Administration,
babies who are breast-fed have lower rates of hospital admissions, ear
infections, diarrhea, rashes, allergies, and other medical problems than
bottle-fed babies. Because human milk contains cells that kill bacteria,
fungi, and viruses, breast-fed babies are protected from a number of
illnesses. To learn more about breast-feeding, see page 951 of the Family
Health Guide. If you are unable to breast-feed, see page 505 for more
information about other ways to prevent childhood asthma. Controllable
risk factors include the presence of house dust and tobacco smoke.
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Thyroid Deficiency During Pregnancy
Researchers have long noted that low thyroid function (hypothyroidism)
during pregnancy is associated with neuropsychological development problems
in babies. A recent study published in the New England Journal of
Medicine has shown that, in fact, hypothyroidism in pregnant women
can negatively affect their children's performance on neuropsychological
tests. And in fact, this effect may be noted even when a woman's thyroid
function is only slightly below normal and without symptoms.
This research suggests that it may be worthwhile to test thyroid function
in all pregnant women. Treating a woman for this condition will not only
benefit her baby, but may also help women with unrecognized hypothyroidism
who have no symptoms yet. 64% of the women in this study who had undiagnosed
low thyroid function during pregnancy were shown to have developed confirmed
hypothyroidism at follow-up 11 years later. While testing all pregnant
women for low thyroid function is not yet standard practice, this research
suggests that it may be in the future. If you are pregnant and have concerns
about this information, talk with your doctor.
If you are a woman and you know you have low thyroid function and are
of childbearing age, be sure to work closely with your doctor to keep
your condition under control. If you do become pregnant, this becomes
even more important. For more information on low thyroid function, see
page 848 in the Family Health Guide.
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Less Painful Newborn Circumcision
Each year, millions of newborn males undergo circumcision. Their facial
expressions and crying indicate that circumcision causes immense pain,
yet many physicians do not administer anesthesia or pain medication for
this procedure. In part, this is because many doctors are unfamiliar
with the use of such medications in infants and are concerned about possible
A number of interventions can help reduce the pain of circumcision.
Dorsal penile nerve block (DPNB), lidocaine-prilocaine cream (a mixture
of local anesthetics), sucrose, and acetaminophen are each individually
safe and effective but do not completely eliminate pain in all infants.
Another approach is to use the Mogen clamp, which is associated with
less pain than the Gomco clamp.
In an effort to minimize the pain of circumcision, researchers conducted
a study on 86 infant males to assess the efficacy and safety of a combination
of interventions. Fifty-seven infants were circumcised using the Mogen
clamp and a combination of analgesics that included acetaminophen, lidocaine-prilocaine
cream placed on the penis, gauze embedded with sugar and dipped in grape
juice placed in the mouth, and an injection of DPNB. Researchers videotaped
the infants during the procedure and assessed pain by analyzing facial
activity and the percentage of time spent crying. The researchers compared
the results with data from a previous study in which 29 infants were
circumcised using the Gomco clamp and lidocaine-prilocaine cream.
Results from this study suggest that circumcision with the Mogen clamp
took less time than circumcision with the Gomco clamp did (mean time
of 55 seconds compared to 9 minutes, 37 seconds). Infants in the combination
group had less facial activity indicating pain and cried for a smaller
percentage of time than the infants in the single intervention group
did. Furthermore, 46% of the infants in the combination group did not
cry at all during the procedure and 12% cried less than 10% of the time.
Infants in the combination group did not experience any adverse effects.
Facial activity and crying was not eliminated in all infants treated
with the combination of interventions, yet researchers do not know if
these responses were due to the pain of the procedure or the discomfort
of restraint. This study demonstrates that circumcision with the Mogen
clamp and combined analgesia is safe, takes less time, and substantially
minimizes pain. Parents of male infants and the physicians performing
circumcisions should consider this approach.
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Pregnancy and the Risk of Blood Clots
Of all the complications that may occur during pregnancy, clots that
obstruct blood vessels are the leading cause of death in pregnant women.
Still, such occurrences are relatively uncommon. How do you know if venous
thrombosis, as the condition is called, is something that you should
worry about? How do you know if drug treatment is necessary? Researchers
are trying to answer these questions.
In Germany, physicians conducted a study to determine the risk of clots
associated with certain genetic and protein factors in pregnant women.
The researchers collected and analyzed blood samples from women with
a history of blood clots during or after pregnancy. These samples were
compared to blood samples from women who did not experience these problems.
According to the results, women with normal genetic and protein factors
had only a 0.03% risk of formation of blood clots. The findings also
showed that two genetic abnormalities, known as G20210A prothrombin-gene
mutation and factor V Leiden, are individual risk factors for blood clots,
increasing the risk of blood clots to 0.5% and 0.25%, respectively. In
addition, a woman who has both variations has a greater probability of
experiencing blood clots during pregnancy (4.6%). However, only 9.3%
of the women with a history of blood clots had both genetic variations.
Women with deficiencies in proteins that prevent blood clotting were
also at increased risk for this complication during pregnancy (0.4% probability).
The results do not suggest that every pregnant woman should be screened
for the genetic variations associated with blood clots. Rather, women
who have a personal or family history of problems due to blood clots
should discuss the need for screening with their obstetrician. Treatment
is available to help prevent the formation of blood clots in women who
are at an increased risk.
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