Pregnancy

Focus on health risks for new mothers for Preeclampsia Awareness Month

May is Preeclampsia Awareness Month and NCMA Women’s OB/GYN Center joins with the Preeclampsia Foundation to help raise awareness. This year the foundation’s efforts are on postpartum preeclampsia as 97 percent of maternal deaths related to preeclampsia and other hypertensive disorders of pregnancy occur within just six weeks of delivery, a time when most new mothers might think the danger has passed.

A woman can develop preeclampsia after her baby is born, regardless of whether she experienced high blood pressure during her pregnancy. With such alarming statistics related to postpartum preeclampsia, it very important that a new mother remain vigilant and continue to monitor her heart health and blood pressure even after delivery.

Understanding preeclampsia

Postpartum preeclampsia is a serious condition related to high blood pressure. Women who have just delivered a baby are most at risk, although it has no effect on the baby. There is no known cause for preeclampsia to manifest in pregnant women. In many cases, women diagnosed with preeclampsia see symptoms abate following delivery, but the Preeclampsia Foundation emphasizes that ‘delivery is not a cure’. In some cases, symptoms begin during pregnancy, but some patients may not be symptomatic until after the baby is born. Postpartum preeclampsia most commonly occurs within the first seven days after delivery although new mothers remain at risk for up to six weeks following delivery.

Know the warning signs

Early diagnosis and being vigilant to symptoms followed by quick response is imperative to saving lives. Symptoms include (and can be complicated by lack of sleep, postpartum depression and/or simple lack of awareness about the signs):

  • nausea
  • swelling in hands/feet
  • severe headache
  • seeing spots or other vision changes
  • shortness of breath

When a patient thinks they are experiencing warning signs of postpartum preeclampsia, the first thing to do is go to the Emergency Department, request to be seen by an OB, and report that they have recently given birth. The first seven days after delivery is when women who experience preeclampsia are at highest risk. Effectively controlling high blood pressure is key to avoiding very serious health risks that include; seizures, stroke, organ damage and sometimes death.

About NCMA Women’s OBGYN Center

Our provider team of expert OB/GYN physicians, certified nurse midwives, family nurse practitioners, and medical assistants provides unmatched care to patients in our region. As women proudly serving women, we understand the needs and expectations of our patients. For more information, visit our website or call 707-579-1102.

Study reveals no increase in risks for women who eat and drink during labor

At most US maternity units, women in labor are put on nil per os (NPO) status -- they're not allowed to eat or drink anything, except ice chips. But new nursing research questions that policy, showing no increase in risks for women who are allowed to eat and drink during labor.

At most US maternity units, women in labor are put on nil per os (NPO) status — they’re not allowed to eat or drink anything, except ice chips. But new nursing research questions that policy, showing no increase in risks for women who are allowed to eat and drink during labor. The study appears in the March issue of the American Journal of Nursing, published by Wolters Kluwer.

“The findings of this study support relaxing the restrictions on oral intake in cases of uncomplicated labor,” write Anne Shea-Lewis, BSN, RN, of St. Charles Hospital, Port Jefferson, N.Y., and colleagues. Adding to the findings of previous reports, these results suggest that allowing laboring women to eat and drink “ad lib” doesn’t adversely affect maternal and neonatal outcomes.

No Increase in Complications with ‘Ad lib’ Oral Intake During Labor

The researchers analyzed the medical records of nearly 2,800 women in labor admitted to one hospital from 2008 through 2012. At the study hospital, one practice group of nurses and doctors had a policy of allowing laboring women to eat and drink ad lib (ad libitum, or “as they please”). Another four practice groups kept all patients NPO (nil per os, or “nothing by mouth”).

Recommendations to restrict oral intake during labor reflect concerns over the risk of vomiting and aspiration (inhalation) in case general anesthesia and surgery are needed. However, with advances in epidural and spinal anesthesia, the use of general anesthesia during labor has become rare (and, if needed, much safer than before).

The study compared maternal and child outcomes in about 1,600 women who were kept NPO (except for ice chips) with 1,200 who were allowed to eat and drink ad lib during labor. The two groups were “sufficiently equivalent” for comparison. The women’s average age was 31 years. Before delivery, a “preexisting medical condition” complicating pregnancy was identified in 14 percent of the NPO group compared with 20 percent of the ad lib group.

Even though the women in the NPO group started out with fewer medical problems, they had a significantly higher incidence of complications during labor and birth, compared with the ad lib group. The women in the NPO group were also significantly more likely to give birth via unplanned cesarean section.

Other outcomes — including requiring a higher level of care after delivery and the newborns’ condition as measured by Apgar score — were not significantly different between groups. Analysis using a technique called propensity score matching, comparing groups of women with similar risk factors, yielded similar results.

The findings add to those of previous studies suggesting that restrictions on eating and drinking during labor could be safely relaxed in uncomplicated cases. “Yet in keeping with current guidelines, most obstetricians and anesthesiologists in the United States continue to recommend restrictions on oral intake for laboring women,” Anne Shea-Lewis and colleagues write.

“Our findings support permitting women who are at low risk for an operative birth to self-regulate their intake of both solid food and liquids during labor,” the researchers add. They note some limitations of their study, especially the fact that the women weren’t randomly assigned to NPO or ad lib groups.

The authors hope their study will lead to reconsideration of current recommendations to keep women NPO during the “often long and grueling” process of labor and delivery. “Restricting oral intake to a laboring woman who is hungry or thirsty may intensify her stress,” Anne Shea-Lewis and colleagues conclude. “Conversely, allowing her to eat and drink ad lib during labor can contribute to both her comfort and her sense of autonomy.”

Story Source:

Read this article on Science Daily: Wolters Kluwer Health. “Ice chips only? Study questions restrictions on oral intake for women in labor.” ScienceDaily. ScienceDaily, 23 February 2018. www.sciencedaily.com/releases/2018/02/180223151852.htm.


The Women’s OB/GYN Medical Group strives to better the lives of all women with a holistic approach to women’s health. Call for an appointment today: (707) 579-1102. Visit our website: www.womensobgynmed.com

Mothers over 40 more at risk of preterm birth

Maternal age over 40 is associated with an increased risk of preterm birth Mothers aged 30-34 years old may have the lowest risk of preterm birth
Pregnant mothers aged 40 and over may have an increased risk for preterm birth, regardless of confounding factors, according to a new study.
Pregnant mothers aged 40 and over may have an increased risk for preterm birth, regardless of confounding factors, according to a study published January 31, 2018 in the open-access journal PLOS ONE by Florent Fuchs from CHU Sainte Justine, Canada and colleagues.

Maternal age at pregnancy has been increasing worldwide and so has the risk for preterm birth. However, the association between maternal age and preterm birth remains a topic of ongoing research.

Fuchs and colleagues sought to investigate the impact of maternal age on preterm birth in a large cohort. The researchers analyzed the previously-collected data from the QUARISMA randomized controlled trial, which had taken place in 32 hospitals in Quebec, Canada, from 2008 to 2011.

The researchers identified five different age groups among the 165,282 pregnancies included in the study, and compared them based on maternal characteristics, gestational and obstetric complications, and risk factors for prematurity. Some of the known risk factors identified more commonly in older mothers (40 and over) included placental praevia, gestational diabetes, medical history, use of assisted reproduction technologies and occurrence of an invasive procedure. On the other hand, nulliparity, past drug use and smoking were more prevalent in younger mothers (30 and under).

Even after adjusting for confounding factors, the researchers found that advanced maternal age (40 or over) was associated with preterm birth. Meanwhile, a maternal age of 30-34 years was associated with the lowest risk of prematurity.


Read this article on Science Daily:  “Maternal age over 40 is associated with an increased risk of preterm birth: Mothers aged 30-34 years old may have the lowest risk of preterm birth.” ScienceDaily. ScienceDaily, 31 January 2018. www.sciencedaily.com/releases/2018/01/180131160346.htm.


About Women’s OB/GYN Medical Group

The Women’s OB/GYN Medical Group strives to better the lives of all women with a holistic approach to women’s health. Call for an appointment today: (707) 579-1102. Visit our website: www.womensobgynmed.com

Researchers use MRI for the first time ever in effort to decode early labor

Scientists are using the latest imaging techniques usually used to map the brain to try and understand why some pregnant women miscarry or go into early labor.
Scientists are using the latest imaging techniques usually used to map the brain to try and understand why some pregnant women miscarry or go into early labor.

They have developed 3D images of the cervix, the load bearing organ which lies at the base of the womb and stops a developing baby from descending into the birth canal before the due date.

Around a quarter of miscarriages during the fourth to sixth month of pregnancy (mid-trimester) occur because of weaknesses in the cervix.

The researchers at the University of Leeds hope by developing a detailed image of its structure, they can develop ways of monitoring women for signs of potential problems before they become pregnant.

Mr Nigel Simpson, Associate Professor in Obstetrics and Gynaecology, said: “Ultrasound monitoring is used to identify women at risk — where their cervix is unable to support the pregnancy. But little is known about why that problem develops.

“This research is attempting to answer that question.”

MRI techniques were used to create 3D images of the cervix. This is the first time extremely high resolution imaging has been used to understand the detailed micro-structure of this organ.

The research is published in the international obstetrics and gynaecology journal, BJOG.

James Nott, from the Faculty of Medicine and Health and lead author, said: “A lot of our understanding of the biology of the cervix is rooted in research carried out 50 years ago.

“By applying the imaging techniques that have been used on the brain, we can get a much clearer understanding of the tissue architecture that gives the cervix its unique biomechanical properties.”

The images reveal a fibrous structure running along the upper part of the cervix. The fibres are much more pronounced near to where it joins the womb. The fibres are made of collagen and smooth muscle and form a ring around the upper aspect of the cervical canal.

During pregnancy, these fibres provide a strong supporting barrier — keeping the fetus and amniotic sac in place and preventing micro-organisms from entering the uterus.

The images reveal that these support tissues are less prominent further down the cervix as it joins the birth canal.

During labour, the body releases chemicals which result in the cervix opening and allowing the baby to enter the birth canal.

But there are medical conditions where earlier in the pregnancy, the cervix fails to support the baby, leading to a miscarriage or premature birth.

Mr Simpson said: “This study’s findings have encouraged us to explore new imaging techniques to check the integrity of these fibres before or during pregnancy in order to identify at-risk mums, intervene earlier, and so prevent late pregnancy loss and pre-term birth.”

The study was funded by Cerebra, the charity for children with brain conditions.

The scientists used diffusion tensor MRI, which is a technology that can remotely sense different types of tissue based on their water content.


Story Source:

Materials provided by University of Leeds. Note: Content may be edited for style and length.


Journal Reference:

  1. JP Nott, E Pervolaraki, AP Benson, EA Bonney, JD Pickering, N Wilkinson, NAB Simpson. Diffusion tensor imaging determines three-dimensional architecture of human cervix: a cross-sectional study. BJOG: An International Journal of Obstetrics & Gynaecology, 2017; DOI: 10.1111/1471-0528.15002

Read this article on ScienceDaily, 20 December 2017. www.sciencedaily.com/releases/2017/12/171220121758.htm.

Start the New Year Right: Quit the nicotine habit using the latest research model for success

In addition to lowering the effects of nicotine withdrawal, exercise is by far the best thing women can do to improve health.The Women’s OB/GYN Medical Group shares insight into how women who have a nicotine habit can take advantage of the latest research trends for quitting that might just guarantee success; starting an exercise routine.

Smoking is a bad habit for anyone and for women it poses very specific problems, particularly for pregnant women and women who are considering pregnancy. “Now is the perfect time for women of all ages to make a commitment to stop smoking,” says Dr. Lela Emad Obstetrician & Gynecologist. “In light of the latest research, we’re asking all of our patients who smoke or use nicotine products, to make the commitment to change this one lifestyle habit, and start the New Year on a better track toward health.”

The Study 

Experts at St George’s University of London set out to understand the underlying mechanism that seems to be exercise’s way of supporting the body against nicotine dependence and withdrawal. The study revealed that even moderate exercise noticeably reduces the severity of nicotine withdrawal symptoms. The findings help to validate the protective effect of exercise during smoking cessation; against the development of physical dependence, which may help smokers in giving up the habit by reducing the severity of withdrawal symptoms.

The Impact of Smoking

According to the Center of Disease Control and Prevention cigarette smoking remains the leading cause of preventable death and disability in the United States, despite a significant decline in the number of people who smoke. More than 16 million Americans have at least one disease caused by smoking.

“If exercise works to decrease the symptoms associated with nicotine withdrawal, then taking up an exercise routine and quitting the habit go hand in hand,” Dr. Emad says. “Statistics show that only 30 percent of women quit smoking when they find out they are pregnant, if we could make a dent in that number, it will have a positive impact on the well-being of both mothers and their children.”

Cigarette smoking alone kills more than 480,000 Americans each year. It causes direct damage to the body, which can lead to long-term health problems. We’ve all heard that smoking causes cancer, lung and heart disease, and stroke, but smoking also causes specific problems for women’s health including:

  • Decreased bone density
  • Rheumatoid arthritis
  • Cataracts
  • Gum disease
  • Ulcers
  • Depression
  • Menstrual problems
  • Low birth-weight
  • Pre-term delivery

In addition to lowering the effects of nicotine withdrawal, exercise is by far the best thing women can do to improve health. Exercise has been found to increase a person’s overall energy level and it releases endorphins—which in turn increases a person’s happiness quotient. Ongoing research suggests that as little as 2.5 hours weekly (about 20 minutes a day) of moderate aerobic exercise such as walking provides all the major health benefits a body needs to stay healthy.

“What a great resolution for women of all ages to make for this New Year; stop smoking, start exercising,” Dr. Emad said.

About Women’s OBGYN Medical Group

The provider team of expert OB/GYN physicians, certified nurse midwives, family nurse practitioners, and medical assistants provides unmatched care to patients in our region. As women proudly serving women, we understand the needs and expectations of our patients. For more information call (707) 579-1102 or visit the Women’s OB/GYN website.

Positive pregnancy test? What’s next?

I might be pregnant, what’s next?

Experiencing early signs of pregnancy or testing positive on a home pregnancy test means it is time to consult with a physician.

Early signs that you might be pregnant include spotting, vaginal discharge, cramps, breast changes (sensitivity, soreness, and color changes), and missing your period. Of course, noting the last time you had sex without using contraception properly can also help indicate whether or not you might be pregnant. When these signs occur, most women opt to use a home pregnancy test before starting care with an OB/GYN MD or certified nurse midwife. Pregnancy tests are easy to use and readily available for purchase over the counter at drug stores.

What to do following a Positive Pregnancy Test

If you think you are experiencing any early signs of pregnancy or have tested positive on a home pregnancy test, it is important to consult a physician in order to establish care with a medical professional as early as possible. Women’s OB/GYN Medical Group offers pregnancy test visits by appointment. At your appointment, our providers will confirm the positive pregnancy with a urine pregnancy test in our office. Once we have confirmed the positive result, we will establish your care regimen and will help you plan your health maintenance throughout your pregnancy.

If your in-office pregnancy result comes back negative but you are still experiencing symptoms, we will help you schedule another appointment if needed in order to provide treatment and advice moving forward.

What to expect at your first visit:

  • A thorough physical exam and review of your medical history.
  • An ultrasound to confirm your due date (when to expect you will go into labor).
  • Blood work and standard cultures for Chlamydia and gonorrhea.
  • A pap smear, unless you’ve had one recently.
  • Arrangement to consult with a specialist (if certain risk factors are present).
  • A request to see your old medical records (if needed).

Our experienced team of physicians, nurse midwives, and nurse practitioners deliver comprehensive, compassionate preconception, pregnancy, and post-partum care to our patients and their families in a comfortable environment close to home.

Malaria drug may prevent Zika virus from infecting fetus

Studying pregnant mice, researchers at Washington University School of Medicine in St. Louis found that Zika virus manipulates the body's normal barrier to infection, and that hydroxychloroquine, a malaria drug related to chloroquine, interferes with this process, protecting the fetus from viral infection.Zika virus infects the fetus by manipulating the body’s normal barrier to infection, according to a new study of pregnant mice. Moreover, the study showed that a drug that interferes with this process protects the fetus from viral infection. That drug is already approved for use in pregnant women for other medical purposes.
Devastating consequences of Zika virus infection are suffered in the womb, where the virus can cause brain damage and sometimes death.

Studying pregnant mice, researchers at Washington University School of Medicine in St. Louis have learned that the Zika virus infects the fetus by manipulating the body’s normal barrier to infection. Moreover, they showed that a malaria drug that interferes with this process protects the fetus from viral infection. That drug already is approved for use in pregnant women for other medical purposes.

“We found that the malaria drug hydroxychloroquine effectively blocks viral transmission to the fetus,” said senior author Indira Mysorekar, PhD, an associate professor of obstetrics and gynecology, and of pathology and immunology. “This drug already is used in pregnant women to treat malaria, and we suggest that it warrants evaluation in primates and women to diminish the risks of Zika infection and disease in developing fetuses.”

The findings are published July 10 in The Journal of Experimental Medicine.

In late 2015, doctors in Brazil began to notice a surge in the number of babies born with microcephaly, or unusually small heads, an indicator of neurological damage. The epidemic soon was linked to the mosquito-borne Zika virus, which was spreading through the tropical parts of the Americas. Doctors advised pregnant women to avoid mosquito bites by wearing bug spray and long-sleeved clothing, but had little other advice to offer. There were, and still are, no drugs or vaccines approved for use in pregnant women to protect them or their fetuses from Zika infection.

The developing fetus is uniquely vulnerable to damage from infection, so the body mobilizes robust defenses to keep microbes from ever reaching the fetus in the first place. The placenta is the last line of defense. Mysorekar and others have shown that a process known as autophagy — the cellular waste-disposal pathway by which cells grind up debris, unwanted organelles and invading microbes — is an important part of the formidable placental barrier to infection. However, previous studies by Mysorekar and others have shown that Zika not only can invade the placenta, but multiply there.

To learn more about how Zika breaches the placenta, Mysorekar, postdoctoral fellow Bin Cao, PhD, and colleagues infected human placental cells with Zika virus. They found that exposure to the virus activated genes related to autophagy.

However, when the researchers treated the cells with drugs to ramp up the autophagy pathway, the number of cells infected with Zika virus increased. Drugs that suppressed autophagy resulted in fewer placental cells infected with Zika virus. In other words, the virus multiplied and spread more effectively when the researchers dialed up the barrier response, and performed more sluggishly when they dialed it down. The virus seemed to be doing a form of microbial martial arts, turning the body’s weapons to its own advantage.

Mysorekar and colleagues verified these findings using mice whose autophagy response was hobbled by low levels of a key autophagy protein. They infected two groups of pregnant mice with Zika: one in which the autophagy process was disrupted and the other in which it worked normally.

Five days after infection, the mothers with a weak autophagy response had about the same amount of virus in their bloodstreams as the mice with a normal response. However, in mice with a weak autophagy response, the researchers found 10 times fewer viruses in the placenta and the heads of the fetuses and less damage to the placentas.

“It appears that Zika virus takes advantage of the autophagy process in the placenta to promote its survival and infection of placental cells,” Cao said.

Since hydroxychloroquine suppresses the autophagy response, the researchers questioned whether it also could protect fetuses against Zika.

To find out, they repeated the mouse experiment using only mice with a normal autophagy response. Female mice at day nine of pregnancy were infected with Zika and then dosed with hydroxychloroquine or placebo every day for the next five days.

Following treatment, the researchers found significantly less virus in the fetuses and placentas from the mice that had received hydroxychloroquine. In addition, these placentas showed less damage and the fetuses regained normal growth. Both the untreated and the treated mothers had about the same amount of Zika virus in their bloodstreams, indicating that hydroxychloroquine was able to protect fetuses even when the virus was circulating through the mother.

Although hydroxychloroquine has been used safely in pregnant women for short periods of time, the researchers caution that further studies are needed before it can be used in pregnant women to fend off Zika. Pregnant women living in areas where Zika circulates may need to take the drug for the duration of their pregnancies, and the safety of hydroxychloroquine for long-term use is unknown.

“We would urge caution but nevertheless feel our study provides new avenues for feasible therapeutic interventions,” said Mysorekar, who is also co-director of the university’s Center for Reproductive Health Sciences. “Our study suggests that an autophagy-based therapeutic intervention against Zika may be warranted in pregnant women infected with Zika virus.”

The Women’s OB/GYN Medical Group strives to better the lives of all women with a holistic approach to women’s health. Call for an appointment today: (707) 579-1102. Visit our website: www.womensobgynmed.com


Story Source:

Materials provided by Washington University School of Medicine. Original written by Tamara Bhandari. Note: Content may be edited for style and length.


Journal Reference:

  1. Indira Mysorekar et al. Inhibition of autophagy limits vertical transmission of Zika virus in pregnant mice. The Journal of Experimental Medicine, July 2017 DOI: 10.1084/jem.20170957

Read this article on ScienceDaily: Washington University School of Medicine. “Malaria drug protects fetuses from Zika infection: Treatment prevents virus from crossing placenta to infect fetus, mouse study shows.” ScienceDaily. ScienceDaily, 10 July 2017. www.sciencedaily.com/releases/2017/07/170710091702.htm.

Good outcomes for older women who give birth at home or in a birth center

Women with some characteristics commonly thought to increase pregnancy risks — being over age 35; being overweight; and in some cases, having a vaginal birth after a cesarean section — tend to have good outcomes when they give birth at home or in a birth center, a new assessment has found.

However, women with some other risk factors, a breech baby and some other cases of vaginal birth after cesarean or VBAC, may face an increased risk of poor outcomes for themselves or their babies, researchers at Oregon State University have found. The study is believed to be the first to examine these risks and the outcomes. About 2 percent of all births in the U.S., and about 4 percent in Oregon, occur at home or in a birth center, rather than in a hospital setting. Generally, women who are considered “low-risk” are good candidates for home or birth center births, also referred to as community births, if they are attended by a midwife or other trained provider and timely access to a hospital is available.

However, there is little agreement among health providers on what should be considered low- or high-risk, and some women choose to have a community birth despite potential risks, said Marit Bovbjerg, a clinical assistant professor of epidemiology at Oregon State University and lead author of the study.

Medical ethics and the tenets of maternal autonomy dictate that women be allowed to decide where and how they wish to give birth. That’s why it’s important to have as much information as possible about potential risks, said Bovbjerg, who works in the College of Public Health and Human Sciences at OSU.

There are also risks associated with hospital births, such as increased interventions, which means there aren’t always clear answers when it comes to determining the best and safest place to give birth, said Melissa Cheyney, a medical anthropologist and associate professor in OSU’s College of Liberal Arts.

The goal of the research was to better understand the outcomes for women and babies with some of the most common pregnancy risk factors, to see how those risk factors affected outcomes.

“There’s a middle or gray area, in terms of risk, where the risk associated with community birth is only slightly elevated relative to a completely low-risk sample,” Cheyney said. “We’re trying to get more information about births that fall in that middle zone so that clinicians and pregnant women can have the best evidence available when deciding where to give birth.”

The findings were published recently in the journal Birth. Other co-authors are Jennifer Brown of University of California, Davis; and Kim J. Cox and Lawrence Leeman of the University of New Mexico. Using birth outcome data collected by the Midwives Alliance of North America Statistics Project, commonly referred to as MANA Stats, the researchers analyzed more than 47,000 midwife-attended community births.

They looked specifically at the independent contributions to birth outcomes of 10 common risk factors: primiparity, or giving birth for the first time; advanced maternal age, or mother over age 35; obesity; gestational diabetes; preeclampsia; post-term pregnancy, or more than 42 weeks gestation; twins; breech presentation; history of both cesarean and vaginal birth; and history of only cesarean birth.

The last two groups are both considered VBACs and hospital policies and state regulations for midwifery practice usually make no distinction between the two types. However, the researchers found a clear distinction between the two groups in terms of community birth outcomes.

Women who delivered vaginally after a previous cesarean and also had a history of previous vaginal birth had better outcomes even than those women giving birth for the first time. On the other hand, women who had never given birth to a child vaginally had an increased risk of poor outcomes in community birth settings.

“That finding suggests that current policies that universally discourage VBAC should be revisited, as the evidence does not support them,” Bovbjerg said. “Women who in the past have successfully delivered vaginally seem to do just fine the next time around, even if they have also had a previous C-section. That’s really important because some medical groups totally oppose VBACs, even in hospital settings, and many hospitals don’t offer the option of a VBAC at all.”

Researchers also found that women whose babies were in breech position had the highest rate of adverse outcome when giving birth at home or in a birth center.

There was only a slight increase in poor outcomes for women over age 35, or women who were overweight or obese, compared to those without those risk factors. In some categories, there were not enough births in the data set to properly evaluate a risk’s impact, such as with gestational diabetes and preeclampsia.

“As is appropriate, women who face high complication risks such as preeclampsia tend to plan for and choose a hospital birth, rather than a community birth,” Bovbjerg said. “But even for these women, it’s important to remember that they can choose a community birth if their faith, culture or other considerations dictate that is the best choice for them.”

The researchers emphasized that the new information about risks and outcomes can serve as an important tool in decision-making for families making very personal choices about where to give birth. “These findings help us to put information and evidence, rather than fear, at the center of discussions around informed, shared decision-making between expectant families and their health care providers,” Cheyney said.

Researchers next plan to examine how the healthcare culture and standards of care in different locations within the U.S. affect outcomes of home and birthing center deliveries.


Story Source:

Materials provided by Oregon State University. Note: Content may be edited for style and length.


Journal Reference:

  1. Marit L. Bovbjerg, Melissa Cheyney, Jennifer Brown, Kim J. Cox, Lawrence Leeman. Perspectives on risk: Assessment of risk profiles and outcomes among women planning community birth in the United States. Birth, 2017; DOI: 10.1111/birt.12288

Read this article on Science Daily: www.sciencedaily.com/releases/2017/04/170413154439.htm.

Mother’s folic acid intake during pregnancy may decrease hypertension risk in children

Avocado – rich in folic acid.

A new article published in the American Journal of Hypertension finds that babies born to mothers with cardiometabolic risk factors were less likely to develop high blood pressure if their mothers had higher levels of folate during pregnancy.

Since the late 1980s, the prevalence of childhood elevated blood pressure has increased in the United States, in particular among African Americans. From a life course perspective, childhood high blood pressure can predict higher blood pressure values later in life, and people with higher blood pressure are at greater risk of developing cardiovascular, metabolic and kidney disease and stroke. Research has also shown that maternal cardiometabolic risk factors during pregnancy — including hypertensive disorders, diabetes, and obesity — are associated with higher offspring blood pressure.

Because controlling hypertension and cardiovascular disease in adults is difficult and expensive, identifying early-life factors for the prevention of high blood pressure may be an important and cost effective public health strategy.

There is growing evidence that maternal nutrition during pregnancy, through its impact on the fetal intrauterine environment, may influence offspring cardiometabolic health. Folate, which is involved in nucleic acid synthesis, gene expression, and cellular growth, is particularly important.

In young adults, higher folic acid intake has been associated with a lower incidence of hypertension later in life. Citrus juices and dark green vegetables are good sources of folic acid. However, the role of maternal folate levels, alone or in combination with maternal cardiometabolic risk factors on child blood pressure has not been examined in a prospective birth cohort.

In the current study, researchers analyzed the data from a prospective U.S. urban birth cohort, enriched by low-income racial and ethnic minorities at high risk for elevated BP, to examine whether maternal folic acid levels and cardiometabolic risk factors individually and jointly affect offspring blood pressure.

Researchers included 1290 mother-child pairs, 67.8% of which were Black and 19.2% of which were Hispanic, recruited at birth and followed prospectively up to age 9 years from 2003 to 2014 at the Boston Medical Center. Of the mothers, 38.2% had one or more cardiometabolic risk factors; 14.6% had hypertensive disorders, 11.1% had diabetes, and 25.1% had pre-pregnancy obesity. A total of 28.7% of children had elevated systolic blood pressure at age 3-9 years. Children with higher systolic blood pressure were more likely to have mothers with pre-pregnancy obesity, hypertensive disorders, and diabetes. Children with elevated systolic blood pressure were also more likely to have lower birth weight, lower gestational age, and higher BMI.

The study findings suggest that higher levels of maternal folic acid may help counteract the adverse associations of maternal cardiometabolic risk factors with child systolic blood pressure, although maternal folic acid levels alone were not associated with child systolic blood pressure. Among children born to mothers with any of the cardiometabolic risk factors, those whose mothers had folic acid levels above the median had 40% lower odds of elevated childhood systolic blood pressure. These associations did not differ appreciably in analyses restricted to African Americans, and they were not explained by gestational age, size at birth, child postnatal folate levels or breastfeeding.

“Our study adds further evidence on the early life origins of high blood pressure,” said Dr. Xiaobin Wang, the study’s senior corresponding author. “Our findings raise the possibility that early risk assessment and intervention before conception and during pregnancy may lead to new ways to prevent high blood pressure and its consequences across lifespan and generations.”


Story Source:

Materials provided by Oxford University Press USA. Note: Content may be edited for style and length.


Journal Reference:

  1. Hongjian Wang, Noel T. Mueller, Jianping Li, Ninglin Sun, Yong Huo, Fazheng Ren, Xiaobin Wang. Association of Maternal Plasma Folate and Cardiometabolic Risk Factors in Pregnancy with Elevated Blood Pressure of Offspring in Childhood. American Journal of Hypertension, 2017; DOI: 10.1093/ajh/hpx003

Cite This Page:

Oxford University Press USA. “High folic acid level in pregnancy may decrease high blood pressure in children.” ScienceDaily. ScienceDaily, 8 March 2017. <www.sciencedaily.com/releases/2017/03/170308081047.htm>.

Researchers find Vitamin B3 beneficial for pregnant women to treat preeclampsia, prevent strokes

Vitamin B3 nicotinamide may help treat pregnant women who suffer from preeclampsia by preventing strokes and in some cases, even stimulating the growth of their fetus, research indicates.

Scientists in Japan and the US have found that vitamin B3 nicotinamide may help treat pregnant women who suffer from preeclampsia by preventing strokes and in some cases, even stimulating the growth of their fetus.

Up to 8% of pregnant women suffer from preeclampsia, a deadly disease characterized by high blood pressure, blood vessel damage, high levels of protein in the urine and fluid retention that causes swelling in the legs and feet. In some cases, preeclampsia is also believed to restrict a fetus’ growth.

Blood pressure-lowering drugs do not improve blood vessel damage. In fact, they reduce blood supply to the babies, which could lead to fetal death.

Until now, the only treatment for preeclampsia-affected pregnant women has been delivery of the baby. Now, researchers at Tohoku University, in collaboration with US scientists, have found that nicotinamide — also referred to as Vitamin B3 — relieves preeclampsia in mouse models. Moreover, they have also discovered that nicotinamide can even improve fetal growth in mothers with preeclampsia.

“We had previously shown that endothelin, a strong vessel narrowing hormone, worsens preeclampsia. But inhibiting the hormone is harmful to the babies,” says Associate Professor Nobuyuki Takahashi of Tohoku University’s Graduate School of Pharmaceutical Sciences, who co-led the study.

“In contrast, nicotinamide is generally safe to mothers and babies, corrects the blood vessel narrowing effect of endothelin, and reduces stress to the babies. Accordingly, we evaluated the effects of nicotinamide using two mouse models of preeclampsia caused by different mechanisms.”

The researchers concluded that nicotinamide is the first safe drug that lowers blood pressure, reduces urine protein and alleviates blood vessel damage in preeclampsia-affected mice. The researchers went on to show that in many cases, nicotinamide also prevents miscarriage, prolongs pregnancy period and improves the growth of the babies in mice with preeclampsia.

“Nicotinamide merits evaluation for preventing and treating preeclampsia in humans,” says Oliver Smithies, a Weatherspoon Eminent Distinguished Professor at the University of North Carolina at Chapel Hill. Smithies is a Nobel Laureate in Physiology or Medicine, and co-leader of this study.

The research team hopes that if the treatment works in humans, nicotinamide could help treat preeclampsia and prevent fetal growth restriction associated with the disease in pregnant women.

Journal Reference:

  1. Feng Li, Tomofumi Fushima, Gen Oyanagi, H. W. Davin Townley-Tilson, Emiko Sato, Hironobu Nakada, Yuji Oe, John R. Hagaman, Jennifer Wilder, Manyu Li, Akiyo Sekimoto, Daisuke Saigusa, Hiroshi Sato, Sadayoshi Ito, J. Charles Jennette, Nobuyo Maeda, S. Ananth Karumanchi, Oliver Smithies, Nobuyuki Takahashi. Nicotinamide benefits both mothers and pups in two contrasting mouse models of preeclampsia. Proceedings of the National Academy of Sciences, 2016; 113 (47): 13450 DOI: 10.1073/pnas.1614947113

Read this article on Science daily:  “Potential treatment for pregnant women who suffer from preeclampsia found in a vitamin.” ScienceDaily. ScienceDaily, 19 December 2016. <www.sciencedaily.com/releases/2016/12/161219100556.htm>.