healthy pregnancy

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.

Breastfeeding after a C-section may help manage pain

Breastfeeding after a cesarean section (C-section) may help manage pain, with mothers who breastfed their babies for at least 2 months after the operation three times less likely to experience persistent pain compared to those who breastfed for less than 2 months, according to new research being presented at this year’s Euroanaesthesia Congress in Geneva (3-5 June).

C-sections account for around a quarter of all births in the UK, USA, and Canada. Chronic pain (lasting for more than 3 months) after C-section affects around 1 in 5 mothers. It is widely accepted that breast milk is the most important and appropriate nutrition in early life, and WHO, the UK Department of Health, and US Department of Health and Human Services all recommend exclusive breastfeeding up to 6 months of age. But until now, little has been known about the effect of breastfeeding on a mother’s experience of chronic pain after C-section.

The study, by Dr Carmen Alicia Vargas Berenjeno and colleagues from the Hospital Universitario Nuestra Señora de Valme in Sevilla, Spain, included 185 mothers who underwent a C-section at the hospital between January 2015 and December 2016. Mothers were interviewed about breastfeeding patterns and the level of chronic pain at the surgical site in the first 24 and 72 hours after C-section, and again 4 months later. The researchers also looked at the effect of other variables on chronic pain including surgical technique, pain in the first 24-72 hours, maternal education and occupation, and anxiety during breastfeeding.

Almost all (87%) of the mothers in the study breastfed their babies, with over half (58%) reporting breastfeeding for two months or longer. Findings showed that around 1 in 4 (23%) of the mothers who breastfed for two months or less still experienced chronic pain in the surgical site 4 months post-op compared to just 8% of those who breastfed for 2 months or longer. These differences were notable even after adjusting for the mother’s age. Further analysis showed that mothers with a university education were much less likely to experience persistent pain compared to those who were less well educated. The researchers also found that over half (54%) of mothers who breastfed reported suffering from anxiety.

The authors conclude: “These preliminary results suggest that breastfeeding for more than 2 months protects against chronic post-cesarean pain, with a three-fold increase in the risk of chronic pain if breastfeeding is only maintained for 2 months or less. Our study provides another good reason to encourage women to breastfeed. It’s possible that anxiety during breastfeeding could influence the likelihood of pain at the surgical site 4 months after the operation.”

The authors are currently analyzing additional data from women interviewed between November 2016 to January 2017, which, when combined with data from all the other women, shows that anxiety is associated with chronic post Cesarean pain in a statistically significant way.


Story Source:

Materials provided by ESA (European Society of Anaesthesiology). Note: Content may be edited for style and length.


Read this article on Science Daily: (European Society of Anaesthesiology). “Breastfeeding may protect against chronic pain after Caesarean section.” ScienceDaily. ScienceDaily, 4 June 2017. www.sciencedaily.com/releases/2017/06/170604115807.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.

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>.

A Mother’s High-fat and Sugar Diet Now Thought to Affect Generations

Dr. Lela Emad of the Women’s OB/GYN Medical Group shares some insight into a recent study pertaining to maternal nutrition and how a mother’s poor diet may predispose children to obesity

A new study from Washington University School of Medicine in St. Louis points to the likelihood that a mother’s high-fat, high-sugar diet can impact not just immediate offspring with genetic abnormalities and chronic health conditions, but as many as three generations into the future.

According to results of this research, regardless of whether offspring of an overweight mother opt to consume healthy diets themselves – their lifetime heath will be affected with potentials for obesity-related conditions such as heart disease and diabetes. The unique factor in this study revealed that even before becoming pregnant, a woman’s lifelong obesity can cause health issues for future generations. Researchers say that this study should serve as a wake-up call for U.S. women of child-bearing age as more than two-thirds are currently overweight or obese.

“Findings such as these help to point out that eating a healthy diet every day as well as during pregnancy is one of the best things women can do for themselves and their baby,” says Dr. Lela Emad of Women’s OB/GYN Medical Group in Santa Rosa, California.

When Eating for Two is Too Much

The amount of weight a woman should gain during pregnancy depends on what her body mass index (BMI) was before becoming pregnant. As a general rule, pregnant women need to consume more protein and calcium, take appropriate vitamins and mineral supplements (folic acid and iron in particular), and consume more calories.

But eating better doesn’t necessarily mean over-eating. Women who start off at a healthy weight need to consume only about 340 extra calories a day during the second trimester and about 450 extra calories per day during the third trimester. Women who are underweight or overweight at the beginning of pregnancy require some adjustment to the average, depending on individual weight gain goals. Consulting with an OB/GYN healthcare provider is the best way to determine projections for healthy weight gain during pregnancy.

“Obviously, the food a mother consumes while pregnant is the baby’s main source of nutrition. And by making healthy lifelong food choices combined with an eye toward eating nutritiously during pregnancy a woman can have a positive impact on her baby’s health as well as potentially; her grandchildren’s children,” points out Dr. Emad.

Women who are overweight or obese before pregnancy are also expected to gain a certain amount of weight during pregnancy, but according to recent studies – women who are obese can safely gain less weight than the guidelines recommend. A healthcare provider will determine what’s best for each case and will also help manage weight throughout pregnancy.

Overweight Mothers Are at Risk

In addition to affecting the health of a baby, women who are overweight before pregnancy are also at an increased risk of developing various pregnancy complications, including gestational diabetes and high blood pressure.  According to the Centers for Disease Control and Prevention pregnant women who are obese are more susceptible to complications including preeclampsia, GDM, stillbirth and cesarean delivery. CDC research shows that obesity during pregnancy is associated with an increase in the need for healthcare services, and can result in longer hospital stays for delivery. But the good news is; overweight women who lose weight before pregnancy are much more likely to have healthier pregnancies.

According to Dr. Emad, when women are thinking about having a baby it is best to begin making healthy lifestyle changes at least one full year prior to trying to get pregnant. This process improves the chances of becoming pregnant sooner and prepares a woman’s body to provide the best environment for her infant – nutrition, exercise and a healthy weight are all key factors in planning ahead. “Eating nutritiously is a good choice for any woman to make, but particularly important for a woman who is considering having a baby – one that can potentially impact the health of her family for generations to come,” says Dr. Emad.

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 our website.