21.8% Of Pregnant White Women Smoke

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Main Category: Pregnancy / Obstetrics
Also Included In: Alcohol / Addiction / Illegal Drugs
Article Date: 13 May 2012 - 8:00 PDT


According to a study by the Substance Abuse and Mental Health Services Administration (SAMHSA), 21.8% of pregnant white women between the ages of 15 to 44 years smoked cigarettes within the past 30 days, which is considerably higher compared with the smoking levels amongst pregnant Black women (14.2%) and pregnant Hispanic women (6.5%) within the same age range.

The report also showed that the rate of pregnant black women who took illicit drugs within the past 30 days was significantly higher, with 7.7% compared with 4.4% of white pregnant women, and 3.1% of Hispanic pregnant women.

Alcohol use within the last 30 days is comparable amongst pregnant black and white women - 12.8% and 12.2 % respectively - yet these levels were considerably higher than the rate among pregnant Hispanic women (7.4%). Pregnant Hispanic women between the ages of 15 to 44 years were overall less likely to drink alcohol and smoke cigarettes in comparison with those who were black or white.

SAMHSA Administrator Pamela S. Hyde commented:

"When pregnant women use alcohol, tobacco, or illicit substances they are risking health problems for themselves and poor birth outcomes for their babies. Pregnant women of different races and ethnicities may have diverse patterns of substance abuse. It is essential that we use the findings from this report to develop better ways of getting this key message out to every segment of our community so that no woman or child is endangered by substance use and abuse."

To address problems of substance abuse amongst pregnant women, the SAMHSA's Fetal Alcohol Spectrum Disorders (FASD) Center for Excellence sponsors a number of state-of-the-art programs that implement evidence-based interventions that have already assisted pregnant women in leading healthier life-styles and improving their children's health. The programs include: Screening and Brief Intervention (SBI) - Helps identify and provide assistance to those who need treatment. It uses a simple written assessment of alcohol use and a 10-15 minute intervention with pregnant women who report drinking. Project CHOICES - Caters for women who are at risk of having an alcohol-exposed pregnancy before they become pregnant by providing information and help. Parent-Child Assistance Program (P-CAP) - The program uses an intensive paraprofessional home visitation model to reduce risk behaviors in women with substance abuse problems over a three-year period.Written by Petra Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today Visit our pregnancy / obstetrics section for the latest news on this subject. "Substance Use during Pregnancy Varies by Race and Ethnicity"
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posted by Booboo on 13 May 2012 at 8:55 am

More fear mongering to scare people with. Lets think about this a bit. Who would admit to smoking while pregnant in todays paranoid society? I know I wouldn't. Not a word. No one even knows that I smoke and I have never even been pregnant. Keep it silent and dark about smoking until the attitudes change again, and they will

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'21.8% Of Pregnant White Women Smoke'

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Pre-Pregnancy Obesity Linked To Lower Test Scores In Offspring

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Main Category: Obesity / Weight Loss / Fitness
Also Included In: Pregnancy / Obstetrics
Article Date: 10 May 2012 - 1:00 PDT


Women who are obese before they become pregnant are at higher risk of having children with lower cognitive function - as measured by math and reading tests taken between ages 5 to 7 years - than are mothers with a healthy pre-pregnancy weight, new research suggests.

In this large observational study, pre-pregnancy obesity was associated, on average, with a three-point drop in reading scores and a two-point reduction in math scores on a commonly used test of children's cognitive function.

Previous research has suggested that a woman's pre-pregnancy obesity can have a negative effect on fetal organs, such as the heart, liver and pancreas. Because fetal development is rapid and sensitive to a mother's physiological characteristics, Ohio State University researchers sought to find out whether a mother's obesity also could affect the fetal brain.

"One way you measure the effects on the brain is by measuring cognition," said Rika Tanda, lead author of the study and a doctoral candidate in nursing at Ohio State.

The research also supported findings in previous studies suggesting that several other conditions affect childhood cognition, including how stimulating the home environment is, family income and a mother's education and cognitive skills.

"The new piece here is we have a measure associated with the fetus's environment to add to that set of potential risk factors," said Pamela Salsberry, senior author of the study and a professor of nursing at Ohio State. "If we have a good way to understand the risks each child is born with, we could tailor the post-birth environment in such a way that they could reach their maximum capabilities."

The research appears online and is scheduled for future print publication in the Maternal and Child Health Journal.

The researchers used data from the National Longitudinal Survey of Youth (NLSY) 1979 Mother and Child Survey, a nationally representative sample of men and women who were 14-21 years old in December 1978. From that dataset, Tanda collected information on 3,412 children born to NLSY mothers who had been full-term births, were between 5 and almost 7 years old at the time of their interview and who had no diagnosed physical or cognition problems.

In addition to documenting a number of characteristics about the mothers and the family environment, the researchers gauged the children's cognitive function based on their performance on Peabody Individual Achievement Test reading recognition and math assessments.

The researchers calculated the mothers' body mass index (BMI) based on their reported heights and weights. More than half of mothers had normal BMIs before pregnancy, and 9.6 percent were obese, meaning they had a BMI of 30 or higher.

Controlling for all other variables, the analysis showed that maternal pre-pregnancy obesity was negatively associated with math and reading test scores. Children of obese women scored, on average, three points lower on reading and two points lower on math than did children of healthy-weight women. The mean reading score among all the children was 106.1 points and the mean math score was 99.9.

Though the score differences seem small, Tanda noted that these effects of pre-pregnancy obesity were equivalent to a seven-year decrease in the mothers' education and significantly lower family income, two other known risk factors that negatively affect childhood cognitive function.

Tanda said clinicians could use these findings to help encourage women patients of childbearing age to maintain a healthy weight, especially if they plan to get pregnant.

"This is a large population study, so at the individual level we can't say that one person's decision to change her weight will change her child's outcome," she said. "But these findings suggest that children born to women who are obese before pregnancy might need extra support."

Added Salsberry, "It's not only for their child's sake. It's also important for the health of the mother. But it is important to understand that maternal obesity during pregnancy could have implications for their children as well."

Without actual measures of women's and fetuses' insulin levels, inflammation and blood sugar readings, scientists can't say for sure how pre-pregnancy obesity might affect the fetal brain. But previous studies have suggested that a mother's impaired metabolic processes affect the fetal brain cell growth and formation of synapses.

The researchers also noted that obesity doesn't automatically equate to unhealthy.

"There may be two obese moms that in fact have very different metabolic profiles. For the purposes of this study, her weight is a stand-in for biological data that we would like to have but don't," Salsberry said.

Socioeconomic data from the study supported previous findings that several post-birth conditions can have a positive association with higher children's test scores. These include a stimulating home environment with plenty of books, a safe play environment and frequent family meals; higher family income; and higher maternal education levels and cognitive function. Girls and first-born children also performed better on the math and reading tests than did boys and younger siblings.

With all these data combined, Tanda said, the study also reveals how health disparities can have long-lasting effects.

"Young females who grow up poor, who have less access to healthy foods resulting in diets that are of poorer quality, are at higher risk of having children with disadvantages and repeating this cycle," she said.

The researchers are continuing to examine additional influences on childhood cognition, including race, sex and age differences among mothers.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our obesity / weight loss / fitness section for the latest news on this subject. This study was supported by a grant from the Ruth L. Kirschstein National Research Service Award predoctoral fellowship sponsored by the National Institute of Nursing Research.
Additional co-authors included Patricia Reagan and Muriel Fang of Ohio State’s Department of Economics and the Center for Human Resource Research.
Written by Emily Caldwell
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Researchers Uncover Important Clues To A Dangerous Complication Of Pregnancy

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Main Category: Pregnancy / Obstetrics
Also Included In: Cardiovascular / Cardiology;  Heart Disease
Article Date: 11 May 2012 - 0:00 PDT


Peripartum cardiomyopathy, a form of heart failure that by definition develops late in pregnancy or shortly after delivery, results in a frightening turn of events that can leave new mothers suffering from a lifelong chronic heart condition.

Now, a research team led by investigators at Beth Israel Deaconess Medical Center (BIDMC) has uncovered important new clues behind this dangerous condition, providing the first clear evidence that peripartum cardiomyopathy (PPCM) is a vascular disease, brought about by an imbalance of angiogenic proteins in the heart during the peripartum period, just prior to and immediately following delivery.

Described in the Advance On-Line issue of the journal Nature, the findings also explain the underlying mechanisms of PPCM, helping to explain why preeclampsia and multiple births are risk factors and suggesting that proangiogenic therapies may be beneficial treatments.

PPCM affects approximately one in 3,000 pregnant women with no known history of heart disease. Symptoms can be mild or severe, and include shortness of breath, caused by the heart's diminished pumping ability. About one-half of women who develop PPCM will spontaneously recover, but for others, the condition will grow worse, even to the point that they require a heart transplant.

"It's been a real mystery," says senior author Zoltan Arany, MD, PhD, an investigator in the CardioVascular Institute at BIDMC and Assistant Professor of Medicine at Harvard Medical School. "The majority of women who develop this condition are otherwise healthy, even active. We know that the real stressors of pregnancy occur in the first trimester. Why then, are these mothers-to-be developing such serious problems at the end of pregnancy? We think we have now come up with a number of important insights into this life-threatening condition."

Through a series of experiments in both animal models and humans, the authors made a number of important discoveries that add up to a strong argument that PPCM is a "two-hit" disease that develops when, first, signals released late in pregnancy to prevent normal blood vessel growth are excessively elevated and, second, for unknown reasons, proangiogenic defenses are insufficient.

Angiogenesis, the process by which new blood vessels grow and develop, can be turned on by a gene called PGC1-alpha, which is a primary focus of research in the Arany laboratory. It was while studying this molecule in heart muscle that the investigation first unfolded.

"We had recently demonstrated that PGC1-alpha could regulate blood vessel density in skeletal muscle," explains Arany. "As we pursued experiments to determine if this was also the case in heart muscle, we made the observation that female mice lacking PGC1-alpha in their hearts invariably died after one or two pregnancies and that the animals' hearts were enlarged and fibrotic. We realized that the mice had developed peripartum cardiomyopathy and that we now had a model of the disease."

The team went on to treat their newly created PPCM knockout mice with vascular endothelial growth factor (VEGF) ,a protein that promotes the growth and health of small blood vessels. Because multiple pathways were affected, the scientists additionally inhibited another anti-angiogenic pathway mediated by the hormone prolactin, which is secreted by the pituitary gland to stimulate mothers' milk production. As predicted, the two actions together resulted in improved heart health in the PPCM mice.

"This told us that PPCM is indeed a vascular disease, something that was previously not appreciated," says Arany. "But our next question was, 'What is triggering this vascular disease in pregnancy?'"

It is known that at the end of a normal pregnancy, large quantities of antiangiogenic factors are secreted to help prevent excessive bleeding as the placenta is delivered, severing the extensive vascular network between mother and fetus. Previous work by study coauthor S. Ananth Karumanchi, MD, a Howard Hughes Medical Institute investigator in the Center for Vascular Biology Research at BIDMC, had established that pregnant women with preeclampsia have markedly increased levels of sFLT1 released by the placenta and that this anti-angiogenic molecule is responsible for narrowed blood vessels and the subsequent rise in blood pressure and accompanying symptoms that characterize the condition.

Arany's team thought that these same agents might be affecting the blood vessels of the heart and to test whether antiangiogenic factors might also be responsible for PPCM, the investigators brought their investigation back into the human setting and looked at women with preeclampsia.In collaboration with several members of BIDMC's Department of Obstetrics and Gynecology, led by co-first author Sarosh Rana, MD, Arany conducted an echocardiographic study to examine the cardiac function of preeclampsia patients and found that the women did exhibit asymptomatic sub-clinical dysfunction in their hearts.

"This strongly supported the idea that PPCM can be induced by excess anti-angiogenic signaling, including the high expression of SFLT1 during late pregnancy," explains Arany.

Subsequently, when SFLT1 was delivered to mice, the PGC1-alpha knockout mice developed profound cardiac failure within only three weeks. Wild-type mice also showed significant (though less extensive) decreases in vascular density and cardiac function after the same length of exposure. The authors also conducted an extensive literature review exploring the relationship between preeclampsia and PPCM, with results showing a significant overlap between the two.

"The last thing we did," says Arany, "was to analyze, in collaboration with Dr. Hilfiker-Kleiner in Germany, 30 or 40 blood samples of women who were diagnosed with PPCM. In about half of these samples, we found markedly elevated levels of antiangiogenic factors."

The study has harnessed significant causal evidence and arrived at a powerful argument that PPCM is a two-hit disease, with the first hit being the anti-angiogenic environment of late pregnancy and the second hit being something as yet undiscovered that leaves women susceptible to cardiac damage, possibly an infection or genetic predisposition.

"PPCM is a common cause of maternal morbidity and mortality," says Uri Elkayam, MD, Professor of Medicine and of Obstetrics and Gynecology at the University of Southern California. "This elegant study confirms and provides a potential mechanistic explanation for the strong association between PPCM and preeclampsia. These findings should help to eliminate existing confusion among clinicians regarding these two conditions and prevent underdiagnosis of PPCM in patients with preeclampsia."

"Going forward, we want to find out why some women's hearts can handle the wave of anti-angiogenic factors that they encounter in late pregnancy and some women can't," note Arany. " This is really a whole new way to think about peripartum cardiomyopathy, and while we still have a lot to learn, I think we are now closer to understanding, and maybe even treating, this devastating disease."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our pregnancy / obstetrics section for the latest news on this subject. This study was supported, in part, by the National Heart, Lung, Blood Institute, Howard Hughes Medical Institute, the Smith Family Foundation, the Ellison Medical Foundation, the March of Dimes Foundation and the Harvard Stem Cell Institute as well as support from a Harvard Faculty Development and Diversity Award, a John Hedley White grant, a Merck Fellowship and Harvard Catalyst, the Clinical and Translational Science Center.
Study coauthors include BIDMC investigators Ian S. Patten and Sarosh Rana (co-first authors), Sajid Shahul, Glenn C. Rowe, Cholsoon Jang, Laura Liu, Michele R. Hacker, Julie S. Rhee, John Mitchell, Feroze Mahmood, Phil Hess, Caitlin Farrell, Nicole Koulisis, Eliyahu V. Khankin, Suzanne D. Burke, Federica del Monte and S. Ananth Karumanchi; and Igor Tudorache, Johann Bauersachs and Denise Hilfiker-Kleiner of Medizinische Hochschule Hannover, Germany.
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Pregnancy Rates And Cost Per Pregnancy Improve Linked To Weight Loss Intervention

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Main Category: Pregnancy / Obstetrics
Also Included In: Obesity / Weight Loss / Fitness
Article Date: 09 May 2012 - 11:00 PDT


At the 19th European Congress on Obesity in Lyon, France, the annual meeting of the European Association for the Study of Obesity, Dr Kyra Sim from The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders at the University of Sydney in Australia presented a new study, which shows that weight loss intervention in obese women who undergo fertility treatment substantially improves their chance of pregnancy and other health indicators, whilst also saving substantial costs per achieved pregnancy.

The study is the first to evaluate the economic value of the impact of women's weight loss strategies on fertility treatment. The randomized controlled trial involved 49 women aged 37 years or younger, with an average BMI of = 30 kg/m2, who were in an assisted reproductive technology program.

The researchers randomized 27 women to a 12-week intervention, consisting of a very-low-energy diet for the first six weeks, after which the women went on a low-energy diet combined with a weekly group multidisciplinary program. The other 22 women in the control group received recommendations for weight loss and the same printed material. The researchers measured multiple parameters at baseline and at 12 weeks. Follow up was at 12 months to confirm whether a pregnancy had occurred.

The findings demonstrated the women in the intervention group registered an average weight loss of 6.6 kg, with a 9 cm waistline reduction compared with those in the control group who lost 1.8 kg on average with a 1 cm reduction in waist circumference. The results also showed that pregnancy rates were significantly improved amongst those in the intervention group with 48% compared to 14% in the control group.

The number of assisted reproductive cycles needed to become pregnant was also less amongst the intervention group, together with a decline in maternal and fetal risk factors. The researchers also noted that the intervention group showed metabolic, hormonal and psychological improvements. The intervention saved US$9360 (AU$9,035 - EUR€6,900 - GBP5865) per pregnancy.

Dr Sim states that the study highlights the significance of implementing a program of preconception weight management together with providing specific information about the maternal and fetal risks of obesity in pregnancy, and concludes:

"A weight-loss intervention, incorporating dietary, exercise and behavioral components, is associated with significantly better pregnancy and economic outcomes in a group of obese women undergoing assisted reproductive technology."

Written By Petra Rattue
Copyright: Medical News Today
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'Pregnancy Rates And Cost Per Pregnancy Improve Linked To Weight Loss Intervention'

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What Is The Best And Worst Place To Be A Mother Worldwide?

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Main Category: Pregnancy / Obstetrics
Also Included In: Aid / Disasters;  Pediatrics / Children's Health;  Nutrition / Diet
Article Date: 09 May 2012 - 14:00 PDT


According to Save the Children's 13th State of the World's Mothers report, Norway is the best place to be a mother in the entire world, and Niger is the worst, overtaking Afghanistan, which for the last two years was classified as the worst place to be a mother. The U.S, as of now, is ranked number 25.

For their study, Save the Children compared 165 countries around the world to determine which ones were the best and worst places to to be a mother. They analyzed certain components to come to their conclusions, such as education, economic status, mother's health, children's health and nutrition.

Carolyn Miles, President and CEO of Save the Children commented:

"While the U.S has moved up in the rankings, ahead of last year's 31st place, we still fall below most wealthy nations. A woman in the US is more than 7 times as likely to die of a pregnancy-related cause in her lifetime than a woman in Italy or Ireland. When it comes to the number of children enrolled in preschools or the political status of women, the United States also places in the bottom 10 countries of the developed world."

The State of the World's Mothers Report says that nutrition is one of the main reasons why mothers and children are either better or worse off in a certain country. They say that more than one fifth of maternal mortality and more than one third of child mortality is a result of malnutrition.

Norway is the best place to be a mother, Afghanistan is the worst

Of the 10 countries which are found at the bottom of this year's list by Save the Children, 7 are in the middle of a food crisis, and 4 have experienced an increase in "stunting", which is described as a child's mental and physical growth permanently stopping.

Niger, in last place on the list, is going through a severe hunger problem, which as a result, is putting millions of children's lives at stake.

In the report, researchers say that these ongoing problems may be due to a repetitive cycle, one which involves "stunted" mothers continuing to have babies who are underweight and malnourished before birth. This is usually due to the mother's lack of education, poor work conditions and bad health, which then results in lack-luster care towards the child.

According to Save the Children, 20% of women in sub-Saharan Africa, and 35% of women in South Asia are malnourished and too thin.

To break the cycle of malnutrition amongst babies and mothers, the report suggests focusing on the first 1000 days - beginning from pregnancy.

Miles comments:

"The 2012 State of the World's Mothers report shows clearly that this crisis os chronic malnutrition has devastating effects on both mothers and their children. We urgently need global leadership on the malnutrition issue, so that policies and programs are put in place to ensure the health and survival of mothers and their babies."

In two weeks, G8 leaders will come together at Camp David, where president Obama will be focusing on agriculture and food, and Save the Children and The World's Mothers report believes more focus on nutrition is necessary to end this global crisis.

Save the Children also says that the small task of urging mothers to breastfeed could be responsible for saving 1 million children's lives each year. However, the 2012 State of the World's Mothers report states that not even 40% of all babies in developed nations actually get full benefits from breastfeeding. They say this is because of certain nations not having access to informative programs which help mothers to exclusively breastfeed.

Miles continues:

"Our research shows that a mother's breast milk - one single nutrition intervention - can save a million children's lives each year. All mothers should have the support they need to choose to breastfeed if they want to. Breastfeeding is good for babies no matter where they live, but in developing countries, especially those without access to clean water, breastfeeding can be a matter of life or death."

Policy Recommendations: The G8 nations deliver bold commitments to tackle the global hidden crisis of chronic malnutrition that is blighting the lives of millions of mothers and children.All health authorities and governments make fighting malnutrition a priority, setting targets for their own countries and around the world.Low- and middle-income country governments should scale up nutrition programs around the first 1000 days, from a mother's pregnancy to the child's second birthday.The governments of developing countries must commit and fund national nutrition plans of action - including breastfeeding - that are aligned with plans for maternal and child health.Countries that donate resources should continue to keep their commitments to deliver their international assistance budgets, so that governments can continue to invest in global health and development, including nutrition.Written By Christine Kearney
Copyright: Medical News Today
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posted by Andreas Richardson on 9 May 2012 at 3:20 pm

I wish studies like these would stop comparing a country with the landmass, population and cultural diversity of the U.S. with countries no bigger than some of our states. First, the assumption that quality of life in California or New York is the same as that in Alabama or Arkansas offends me slightly and does a disservice to everyone involved. Secondly, it more or less makes the results of the study worthless. Parts of the U.S. would top this list and others would fall even lower. I don't understand the point of lumping all 50 states together when a finer grained approach would give a more edifying look into the subject.

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posted by Lisa S. on 9 May 2012 at 3:07 pm

It is striking that the American-based Save the Children spokesperson reports here that the reason behind dismal records of maternal and infant mortality lie in nutrition (specifically mentioning breastfeeding, as well), and reports that "the day a baby is born is the most dangerous day in their life," citing lack of health care attendant for that poor statistic.

These statements are striking because they divert attention from the fact that Americans continually hold maternal and infant health in the hands of the mothers themselves (obesity, poor prenatal care, etc.) and lack of breastfeeding, when our intervention rates, highly medicalized, bureaucratic birth practices, and lack of support of breastfeeding (see need book titled Breasts for latest on this).

I am so tired of living in a supposed democracy that uses century-old tactics to instill fear in mothers at birth, and then blames them for their lack of involvement in the birth. Please, "the most dangerous day of their life?" Maybe so, if they are born in America. I resent the media for not double-checking the statistics before releasing such opinionated poppycock as facts from so-called experts, before airing a story.

This type of journalism with its "West is Best" attitude is what perpetuates the myths that support medicalized birth, at the expense of losing any advantages that are to be gained from less intervention. We are highest among developed nations in C-sections, preterm babies, infant mortality, and other non-flattering statistics--and the best we can come up with is, "well, at least we're not Afghanistan?" When will we see the connections among high intervention rates, C-sections, and poor outcomes. Studies are coming out connecting C-sections to poor lung development, and unnecessary pre-term deliveries...wake up, America. It's not 1950 anymore. Not all qualified, skilled birth attendants wear white coats and stethoscopes, bearing medical school degrees.

Surgeons are not always the BEST, nor certainly the STANDARD of care. Quite making a false relationship between M.D.-deliveries and good mother getting the best of care. Strive for mothers all around the world being attended by skilled attendants? Yes. Defining the skills of those attendants based on our hegemonic practices here in the US? No.

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posted by Lyle Ernst on 9 May 2012 at 2:29 pm

Where are the standings of best country for mothers? this is a very brief article on an extremely important issue.

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'What Is The Best And Worst Place To Be A Mother Worldwide?'

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New Study Shows The Hormone Adrenomedullin Plays Significant Role In Tubal Ectopic Pregnancies

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Article Date: 07 May 2012 - 0:00 PDT


Tubal ectopic pregnancy (TEP) is currently the leading cause of pregnancy-related deaths during the first trimester and a recent study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM) shows that the hormone adrenomedullin (ADM) may help predict this condition.

TEP is a condition where the fertilized egg implants in the fallopian tubes instead of in the uterus. In pregnant women, cilia (small protuberances) pulsate, or beat, to propel an embryo through the fallopian tubes towards the uterus. Defects in ciliary beats and muscle contractions may predispose a woman to TEP. With rare exceptions, ectopic pregnancies are not viable, and they are also dangerous for the mother and without proper treatment, can lead to death.

"This is the first report to address the effect of ADM on cilia beat frequency and muscular contraction in the oviduct," says the lead author of this study, Wai-Sum O, PhD, of the University of Hong Kong. "We found that low ADM expression may contribute to slower muscle contraction and ciliary beating, which hampers embryo transport and favors embryo retention in the oviduct. This finding is significant because plasma ADM levels may be useful in predicting TEP."

In this study, researchers examined women who were having their fallopian tubes removed or were having a hysterectomy for non-cancerous reasons. Each participant had tissue from their oviduct incubated in conditions to replicate the hormonal state of early pregnancy. In the oviducts of patients who had TEP, the ciliary beats were slower, the muscle contractions were less frequent, and there were lower levels of ADM than in the oviducts from a normal pregnancy. Administering ADM reversed the retardation of ciliary beating and muscle contraction and restored them to normal levels.

"We reported for the first time a significantly reduced expression of ADM in human oviduct tissue in TEP compared to control," said O. "ADM increases cilia motility, smooth muscle tone and contraction frequency, and the reduced ADM level in TEP may contribute to its pathogenesis by impairing embryo transport."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our pregnancy / obstetrics section for the latest news on this subject. Other researchers working on the study include: Liao SB, Li HWR, Ho JC, Yeung WSB, Ng EHY, Cheung ANY, and Tang F, all of The University of Hong Kong.
The article, "Possible role of adrenomedullin in the pathogenesis of tubal ectopic pregnancy," appears in the June 2012 issue of JCEM.
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Guidelines For Management Of Lupus Nephritis Issued By The American College Of Rheumatology

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Main Category: Lupus
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Article Date: 07 May 2012 - 0:00 PDT


The American College of Rheumatology (ACR) has issued newly created guidelines for the screening, treatment, and management of lupus nephritis - a severe manifestation of systemic lupus erythematosus (SLE) where the disease attacks the kidneys. Previously, only general guidelines for SLE existed for clinicians. The guidelines, available in Arthritis Care & Research, are specific to lupus nephritis and include methods for identifying renal disease, newer therapies, and treatment of pregnant SLE patients with kidney involvement.

The ACR estimates that up to 322,000 adult Americans are diagnosed with SLE, a chronic autoimmune disease that causes inflammation, fatigue, joint pain, and organ damage. Lupus nephritis is one of the most serious complications of SLE where inflammation of the kidney could lead to renal failure. Medical evidence suggests that 35% of adults in the U.S. have evidence of nephritis at the time of SLE diagnosis, and up to 60% develop kidney involvement during the first 10 years with the disease.

Furthermore, previous studies report that patient survival is reduced to 88% at 10 years when lupus nephritis is present, and that survival rate is even lower for African Americans. "Lupus nephritis can be life-threatening, and proper management of the disease is vital to prevent permanent organ damage and preserve quality of life for patients," explains one of the lead guideline contributors, Dr. Bevra Hahn, Professor of Medicine at the University of California, Los Angeles (UCLA). "Given the serious threat of kidney involvement in SLE and the availability of newer therapies, it was necessary to create specific guidelines for managing the care of patients with lupus nephritis."

To establish the 2012 lupus nephritis guidelines, investigators reviewed medical literature from 1966 through 2010 for all evidence pertaining to "lupus kidney disease." Three panels of researchers were involved with reviewing the data and producing the recommendations that include: Advising renal biopsy (in previously untreated patients with active nephritis) Adjunctive treatment (background therapy with hydroxychloroquine, ACE inhibitors, control of blood pressure to goal of 130/80 or lower for almost all SLE patients with nephritis) Induction of improvement in patients
with ISN Class III/IV lupus glomerulonephritis
with Class IV or IV/V plus cellular crescents
with Class V "pure membranous" lupus nephritis Maintaining improvement in patients responsive to induction therapy (with azathioprine or mycophenolate mofetil) Changing therapies in patients not adequately responsive to induction therapy Identifying vascular disease in SLE patients with renal abnormalities Treating nephritis in pregnant patients Despite the availability of new therapeutics, studies have shown an increase in the incidence of end-stage renal disease from lupus over the past twenty years, with specific increases in young patients, African Americans, and in the southern U.S. "We look forward to seeing a reduction in these trends with implementation of these guidelines as part of high-quality, comprehensive care for SLE patients," said Dr. Hahn.

The authors acknowledge that the guidelines are limited by the absence of agreed terms for remission, flare and response, and limited data to inform recommendations for steroid dosing and tapering of immunosuppressive therapies. Dr. Hahn concludes, "Ongoing evaluation and expansion of the guidelines is necessary to further improve outcomes for patients with SLE and nephritis."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our lupus section for the latest news on this subject. Full citation: : "American College of Rheumatology Guidelines for Screening, Treatment, and Management of Lupus Nephritis." Bevra H. Hahn, Maureen McMahon, Alan Wilkinson, W. Dean Wallace, David I. Daikh, John Fitzgerald, George Karpouzas, Joan T. Merrill, Daniel J. Wallace, Jinoos Yazdany, Rosalind Ramsey-Goldman, Karandeep Singh, Mazdak Khalighi, Soo-In Choi, Maneesh Gogia, Suzanne Kafaja, Mohammad Kamgar, Christine Lau, William J. Martin, Sefali Parikh, Justin Peng, Anjay Rastogi, Weiling Chen, and Jennifer M. Grossman. Arthritis Care & Research; Published Online: May 3, 2012 (DOI: 10.1002/acr.21664).
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Discovery Of First Gene Linked To Missing Spleen In Newborns

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Main Category: Infectious Diseases / Bacteria / Viruses
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Article Date: 07 May 2012 - 1:00 PDT


Researchers at Weill Cornell Medical College and Rockefeller University have identified the first gene to be linked to a rare condition in which babies are born without a spleen, putting those children at risk of dying from infections they cannot defend themselves against. The gene, Nkx2.5, was shown to regulate genesis of the spleen during early development in mice.

The study, published online in Developmental Cell, raises the hope that a simple genetic screening test for Nkx2.5 mutations can be developed that will alert parents that their developing child may be missing the organ, which could then be confirmed with a diagnostic scan.

"The great news is that with the appropriate preventive antibiotic treatment these children will not succumb to fatal infections. This test could potentially save lives," says the study's lead investigator, Dr. Licia Selleri, an associate professor in the Department of Cell and Developmental Biology at Weill Cornell Medical College.

Because defense against infections depends, in part, on the spleen, children known to be born without the organ require treatment with a regimen of antibiotic therapy throughout their lives. But most diagnoses of this condition, congenital asplenia, are made during an autopsy after a child dies, suddenly and unexpectedly, from a rapidly lethal infection, usually from bacteria that causes pneumonia or meningitis, Dr. Selleri says. "For those reasons, we believe this condition is not quite as rare as believed. Not every child who dies from an infection is given an autopsy."

Long search for genetic culprits

Patients with congenital asplenia usually lack a spleen as the sole abnormality, but sometimes have abnormalities of the heart and blood vessels. The majority of those cases arise sporadically, so are not believed to be inherited. One form of this disorder is known as Isolated Congenital Asplenia (ICA), characterized by a spleen that is missing but with no other developmental abnormalities. The cause is believed to be genetic, but no candidate genes in humans had been found before this study.

This research project was a collaboration between Dr. Selleri and her colleagues, and Rockefeller University's Dr. Jean-Laurent Casanova, professor in the St. Giles Laboratory of Human Genetics of Infectious Diseases. Dr. Casanova had led a previous study describing 20 ICA patients, of which most children suffered their first serious infection by age one, and nine died of an invasive pneumonia.

Dr. Selleri has long been studying congenital asplenia in the laboratory using the mouse as a model system and had previously discovered that a transcription factor known as Pbx is the prime regulator of spleen development in mouse models. Dr. Matthew Koss, a recent Ph.D. graduate who had studied in Dr. Selleri's lab, led the effort to create a strain of mice that lacked Pbx in the spleen, and were born without a spleen. He identified a regulatory module that is controlled by Pbx and targets Nkx2.5, a gene downstream of Pbx, in the developing spleen of the mouse embryo. He also discovered that Pbx controls the growth of the spleen by directly regulating the expression of Nkx2.5, which in turn controls cell proliferation within the primitive spleen organ.

Then, in Dr. Casanova's lab, Alexandre Bolze, a graduate student, sequenced genetic samples from ICA patients and analyzed them using whole exome sequencing technology, which allows sequencing of the entire coding genome of multiple patients -- a technique routinely employed by Dr. Casanova. Bolze found that Nkx2.5 was mutated in a family of asplenic patients, some of which died from lethal infections -- confirming the importance of Nkx2.5 in human congenital asplenia as in the mouse model of the disorder.

"This study illustrates the unique strength in using mouse models and human genetics hand-in-hand," says Dr. Selleri. "It demonstrates how genetic pathways identified in mouse models can be exploited to further understand the pathogenesis of human disease towards a better prenatal diagnosis."

She says that other patients and families with this disorder need to be studied in order to develop a comprehensive prenatal test. "It may be that there are other mutations that are acting in concert or independently of Nkx2.5 in other asplenic patients," Dr. Selleri says. Those studies in human patients are currently underway in the Rockefeller University lab, while at the Weill Cornell lab additional studies on mouse models are ongoing.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our infectious diseases / bacteria / viruses section for the latest news on this subject. The research was funded by the National Institutes of Health, the March of Dimes and Birth Defects Foundation, the Associazione Italiana Ricera Cancro, the Marie Curie Foundation and the St. Giles Foundation.
Other co-authors include Dr. Andrea Brendolan, Dr. Matilde Saggese, Dr. Terence D. Capellini and Dr. Ekaterina Bojilova from Weill Cornell Medical College; Dr. Bertrand Boisson from Rockefeller University; Dr. Owen W.J. Prall, Dr. David Elliott, Dr. Mark Solloway and Dr. Richard P. Harvey from the Victor Chang Cardiac Research Institute in Darlinghurst, Australia; Dr. Elisa Lenti from the Fondazione Centro San Raffaele Del Monte Tabor in Milan, Italy; Dr. Chisa Hidaka from the Hospital of Special Surgery; Dr. Ching-Pin Chang from Stanford University School of Medicine; and Dr. Nizar Mahlaoui from Necker Hospital in Paris, France.
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Some Forms Of Assisted Reproduction Increase Risk Of Birth Defects

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Main Category: Fertility
Also Included In: Pediatrics / Children's Health;  Pregnancy / Obstetrics
Article Date: 08 May 2012 - 0:00 PDT


A University of Adelaide study has identified the risk of major birth defects associated with different types of assisted reproductive technology.

In the most comprehensive study of its kind in the world, researchers from the University's Robinson Institute have compared the risk of major birth defects for each of the reproductive therapies commonly available internationally, such as: IVF (in vitro fertilization), ICSI (intracytoplasmic sperm injection) and ovulation induction. They also compared the risk of birth defects after fresh and frozen embryo transfer.

The results were published in the prestigious New England Journal of Medicine, and presented in Barcelona, Spain at the World Congress on Building Consensus in Gynecology, Infertility and Perinatology.

"While assisted reproductive technologies are associated with an increased risk of major birth defects overall, we found significant differences in risk between available treatments," says the lead author of the study, Associate Professor Michael Davies from the University of Adelaide's Robinson Institute and School of Paediatrics and Reproductive Health.

Researchers linked a census of more than 6100 assisted reproductive technology births in South Australia to a registry of more than 300,000 births and 18,000 birth defects. They compared risks of birth defects across all infertility treatments to pregnancies in women with no record of infertility. They also compared successive pregnancies for women.

Previous studies have identified an increased risk of birth defects associated with infertility treatment, but this is the first study to compare all forms of available treatment. This is also the first study to compare pregnancies within women by the treatments received.

"The unadjusted risk of any birth defect in pregnancies involving assisted conception was 8.3% (513 defects), compared with 5.8% for pregnancies not involving assisted conception (17,546 defects)," Associate Professor Davies says.

"The risk of birth defects for IVF was 7.2% (165 birth defects); and the rate for ICSI was higher at 9.9% (139 defects).

"A history of infertility, either with or without assisted conception, was also significantly associated with birth defects. While factors associated with the causes of infertility explained the excess risk associated with IVF, the increased risk for a number of other treatments could not readily be explained by patient factors. ICSI, for instance, had a 57% increase in the odds of major defect, although the absolute size of the risk remained relatively small," he says.

Associate Professor Davies says cryopreservation (freezing) of embryos was associated with a substantially reduced risk of birth defects, particularly for ICSI. "This may be due to developmentally compromised embryos failing to survive the freeze/thaw process," he says.

Also of concern was the tripling of risk in women using clomiphene citrate to stimulate ovulation outside of a closely supervised clinical setting.

"While confined to a small group in our study, this is of particular concern as clomiphene citrate is now very widely available at low cost, and may easily be used contrary to manufacturers' very specific instructions to avoid use if pregnant, as it may cause fetal malformations. This aspect of the study will need additional confirmation from future research," Associate Professor Davies says.

He says the study now needs to be expanded to include more recent years of treatment, as the reproductive technologies have undergone continual innovation which may influence the associated risks of treatment.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our fertility section for the latest news on this subject. Background: World wide, more than 3.7 million babies are born annually as a result of assisted reproductive technology.
Assisted reproduction is usually invasive, expensive, and deals with matters of intense emotional content.
There are several areas of public health interest. These include:
Risks associated with multiple embryo transfer
Risks to the health of the offspring as a result of treatment
Patient mental health as a result of treatment
Long-term social functioning of the offspring born as a result of assisted reproduction.
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Waking Embryos Before They Are Born

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Main Category: Neurology / Neuroscience
Also Included In: Pregnancy / Obstetrics;  Pain / Anesthetics
Article Date: 07 May 2012 - 0:00 PDT


Under some conditions, the brains of embryonic chicks appear to be awake well before those chicks are ready to hatch out of their eggs. That's according to an imaging study published online in Current Biology, a Cell Press publication, in which researchers woke chick embryos inside their eggs by playing loud, meaningful sounds to them. Playing meaningless sounds to the embryos wasn't enough to rouse their brains.

The findings may have implications not only for developing chicks and other animals, but also for prematurely born infants, the researchers say. Pediatricians have worried about the effects of stimulating brains that are still under construction, especially as modern medicine continues to push back the gestational age at which preemies can reliably survive.

"This work showed that embryo brains can function in a waking-like manner earlier than previously thought - well before birth," said Evan Balaban of McGill University. "Like adult brains, embryo brains also have neural circuitry that monitors the environment to selectively wake the brain up during important events."

That waking-like brain activity appears in a latent but inducible state during the final 20 percent of embryonic life, the researchers found. At that point, sleep-like brain activity patterns also emerge.

Before that major dividing line in development - for the first 80 percent of embryonic life - "embryos are in a state that is neither like sleep nor waking," Balaban said. He suggests it may be useful to compare that state to what happens when people are comatose or under the influence of anesthesia.

This entire line of work was made possible by a new generation of molecular brain imagers developed by Balaban's coauthors Juan-José Vaquero and Manuel Desco at the Universidad Carlos III in Madrid. Those state-of-the art machines can detect very small amounts of tracer molecules and pinpoint them to a tiny region of the brain (about 0.7 mm, or less than 3/100ths of an inch).

The researchers say they were surprised to capture waking-like activity before birth. And there were other surprises, too. The embryo brains they observed showed considerable variation in activity, for one.

Before the emergence of sleep and waking patterns of brain activity, the chick embryos in their study exhibited lots of spontaneous movement, even as their higher-brain regions remained inactive. Once the chicks reached that 80 percent mark in development, higher-brain regions began crackling with activity. At the same time, those physical movements ceased as the embryos entered a sleep-like state.

"The last 30 percent of fetal brain development is a more interesting time than we previously thought, because it's when complex whole-brain functions that depend on coordination of widely separated brain areas first emerge," Balaban said. "Embryos begin to cycle through a variety of brain states and are even capable of showing waking-like brain activity."

That might explain instances of complex fetal and early neonatal learning. "It also raises questions about the longer-term developmental consequences that such brain activity may have, if it is induced before intrinsic brain wiring is sufficiently completed," Balaban said, "for example, in babies born very prematurely. We are excited by the possibility that the techniques developed here can now be used to provide answers to these questions."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our neurology / neuroscience section for the latest news on this subject. Balaban et al: "Waking-like brain function in embryos."
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Choline Consumption During Pregnancy May 'Program' Healthier Babies

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Main Category: Pregnancy / Obstetrics
Also Included In: Nutrition / Diet;  Pediatrics / Children's Health
Article Date: 06 May 2012 - 0:00 PDT


Pregnant women may have added incentive to bulk up on broccoli and eggs now that a Cornell University study has found increased maternal intake of the nutrient choline could decrease their children's chances of developing hypertension and diabetes later in life.

In a study led by Marie Caudill, associate professor of nutritional sciences, and graduate student Xinyin Jiang, a group of third-trimester pregnant women consumed 930 milligrams of choline, more than double the recommended 450 milligram daily intake. The result for their babies was 33 percent lower concentrations of cortisol - a hormone produced in response to stress that also increases blood sugar - compared to those from a control group of women who consumed about 480 milligrams of choline.

Caudill believes this happened because the choline changed the expression patterns of genes involved in cortisol production. The work, published online in The Journal of the Federation of American Societies for Experimental Biology, is the first human study to suggest a role for choline in the "programming" of key biological processes in the baby.

"The study findings raise the exciting possibility that a higher maternal choline intake may counter some of the adverse effects of prenatal stress on behavioral, neuroendocrine and metabolic development in the offspring," Caudill said.

This could be especially useful for women experiencing anxiety and depression during their pregnancy, as well as conditions such as pre-eclampsia.

"A dampening of the baby's response to stress as a result of mom consuming extra choline during pregnancy would be expected to reduce the risk of stress-related diseases such as hypertension and type 2 diabetes throughout the life of the child," she added.

She said additional studies are needed to confirm the study findings and further explore long-term effects. Dietary sources of choline include egg yolks, beef, pork, chicken, milk, legumes and some vegetables. Most prenatal vitamin supplements do not include choline.

"We hope that our data will inform the development of choline intake recommendations for pregnant women that ensure optimal fetal development and reduce the risk of stress-related diseases," Caudill said.

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Born infants extended high-risk more problem behaviours and emotional childhood

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Main Category: ADHD
Also Included In: Pediatrics / Children's Health;  Pregnancy / Obstetrics
Article Date: 04 May 2012 - 0:00 PDT

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We already know there are long-term health problems associated with pre-term birth, but what about babies born post-term? New research published in the International Journal of Epidemiology has found that post-term birth, defined as a birth after a pregnancy of 42 weeks, is associated with more behavioural and emotional problems in early childhood, especially Attention Deficit/Hyperactivity Disorder (ADHD) problems.

Lead author Hanan El Marroun, of the study entitled 'Post-term birth and the risk of behavioural and emotional problems in early childhood', comments that "post-term children have a considerably higher risk of clinically relevant problem behaviour and are more than twice as likely as term born children to have clinical ADHD. Further research is needed in order to determine the causes of post-term birth and to minimize the long-term consequences. It is also important that further research is carried out in order to demonstrate a causal relation between post-term birth and behavioural problems and longer follow ups would also be advantageous."

The research found a U-shaped association between gestational age at birth and behavioural and emotional problems in early childhood. This indicates that both preterm and post-term children are at higher risk for problems. Post-term children were almost twice as likely as term born children to have behavioural and emotional problems and were more likely to show problems in the clinical range on the ADHD scale. A linear regression analysis also showed a curvilinear relation between gestational age and behavioural problems for the continuous scores on the total problems, ADHD, affective problems scale and pervasive developmental problems, which suggests that children with a shorter or longer gestation have a higher behavioural problem score compared to children born at term.

The study was embedded in the Generation R Study, a large population-based prospective cohort study from foetal life onwards. Pregnant mothers who were residents of Rotterdam and due to give birth between April 2002 and January 2006 were asked to participate by their midwives and gynaecologists. The researchers measured gestational age using ultrasound, a method thought to be superior to date of last period. Based on this measure, out of a total of 5145 babies, 382 (7%) were born post-term and 226 (4%) were born pre-term. A standardized and validated behavioural checklist (Child Behaviour Checklist, CBCL/1.5-5) was used to assess the children. At both 18 and 36 months old a postal questionnaire was sent to the mother of the child and the father was also sent a questionnaire when the child was aged 36 months. Both post-term and pre-term babies were at higher risk of behavioural and emotional problems at 18 and 36 months.

Supplementary analysis found similar results when children whose gestational age was measured in the second or third trimester were excluded and the results did not appear to be explained by factors such as mother's weight and height, ethnicity, family income, alcohol consumption, smoking, education level or maternal psychopathology in mid-pregnancy. However, the authors point out that although they controlled for a large number of covariates, other factors, for example maternal malnutrition during pregnancy, cannot be ruled out.

The authors propose several potential explanations for their findings. First they discuss the higher risk of perinatal problems known to be associated with larger babies. However, excluding babies that weighed over 4000 grams at birth and babies that were induced did not alter their findings. Second they discuss uteroplacental insufficiency; the situation in which an "old" placenta offers fewer nutrients and less oxygen than required by a full term foetus. This lack of nutrients and oxygen may predispose to abnormal foetal development which, in turn, may lead to abnormal emotional and behavioural development. However, the observational nature of the present study did not enable the authors to distinguish possible effects of uteroplacental insufficiency from perinatal problems. Third they discuss potential disturbance of the "placental clock" which controls the length of pregnancy and regulates the maternal and foetal hypothalamic-pituitary-adrenal axis (HPA-axis). It has been suggested that placental endocrine malfunctioning or maternal stress at critical times during foetal development may influence the foetal HPA-axis, leading to neuroendocrine abnormalities that could increase the child's vulnerability to emotional and behavioural problems later in life. Finally, they suggest that the same cause may underlie being born post-term and having behavioural problems, for example, neurodevelopmental factors related to behavioural problems could be involved in the complex process of birth.

The authors caution that longer follow-up is necessary to establish whether the relationship between post-term birth and behavioural problems persist beyond 36 months. However, they also advise that practitioners involved in the management of prolonged pregnancy should take note of their findings.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Oxford University Press. "Infants Born Post-Term At Greater Risk Of Behavioural And Emotional Problems In Early Childhood." Medical News Today. MediLexicon, Intl., 4 May. 2012. Web.
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'Infants Born Post-Term At Greater Risk Of Behavioural And Emotional Problems In Early Childhood'

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Rural Obstetric Care Improves When Midwives Are Brought In

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Main Category: Pregnancy / Obstetrics
Also Included In: Pediatrics / Children's Health
Article Date: 02 May 2012 - 15:00 PDT

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A study published in this week's PLoS Medicine, reveals that maternal, newborn and child health has improved in Nigeria as a result of the Midwife Service Scheme.

According to the team of Nigerian researchers from the National Primary Health Care Development Agency in Abuja, and the Federal Ministry of Health, the scheme encourages newly graduated, unemployed and retired midwives to work for one year in rural areas of Nigeria, in order to provide basic essential obstetric care.

The primary care facilities where the midwives are posted to are also linked to a secondary health care facility that is able to provide comprehensive emergency obstetric care.

According to the researchers, this scheme could potentially serve as a model for other low-income countries and could help to redistribute health workforce and reduce the health inequities between urban and rural areas.

The researchers explained:

"The [Midwife Service Scheme] Strategy of the Nigerian government recognizes that strategically redistributing and improving the skill set of existing cadres of health workers is achievable on a large scale."

The researchers found that after one year of the scheme, improvement in maternal, newborn, and child health indices were uneven in the 6 geopolitical zones of Nigeria. Even though there have been major challenges to continue the scheme, such as the retention, availability and training of midwives, and varying levels of commitment from state and local governments across Nigeria, there are plans to overcome these obstacles and continue to develop the scheme.

The researchers said:

"The initiative potentially serves as a model for other developing countries within and outside sub-Saharan Africa who may need to redistribute their health workforce to reduce the inequities that exist among geographical zones and between urban and rural areas."

Written By Grace Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our pregnancy / obstetrics section for the latest news on this subject. "The Midwives Service Scheme in Nigeria"
Seye Abimbola, Ugo Okoli, Olalekan Olubajo, Mohammed J. Abdullahi, and Muhammad A. Pate
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Grace Rattue. "Rural Obstetric Care Improves When Midwives Are Brought In." Medical News Today. MediLexicon, Intl., 2 May. 2012. Web.
5 May. 2012. APA

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'Rural Obstetric Care Improves When Midwives Are Brought In'

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Insecticide Exposure During Pregnancy Linked To Alterations In Brain Structure And Cognition

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Main Category: Pregnancy / Obstetrics
Also Included In: Public Health;  Neurology / Neuroscience
Article Date: 02 May 2012 - 0:00 PDT

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Even low to moderate levels of exposure to the insecticide chlorpyrifos during pregnancy may lead to long-term, potentially irreversible changes in the brain structure of the child, according to a new brain imaging study by researchers from the Columbia Center for Children's Environmental Health at the Mailman School of Public Health, Duke University Medical Center, Emory University, and the New York State Psychiatric Institute. The changes in brain structure are consistent with cognitive deficits found in children exposed to this chemical.

Results of the study appear online in PNAS.

The new study is the first to use MRI to identify the structural evidence for these cognitive deficits in humans, confirming earlier findings in animals. Changes were visible across the surface of the brain, with abnormal enlargement of some areas and thinning in others. The disturbances in brain structure are consistent with the IQ deficits previously reported in the children with high exposure levels of chlorpyrifos, or CPF, suggesting a link between prenatal exposure to CPF and deficits in IQ and working memory at age 7.

The study also reports evidence that CPF may eliminate or reverse the male-female differences that are ordinarily present in the brain. Further study is needed to determine the consequences of these changes before and after puberty, the researchers say.

Notably, the brain abnormalities appeared to occur at exposure levels below the current EPA threshold for toxicity, which is based on exposures high enough to inhibit the action of the key neurological enzyme cholinesterase. The present findings suggest that the mechanism underlying structural changes in the brain may involve other pathways.

According to the lead author, Virginia Rauh, ScD, Professor at the Mailman School of Public Health and Deputy Director of the Columbia Center for Children's Environmental Health, "By measuring a biomarker of CPF exposure during pregnancy, and following the children prospectively from birth into middle childhood, the present study provides evidence that the prenatal period is a vulnerable time for the developing child, and that toxic exposure during this critical period can have far-reaching effects on brain development and behavioral functioning."

"By combining brain imaging and community-based research, we now have much stronger evidence linking exposure to chlorpyrifos with neurodevelopmental problems," adds senior author Bradley S. Peterson, MD, Chief of Child & Adolescent Psychiatry, New York State Psychiatric Institute, and Director of MRI Research in the Department of Psychiatry, Columbia University Medical Center.

In the current study, the researchers used MRI to evaluate the brains of 40 New York City children, ages 5 to 11, whose mothers were enrolled prenatally in a larger cohort study. Researchers compared 20 children with high exposures to CPF with 20 children with lower exposures; all exposures occurred prior to the EPA ban on household use of the chemical in 2001. They found brain anomalies were associated with the higher exposure.

Since the 2001 ban, a drop in residential exposure levels of CPF has been documented by Robin Whyatt, DrPH, a co-author on the present study and Professor of Clinical Environmental Health Sciences and Co-Deputy Director of the Columbia Center for Children's Environmental Health at the Mailman School. However, the chemical continues to be present in the environment through its widespread use in agriculture (food and feed crops), wood treatments, and public spaces such as golf courses, some parks, and highway medians. People near these sources can be exposed by inhaling the chemical, which drifts on the wind. Low-level exposure can also occur by eating fruits and vegetables that have been sprayed. Although the chemical is degraded rapidly by water and sunlight outdoors, it has been detected by the Columbia researchers in many urban residences years after the ban went into effect.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our pregnancy / obstetrics section for the latest news on this subject. The study was supported by the National Institute of Environmental Health Sciences Grants 5P01ES09600, P50ES015905, and 5R01ES08977, as well as pilot funding through ES009089; EPA STAR Grants RD834509, RD832141, and R827027; National Institute of Mental Health Grants MH068318 and K02-74677; and the John and Wendy Neu Family Foundation.
Additional co-authors included Frederica P. Perera and Megan K. Horton, Mailman School; Ravi Bansal, Xuejun Hao, and Jun Liu, Columbia University Medical Center; Dana Boyd Barr, Emory University; and Theodore A. Slotkin, Duke University.
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