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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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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Child size, birth weight not affected by the use of drugs HIV during pregnancy

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Main Category: HIV / AIDS
Also Included In: Pregnancy / Obstetrics;  Pediatrics / Children's Health
Article Date: 03 May 2012 - 2:00 PDT

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Infants born to women who used the anti-HIV drug tenofovir as part of an anti-HIV drug regimen during pregnancy do not weigh less at birth and are not of shorter length than infants born to women who used anti-HIV drug regimens that do not include tenofovir during pregnancy, according to findings from a National Institutes of Health network study. However, at 1 year of age, children born to the tenofovir-treated mothers were slightly shorter and had slightly smaller head circumference - about 1 centimeter each, on average - than were infants whose mothers did not take tenofovir.

The study authors described the findings as reassuring, noting that the study did not identify any serious safety concerns during pregnancy for tenofovir. In combination with other anti-HIV drugs, tenofovir is the first line of treatment for adults with HIV. The researchers called for additional studies to follow the children as they grow and develop, to identify any potential long term effects of the treatment.

The study was undertaken because earlier studies had shown laboratory animals exposed to tenofovir in the womb were smaller at birth than were their unexposed peers.

Because of its safety and effectiveness, many women who have HIV take the drug for their health, often before they become pregnant. Similarly, because the drug is so effective for adult use and because there have been no problems reported in human infants related to their mother's use of tenofovir, many physicians will prescribe it for pregnant women, both to safeguard the women's health and to prevent the virus from being passed on to their infants. However, before the current research, the drug had not been specifically studied for its potential effects on infants whose mothers took it during pregnancy.

"Physicians treating pregnant women for HIV face a dilemma: do they continue treating a pregnant woman with a drug that is highly effective for adults but which has not been studied for its effects on infants, or do they switch the woman to another therapy, which may not be as effective and well-tolerated?" said first author George K. Siberry, M.D., of the Pediatric, Adolescent and Maternal AIDS Branch of the NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the NIH institute that conducted the study. "Our findings indicate that tenofovir does not affect the growth of the fetus."

Over the seven years of the study, the number of participants being treated with tenofovir increased sharply, the study authors noted. In 2003, 14 percent of mothers in the study had been prescribed the drug, compared with 43 percent in 2010.

"The priority has been to treat mothers and prevent an infant's infection," said co-author Paige L. Williams, Ph.D., of the Harvard School of Public Health, Boston. "However, it's important to monitor the effects of these drugs on the infant."

The research was conducted as part of the Pediatric HIV/AIDS Cohort Study (PHACS), which is supported by the NICHD, the National Institute of Allergy and Infectious Diseases, the National Institute on Drug Abuse, the National Institute of Mental Health, the National Institute on Deafness and other Communication Disorders, the National Heart, Lung, and Blood Institute, the National Institute of Neurological Disorders and Stroke, and the National Institute on Alcohol Abuse and Alcoholism.

Dr. Siberry and Dr. Williams collaborated with colleagues at the State University of New York Downstate, Brooklyn; University of Miami School of Medicine; Indiana University School of Medicine, Indianapolis; Harvard; and the NICHD.

Their findings appear online in the journal AIDS.

The study included 2,000 U.S. infants born to HIV-positive mothers between 2003 and 2010. The researchers collected data for the infants' size relative to their gestational age (time they had spent in the womb), their birth weight, length at birth, and the circumference of their head. The researchers recorded similar measurements when the child was 1 year old.

They found that mothers taking tenofovir in combination with other anti-HIV medications and mothers on anti-HIV drug combinations that did not include tenofovir gave birth to infants who were smaller, on average, than infants born to HIV-negative mothers. However, they did not find significant differences between infants from the two groups of HIV-positive mothers.

The tenofovir-exposed infant's smaller average size and head circumference at one year of age suggests tenofovir could have a delayed effect on growth. Further research on this and other classes of anti-HIV drugs is ongoing in the PHACS.

"Overall, this study produced reassuring information regarding the use of tenofovir," said Dr. Siberry. "Although further research is needed, on balance, our findings favor the use of tenofovir in pregnancy to ensure good outcomes in the mother and prevent transmission of HIV to the infant."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Potential Link Between Autism And Smoking During Pregnancy

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Main Category: Autism
Also Included In: Pregnancy / Obstetrics;  Smoking / Quit Smoking
Article Date: 30 Apr 2012 - 1:00 PDT

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Women who smoke in pregnancy may be more likely to have a child with high-functioning autism, such as Asperger's Disorder, according to preliminary findings from a study by researchers involved in the U.S. autism surveillance program of the Centers for Disease Control and Prevention.

"It has long been known that autism is an umbrella term for a wide range of disorders that impair social and communication skills," says Amy Kalkbrenner, assistant professor in the University of Wisconsin-Milwaukee's Joseph J. Zilber School of Public Health, lead author of the study. "What we are seeing is that some disorders on the autism spectrum, more than others, may be influenced by a factor such as whether a mother smokes during pregnancy."

The study was published in an advance online release by the journal Environmental Health Perspectives.

Smoking during pregnancy is still common in the U.S. despite its known harmful impacts on babies. Kalkbrenner found that 13 percent of mothers whose children were included in the study had smoked during pregnancy.

Kalkbrenner and colleagues' population-based study compared smoking data from birth certificates of thousands of children from 11 states to a database of children diagnosed with autism maintained by the CDC's Autism and Developmental Disabilities Monitoring Network (ADDMN). Of the 633,989 children, born in 1992, 1994, 1996 and 1998, 3,315 were identified as having an autism spectrum disorder at age 8.

"The study doesn't say for certain that smoking is a risk factor for autism," Kalkbrenner says. "But it does say that if there is an association, it's between smoking and certain types of autism," implicating the disorders on the autism spectrum that are less severe and allow children to function at a higher level. That connection, she adds, needs further study.

April is Autism Awareness Month, and several studies of possible links between environmental factors and autism are being published by Environmental Health Perspectives at the same time as Kalkbrenner's study. "The CDC recently released data indicating that 1 in 88 children has an autism spectrum disorder, making such environmental studies even more timely," says Kalkbrenner.

Because autism involves a broad spectrum of conditions and the interplay of genetics and environment is so complex, no one study can explain all the causes of autism, she adds. "The goal of this work is to help provide a piece of the puzzle. And in this we were successful."

Other research articles published in Environmental Health Perspectives show that polychlorinated biphenyls disrupt early brain development by interfering with the signals that promote normal neuron branching. A review article suggests research directions for exploring a potential link between pesticides and autism. An editorial calls for increased discovery research to identify possible environmental causes of autism in America's children.

"PCB 95 Promotes Dendritic Growth via Ryanodine Receptor-Dependent Mechanisms"

"PCB 95 Modulates Calcium-Dependent Signaling Pathway Responsible for Activity-Dependent Dendritic Growth"

"Tipping the Balance of Autism Risk: Potential Mechanisms Linking Pesticides and Autism"

"A Research Strategy to Discover the Environmental Causes of Autism and Neurodevelopmental Disabilities"

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our autism section for the latest news on this subject. For a pdf of the study, go to: http://dx.doi.org/10.1289/ehp.1104556.
In addition to lead author Kalkbrenner, co-authors include: Joe Braun, Harvard School of Public Health; Maureen Durkin, University of Wisconsin-Madison School of Medicine and Public Health; Matthew Maenner, Waisman Center at UW-Madison; Christopher Cunniff, University of Arizona College of Medicine; Li-Ching Lee, Johns Hopkins Bloomberg School of Public Health; Sydney Pettygrove, Mel and Enid Zuckerman College of Public Health at the University of Arizona; Joyce Nicholas, Medical University of South Carolina; and Julie Daniels, UNC Gillings School of Public Health.
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Pregnancy Related DVT - Using Scan To Rule It Out

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Main Category: Pregnancy / Obstetrics
Also Included In: Cardiovascular / Cardiology
Article Date: 26 Apr 2012 - 11:00 PDT

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A study published by BMJ (British Medical Journal) reports that a single ultrasound scan, i.e. compression ultrasonography, could safely rule out a diagnosis of deep vein thrombosis (DVT) in pregnant women, or in those within the first few weeks after giving birth (post-partum period).

An accurate diagnosis of DVT remains challenging for doctors, particularly as the risk of DVT elevates during pregnancy, and because otherwise safe and reliable tests in non-pregnant patients are not always appropriate to use during pregnancy.

Leading researcher, professor Grégoire Le Gal, from the University of Brest in France, and his team decided to evaluate the safety of a single complete compression ultrasonography in pregnant and post-partum women with suspected DVT by recruiting 210 pregnant and post-partum women who were referred for suspected DVT from medical practices in France and Switzerland.

The researchers performed a single compression ultrasound scan on each patient and administered an anti-clotting treatment to those whose results were positive.

Overall, 22 women (10.5%) were diagnosed with DVT. Of the 177 without DVT, 2 of them (1.1%) received no anti-clotting treatment and developed DVT during the 3 month follow-up period.

Although limitations of the study prevent firm conclusions, the researchers nevertheless believe that a single complete compression ultrasonography "might be safe for ruling out deep vein thrombosis in pregnant and post-partum women," and add that in order to confirm their findings, further studies need to be conducted.

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. "Diagnostic value of single complete compression ultrasonography in pregnant and postpartum women with suspected deep vein thrombosis: prospective study"
Grégoire Le Gal, Geneviève Kercret, Khalil Ben Yahmed, Luc Bressollette, Helia Robert-Ebadi, Louise Riberdy, Patrick Louis, Aurélien Delluc, Marie-Luce Labalette, Mohamed Baba-Ahmed, Henri Bounameaux, Dominique Mottier and Marc Righini
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Obesity In Pregnancy, Fetal Growth And Stillbirth

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Main Category: Pregnancy / Obstetrics
Also Included In: Obesity / Weight Loss / Fitness;  Hypertension
Article Date: 01 May 2012 - 0:00 PDT

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Obesity during pregnancy puts women at higher risk of a multitude of challenges. But, according to a new study presented at the American Institute of Ultrasound in Medicine annual convention, fetal growth restriction, or the poor growth of a baby while in the mother's womb, is not one of them. In fact, study authors from the University of Rochester Medical Center found that the incidence of fetal growth restriction was lower in obese women when compared to non-obese women.

Researchers, led by senior study author and high-risk pregnancy expert Loralei Thornburg, M.D., conducted the study because a wealth of data shows that obese women are at greater risk of fetal death or stillbirth. Unfortunately, in the majority of cases, doctors don't know why. Thornburg's team wanted to determine if fetal growth restriction - which increases the likelihood of stillbirth - might play a role. She says growth restriction may go undiagnosed in obese women because it can be difficult to get an accurate measure of mom's belly size, which is a tool used to gauge the baby's growth - or lack of growth.

"We wondered if the increased risk of stillbirth could be due to a high level of undiagnosed growth restriction - the idea being that if the physician doesn't know that the baby is too small then they don't know that mom and baby need additional monitoring, which is essential to prevent fetal death," said Thornburg, an assistant professor in the Department of Obstetrics and Gynecology at the Medical Center whose research focuses on obesity in pregnancy.

The team, including lead study author and Maternal-Fetal Medicine Fellow Dzhamala Gilmandyar, M.D., found that growth restriction was significantly lower in obese and diabetic women; it was higher in women with preeclampsia, or pregnancy-induced high blood pressure, and smokers - a finding in line with past research. Of the babies that had growth restriction, they determined how many moms were given an accurate diagnosis before birth and found that the rate was the same for obese and non-obese women, suggesting that missed diagnoses are not a major problem in obese pregnancies.

"Our results defeat the idea that undiagnosed growth restriction is behind increased rates of fetal death in obese women," noted Thornburg. Many obese women also have diabetes, which could influence the risk of fetal death, but more research is needed to understand whether or not that is the case.

Though stillbirth, most often defined as death occurring after 20 weeks gestation, is not very common in the general population - it occurs in around six of every 1,000 births in the U.S., according to the Centers for Disease Control and Prevention - it is more common in specific populations, including obese women, African Americans and teens.

While the cause of stillbirths in obese women remains elusive, Thornburg says "One thing we do know is that we are not just dealing with obesity in pregnancy anymore. We are seeing a real increase in extreme obesity, which may represent a different condition altogether, so we need to look at moderate obesity compared to severe, morbid obesity."

Thornburg and Gilmandyar reviewed birth record data from more than 16,000 women who delivered at the Medical Center between 2000 and 2010. Obesity was defined as having a pre-pregnancy body mass index or BMI of 30 or greater and growth restriction was defined as being below the tenth percentile of expected birth weight for gestational age. After taking into account the effects of diabetes, high blood pressure and tobacco use, growth restriction remained lower in obese women (8.5 percent) compared to non-obese women (nearly 10 percent).

"While our study shows that obesity by itself may not be a risk factor for growth restriction, it is still important to closely monitor women who also have high blood pressure or who are smokers, because these are established risk factors for growth restriction," said Gilmandyar, who is completing her second year as a fellow at the Medical Center.

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. In addition to Gilmandyar and Thornburg, Kristin Knight, M.D., Maureen Perdue, M.D., Oluwateniola Brown, Tina Jensen, David Hackney, M.D., and Eva K. Pressman, M.D., from the Medical Center contributed to the research.
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Maternal Stress During Pregnancy Can Affect Baby's Iron Status

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Main Category: Pregnancy / Obstetrics
Also Included In: Pediatrics / Children's Health;  Anxiety / Stress
Article Date: 01 May 2012 - 0:00 PDT

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Newborns whose mothers are under stress during the first trimester of pregnancy may be at risk for low iron status, which could lead to physical and mental delays down the road, according to a study presented at the Pediatric Academic Societies (PAS) annual meeting in Boston.

Iron plays an important role in the development of organ systems, especially the brain. Well-known risk factors for poor iron status in infants are maternal iron deficiency, maternal diabetes, smoking during pregnancy, preterm birth, low birthweight and multiple pregnancy.

This study, conducted by researchers from Ashkelon Academic College and Barzilai Medical Center in Israel and the University of Michigan, is the first in humans to suggest that maternal stress early in pregnancy is another risk factor for low iron status in newborns.

Researchers, led by Rinat Armony-Sivan, PhD, director of the psychology research laboratory at Ashkelon Academic College, recruited pregnant women who were about to give birth at Barzilai Medical Center. The first group of women (stress group) lived in an area where there were more than 600 rocket attacks ("Oferet Yetzuka" operation) during their first trimester of pregnancy. The control group lived in the same area and became pregnant three to four months after the rocket attacks ended.

Women were questioned briefly at the delivery room reception desk to determine whether they were healthy and without pregnancy complications. Eligible women who agreed to participate in the study were interviewed one or two days after delivery about their background and health during pregnancy. They also filled out questionnaires about depression and anxiety, and rated their stress level during pregnancy.

Cord blood was collected from newborns, and serum ferritin (iron) concentrations were measured.

Results showed that the 63 babies whose mothers were in the stress group had significantly lower cord-blood ferritin concentrations than the 77 infants in the control group.

"Our findings indicate that infants whose mothers were stressed during pregnancy are a previously unrecognized risk group for iron deficiency," Dr. Armony-Sivan said. "Pregnant women should be aware that their health, nutrition, stress level and state of mind will affect their baby's health and well-being."

Dr. Armony-Sivan concluded that it may be advisable to consider additional blood work before the well-child visit at 12 months of age, especially in high-risk populations, so that iron deficiency, with or without anemia, can be detected early and treated before it becomes chronic and severe.

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More Research Needed Into The Fetal Effects Of Some Drugs During Pregnancy

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Main Category: Pregnancy / Obstetrics
Also Included In: Epilepsy;  Depression;  Hypertension
Article Date: 29 Apr 2012 - 0:00 PDT

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Prescription drug use during pregnancy is prevalent, however, not enough is known about the adverse effects they may have on the developing fetus, concludes a new review published in The Obstetrician & Gynaecologist.

The majority of women take prescriptions for pregnancy-related complaints and minor infections. However, a small proportion of women receive medication for treatment for chronic diseases such as asthma, depression or hypertension.

The prevalence of congenital malformations is estimated at 2% of all births, of which approximately 1% are considered attributable to prescription drug use during pregnancy, states the review.

Two common groups of drugs, anti-epileptics and antidepressants are explored in the review.

Anti-epileptic drugs (AEDs) are the most studied group of drugs in pregnancy, with an estimated 1 in 250 pregnancies exposed.

National Institute for Health and Clinical Excellence (NICE) guidelines state that it is not possible to comment on the risks of physical abnormalities from the drugs in view of the limited data available.

The review also looks at preliminary data collated from the UK Epilepsy and Pregnancy Register which found that the risk of congenital malformations with the use of one AED was 3.7% (n = 2598), compared with 6.0% (n = 770) in those women taking two or more AEDs.

Up to 4% of women use antidepressants during pregnancy, with 2.3% taking selective serotonin reuptake inhibitors (SSRIs).

A large birth defect registry study found no association between maternal SSRI use and cardiac malformations. However, the review states that antidepressant use in late pregnancy is associated with neonatal complications such as premature birth, feeding problems, respiratory distress syndrome, endocrine and metabolic disorders and temperature regulation disorders.

The review concludes that our evidence base for using prescription drugs in pregnancy remains limited and that drug companies do not recruit pregnant women to their clinical trials unless the drug in question is aimed at pregnancy-related disease.

Alastair Sutcliffe, Reader in Child Health, UCL Institute of Child Health and co-author of the review said:

"Many pregnant women use prescription drugs, however, the risk to the fetus remains unknown.

"Pregnant women are excluded from clinical trials, which means when new drugs are released there is almost no information on their safety and efficacy in pregnancy."

TOG's Editor-in-Chief, Jason Waugh said:

"The maternal physiological changes that occur during pregnancy can alter what the body does to the drug in some cases. More research is needed into the fetal effects of some drugs as there are big gaps in our knowledge."

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Ensuring Good Health Prior To Conception Minimizes Risk Of Complications In Pregnancy

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