The Chicago Tribune reports, “Headlines about the potential risks of antidepressants on a developing fetus, including miscarriage, premature birth and newborn breathing problems, have produced angst for many moms on medication.” Continue reading
USA Today reports, “Births taking place outside of the traditional hospital setting increased 29 percent between 2004 and 2009, from 0.56 percent of all births to 0.72 percent – almost 30,000 births – according to a new report from the US Centers for Disease Control and Prevention.” Continue reading
One of the joys for me in being a family physician is the honor I have had to attend the births of over 1500 of my patients. There’s nothing quite like the experience (indeed, the miracle) of a birth. And, arriving at a safe and healthy birth involves a lot of prenatal prayer and excellent care. As part of my prenatal care, I’ve emphasized to women the critical value of brushing and flossing. Most of my patients did not know:
(1) gum disease can be prevented,
(2) gum disease can be safely treated during pregnancy, and
(3) preventing or treating gum disease in pregnancy significantly reduces the risk of premature birth associated with periodontal disease.
Here’ s the latest article on the the most recent study looking at treating gum disease in pregnancy:
“The present study has potential implications” for the calculations dentists make when deciding whether to treat gum disease during pregnancy, the researhers write in the British Journal of Obstetrics and Gynecology.
Gum disease – typically caused by a bacterial infection that deteriorates gum tissue and leaves it chronically inflamed – is a particular problem during pregnancy. Hormonal changes appear to make a pregnant woman more susceptible to developing it, yet the standard tetracycline-based therapy is not recommended because of its risk to the baby.
Nevertheless, considerable evidence points to gum disease itself raising the risk of premature birth.
Dr. Marjorie Jeffcoat of the University of Pennsylvania’s School of Dental Medicine and her colleagues wanted to know if treating pregnant women with periodontal disease using non-drug methods would reduce their risk of early delivery.
The group recruited 322 pregnant women with gum disease for the study. Participants were randomly assigned to receive active treatment in the form of an aggressive teeth-cleaning method – known as scaling and planning – plus oral hygiene education, or to get oral hygiene education alone. (After delivery of their babies, all study participants were offered treatment for their gum disease.)
At the study’s conclusion, the researchers found no statistically significant difference in the number of premature births among the women who had been treated and the ones who were not. Of the untreated women, 52.4 percent delivered early, while 45.6 percent of women getting treatment had early births.
On closer analysis, however, treatment – when it was successful in curing the gum disease – appeared to reduce the likelihood of an early delivery considerably; “a very exciting finding,” Jeffcoat said.
Among the women in the treatment group, 42 were treated successfully, meaning that on a second dental exam, their gum inflammation had disappeared and the separation of their gums from the teeth had not progressed any further. One hundred and eleven women in the treatment group continued to show signs of gum disease, representing unsuccessful treatment.
Just four of the 42 successfully treated women, or 10.5 percent, delivered prematurely compared to 69 premature deliveries, or 62 percent, among the 111 women who failed treatment.
The researchers conclude that their results confirm the non-drug treatment method is safe and associated with reduced risk of premature birth.
“It is appropriate for obstetricians to refer patients who require dental care to the dentist,” they write.
“It’s not enough to treat periodontal disease, however,” Jeffcoat told Reuters Health. “The treatment must be ‘successful’ and why the scaling and planing treatment was successful in some women and not others isn’t known yet.”
Studies to answer those questions are currently underway.
In the past, when I’ve had a family suffer a miscarriage, I’ve advised them to wait three to six months before trying to conceive again. There were a couple of reasons for this: (1) this gives the endometrium (the lining of the uterus) time to recover and refresh itself, and (2) this gives the family time to deal with the loss of their child emotionally, relationally, and spiritually.
CNN recognizes this when it reports, “When women have a miscarriage, one of the first questions they often ask is how long they should wait before getting pregnant again.”
Now, research from Scotland may change the advice that I (and other doctors) give because it indicates that “the sooner they start trying, the better.”
In fact, those “who conceive within six months of a miscarriage instead of waiting up to a year reduce their risk of another miscarriage by one-third, and they also increase their chances of a healthy and successful pregnancy.”
At present, “guidelines from the World Health Organization … recommend women delay getting pregnant for at least six months after a miscarriage,” the AP reports.
Lead investigator Sophinee Bhattacharya, of the University of Aberdeen, “said WHO guidelines are based on a study from Latin America, where women usually have children at an earlier age than in the West.” Yet, “because women in developed countries often wait until they are older to have children, Bhattacharya said any delays to conception could reduce the chances of a healthy baby.”
Before reaching those conclusions, investigators “collected data on 30,937 women who had had miscarriages in their first pregnancy and then became pregnant again,” HealthDay reported.
The team eventually discovered that “women who got pregnant again within six months were less likely … to have to terminate the pregnancy or to have an ectopic pregnancy compared with women who got pregnant six to 12 months after their miscarriage.”
They were also “less likely to have a cesarean delivery, have a premature delivery or have a low birth weight baby,” according to the paper in the BMJ.
The team did find, however, that “getting pregnant less than six months after a miscarriage was associated with higher risk of induced labor than an interval of six to 12 months,” MedPage Today reported.
And, “mental recovery may take some time … Bhattacharya’s group acknowledged. But a delay poses problems for women in the Western world, where for social and economic reasons women tend to delay childbearing, they noted.”
Medscape also covered the story.
So, how will this change my advice? Not very much. I’ll still recommend that families that experience a miscarriage undergo counseling (marriage or family counseling) to talk about and deal with the incredible impact that losing a child can have on emotional health, relationship health, and spiritual health.
However, once a family has dealt with the emotional, relational, and spiritual aspects of their loss, they then can consider conceiving again … whether it be 2 months, 4 months, 6 months, or later.
A pregnant mother’s exercise may lower her baby’s risk of obesity later in life. The new research shows that regular moderate-intensity exercise during pregnancy reduces an infant’s birth weight, which may lower the child’s risk of obesity later in life. In a new study, 84 first-time pregnant women were randomly assigned to exercise or control groups, with those in the exercise group participating in a weekly maximum of five 40-minute sessions on a stationary cycle. They did this program until at least 36 weeks into their pregnancy. Here are the details from HealthDay News:
Babies born to mothers in the exercise group were an average of 143 grams lighter than infants born to mothers in the control group, and also had a lower body-mass index (a measurement that takes into account height and weight), the researchers found.
The exercise training had no effect on the mothers’ body weight or body-mass index during late pregnancy, and had no effect on insulin resistance from the start of the study to late gestation, according to the report published online in the Journal of Clinical Endocrinology & Metabolism.
“Our findings show that regular aerobic exercise alters the maternal environment in some way that has an impact on nutrient stimulation of fetal growth, resulting in a reduction in offspring birth weight,” study co-author Dr. Paul Hofman, of the University of Auckland in New Zealand, said in an Endocrine Society news release.
“Given that large birth size is associated with an increased risk of obesity, a modest reduction in birth weight may have long-term health benefits for offspring by lowering this risk in later life.”
Hofman added that the “physiological response to pregnancy appears to supersede the chronic improvements in insulin sensitivity previously described in response to exercise training in non-pregnant individuals. This may be an important finding for athletes who want to continue regular training during their pregnancy as it suggests that training will not have a major adverse impact on insulin resistance.”
For more information, the Nemours Foundation has more about exercising during pregnancy.
Low back pain in pregnancy is extremely common and manipulative therapy has been shown in a number of studies to be very helpful — especially for a condition called sacroiliac subluxation. Now, comes a story from Reuters Health confirming that gentle manipulation from an osteopathic doctor may relieve late-pregnancy back pain that frequently hinders bending, lifting, or walking.
The findings came from a small study hint and was performed by doctors in osteopathic medicine (DOs), who are medical doctors additionally trained in gentle manipulative techniques to help restore function, range of motion, and lessen pain in bones and adjoining muscles supporting the neck, back, chest, shoulders, and hips.
Osteopathic manipulation may particularly benefit pregnant women seeking medication-free back pain relief, note Dr. John C. Licciardone and colleagues at University of Texas Health Science Center in Fort Worth.
The study, in the American Journal of Obstetrics and Gynecology, included 144 otherwise healthy pregnant women, about 24 years old on average, with moderate levels of back pain and related movement difficulties during late pregnancy.
The women were randomly assigned to one of three groups: usual obstetric care only, usual obstetric care plus weekly 30-minute osteopathic manipulation treatments from the 30th week of pregnancy through delivery, or usual obstetric care plus sham ultrasound skin stimulation sessions.
Over the course of the study, women in the osteopathic group reported improved back pain and related symptoms, Licciardone noted in an email to Reuters Health. The sham ultrasound group reported no pain improvement and those in the standard care group reported increased pain. However, none of these differences were statistically significant.
Late pregnancy back-related movement problems generally worsened until delivery, but did so to a lesser degree in the osteopathic manipulation group.
Overall, these results suggest osteopathic manipulation may compliment conventional obstetric care, Licciardone and colleagues conclude. They call for further, larger investigations to assess the benefits and costs of this form of combined care.
So, if you or a good friend are pregnant, and suffering from low back pain, and your healthcare professional is no trained in low-back manipulation, consider asking for a referral to a healthcare professional (DO, MD trained in manipulation, chiropractor, or physical therapist) who can provide you this service.
Nicotine patches and gum seem to be safe and effective in pregnant women, according to a new study.
Such patches and gum have been shown to help non-pregnant adults stop smoking, study co-author Dr. Geeta K. Swamy told Reuters Health. However, women and their physicians have been uncertain about their safety and effectiveness during pregnancy.
Reuters Health reports Dr. Swamy, from Duke University Medical Center in Durham, North Carolina, and colleagues took another look at data on pregnant smokers who had participated in a study comparing psychological treatments with nicotine patches or gum to help them quit.
Adding nicotine patches or gum tripled the number of women who quit, from 8 percent to 24 percent.
However, almost a third, 31%, of the women who used the patch or gum had pregnancy complications, compared to 17% of the women who did not use it. And, there was a much higher risk of such complications in black women, in those with complications in previous pregnancies, and in those using painkillers. However, the use of the patch did not seem to have a direct effect, the researchers noted.
Based on the findings, although the patch is not “absolutely safe,” the researchers believe it may still be worth using in heavy smokers, given the known association between smoking and bad pregnancy outcomes, particularly premature birth and low birth weight, they conclude.
The editors of the journal wrote that this study was “an important reanalysis of a randomized trial that compared cognitive therapy with cognitive therapy and nicotine replacement therapy to reduce smoking in pregnancy” and revealed “it is unlikely that the nicotine replacement therapy was associated with adverse outcomes.”
Nevertheless, we may not know for sure until the “Smoking, Nicotine, and Pregnancy trial,” which is a large-scale randomized trial of nicotine replacement therapy during pregnancy that is being conducted in the United Kingdom, is published. It will likely provide useful insight into any potential safety concerns because it will follow the offspring up to 2 years of age.
In the meantime, I consider smoking in pregnancy to be much more likely to harm a woman or her baby than using a nicotine replacement therapy to stop smoking. In addition, carrying an unborn baby is often a motive for women to stop smoking.
And, stopping smoking is health at any time!
Here the second part of a discussion I’m having with a family physician who is wrestling with extremely important questions about the value of the unborn child’s life. I thought you’d enjoy watching our conversation.
More Information: Continue reading
Most new moms will weigh more after delivery of the new baby that they did prior to becoming pregnant. And, most new moms are concerned about these extra pounds. So, is it safe or harmful to try to lose these extra pounds quickly?
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As a family physician, I had the honor and unmitigated privilege of attending the birth of over 1500 babies in my career. Each one was a special experience for me. And, as you can imagine, mothers-to-be always had tons of questions about pregnancy and their newborn-to-be. Of course, the issue of weight gain was always on the list. This is of great importance to many mothers-to-be, because the health of the newborn depends a lot on the mom’s weight. And now, for the first time in nearly two decades, officials at the Institute of Medicine (IOM) have issued new guidelines regarding weight gain during pregnancy.
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The most proficient killing machine in the U.S. is the Planned Parenthood Federation of America (PPFA) – and according to their new annual report PPFA is committing more abortions than ever. Not only that, they bring in over $1 billion a year – a third from our tax dollars. “For decades now, Planned Parenthood has operated the most proficient killing machine in the United States,” said Douglas R. Scott Jr., president of Life Decisions International (LDI) in a recent interview. “And for decades, the machine has killed more preborn children than the year before.”
More Information: Continue reading