About Pregnancy

Women with low risk pregnancies should be able to choose where they give birth, concludes a study published on bmj.com today. Although it shows that first-time mums who opt for a home birth are at a higher risk of adverse outcomes, the overall risk is low in all birth settings.

The researchers say their results “support a policy of offering women with low risk pregnancies a choice of birth setting” and will enable women and their partners to have informed discussions with health professionals about planned place of birth.

The benefits and risks of birth in different settings have been widely debated in recent years, but there is a lack of good quality evidence comparing the risk of rare but serious perinatal adverse outcomes in these settings.

Perinatal refers to the period just before, during or shortly after birth.

Though most doctors will give you a definition of when pregnancy begins, it’s not always the same one, according to a new survey.

Most of the polled obstetrician-gynecologists believe pregnancy begins when the sperm fertilizes the egg. But a minority say it doesn’t begin until a week later when the fertilized egg implants in the uterus—the definition given by the American College of Obstetrics and Gynecology (ACOG).

“People say that the medical profession has settled on this,” said Dr. Farr Curlin, the senior author of the study and a professor at the University of Chicago. “And what our data show rather clearly is that it is not at all settled among the medical profession.”

Two studies from the Mayo Clinic presented during the American Society of Nephrology’s Annual Kidney Week provide new information related to high blood pressure during pregnancy.

In one study, Vesna Garovic, MD and her team examined the potential of a test done mid-pregnancy to predict which women will later develop preeclampsia, a late-pregnancy disorder that is characterized by high blood pressure and excess protein in the urine and that affects 3% to 5% of pregnancies. Left untreated, preeclampsia can lead to serious—even fatal—complications for a pregnant woman and her baby.

Among a group of 315 patients, 15 developed preeclampsia and 15 developed high blood pressure (but not preeclampsia) during pregnancy. All of the patients who developed preeclampsia tested positive in mid-pregnancy for a test that detects the shedding of certain kidney cells called podocytes in the urine. None of those with only high blood pressure tested positive, and none of 44 women with normal pregnancies tested positive. Therefore, this test is highly accurate for predicting preeclampsia, which could alert clinicians to take steps to safeguard against the condition.

In another study, Dr. Garovic’s team looked at the long-term health effects of high blood pressure during pregnancy. They identified female residents of Rochester, Minnesota and the surrounding townships in Olmsted County who delivered between 1976 and 1982. The investigators divided the women into two groups—those with high blood pressure during pregnancy and those without—and followed them after they reached 40 years of age to monitor their heart and kidney health.

Poor sleep quality in both early and late pregnancy has been linked to an increased risk of delivering preterm.

A study published in the Nov. 1 issue of the journal Sleep shows a significant risk for preterm birth in women reporting sleep disruptions during their first and third trimesters. The connection remained even after medical risk factors and income levels were taken into account.

“This supports the growing evidence that poor sleep is an important risk factor for preterm birth,” said Michele Okun, PhD, assistant professor of psychiatry and psychology at the University of Pittsburgh School of Medicine.

“It likely occurs in the presence of other risk factors, but sleep can be measured easily and quickly during prenatal visits. Simply by assessing a woman’s sleep quality, we may be able to identify a risk early in the pregnancy, when there is time to intervene. The data suggest that beneficial outcomes may be possible through modifications in behavior,” Okun said.

Reduced thyroid function during pregnancy can have adverse effects on both the mother and fetus, including increased risk of miscarriage and preterm labor. Thyroid autoimmunity also puts the mother at increased risk of developing postpartum thyroiditis and hypothyroidism in the future. While screening of high-risk women for thyroid dysfunction is recommended, universal screening of pregnant women remains controversial.

Chrysoula Dosiou, MD, of Stanford University School of Medicine, and colleagues from the University of Illinois at Chicago, V. Fazzi Hospital in Lecce, Italy, Stanford University School of Medicine in Stanford, California, and George Washington University School of Medicine and Health Sciences Washington, D.C., developed a computer model to compare the cost-effectiveness of three screening strategies: universal screening with thyroid-stimulating hormone and anti-thyroid peroxidase antibodies during the first trimester, risk-based screening, and no screening. In this model, a positive screening test led to follow-up testing and treatment with thyroid hormone when indicated. The model takes into account the development of adverse obstetrical outcomes during pregnancy, postpartum thyroiditis, and overt hypothyroidism during a woman’s lifetime.

According to data presented today at the 81st Annual Meeting of the American Thyroid Association (ATA), universal screening for autoimmune thyroid disease in the first trimester of pregnancy is cost-effective compared with screening of only high-risk women. Both the risk-based and universal screening options are cost-effective when relative to no screening.

A new study recently published in the American Journal of Transplantation reveals that the ability to successfully carry a pregnancy after kidney transplantation is very high, with 73.5% live birth rates.

Researchers led by Dorry Segev, MD, PhD, of Johns Hopkins University performed a systematic review and meta-analysis of articles published between 2000 and 2010 that reported pregnancy-related outcomes among KT recipients.

Results found that a successful pregnancy is possible after receiving a kidney transplant, although the relatively high rate of medical complications of the pregnancy motivates very careful monitoring.

Exercising during pregnancy was safe for both moms and babies in a new study of heavy women in Brazil, but fitness classes and at-home exercises didn’t keep moms-to-be from gaining too much weight.

The finding is “not surprising,” according to Dr. Patrick Catalano, a maternal-fetal medicine researcher from Case Western Reserve University School of Medicine in Cleveland.

“Lots of studies have not shown any benefits relative to weight gain in pregnancy using either diet or exercise,” said Catalano, who didn’t participate in the new research.

Research has established that taking folic acid supplements during pregnancy reduces the risk of bearing a child with neural tube defects, but little is known about the relationship between prenatal folic acid and neurodevelopment after birth. A collaborative study between investigators at the Norwegian Institute of Public Health and Columbia University’s Mailman School of Public Health has now reported that mothers who took folic acid supplements from 4 weeks before to 8 weeks after conception reported a significantly lower prevalence of severe language delay in their children at age 3. The study was based in a unique Norwegian pregnancy cohort often referred to as “MoBa”.

The full study findings are published online in the October 12 issue of JAMA.

The current analysis included 19,956 boys and 18,998 girls. Of these children, 204 (0.5%) were rated as having severe language delay, defined as minimal expressive language, only 1-word or unintelligible utterances. Among women who took folic acid supplements in early pregnancy, the reported prevalence of such delay was 0.4%, but among the approximately 9,000 children whose mothers took no folic acid, the delay was more than twice as common: 0.9% (81 children).

Across the entire sample, severe language delays were four times more common in boys than girls, as is typically the case.