Pregnancy
Drug prevents passage of HBV during pregnancy
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The antiviral drug telbivudine prevents perinatal transmission of hepatitis B virus (HBV), according to a study1 in the June issue of Clinical Gastroenterology and Hepatology, the official clinical practice journal of the American Gastroenterological Association.
“If we are to decrease the global burden of hepatitis B, we need to start by addressing mother-to-infant transmission, which is the primary pathway of HBV infection,” said study author Yuming Wang from Institute for Infectious Diseases, Southwest Hospital, Chongqing, China. “We found that telbivudine not only eliminated vertical transmission of HBV from pregnant women to theirs infants, but that it is also safe and well tolerated by women and infants.”
Researchers performed a prospective study of 450 HBV-positive pregnant women with high viral load, or significant HBV in the blood, during the second or third trimester of pregnancy. Two hundred and seventy nine women received telbivudine (600 mg daily) during weeks 24 through 32 of gestation, and 171 women who were unwilling to take antiviral drugs participated as controls. At six months after birth, none of the infants whose mothers were given telbivudine tested positive for HBV, compared to 14.7 percent of infants in the control group.
BGI study confirms accuracy of its NIFTY in nearly 147,000 pregnancies
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BGI has published a study tracking the clinical performance of its whole genome sequencing-based non-invasive prenatal test (the NIFTY® test) in nearly 147,000 pregnancies, the largest such study to date. The results showed high sensitivity and specificity and no significant difference between high-risk and low-risk pregnant women.
The study, published in the journal Ultrasound Obstetrics and Gynecology, reported on 146,958 samples from 508 medical centers in mainland China, which were collected between early 2012 and mid-2013 for trisomy 21, 18, and 13. Although NIFTY® measures other chromosomal abnormalities, these results were not included in the study.
According to the study’s results, NIFTY® identified 1,578 trisomy-positive and 145,380 negative samples. Comparing the results with follow-up confirmatory invasive testing, or by tracking patients’ eventual pregnancy outcomes, the study team then calculated the false positive (FPR) and false negative rate (FNR) for each tested trisomy, and the overall sensitivity, specificity, and positive predictive value (PPV).
Arkansas to appeal ruling on abortion restriction law
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Arkansas Attorney General Dustin McDaniel said on Friday he would appeal a federal judge’s decision striking down a state law that bans most abortions starting at 12 weeks of pregnancy, one of the most stringent such statutes in the United States.
U.S. District Judge Susan Webber Wright ruled last month that the Arkansas law violated the U.S. Supreme Court decision that a woman has the right to an abortion until the fetus is viable outside the womb, which medical experts say is around the 23-to-24-week mark
A number of states have recently enacted restrictive bans on abortion, including North Dakota, Arizona and Texas, setting off a round of court battles.
Immune system ‘overdrive’ in pregnant women puts male child at risk for brain disorders
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Johns Hopkins researchers report that fetal mice - especially males - show signs of brain damage that lasts into their adulthood when they are exposed in the womb to a maternal immune system kicked into high gear by a serious infection or other malady. The findings suggest that some neurologic diseases in humans could be similarly rooted in prenatal exposure to inflammatory immune responses.
In a report on the research published online last week in the journal Brain, Behavior and Immunity, the investigators say that the part of the brain responsible for memory and spatial navigation (the hippocampus) was smaller over the long term in the male offspring exposed to the overactive immune system in the womb. The males also had fewer nerve cells in their brains and their brains contained a type of immune cell that shouldn’t be present there.
“Our research suggests that in mice, males may be more vulnerable to the effects of maternal inflammation than females, and the impact may be life long,” says study leader Irina Burd, M.D., Ph.D., an assistant professor of gynecology/obstetrics and neurology at the Johns Hopkins University School of Medicine and director of the Integrated Research Center for Fetal Medicine. “Now we wonder if this could explain why more males have diseases such as autism and schizophrenia, which appear to have neurobiological causes.”
For the study, researchers sought to mimic the effects of a maternal infection or other condition that causes inflammation in a pregnant mother. This type of inflammation between 18 and 32 weeks of gestation in humans has been linked to preterm birth as well as an imbalance of immune cells in the brain of the offspring and even death of nerve cells in the brains of those children. Burd and her colleagues used a mouse model to study what happens to the brains of those offspring as they age into adulthood to see if the effects persisted.
Is it safe for pregnant women to eat peanuts?
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So long as they don’t have nut allergies themselves, pregnant women shouldn’t be afraid that eating nuts might trigger allergies in their child, according to a large new study.
In fact, when women ate nuts more than five times a month during pregnancy, their kids had markedly lower risk of nut allergies compared to kids whose mothers avoided nuts, researchers found.
“The take-home message is that the previous concerns or fears of the ingestion of nuts during pregnancy causing subsequent peanut or nut allergy is really unfounded,” Dr. Michael Young said.
Young is the study’s senior author and an attending physician in allergy and immunology at Boston Children’s Hospital.
Preterm birth of mother increases risk of pregnancy complications
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Women who were born preterm are at increased risk of complications during pregnancy compared to those born at term, and the risk almost doubles for mothers born before 32 weeks, according to a study in CMAJ (Canadian Medical Association Journal).
Pregnancy complications include gestational diabetes, gestational hypertension, and preeclampsia or eclampsia.
The findings are based on a study of 7405 women born preterm and 16 714 women born at term between 1976 and 1995 in the province of Quebec. Of the preterm women, 554 were less than 32 weeks at birth and 6851 were at 32- weeks’ gestation.
“We found that the risk of pregnancy complication was significantly higher among women born preterm, independently of their own fetal growth,” writes Dr. Anne Monique Nuyt, Sainte-Justine University Hospital and Research Center, University of Montréal, with coauthors. “When divided into categories of gestational age, the risk of having at least 1 pregnancy complication nearly doubled among women born before 32 weeks’ gestation versus those born at term.”
U.S. teen birth rate lowest since 1946
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Fewer babies were born to U.S. teenagers ages 15-19 in 2010 - 367,752 - than in any year since 1946’s 322,380, federal health officials said.
The preliminary report by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention in Atlanta, used the most current data available from the National Vital Statistics System found the 2010 total of births to teenagers was 43 percent lower than the peak recorded in 1970 at 644,708, the report said.
The U.S. teen birth rate declined 9 percent from 2009 to 2010, reaching a historic low at 34.3 births per 1,000 women ages 15-19; the rate dropped 44 percent from 1991 through 2010, the report said.
Vitamin D supplements found to be safe for healthy pregnant women
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Use of vitamin D supplements during pregnancy has long been a matter of concern but now researchers writing in the Journal of Bone and Mineral Research report that even a high supplementation amount in healthy pregnant women was safe and effective in raising circulating vitamin D to a level thought by some to be optimal. The study also found no adverse effects of vitamin D supplementation, even at the highest amount, in women or their newborns.
The research team, led by Dr. Bruce Hollis from the Medical University of South Carolina in Charleston, used a randomized controlled trial with healthy expectant mothers to discover how varying dosages of daily supplements could safely sustain a circulating vitamin D level of at least 32 nanograms per milliliter.
“Vitamin D supplementation during pregnancy remains controversial largely due to severe misconceptions about the potential harm it may cause to the fetus,” said Dr Hollis. “Surprisingly the scientific debate has made little progress since Dr. Gilbert Forbes made a recommendation of 200 IU (international units) per day in 1963, which was based on a hunch.”
Study finds that folate does not offer protection against preterm delivery
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In a study to be presented today at the Society for Maternal-Fetal Medicine’s (SMFM) annual meeting, The Pregnancy Meeting ™, in San Francisco, researchers will present findings that show that folate intake before and during pregnancy does not protect Norwegian women against spontaneous preterm delivery.
“Sufficient folate intake has been studied as a possible protecting factor against spontaneous preterm delivery with conflicting results,” said Verena Senpiel, M.D., one of the study’s authors. “Preterm delivery is the major cause of perinatal mortality and morbidity worldwide and still difficult to predict and prevent. So when a recent American study found that preconceptional folate supplementation could reduce the risk for early spontaneous preterm delivery 50-70% we hoped to confirm these findings in another big cohort study.”
The study selected controls and cases from the Norwegian Mother and Child Cohort Study (http://www.fhi.no/) that included 72,989 children. Cases were defined as singleton live births with spontaneous onset of preterm delivery between 22 and 36 gestational weeks and after pregnancies without medical or obstetric complications. Controls were chosen according to the same criteria, except spontaneous onset of term delivery between gestational weeks 39 and 40. Folate data was obtained from questionnaires completed at gestational week 17, 22 and 30, including a semi-quantitative food frequency questionnaire in the second trimester (week 22).
New tests and interventions may help prevent future health problems
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1. Potassium Citrate May Help Prevent and Treat Osteoporosis Supplement Neutralizes Bone Damage Inflicted by the Western Diet
The Western diet creates an acidic environment in the body that removes calcium from bones and may contribute to the development of osteoporosis. Healthy adults who consume the standard US diet sustain a chronic, low-grade state of acidosis that worsens with age as kidney function declines, limiting urinary acid excretion. Reto Krapf, MD (University of Basel, in Bruderholz/Basel, Switzerland) and colleagues designed a study to see if daily alkali as potassium citrate supplement tablets might neutralize these effects. They enrolled 201 healthy elderly individuals of both genders with normal bone mass in a randomized double-blind, placebo-controlled clinical trial. Participants received either 60 mmol alkali as potassium citrate (a base) or a placebo every day for 2 years. Bone density and high resolution computed tomography scans after 2 years revealed that neutralizing diet-induced acid production with potassium citrate significantly and safely increased subjects’ bone density vs. placebo. “In addition, we discovered that bone architecture improved significantly, suggesting that not only bone mass, but also its quality was improved,” said Dr. Krapf. These results suggest and predict that potassium citrate may be effective for preventing and even treating osteoporosis.
Study co-authors include Sigrid Jehle, MD (University of Basel, in Bruderholz/Basel, Switzerland) and Henry N. Hulter, MD (FibroGen, Inc., San Francisco).
Disclosures: The authors reported no financial disclosures.
UNC Miscarriage Expert Available to Comment on Bush’s Miscarriage Disclosure
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Kristen M. Swanson, Ph.D., dean of the School of Nursing at the University of North Carolina at Chapel Hill, is available for interviews about President George W. Bush’s disclosure of his mother’s miscarriage in his book ‘Decision Points.’
Swanson is an expert on miscarriage and how couples respond emotionally to it. She began her work on miscarriage 25 years ago with her dissertation, “The Unborn One: A Profile of The Human Experience of Miscarriage,” and has continued studying this area both as an investigator and as a consultant to other researchers’ works.
Although some have been shocked that President George W. Bush saw the fetus in a jar when he drove his mother to the hospital, Swanson said that the holding of the fetus is one of the most tender and private losses that a woman goes through when she miscarries.
Pregnancy outcome affected by immune system genes
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A team of researchers, led by Ashley Moffett, at the University of Cambridge, United Kingdom, has shed new light on genetic factors that increase susceptibility to and provide protection from common disorders of pregnancy, specifically recurrent miscarriage, preeclampsia, and fetal growth restriction.
A key step in the initiation of a successful pregnancy is the invasion of the lining of the uterus by fetal cells known as trophoblasts, which become the main cell type of the placenta. Recurrent miscarriage, preeclampsia, and fetal growth restriction are thought to result from inadequate trophoblast invasion of the uterus lining. Interactions between maternal cells known as uterine NK cells and fetal trophoblasts — specifically interactions between HLA-C molecules on the fetal trophoblasts and KIRs on the maternal uterine NK cells — are key to determining the extent of trophoblast invasion. Previous data from Moffett’s lab indicated that a particular combination of fetal HLA-C and maternal KIR was associated with increased risk of preeclampsia. In this study, the team has extended this correlation to recurrent miscarriage and fetal growth restriction. Furthermore, they have determined that the presence of other maternal KIRs that combine with the same HLA-C molecule provides protection against the same common disorders of pregnancy.
Students design early labor detector to prevent premature births
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The birth of a baby is usually a joyous event, but when a child is born too early, worrisome complications can occur, including serious health problems for the baby and steep medical bills for the family. To address this, Johns Hopkins graduate students and their faculty adviser have invented a new system to pick up very early signs that a woman is going into labor too soon.
The normal length of a pregnancy is 40 weeks, while babies born before 37 weeks gestation are considered to be preterm. By detecting preterm contractions with greater accuracy and sensitivity than existing tools, the new system could allow doctors to take steps at an earlier stage to prevent premature births, its inventors say.
The health concerns and costs associated with premature births have received increasing attention in recent years, due in part to a rise in the number of multiple births, to the use of fertility treatments, which can cause multiple births, and to an increase in women who are having babies later in life. These trends are all associated with a higher risk of preterm labor.
Gestational Diabetes Linked to Protein in Pregnancy Diet
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It seems like just yesterday I was posting that there was little to no info about the causes of Gestational Diabetes. Today, it seems like there may be a tiny bit more. A new study shows that women with Gestational Diabetes have lower levels of the chemical Serotonin. Serotonin is made from tryptophan, an amino acid found in high protein foods.
So does this mean that women who eat more protein in the first trimester are less likely to get Gestational Diabetes?
The study shows what is described as “a clear link between the amount and type of protein consumed by the mother early in pregnancy and the generation of islet cells needed to protect her against gestational diabetes late in pregnancy”.
PBDE Flame Retardant Linked to Thyroid Hormone Levels in Pregnant Women
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The largest study yet to investigate exposure to polybrominated diphenyl ether (PBDE) flame retardants and pregnant women’s thyroid hormone levels correlates exposure to PBDEs with reduced levels of thyroid-stimulating hormone (TSH) and increased odds of subclinical hyperthyroidism.
“There is very clear evidence from animal studies that PBDEs affect thyroid hormones, but very few human studies have attempted to determine whether pregnant women’s PBDE levels can impact the developing fetus,” says the study’s lead author, Jonathan Chevrier of the University of California, Berkeley, Center for Children’s Environmental Health Research.
“A mother’s thyroid hormones affect her developing baby throughout her pregnancy, and they are essential for fetal brain development,” says coauthor Brenda Eskenazi, director of the Center for Children’s Environmental Health Research.
