A woman who becomes pregnant is prescribed by her obstetrician prenatal vitamin supplements. And one of the most important of these is folic acid. Folic acid is a synthetic form of folate; folate is an essential B vitamin that plays an important role in many bodily functions. Folic acid supplementation has helped prevent many birth defects over the years, especially spina bifida. What many of us may not know is that flour and grains in most developed countries, including the US, are also fortified with folic acid for more than a decade now.

Unfortunately, recent research studies are casting doubt on the benefit of folic acid fortification and supplementation. Several clinical trials have shown for example that folic acid does not reduce risks of developing chronic diseases and may even have some adverse effects. Below I summarize some of the studies on folic acid supplementation.

Folic acid and its effects on the genes of offspring

Researchers from the University of Toronto have observed in mice that folic acid supplementation during pregnancy induces changes in the genes of the offsprings. The changes may consist of either silencing or activating genes that suppress tumors. This suggests that maternal supplementation with folic acid can have an effect on the susceptibility of the offsprings to cancer.

Folic acid and heart disease

This clinical trial of Harvard’s Brigham and Women’s Hospital in Boston followed up 5,400 female health professionals for about 7.3 years. The results suggest that folic acid did not lower levels of the amino acid homocysteine, believed to be a biomarker for cardiovascular disease. Thus, folic acid supplemention does not reduce cardiovascular risks.

Folic acid and cancer

This study by researchers at Harvard Medical School looked at the effect of folic acid, vitamin B₆, and vitamin B₁₂ in reducing cancer risk in women. The results showed that a combination of these three vitamins did not protect women from breast cancer or total invasive cancer.

This recent research results raise the question of the benefits of folic acid fortification of food for the general population. Could it be that people in developed countries like the US are consuming too much folic acid? Could it be that long-term consumption of folic acid (as found in our food) can increase development of cancer in some people? Could folic acid supplementation during pregnancy increase cancer risk in the unborn child?

Currently, there isn’t enough evidence to change the clinical practice of taking folic acid supplementation during pregnancy. Several studies are ongoing to try to answer the aforementioned questions.

Traffic Pollution Affects Unborn Babies Development

The results of a study released this week have alarming news. It’s long been suspected that traffic fumes affect unborn babies, but now a large study has shown that mothers who were exposed to higher levels of traffic pollution in early and late pregnancy were more likely to have low birth weight babies who did not grow as they should in the womb.

Mothers who lived near busy streets  and freeways were found to be more at risk of low birth weight babies.  The authors of the study say that it’s not a definitive conclusion and that there might be some other factors other than pollution involved, but it still makes for worry for any pregnant woman living near a highway.

While moving house is not an option for many of us, anyone who is planning to move house can take proximity to major roads into consideration when choosing a new home.

As well as the effect on unborn babies, children living near freeways are more likely to have respiratory problems. Living near a freeway also negatively affects lung development in children.

If you already live near a major road, there are things you can do to reduce the level of pollutants in our home. Air cleaners or air filters can reduce the amount of small particle pollution generated by vehicles, suspected to be one of the culprits in the study. Gaseous pollutants are harder to remove inside, but some research suggests that houseplants can filter and remove chemicals from the air and improve indoor air quality.

Every month of the year is in honor of something. January, for example, is National Hobby Month as well as National Oatmeal Month, among others. For us here at BOL, however, the most significant thing about January is that it is the National Birth Defects Prevention Month in the US.

Here are some statistics on birth defects from the March of Dimes:

• A birth defect refers to an abnormality in structure, function or metabolism of an infant at birth. Birth defects can result in physical or mental disabilities or death.
• About 120,000 infants in the United States are born with birth defects each year. This is equivalent to 1 in every 33 babies.
• Birth defects are the leading cause of infant mortality in the first year of life.
• Thousands of different birth defects have been identified; however, only 30% of these are well-studied enough to pinpoint the causes. The causes of 70% remaining defects are unknown

Those birth defects whose causes are known can be grouped into three categories:

Birth defects due to genetic factors. The most commonly known of these are defects due chromosomal aberrations such as Down syndrome. Other well-known genetic birth defects are cystic fibrosis, hemophilia, and sickle cell anemia.

Birth defects due to environmental factors. Defects can result from exposure to certain environmental factors during pregnancy. These factors may be in the form of chemicals, pathogens, electromagnetic fields, and radiation (among others) and are called teratogens. The most commonly known teratogens are alcohol, chemicals from cigarettes, and certain drugs. Infections during pregnancy can also cause serious birth defects. Examples of teratogenic infections are the varicella (chicken pox) virus and the syphilis virus.

Multi-factorial birth defects. These defects are caused by a combination of genetic and environmental factors. Examples of these types of defects are cleft lip/palate, spina bifida and congenital heart defects.

The most commonly reported birth defects in the US are as follows:

• Cleft lip/palate – 6,800 babies each year
• Down syndrome – 5,500 babies each year
• Transposition of the great arteries (heart defects9 – 1,900 babies each year)
• Spina bifida – 1,300 babies each year

For more information about birth defects, check out the National Birth Defects Prevention Network.

With any pregnancy, a woman as a lot of new information to take in, mostly related to caring for herself and her unborn child. Many women are advised to avoid certain foods or to go easy or have them in moderate amounts because of the potential impact on the fetus, as well as the mother’s health. Now reports have surfaced that women are being advised to do without makeup while pregnant.

Concerns have been raised for some time regarding the chemicals used in cosmetics and their possible long term risks. In the EU there have been calls for a new labeling system warning pregnant women not to use certain beauty products.

A recent study showed that women exposed to a lot of hairspray during pregnancy were two times more likely to have babies with a deformity known as hypospadias. This refers to a condition in which the urinary tract ends up on the underside of the penis. The study which was performed by the Imperial College London implied that this birth defect could be traced to chemicals which are used in hairspray. They claim that these chemicals can adversely affect the body’s hormonal system as well as reproductive functions.

Parabens, which are used as preservatives in beauty products, and phthalates, have both raised concerns about the health and safety of cosmetics users. A study done in 2004 suggested that parabens used in deodorants were found in cancerous breast tissue. Phthalates are sometimes used soften plastics, and at high levels have been proven to affect hormones.

It is not always easy to make sense of all these studies that come out, but clearly this one is pretty straightforward and should be taken seriously. Women who still feel the need to wear makeup should try to use less, or have a few makeup free days. There are natural cosmetics on the market which are said to be free of parabens and phthalates, it’s always going to be much healthier to care for your skin organically. If you’re at all concerned about looking beautiful during your pregnancy, remember, it’s only for a few months, and you’re just as beautiful without it.

Another reason to be glad that the days of beehives and Farrah Fawcett flips are over, and women don’t use anywhere near the amount of hairspray we used to.

Women pregnant with a son who used or were exposed to hairspray during the first three months of pregnancy are two to three times likely to have a baby with hypospadias. Hypospadias is a birth defect where the urinary opening in the penis of a baby boy is malformed, and requires corrective surgery. Most milder cases can be completely repaired although severe cases can cause lifelong problems with urinating, sexual relations and fertility.

Hypospadias affects around 1 in 250 baby boys in the US, and the cause is usually unknown. With the results of this study, scientists think that chemicals in hairspray, namely phthalates, a chemical found in many beauty products that has been linked to genital abnormalities in baby boys and girls. Phthalates in hairspray may be more damaging than phthalates on other products because it’s very easy to inhale hairspray, where the phthalates can be absorbed internally.

It’s scary what seemingly innocent products can affect babies. At least we can avoid hairspray quite easily. So if you are pregnant, stay out of the restroom when your colleague with the updo goes in, and perhaps consider changing your hairstyle for something a little less high-maintenance if you are use hairspray on yourself.

Consider it part of the lifestyle transition to when your baby is born. Most new moms don’t have time to maintain anything more elaborate than a ponytail with a newborn!

Here are some troubling study results that bring bad news to both parents and doctors who had anything to do with assisted reproductive techniques – babies born via in vitro fertilization (IVF) have 2 to 4 times higher likelihood of having birth defects compared to babies conceived naturally, according to an article in the New York Times.

Now, before you start panicking, there are some limitations to the study mainly:

• The study only looked at singletons, not multiples.
• The study only looked at babies born via IVF, i.e. fertility treatments that involved handing the eggs and the sperm in the lab, but not babies born through other types of treatment.
• The birth defects in question – cleft lip and cleft palate and abnormalities in the heart, esophagus or rectum – are very rare conditions, so that despite the increased likelihood, the risk is still low.
• The study only compared 281 IVF-assisted births vs 14,085 natural births, thus making its statistical power a bit suspect.
• The study observed an IVF-birth defect link but could not explain the mechanism behind the link.

The article moved on to give us the following statistics:

• 52,000 babies were born via assisted reproduction in the US in 2005.
• 12% American of women ages 15 to 44 years seek fertility treatments.

Conclusions of the experts? Maybe. But larger studies are needed to confirm the results before doctors and parents should start worrying.

I know it’s been said, it’s been written before. But it is still a topic that is worth revisiting – smoking during pregnancy. This time I am summarizing two new studies published in the November issue of the Journal of Pediatrics.

Study # 1:

This international study looked at pregnant women from the US (Texas), Norway, and Holland and the levels of the nicotine metabolite cotinine in their blood serum. The researchers found that women who smoked during pregnancy -as indicated by high levels of cotinine – have almost 2.5 times higher likelihood of having a baby with oral clefts.

Study #2:

Another study by researchers at Brown University looked at the effect of cigarette smoke exposure on the behavior of babies. Similarly, they also measured the cotinine levels in the blood of 56 healthy babies. Half of the babies exposed to cigarette smoke were “irritable and difficult to soothe” compared to unexposed babies.

Children are exposed to cigarette smoke in different ways, namely:

• as a fetus in the uterus of a smoking mother
• secondhand smoke from smoking adults in the environment, mainly the parents
• through breast milk of a smoking mother

The editorial of the abovementioned journal described smoking as a “major pediatric problem” and therefore pushes for more active preventive measures.

Researchers at the Medical College of Georgia Schools of Medicine and Graduate Studies have been studying the mechanism by which alcohol damages unborn babies.

Pregnant women who drink alcohol put their babies at risk of Fetal Alcohol Syndrome, FAS. Babies born with FAS have liver abnormalities, facial deformities, and brain and spine problems.

As a fertilized cell begins to divide and grow into an embryo and then into a fetus, some cells are used to build new tissues, and some cells are designed to help and then die once they are not needed. The scientists have found that alcohol increases the number of cells that die, so cells that are actually needed are dying, which is what they think leads to abnormalities.

They found very strong evidence that a couple of glasses of wine drunk in a few hours seriously increases the rate of cell death, and that drinking alcohol in early pregnancy – even before you know you are pregnant – is the most damaging.

The bottom line? As the advice has always been, pregnant women shouldn’t drink alcohol. And, if you are trying to conceive, or just not using any contraception – it’s wisest to avoid alcohol too.

Sorry ladies: I know it’s not fun. I remember feeling as cross as anything watching my ex-husband and his buddies down cold beers one hot afternoon when I was 8 uncomfortable months pregnant, and going without a nice glass of wine while watching a movie was something I really missed. But it’s worth it for your baby, and just think how good that glass of wine is going to taste once you can have it again!

Sorry to bring some not-so-good news today.

In a previous post, I touched on the alarming increase in the incidence pregestational diabetes (not be confused with gestational diabetes) – pre-existing diabetes mellitus among women of childbearing age before pregnancy. This study I am reviewing here investigated the link between birth defects and pregestational diabetes mellitus (PGDM) in mommies.

The study examined data on 13,030 babies born with congenital defects and 4,895 babies without birth defects babies born from 1997 to 2003. They then looked into association between the mothers’ health conditions and 39 categories of birth defects, which included cardiovascular, neurological, and musculoskeletal defects.

Analysis of the large dataset showed that PGDM was significantly associated about 50% of all birth defect categories, both cardiac and noncardiac birth defects. Furthermore, more defects were associated with PGDM than gestational diabetes.

This doesn’t mean to say that women with PGDM shouldn’t get pregnant. There are many women out there with diabetes who have perfectly healthy babies. It is, however, strongly recommended that women with pre-existing f?diabetes should talk to their doctors before getting pregnant so that preventive measures such as blood sugar level control and vitamin intake be implemented.

I also hope that health insurance companies wouldn’t use studies such as these as their basis to deny coverage. Medical studies are conducted with the aim of improving healthcare and quality of life of patients and shouldn’t be used as weapons against the patients they are supposed to benefit.

Source:

Am J Obstet Gynecol, July 2008

I just read and update this morning about Alaska governor Sarah Palin and her newborn infant son Trig. Governor Palin, 42, gave birth to her 5th child April 18th. I was impressed with the fact that she was still on the job the day she gave birth! According to press, the Governor went into labor while attending a conference in Texas, and flew back to Alaska for the birth.

Shortly after the birth, a press release stated that the child had “special needs.” Governor Palin has now said that Trig has Down’s Syndrome, and that the doctor’s revealed the diagnosis during her fourth month of pregnancy. Down Syndrome is a birth defect cause by an extra chromosome and occurs in 1 out of every 100 births in women who conceive after the age of 40.

This story was very personal for me as I have 5 children myself. Two of my children have numerous handicaps and so I am aware of how a special needs child can incredibly change one’s life. Last week, my sister-in-law discovered that the child she miscarried had Down’s Syndrome as well. Parenting a special needs child is certainly a demanding job, although parenting in general is a demanding job as well. Despite her new job as a parent to a speical needs child, Governor Palin vows that she will still continue on in her role as Governor and that her new duties will not affect her work. I am impressed with her strength and tenacity! Although my personal decision was very different than hers(I chose to freelance from home instead of continuing on with my career), I wish her and her family the very best as they begin this new life journey.

We all know that folic acid aids in preventing birth defects of the brain and spinal cord called neural tube defects (NTDs). In addition, studies have shown that it can prevent other birth defects, including cleft lip and palate, and some heart defects. The March of Dimes recommends that women who are or plan to become pregnant take a multivitamin that contains 400 micrograms of folic acid daily starting before pregnancy, as part of a healthy diet. Folic acid is recommended for all women of child-bearing age because about 50% of all pregnancies are unplanned, the organization reports.

But did you know that taking folic acid may also help prevent premature births? Researchers at the 28th Annual Society for Maternal-Fetal Medicine (SMFM) meeting unveiled a study that revealed women who took folic acid supplements for a year or longer before they conceived had a 70% decreased risk of preterm birth between 20 and 28 weeks of gestation. A year of folic acid supplementation dropped the risk of delivering during weeks 28-32 by 50%.

A premature birth is defined as one that occurs before 37 weeks of gestation, says the U.S. National Institutes of Health (NIH). Improved medical knowledge and technology have made survival for these small infants more likely; of babies born at 28 weeks or later, 90% are expected to survive, according to the NIH.

Folic acid is important in maintaining health for everyone. It has been known for a long time that folic acid plays an important role in producing normal red blood cells. People who are deficient in folic acid sometimes develop a form of anemia called megaloblastic anemia, which is characterized by a reduced number of red blood cells.

Folic acid may also play a role in preventing other health problems, the March of Dimes reports.

Has your obstetrician talked to you about cytomegalovirus? This infection, also known as CMV, is a member of the herpes family and causes birth defects in thousands of babies each year. Infection occurs from contact with saliva or urine of another infected person. Frequently, this contact comes from a preschool-age child. The problem is that CMV can be passed through the placenta to the developing baby, potentially causing birth defects such as cerebral palsy, hearing or vision loss, or mental disabilities. Strikingly, CMV affects about 1 in 150 babies born each year.

In its list of common workplace hazards, WebMD lists cytomegalovirus and rubella as important considerations for pregnant nurses and day-care workers, who are often exposed to the virus.

The Center for Disease Control and Prevention (CDC), recently surveyed obstetricians and found that only 44% discuss CMV with their patients. As a result, the CDC released statements urging obstetricians to inform pregnant women, or those considering becoming pregnant, about steps they can take to prevent contracting CMV. Steps include washing hands frequently, especially after changing a child’s diaper or coming in contact with his saliva; avoiding kissing younger children (under age six) on the mouth or cheek; and avoiding sharing food, drink, and utensils with younger children.

Unfortunately, many people infected with CMV do not show any symptoms; if they do, it may include swollen glands, fatigue, and fever. In addition, there is no vaccine to prevent CMV, and drugs currently used against CMV are not safe for pregnant women.

Resources:

http://abcnews.go.com/Health/ReproductiveHealth/WireStory?id=4184903&page=1

http://www.webmd.com/baby/guide/working-while-pregnant