Mothers' High Normal Blood Sugar Levels Place Infants at Risk for Birth Problems

Thursday, May 8, 2008

Pregnant women with blood sugar levels in the higher range of normal — but not high enough to be considered diabetes — are more likely than women with lower blood sugar levels to give birth to babies at risk for many of the same problems seen in babies born to women with diabetes during pregnancy, according to a study funded in large part by the National Institutes of Health.

These problems included a greater likelihood for Caesarean delivery and an abnormally large body size at birth. Infants born to women with higher blood sugar levels were also at risk for shoulder dystocia, a condition occurring during birth, in which an infant’s shoulder becomes lodged inside the mother's body, effectively halting the birth process.

The study authors declined to make recommendations for acceptable blood sugar levels for pregnant women. The researchers were unable to identify a precise level where an elevation in blood sugar increased the risk for any of the outcomes observed in the study. Rather, the chances for the outcomes were observed to increase gradually, corresponding with increases in the women’s blood sugar levels.

It is well known that high blood sugar levels characteristic of the diabetes that occurs during pregnancy present risks for expectant mothers and the infants born to them. The current study is the first to document that higher blood sugar levels, not high enough to be considered diabetes, also convey these increased risks. Furthermore, when the researchers mathematically adjusted for other potential causes of these risks — such as older maternal age, obesity, and high blood pressure — the increased risks due to higher blood sugar levels were still present.

"These important new findings highlight the risks of elevated blood sugar levels during pregnancy," said Duane Alexander, M.D., director of the NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development, which provided much of the funding for the study. "NIH-supported studies now in progress will provide guidance on how to manage them. Until the results of those studies are available, all pregnant women should consult a health care professional about being screened for diabetes during pregnancy."

Additional NIH funding was provided by the National Institute of Diabetes and Digestive and Kidney Diseases, and the National Center for Research Resources.

Diabetes results from difficulty transferring sugar (glucose) from the blood to the body’s tissues. It occurs in roughly 5 percent of all pregnancies in the United States. Mothers with diabetes during pregnancy are also at increased risk for preeclampsia, a potentially fatal disorder involving dangerously high blood pressure. Babies born to mothers with diabetes — when they reach adulthood — are at higher risk for obesity as well as diabetes, high blood pressure, and heart disease.

The seven-year study involved more than 23,000 pregnant women at 15 centers in 9 countries.

The results of the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study appear in the May 8 New England Journal of Medicine. The researchers were led by Boyd E. Metzger, M.D. Professor of Medicine at the Northwestern University Feinberg School of Medicine in Chicago.

Dr. Metzger explained that before the current study, physicians were not sure at which point elevated maternal blood sugar posed a risk for the baby. Frequently, high maternal blood sugar levels accompany such conditions as obesity, high blood pressure and older maternal age — all known to increase the likelihood for Caesarean delivery. For this reason, it wasn’t known whether the increased risk for Caesarean delivery and other problems seen with mild elevations in blood sugar during pregnancy were caused by the elevated blood sugar levels, or by these accompanying conditions. In their study, however, the researchers made adjustments for these accompanying conditions and found that the higher blood sugar levels still conveyed increased risks.

To conduct the study, the researchers performed an oral glucose tolerance test on each woman, from the 24th through the 32nd week of pregnancy. For the test, the women fasted, after which their blood glucose level was measured. Next, the women drank a glucose solution, and then their blood glucose was measured at predetermined intervals. Women with blood sugar levels high enough to raise safety concerns were referred for treatment and were not included in the study. The remaining women were observed throughout the study until they gave birth.

The researchers found that the higher the mother's blood sugar levels, the greater the chances that they would deliver by Caesarean section. In addition, the higher the mother's blood sugar levels, the more likely the infants were to have high insulin levels and low blood sugar levels at birth. Both conditions indicate exposure to high glucose levels in the womb. Moreover, the higher the mother’s blood sugar levels, the more likely the women were to develop preeclampsia, and the more likely their infants were to be born prematurely, and to experience shoulder dystocia. So, for example, women with the lowest fasting blood sugar levels gave birth to abnormally large babies roughly 5 percent of the time, while women with the highest blood sugar level gave birth to large babies 26 percent of the time.

"These relationships are continuous and generally increase incrementally over the range of blood glucose levels we saw in the study," he said.

Source: NIH

Permalink: http://www.sflorg.com/comm_center/womens_health/p421_15.html

Time Stamp: 5/8/2008 at 1:26:46 PM UTC

Young Women Need to Think About Strong Bones Now

Tuesday, May 6, 2008

May is Osteoporosis Prevention Month

Women in their 20s and 30s will have big problems as they age if they don’t start thinking about bone health now, according to a University of Missouri nutritional scientist who studies osteoporosis. Bone mass in women peaks at age 30 and is stable until age 50 when a rapid loss begins to occur. Men stay relatively steady over time and do not experience a significant bone loss until age 70.

In a recent study, Pam Hinton, associate professor of nutritional sciences in the MU College of Human Environmental Sciences, found that physically active women had a major risk for osteoporosis if their body mass index (BMI) was too low and they had too few menstrual cycles – fewer than four per year – despite being physically active. The average age of the women in the study was 22 year old. The study was published in the journal Women in Sport and Physical Activity.

Hinton says physical activity alone cannot protect women from low bone mass or make up for a loss of estrogen.

“The women in the study did not have eating disorders and would not be expected to be at risk for low bone density,” Hinton said. “That is why several factors are important for bone health: body weight, physical activity, estrogen status, calcium and vitamin D intake.”

According to Hinton, the skeleton responds to impact or weight-bearing activity such as running, soccer, volleyball, group exercise classes, and resistance training. Swimming, walking and cycling will not help build or maintain bone mass.

Calcium also is very important for strong, healthy bones. Hinton suggests that supplements such as calcium citrate or calcium carbonate are best. She says to be wary of calcium is from bone meal or oyster shells, as those supplements are not well absorbed and may have contaminants.

“Supplements are certainly better than nothing; but, dairy products are better because you can get calcium and other healthy benefits like vitamin D and protein,” Hinton said.

It is inevitable as people age bone mass will be lost. Beginning with the highest bone mass possible is the best way to combat the loss that comes with aging.

“If you didn’t do anything while you were younger, it is never too late to take action,” Hinton said. “You can at least prevent more bone loss and add small amounts of bone mass through exercise and vitamin intake.”

Source: University of Missouri

Permalink: http://www.sflorg.com/comm_center/womens_health/p415_14.html

Time Stamp: 5/6/2008 at 7:42:59 PM UTC

Better-Educated Women Are a Healthier Weight, New Research Reveals

Thursday, May 1, 2008

Handbook of Development Economics Gets First Update in More Than a Decade

A new comparison of multinational data, released this month, reveals that highly educated women have a healthier average weight than less educated women, but that the meaning of "healthier" changes according to a nation's relative wealth. In countries where malnutrition is prevalent, better-educated women weigh more. But in wealthier countries -- with rapidly growing rates of obesity -- better-educated women weigh less.

"As a population moves through the nutrition transition, it is the most educated, and highest income, who are the first to exit under-nutrition. They are also the first to adjust their diet and physical activity to avoid the deleterious effects of being overweight," explained John Strauss, professor of economics at the University of Southern California.

"It appears that it is women who tend to lead this transition," he added.

More than half of the adult population is underweight in Bangladesh, the poorest country analyzed by Strauss and Duncan Thomas (Duke University). In Bangladesh, average female body mass increased with every additional year of schooling.

In contrast, only 1 percent of people in the United States are underweight. Better-educated women in the United States, the wealthiest country in the study, had a lower average body mass index the more education they'd received, the researchers found.

"Obesity rates rise with economic development, which is troubling given the relationship between obesity and cardiovascular disease, stroke, diabetes and possibly cancer," Strauss said. For example, the researchers show that in China almost twice as many women are now overweight as are underweight.

Furthermore, in developing countries worldwide, women are more likely than men to be overweight or obese. The gender gap is largest in South Africa, where more than one-third of women are obese, compared with about 10 percent of South African men.

However, Strauss and Thomas show that once women receive a certain amount of schooling, average body mass index (BMI) falls and they are more likely to be at a healthy weight.

"Behavioral changes have important impacts on health outcomes," Strauss said.

For example, the average BMI of a Mexican woman -- where 74 percent of the women are overweight or obese -- declines for every year of schooling she receives in excess of just five years. There is a similar sharp decline in the average female's BMI in South Africa after five years of education.

BMI is a widely used measure that accounts for both weight and height.

The United States was the only nation surveyed in which better-educated men had a lower average BMI than less-educated men. In every other country, the average male body mass increased with every additional year of schooling.

The findings appear in the latest volume of the Handbook of Development Economics, edited by Strauss and T. Paul Schultz (Yale University). The new book is the first update in more than 13 years to the Handbook of Development Economics, which has counted at least six Nobel Prize laureates among its contributors.

"Data has vastly improved since the last volume," said Strauss, who is also the principal investigator for the long-term Indonesia Family Life Survey, which tracks more than 30,000 individuals.

An unmatched resource for scholars, the Handbook of Development Economics summarizes and synthesizes important research about economic development, including the role of institutions such as schools, medical facilities and fair court systems. Nobel Prize laureate Amaryta Sen wrote the first chapter of the first volume of the Handbook in Development Economics in 1988.

Topics explored in the latest volume, released in April 2008, include the decline of agricultural employment, the effects of changing fertility through availability of contraception or family planning programs, child labor and political corruption.

Source: University of Southern California

Permalink: http://www.sflorg.com/comm_center/womens_health/p413_13.html

Time Stamp: 5/1/2008 at 2:12:53 PM UTC

Heart Disease Predetermined By Oxygen Levels In The Womb

Wednesday, April 9, 2008

The amount of oxygen available to a baby in the womb can affect their susceptibility to developing cardiovascular disease later in life.

Research from scientists at the University of Cambridge indicates that your risk of developing cardiovascular disease can be predetermined before birth, not only by your genes, but also by their interaction with the quality of the environment you experience in the womb. Their research was presented this week at the annual Society for Endocrinology, British Endocrine Society meeting.

The Cambridge researchers, led by Dr Dino Giussani, examined the role that oxygen availability in the womb plays in programming your susceptibility to different diseases. His group found that babies that don’t receive enough oxygen in the womb, e.g. due to pre-eclampsia (high-blood pressure during pregnancy) or placental insufficiency, are more likely to suffer from cardiovascular disease when they are adult.

A reduction of oxygen levels in the womb can lead to reduced growth rates in the baby and to changes in the way that their cardiovascular, metabolic and endocrine systems develop. Combined, these alterations to the development of key systems in the body can leave the baby more prone to developing cardiovascular disease later in life.

Dr Giussani’s research also indicates methods by which we can potentially combat this problem. The detrimental effects of low oxygen levels on the development of the fetus’ cardiovascular system appear to be due to the generation of oxidative stress. Treatment with antioxidants in animal pregnancies complicated by low oxygenation can reverse these effects on the developing cardiovascular system and this could form the basis for new therapeutic techniques to prevent the early origin of heart disease in complicated human pregnancy.

Cardiovascular disease is the most common cause of death in the UK, accounting for 4 in every 10 deaths. Almost 2.6 million people are affected by heart and circulatory conditions in the UK, with someone having a heart attack every 2 seconds.

Dr Giussani said: “We have known for a while that changes in maternal nutrition can affect fetal development and influence disease susceptibility later in life, but relatively little work has investigated how low oxygen levels in the womb may affect infant development. Our research shows that changes to the amount of oxygen available in the womb can have a profound influence on the development of the fetus in both the short and long term, and trigger an early origin of heart disease.

“Interestingly, the adverse effects on the developing heart and circulation of poor fetal oxygenation are due to oxidative stress. This gives us the opportunity to combat prenatal origins of heart disease by fetal exposure to antioxidant therapy. This may halt the development of heart disease at its very origin, bringing preventative medicine back into the womb.”

Source: University of Cambridge

Permalink: http://www.sflorg.com/comm_center/womens_health/p373_12.html

Time Stamp: 4/9/2008 at 5:33:24 AM CST

Smoking Early In Pregnancy Raises Risks Of Heart Defects In Newborns

Tuesday, April 8, 2008

Mothers who smoke early in pregnancy are more likely to give birth to infants with heart defects, according to a study funded by the Centers for Disease Control and Prevention (CDC).

The study, published in the April issue of Pediatrics, shows that women who smoked anytime during the month before pregnancy to the end of the first trimester were more likely to give birth to infants with certain congenital heart defects (CHDs) compared to women who did not smoke during this time period. The association was stronger for mothers who reported heavier smoking during this time period.

“Most people know that smoking causes cancer, heart disease and other major health problems,” said Margaret Honein, Ph.D., MPH, CDC’s National Center for Birth Defects and Developmental Disabilities, one of the researchers. “The indisputable fact is that women who smoke during pregnancy put themselves and their unborn babies at risk for other health problems.”

The findings from the study, “Maternal Smoking and Congenital Heart Defects,” were based on the National Birth Defects Prevention Study, which is the largest population-based study ever done on the causes of birth defects in the United States. Nine states participated in the study: Arkansas, California, Georgia, Iowa, Massachusetts, New York, North Carolina, Texas and Utah. This research included 3,067 infants with CHDs and a comparison group of 3,947 infants with no major birth defects.

The study found that septal heart defects – a hole in the heart between the left and right heart chambers, which disrupts the flow of blood and oxygen to the body – were the most common defect found among infants who were born with a cardiac defect. Researchers also found conotruncal (poor blood circulation from lower heart chamber), right-side obstructive (blood is blocked from flowing freely from the right side of the heart) and left-side obstructive (blood is blocked from flowing freely from left side of heart) defects.

CHDs are the most common type of birth defect, occurring in eight to 10 of every 1,000 live births in the United States. Many infants with CHDs die in the first year of life, and infants who survive often require numerous surgeries, lengthy hospitalizations and a lifetime of treatment for related disabilities.

Women who smoke should know that in addition to smoking being a possible cause for heart defects, the following are also of concern:

• Smoking makes it harder for a woman to get pregnant.

• Women who smoke during pregnancy are more likely than other women to have a miscarriage.

• Smoking during pregnancy causes major health problems for both mother and baby. For example, smoking is one of the causes of problems with the placenta — the source of the baby's nutrition and oxygen during pregnancy.

• Smoking during pregnancy can cause a baby to be born too early and have low birth weight — making it more likely the baby will become sick or die.

• Babies born to women who smoke are more likely to have a cleft lip or cleft palate — types of birth defects.

• Smoking during and after pregnancy is one of the causes of Sudden Infant Death Syndrome (SIDS).

Source: CDC

Permalink: http://www.sflorg.com/comm_center/womens_health/p369_11.html

Time Stamp: 4/8/2008 at 12:22:10 AM CST