Caffeine Intake In Pregnancy Leads To The Risk Of Miscarriage.

Is caffeine safe for pregnant women? There has been speculation that excessive caffeine intake can lead to pregnancy loss. The Kaiser Permanente Division of Research conducted a study on 1,063 pregnant Kaiser Permanente members in San Francisco from October 1996 through October 1998 to answer this question. The researchers examined the caffeine effect on women who never changed their pattern of caffeine consumption during their pregnancy.

Women who consumed 200 mg or more of caffeine per day (two or more cups of regular coffee or five 12-ounce cans of caffeinated soda) had twice the miscarriage risk as women who consumed no caffeine. Women who consumed less than 200 mg of caffeine daily had more than 40 percent increased risk of miscarriage. The increase in the risk appears to come from the caffeine itself. The main message from this study is that pregnant women who consume caffeinated beverages should go off caffeine.

Reference: http://www.sciencedaily.com/releases/2008/01/080121080402.htm

CHP Lorain Spirit of Women Wins National Recognition

Mario Sertich, MD, introduced the spirit of women to the Lorain Community Hospital. This organization aims at bringing women's attention to different programs in the community hospital. Please, read on:

Antidepressants In Pregnancy. Are they Safe?

Depression is a common condition that afflicts women. Depressed pregnant women are at risk of preterm labor and worsening of their depression. Hence, treatment of these patients is important. That is why two recent articles that appeared in the New England Journal of Medicine about drug treatment of depression in pregnancy are important.

Previous studies implicated the selective serotonin reuptake inhibitors (SSRI's) like Paxil, Prozac and Zoloft in causing birth defects. These two new studies agree that the SSRI's have low risk of causing fetal abnormalities. Pregnant women who have depression should take comfort that they can take the SSRI's without having to worry about having abnormal babies. The abnormalities found in previous studies are rare.

Reference: New England Journal of Medicine.

Depressed Women May Have Premature Babies

A study done in England on depressed pregnant women showed the severely depressed women who were not taking medications had premature labor.

That depression produces stress hormones is exemplified by this study. Dr. O'Keane, a perinatal psychiatrist at the King's College in London measured corticotrophin releasing hormone (CRF) in 25 depressed pregnant women who were not on any antidepressant medications and 35 pregnant women who had no depression.

Levels of CRF and cortisol, hormones related to stress and also produced  by the placenta in pregnancy were found to be higher in women with depression.

While none of the mothers that were not depressed had premature deliveries, on the average, the depressed mothers had their babies 2 days earlier and 3 of them had premature deliveries.

During the follow up visit, the babies whose mothers had depression had high levels of cortisol in their saliva, a sign that their mothers' stress had effect on them..

The study involved a few patients. More studies are needed to elucidate the findings of this interesting small study. The take home message is that depressed pregnant patients' stress may have effect on their unborn babies. The effect may even continue after delivery. Hence pregnant women who are depressed should be treated with antidepressants despite the fear that some of the antidepressants may have effect on the newborn babies.

 

Reference: From issue 2599 of New Scientist magazine, 14 April 2007, page 18

Dental Care In Pregnancy Can Prevent Premature Labor

Gum disease has been found to cause heart disease because of the increased production of the C-Reactive Protein. The level of the C Reactive Protein decreases when the gum disease is treated. It is therefore interesting to find that a similar mechanism can affect the outcome of childbirth.

A recent study that appeared in the American Journal Of Obstetrics and Gynecology showed that gum disease can cause premature labor. Among 1020 pregnant women who were followed in pregnancy, 28.6% women with moderate to severe periodontal disease had preterm delivery as compared to 11.2% of women with no periodontal disease. The authors concluded that gum disease in pregnancy is a predictor of premature labor.

Hence dental care should not stop in pregnancy. It will be more prudent for women who want to get pregnant to see their dentist to give them a clean bill of dental health before they get pregnant.

Reference:

Offenbacher et al

Obst Gynec. 2006, 107:29-36

Maternal Fish Consumption in Pregnancy Provides “Brain Food” For Baby’s Brain

"Seafood is the main food source of omega-3 fatty acids, which are essential for optimum neural development. However, in 2004, the FDA and the Environmental Protection Agency advised women who were pregnant or might become pregnant to limit seafood intake during pregnancy to 340 g per week (less than three portions) to avoid exposure to trace amounts of neurotoxins, especially methylmercury"

Judith Groch

Many of my patients are afraid of eating fish because of the fear that they will ingest too much mercury to affect the developing baby's brain. This deprives them of the Omega 3 Acid that is good for the development of the baby's brain. It is therefore very encouraging that a recent Lancet article summarized in Medpage Today, showed evidence to the contrary. According to many pregnant women, this is serious enough for them not to eat fish in pregnancy.

"A U.S. survey showed that two-thirds of Americans believe that 1,000 to 100,000 U.S. children are poisoned by mercury from eating fish every year. In fact, Drs. Myers and Davidson said that there has never been even one child with prenatal mercury poisoning from consuming fish documented outside Japan." Judith Groch

Joseph Hibbeln, MD of the National Institute of Alcoholic Abuse and Alcoholism and colleagues, showed that:

"After adjustment, maternal seafood intake during pregnancy of less than 340 g per week was associated with an increased risk at age eight years of the child being in the lowest quartile for verbal IQ (no seafood consumption, odds ratio [OR] 1.48, 95% CI 1.16-1.90; some seafood, 1.09, CI 0.92-1.29; overall trend, P=0.004), compared with mothers who consumed more than 340 g per week. At seven years, low maternal seafood intake was also associated with an increased risk of suboptimum outcomes for prosocial behavior 1.44 (CI 1.05-1.97) for no seafood consumption versus more than 340 g/week. Overall, the investigators said, the higher the maternal seafood intake, the less likely the infant was to have a poor score. At ages up to 3.5 years, scores were also lower for fine-motor skills, communication, and social development, they reported. Maternal seafood consumption reached a mean of 235 g a week, resulting in estimated weekly intakes of zero to 15.6 g, and a mean intake of 1.06 g of omega-3 fatty acids a week. " Judith Groch

Hence it is important that pregnant women know that fish, the major source of Omega 3 Acid is important for the development of the baby's brain. The benefits far outweigh the risks of Mercury poisoning from seafood. A risk largely attributed to fatty fish.

"Additional source: The Lancet

Source reference:

Hibbeln, JR, et al "Maternal seafood consumption in pregnancy and neurodevelopmental outcome in childhood (ALSPAC study): an observational cohort study" Lancet 2007; 369: 578-585. "



"Additional source: The Lancet

Source reference:

Myers, GJ, Davidson PW "Maternal fish consumption benefits children's development" Lancet 2007; 369: 537-539."

Genital Herpes in Pregnancy-A Health Hazard for the Baby

Question:

I got married a week ago and I have missed my period. I saw my doctor who did a pregnancy test and pelvic ultrasound and told me I was 6 weeks pregnant. Two weeks ago I started having painful urination and multiple blisters on my vulva. My doctor diagnosed me with genital herpes and started me on medications. I have finished the treatment but I am supposed to take the medication throughout the pregnancy. Is my baby going to be alright?

Answer:

Genital Herpes is a common sexually transmitted disease which is under diagnosed because sometimes patients with the disease don’t have any symptoms. In your case, your doctor did the right thing by treating you and giving you medication to prevent recurrent infections during your pregnancy and after delivery. Your husband has to have blood test to ensure that he does not have the disease. If he has it he should also be treated as he may have outbreaks and transmit the disease to you again. I will suggest that even if his test is negative you should use condoms for sexual intercourse.

The effect of the infection on the new born baby is severe. About 80% of the babies may be infected by the virus at birth if untreated. Hence if you are found to have the disease at the time of your delivery, you would be delivered by cesarean section to prevent the baby from being infected by the virus. Other prevention measures include giving you prophylactic antiviral medications to suppress the infection during the pregnancy. Three medications are available for treatment. Valacyclovir and Famciclovir would be more convenient as prophylaxis than Acyclovir because of convenience in their dosing.

Since many people with genital herpes don’t know they have the disease, it will seem to be reasonable to screen all pregnant women for genital herpes with blood test. This way, if their test is positive, they would receive prophylactic medication to prevent possible herpes infection in the pregnancy and the postpartum period.