This section of the APPPAH Newsletter is intended to draw attention to items in the news that are pertinent to prenatal and perinatal psychology. APPPAH does not necessarily agree with, or vouch for, the scientific worthiness of any of the news items mentioned here. We mean merely to take note of what is going on, so that you may.
MIGHT BIRTH REFORM "FOLLOW THE MONEY" AND THE BABY?
It was reported during a series on health care reform on PBS' The NewsHour with Jim Lehrer that "for the Dutch, a huge cost saver starts the day you're born." Reporter Ray Suarez noted that the majority of Dutch babies are born at home in a nation where the infant mortality rate is 25% lower than that of the U.S.—which is consistent with a recent study of more than 500,000 births in the Netherlands, which found that planned home birth with trained midwives is as safe as hospital birth.
"What we've learned from the Netherlands and other countries is that expanding access to out-of-hospital maternity care by providers with the type of training that Certified Professional Midwives receive benefits mothers and babies," said Katherine Prown, Campaign Manager for The Big Push for Midwives. "The research shows that we could make significant improvements in birth outcomes and in lowering health care costs here in the United States by implementing very basic policy measures, such as closing the gap in federal Medicaid law that neglects to include CPMs as eligible providers." David A. Anderson, a professor of economics with a research specialization in the costs of out-of-hospital maternity care, calculates that a 5% increase the rate of both home births and births in freestanding birth centers would result in an annual savings of more than $9 billion. The Big Push for Midwives Campaign represents thousands of grassroots advocates in the United States who support expanding access to Certified Professional Midwives and out-of-hospital maternity care. The mission of The Big Push includes educating national policy- makers about the reduced costs and improved outcomes associated with out-of-hospital birth and advocating for including the services of Certified Professional Midwives in Medicaid. [Reported in Oct. 2009 on PBS; for more info., visit www.thebigpushformidwives.org.]
DNA CHANGES AFTER C-SECTION AND INCREASED RISK OF DISEASE
Researchers at Karolinska Institute have discovered that babies born by planned cesarean section experience changes to the DNA pool in their white blood cells, possibly related to altered stress levels during this method of delivery. The findings help explain why babies born by cesarean section are more susceptible to immuno- logical diseases such as diabetes, asthma or leukaemia than those born by normal vaginal deliveries. "Our results provide the first pieces of evidence that early so-called epigenetic programming of the immune system during birth may have a role to play," says researcher Mikael Norman. Blood was sampled from the umbilical cords of 37 newborn infants just after delivery and then again three to five days after the birth. The blood samples were analyzed to see the degree of DNA-methylation (chemical altering of the DNA) in the white blood cells; the 16 babies born by cesarean section exhibited higher DNA-methylation rates immediately after delivery than the 21 born by vaginal delivery. Three to five days after birth, DNA-methylation levels had dropped in the c-section infants to the degree that there were no longer significant differences between the two groups. "Although we do not know yet how specific gene expression is affected after Caesarean section deliveries, or to what extent these genetic differences related to mode of delivery are long-lasting, we believe that our findings open up a new area of important clinical research," concludes lead author Titus Schlinzig, a research fellow at Karolinska Institute. [Published July 2009 in Acta Paediatrica.]
HORMONAL LINK TO BREASTFEEDING SUCCESS (AND BENEFITS?)
A Norwegian study concludes that difficulty breastfeeding a newborn may involve higher levels of the male hormone testosterone during pregnancy. The team from the Norwegian University of Science and Technology followed 180 pregnant women, including those at risk of delivering a small baby—a risk that is known to be influenced by higher levels of testosterone. After taking into account other factors such as age, education and smoking, they still found a clear relationship between low rates of breastfeeding at three and six months and higher levels of testosterone. The team suggests that the hormone may impact negatively on the development of glandular tissue in the breast, in turn affecting her ability to feed her baby. Lead researcher Professor Sven Carlsen said: "Basically a mother who finds she has difficulty shouldn't feel guilty - it probably is just the way it is, and her baby will not suffer for being fed formula milk." He argues that it is the hormone balance in the womb that explains both a mother's ability to breastfeed and any apparent health benefits of a baby who is breastfed - rather than the breast milk itself. Last year Professor Carlsen's team reviewed 50 international studies on the relationship between breastfeeding and health. Based on this work he concludes the benefits of breast over formula milk may have been exaggerated. "When you look at the epidemiological studies and try to strip away the other factors, it is really hard to find any substantial benefits among children who were breastfed as babies." Professor Ashley Grossman of the Centre for Endocrinology at Barts in London said the suggestion that male hormones may influence the ability to feed was an interesting one. "We are learning more and more about how the environment of the womb may influence a child's future development - this is really where it's all happening, and it has a much greater impact than whether or not a child is breastfed or not." [Reported Jan. 2010 in BBC News, http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/8443904.stm.]
HORMONAL LINK TO CHILDBIRTH COMPLICATIONS
A Dutch team has found even "low to normal" levels of thyroid hormone thyroxin may cause problems during labor and delivery. In their study of nearly 1,000 apparently healthy mums-to-be, lower levels of thyroxin at 36 weeks of pregnancy was strongly linked to abnormal positioning of the baby's head and risk of assisted delivery. Although still head down, the babies tended to be posterior, making labor generally longer and harder, and more likely to end in an assisted delivery with forceps or suction, or with a cesarean. The researchers from the University of Tilburg believe the hormone problem is so common, affecting about one in 10 pregnancies, that a blood test for it should become a routine part of prenatal care. Too little thyroxin is already known to complicate pregnancy, increasing the risk of miscarriage, premature birth and pre-eclampsia. Professor Victor Pop and his team believe the relative lack of hormone might stop the unborn child moving as well as it should, preventing the baby from getting into the optimal position for labor. He said more work was needed to explain the link found and to see if giving pregnant women extra thyroxin, even if they do not have full-blown thyroid disease, would be beneficial. Professor John Lazarus, an expert in endocrinology at Cardiff University School of Medicine, said the link found was not necessarily causal. "However it does highlight the importance of checking thyroid hormone levels in pregnancy." [Reported Dec. 2009 in BBC NEWS, http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/8425901.stm]
BABIES "CRY IN MOTHER'S TONGUE"
New findings by German researchers suggest that babies begin to pick up the nuances of their parents' accents while still in the womb. Studying the cries of 60 healthy babies born to families speaking French and German, they found that French newborns cried with a rising "accent" while the German babies' cries had a falling inflection. Writing in the journal Current Biology, they say the babies are probably trying to The APPPAH Newsletter 9 form a bond with their mothers by imitating them. This extends earlier findings that fetuses could memorize sounds from the outside world in the last three months of pregnancy; are particularly sensitive to the contour of the melody in both music and human voices; and that infants can match vowel sounds presented to them by adult speakers, after 12 weeks of age. Says lead researcher Kathleen Wermke from the University of Wurzburg, "The dramatic finding of this study is that not only are human neonates capable of producing different cry melodies, but they prefer to produce those melody patterns that are typical for the ambient language they have heard during their fetal life." Debbie Mills, from the department of develop- mental cognitive neuroscience at Bangor University, said: "This is really interesting because it suggests that they are producing sounds they have heard in the womb and that means learning and that it is not an innate behavior." [Reported Nov. 2009 in BBC News, http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/8346058.stm.]
STUDY EXAMINES SIDS AND COSLEEPING
A four-year, population-based, case-control study conducted in southwest England, investigated risk factors for Sudden Infant Death Syndrome (SIDS), including an examination of specific circumstances in which SIDS occurs while cosleeping (infant sharing the same bed or sofa with an adult or child). Researchers found that many of the SIDS infants had coslept in a hazardous environment. They concluded that the major influences on risk included use of alcohol or drugs before cosleeping, regardless of parents' socioeconomic status. In addition, more mothers of SIDS infants smoked during pregnancy, and a greater proportion of SIDS infants were preterm. [Published Oct. 2009 in BMJ http://www.bmj.com/cgi/content/abstract/339/oct13_1/b3666, reported by National Healthy Mothers, Healthy Babies]
TECHNIQUE TO MEASURE PLACENTA'S VOLUME
Yale researchers have developed an easy method of measuring the volume of the placenta during pregnancy. Harvey J. Kliman, the doctor who developed the technique with a team of scientists, likens the placenta to a fuel tank, and the measurement to a gas gauge. "Here's the sad part," he says: "A minute before your car runs out of gas, it still runs perfectly normally. If you don't have a gauge, you don't know that it's literally running on fumes. If you did, you would do something." A small placenta can endanger a fetus by limiting the delivery of food and oxygen. Dr. Kliman worked with his father, Merwin Kliman, a mathematician from Hofstra University, who derived a formula for finding the placenta's volume using measurements that can be obtained during an ultrasound typically done halfway through a pregnancy: the placenta's maximal width, maximal height and thickness at maximal height. "The problem is that a placenta is shaped like a yarmulke," making it hard to measure, the younger Kliman said. "It's as if you molded clay on top of a ball." But he said the formula could be programmed into an ultrasound machine. "This should be routine," he added. "It's so easy to do." [Reported in the NTY; read the Amer J of Perinatology abstract at http://www.thieme-connect.de/ejournals/abstract/ajp/doi/10.1055/s-0029-1234034]
DESIGNING CARS FOR EXPECTANT MOTHERS
UK researchers have developed a new computer model—"Expecting"—that can be used as a tool for automotive designers to help ensure that vehicles can accommodate the safety needs of pregnant occupants. The researchers explain that the safety of pregnant women is often compromised because of the changes in their body size and shape that occur during pregnancy. These changes are not limited to the abdominal region, but affect the chest and thigh areas, all of which can affect sitting and driving posture and seat belt use. Inappropriate seat belt is a significant problem for pregnant women. It is often difficult and sometimes impossible for a pregnant user to get her seat belt into a comfortable position. Another problem is pressure on the abdomen from the steering wheel in the event of a crash. Researchers have found that more than one in ten pregnant women finds the gap between their abdomen and the steering wheel is less than 2.5 cm and for some there is no gap at all. This proximity to the steering wheel may put the placenta at increased risk of abruption from direct impact with the steering wheel. Serpil Acar and Alix Weekes have taken 48 different measurements from 100 pregnant women in different postures and at different terms in their pregnancies to create their computer model. The measurements show that even the designs that take into account the measurements of larger men, may still exclude majority of women at the late stages of pregnancy. "Expecting" has been further developed to become the world's first computational model of a 38-week pregnant car occupant, complete with a detailed representation of a fetus within the uterus, and is to be used in further research, including the simulation of crash scenarios. [Published in Intl J of Vehicle Design; reported at www.sciencedaily.com/releases/2009/09/090903165013.htm]
FISH OIL DURING PREGNANCY MAY SLASH INFANT ALLERGY
A new randomized, placebo-controlled double-blind study finds that omega-3 supplementation during pregnancy and lactation may reduce a child's risk of developing allergic sensitization to egg, IgE-associated eczema and food allergy during the first year of life. Immunoglobulin E (IgE) is the predominant antibody associated with an allergic response. The Swedish study found that the occurrence of eczema and food allergies was 16 and 13 per cent lower, respectively, in infants of mothers receiving the fish oil supplements during pregnancy and the early months of breast-feeding, compared to placebo, according to findings published in the journal Acta Paediatrica. recruited 145 pregnant women with allergies, or with partners or other children with allergies. Starting at the 25th week of their pregnancy, and continuing for between three and four months of breastfeeding, the women were randomly assigned to receive either daily fish oil supplements providing 1.6 g of EPA and 1.1 g of DHA (Bio Marin capsules from Pharma Nord, Denmark), or placebo. Among the possible mechanisms proposed, the Linkoping-based scientists proposed that both DHA and EPA may produce changes in the fluidity of the membranes of immune cells, and reduce the levels of the omega-6 fatty acid arachidonic acid (AA). By inhibiting the metabolism of AA, the formation of the less inflammatory eicosanoids is favored, which may be linked to lower allergic sensitization in the children. "Additional anti-inflammatory effects of EPA andDHA in early immune development through bioactive lipids, lipoxins, neuroprotectines and resolvins, have been discussed but it is not clear whether those are plausible explanatory mechanisms regarding our findings," they said. [Published in Acta Paediatrica; read online at http://www.nutraingredients.com/Product- Categories/Nutritional-lipids-and-oils/Fish-oil-during-pregnancy-may-slash-infant-allergy]