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Pregnancy should last 9 months, but sometimes it doesn't. With medical advances some babies born as early as 22 or 23 weeks can now survive. Truly miraculous! But how are these extremely preterm babies doing long-term?

A University of Gothenburg study examined this issue by following up on all 383 Swedish children born before 24 weeks (most at 23 weeks) between 2007 to 2018 and who survived. At follow-up the children were between 2 to 13 years of age. The researchers found that almost all of the children had serious long-term problems, whether health or developmental problems.

75% of children born before 24 weeks of gestation had neurodevelopmental disorders, including intellectual disabilities (40%), autism (24%), and 55% required habilitation services. 88% of the group had other physical problems - for example, 63% had asthma and 39% failed to thrive and/or were short for their age. Boys were more likely to have intellectual disabilities and visual impairment than girls.

Looking at the results in the study (see Table 1), it is clear that babies born at 23 weeks had significantly fewer serious problems than at 22 weeks. Every extra week is important!

From Science Daily: Wide-ranging problems in children born before 24 weeks gestation

In a study of children born after a pregnancy of less than 24 weeks, nearly all (96 percent) proved to have any of the diagnoses studied. According to the study, lead from the University of Gothenburg, neuropsychiatric and somatic diagnoses are prevalent as these extremely preterm infants grow into adulthood. ...continue reading "Babies Born Much Too Early May Have Long-term Problems"

Pregnant women turn to the internet for pregnancy information. There are some good sites out there, but also some pregnancy apps loaded with all sorts of false pregnancy information. This is because many of them primarily view pregnant women as customers to be advertised to and sold products. Beware!

A good article about the problems with many pregnancy apps (written by disinformation researcher Nina Jankowicz) sums it up. From Wired: The Internet Is Failing Moms-to-Be

"Pregnancy apps, I quickly learned, aren’t in the business of providing comfort; they are a fantasy-land-cum-horror-show, providing little realistic information about the journey to parenthood. They capitalize on the excitement and anxiety of moms-to-be, peddling unrealistic expectations and even outright disinformation to sell ads and keep users engaged. They foster negative repercussions on the physical and mental health of both mothers and their unborn children, generating profit from the onslaught of emotions brought on by pregnancy."

Studies find that the majority (over 50%) of pregnant women do internet searches (e.g. Google), and then download apps (an average of 3 apps) focused on pregnancy. The overwhelmingly main reason (83%) is to monitor fetal development (e.g. how big is the fetus now? what can it do?). In a distant second and third place are prenatal nutrition and prenatal care. Researchers found that more free apps are downloaded, rather than apps that have to be paid for. (Of course!)

This is why good information pregnancy sites are important. The Wired article mentions that a Forbes article has a list of Best Pregnancy Apps of 2022, but that accuracy of information of the apps is not part of the ranking. Too bad, but at least this list is a start.

Human fetus attached by umbilical cord to placenta, 3 months. Credit: National Museum of Health and Medicine

Unfortunately, while the CDC (Centers for Disease Control and Prevention) has a pregnancy site, it doesn't have a fetal development (e.g. what occurs week by week) page. It needs lots and lots of photos of how the baby (fetus) looks at each stage of development.

Decades ago the Swedish photographer Lennart Nilsson published a book A Child Is Born with photographs of what the developing fetus looks like throughout pregnancy. Pregnant women loved the photos, and this is what women still want to see - What does the baby look like week by week during pregnancy? What is happening each week? There is now a 5th edition of the book, and while it is still a great book, it should contain more photos which are organized chronologically.

Some good news for women who had a Covid-19 infection during pregnancy - one small study found reassuring results about the growth and development of the babies. The Northwestern University researchers found that at the 6 month checkup the babies overall had normal growth patterns and developmental milestones. This is great, great news!

Yes, it was a small study (33 low-income women and their babies). Three infants (10%) did receive development-related referrals (one had an underlying genetic diagnosis) - but the "referrals not higher" than what the physicians said they normally see. More good news: none of the babies tested positive for COVID-19.

From Science Daily: Normal 6-month outcomes in babies of women with COVID-19 during pregnancy

Babies born to women who had COVID-19 during pregnancy showed reassuring patterns of growth and development at 6-month follow-up, according to a study from Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern Medicine in partnership with Erie Family Health Center, a Federally Qualified Health Center (FQHC) that serves a diverse and low-income patient population.  ...continue reading "COVID-19 During Pregnancy and Some Reassuring News About the Baby"

The possibility of amniotic fluid being flavored by the foods a mother eats is wild! Makes sense, but it is not something normally mentioned anywhere. It turns out that in the last few years a few studies were published that looked at foods flavoring the amniotic fluid and breast milk, and which later influence the flavors and foods a child prefers.

Research finds that at least some of the foods (e.g., alcohol, anise, carrot, garlic) that a mother eats during pregnancy flavors the amniotic fluid and breast milk, and then these foods or flavors are more accepted during infancy and childhood. During the period a mother breastfeeds, there is evidence babies detect the flavors of alcohol, anise/caraway, carrot, eucalyptus, garlic, mint, a variety of vegetables, peaches, and vanilla. Foods with these flavors appear in breastmilk soon after eating them - within 1 hour!

The few studies done all found greater acceptance and willingness to eat foods in infancy and childhood that had flavors the children were exposed to during pregnancy and/or when nursed. The overall thinking of researchers Spahn and others is that the mother's diet during pregnancy and lactation provides "the earliest opportunity to positively influence child food acceptance and preferences."

Of course the studies are limited in that only a few flavors are looked at in each study. But thinking about it - of course that is how a child accepts new flavors. It's the exposure and getting used to them. Formula always tastes the same, but breast milk varies a little every day! Some researchers suggest that there may be a critical period early in life where exposure to sour and bitter tastes (e.g., broccoli) can be made palatable to the baby. [scroll down to study #3]

These results also support not giving bland and unappetizing single flavor foods in baby jars to babies - instead give them the actual foods the parents are eating! Mash it with a fork, or even use a blender or food mill, but give them the real foods, flavored how the parent likes it. After all, they've already been exposed to those tastes.

The following 3 studies discuss this topic in more detail:

1) A group of researchers reviewed studies related to the topic of the mother's diet during pregnancy and lactation (breastfeeding), amniotic fluid flavor, breast milk flavor, and children's food acceptability. From the American Journal of Clinical Nutrition (2019): Influence of maternal diet on flavor transfer to amniotic fluid and breast milk and children's responses: a systematic review

Limited but consistent evidence indicates that flavors (alcohol, anise, carrot, garlic) originating from the maternal diet during pregnancy can transfer to and flavor amniotic fluid, and fetal flavor exposure increases acceptance of similarly flavored foods when re-exposed during infancy and potentially childhood.  ...continue reading "Amniotic Fluid is Flavored by the Foods the Pregnant Woman Eats"

Planned home births are safe, as safe as births at a birth center. Those are the conclusions from a large Washington state study looking at low-risk women delivering with a licensed midwife at either a licensed birth center or at home. This is very reassuring because home births are considered controversial in the US.

The Univ. of British Columbia and Bastyr Univ. researchers analyzed outcomes of 10,609 births, of which 40.9% were planned home births and 59.1% were planned birth center births. Overall, they found low Cesarean rates (4.7%), high breastfeeding rates (93%), and low rates of complications in both groups. The infant death rate was also low in both groups, with 0.57 deaths per 1,000 (includes perinatal and and neonatal deaths).

It must be stressed that in this study they looked at low-risk pregnant women. Low-risk meant they were healthy pregnancies, with babies full-term, only 1 baby (not twins), babies were in a head down position (not breech), the women did not have a prior cesarean delivery, no hypertensive disorders, and no pre-pregnancy diabetes. By the way, Washington state is supportive of midwives, and they are well-integrated into the health care system.

The study results are similar to a large international study comparing planned home births with planned hospital births and finding no differences between the two in risk of perinatal or neonatal death.

From Medical Xpress: Planned home birth presents little risk where midwifery is well-integrated: study

In the state of Washington, a planned home birth with a licensed midwife is just as safe as a birth at a licensed birth center.  ...continue reading "Comparing Home Births With Birth Center Births"

For years pregnant women were told that taking acetaminophen (also known as paracetamol) during pregnancy is OK - that it doesn't harm the baby. And more than half of pregnant women worldwide report taking acetaminophen (in Tylenol) during pregnancy, whether for pain, fever, or headaches. Ooops! It may not be harmless.

Acetaminophen is the most common drug taken by pregnant women. But... research suggests that the drug can alter fetal development, and this can increase the risks of some neurodevelopmental disorders (e.g. autism spectrum disorder, ADHD, language delay in girls, and decreased IQ), reproductive tract disorders (e.g. male undescended testicles), and urogenital disorders in the baby. It is an endocrine disruptor. The studies find similar results in both humans and animals.

As a result, more than 90 scientists, doctors, and public health researchers published a consensus statement calling on U.S. and European regulators to conduct new safety reviews of acetaminophen, to raise awareness of possible dangers of the drug, and for doctors to inform women of possible risks of taking the drug during pregnancy..

Bottom line:  If you absolutely need to take Tylenol during pregnancy, use the lowest effective dose for the shortest possible time.

From Environmental Health News: Researchers, doctors call for regulators to reassess safety of taking acetaminophen during pregnancy

More than 90 scientists, doctors, and public health researchers are calling on U.S. and European regulators to conduct new safety reviews of acetaminophen, pointing to mounting evidence that fetal exposure to the commonly used pain reliever could increase the risk of neurodevelopmental disorders and reproductive system effects.  ...continue reading "Acetaminophen Use During Pregnancy May Harm the Baby"

When COVID-19 vaccines first became available to the general public in 2021, women were concerned over whether it was safe to get vaccinated during pregnancy. The answer (from medical studies) is yes, the vaccines are safe and beneficial for both the mother and baby. This is great news!

Also, a recent study found that when women get a mRNA vaccine (either Pfizer or Moderna) during pregnancy, they pass high levels of antibodies to their babies. This means 100% of the babies had protective antibodies to COVID-19 when they were born. The New York University researchers found the highest level of antibodies in the infants when the mothers received the vaccine in the second half of pregnancy.

Current CDC (Centers for Disease Control and Prevention) guidelines recommend that pregnant and breastfeeding women get the COVID-19 vaccine. This is because getting COVID-19 during pregnancy can result in more severe disease, higher risk of preterm birth and  pregnancy outcomes.

BOTTOM LINE: Getting the COVID-19 vaccine during pregnancy protects both the mother and baby. (By the way, studies also find that nursing transfers antibodies to the baby in the breast milk, but it is still unclear if the levels are high enough to fully protect the baby from COVID-19).

From Science Daily: Pregnant women who receive COVID-19 vaccination pass protection from the virus to their newborns

Women who receive the mRNA COVID-19 vaccine during pregnancy pass high levels of antibodies to their babies, a new study finds.  ...continue reading "The COVID-19 Vaccine During Pregnancy Protects Both Mother and Baby"

Breastfeeding
Credit: Wikimedia Commons/ Anton Nosik

Some women struggle with breastfeeding, and wind up breastfeeding for a shorter duration than other women. A recent study suggests one reason for women stopping breastfeeding early - they may have higher levels of PFAS chemicals, called "forever chemicals", in their bodies. These chemicals have many harmful health effects, including reproductive effects (such as endocrine disruption, higher levels of infertility).

The researchers analyzed levels of 5 different PFAS (perfluoroalkyl substances) chemicals in the blood of more than 1000 pregnant Dutch women. They found that those with higher levels  breastfed their babies for a shorter time (up to 20% shorter time) than those with lower levels. [NOTE: almost all humans are contaminated with PFAS chemicals, but levels vary}

Where did the PFOS chemicals come from? These human-made chemicals are used as water and stain repellants, and as coatings in many common products. For example, in rugs and fabrics with added stain resistance, certain dental flosses (e.g., Oral-B Glide floss), non-stick pots and pans (e.g., Teflon coating), water resistant long-lasting make-up, water and stain resistant food packaging, and even many water supplies.

How can we reduce exposures to these chemicals and lower levels in our bodies?  There are reasons they are known as "forever chemicals" - they stick around (persist), and contaminate both humans and the environment! But we can reduce our exposures to these chemicals and then levels in our bodies will go down. It just means making some changes.

For example, avoid using non-stick pots and pans, use plain waxed dental floss, cook more at home, and eat less take-out or fast-food (to avoid the water and grease resistant package coatings). For more tips:  Avoiding Harmful Chemicals.

From Science Daily: PFAS exposure can affect women’s ability to breastfeed

Women with higher levels of PFAS in their system may be 20% more likely to stop breastfeeding early, according to a new study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.  ...continue reading "Certain Chemicals May Have An Effect On Breastfeeding"

Another recent study found an association with pesticide exposure (both herbicides and insecticides) and leukemia risk in infants and children. The study found that exposure prenatally or during childhood to pesticides increases the risk for leukemia. (Keep in mind that cancer in childhood is rare, but it does occur.)

Researchers at the School of Medicine (in Greece) did a review and analysis of 52 studies and found that preconception exposure to pesticides by either the father and mother can increase the risk, also childhood exposure. But the biggest risk was a mother's exposure during pregnancy, and this was linked to both infant and childhood leukemia. (Yes,  the developing baby is also exposed when the mother is exposed during pregnancy)

What to do? If thinking about conceiving a child, already pregnant, or have children - try to eliminate as much exposure to pesticides as possible. Many of us have chronic exposures to low levels of pesticides - whether in our homes, yards, workplaces, and food. So this is important.

This means avoiding pesticide treatments or flea collars in pet dogs, not routinely applying pesticides in residences or outdoors, which includes outdoor weed + feed  or mosquito treatments (toxic pesticides!). Eat organic as much as possible. Use least toxic integrated Pest Management (IPM) if need to deal with a pest problem. (Beyond Pesticides is a good resource site for pesticide information, organic approaches, and IPM)

From Beyond Pesticides (they frequently write about pesticide studies): In Utero and Childhood Pesticide Exposure Increases Childhouse  Cancer Risk

A study published in Environmental Pollution finds the risk of acute childhood leukemia (AL) increases with prenatal and newborn exposure to pesticides (i.e., insecticides and herbicides). The study results support the hypothesis that chronic environmental pesticide exposure increases childhood leukemia risk up to two times. Maternal exposure has a stronger association with leukemia than childhood exposure. Insecticides and herbicides are of particular significance in increasing leukemia risk, especially for acute lymphoblastic leukemia. ...continue reading "Pesticide Exposure and Increased Leukemia Risk In Children"

There are microbial differences (microbiome) in babies who are born by cesarean vs vaginal deliveries. Research shows that bacterial differences can be minimized by a simple procedure - swabbing the newborn infant with the mother's vaginal fluids (using a gauze pad).

An infant normally picks up bacteria during birth as it passes through the birth canal, and these bacteria "seed" (colonize) the baby's skin and gut microbial community. On the other hand, babies born by C-section are colonized by microbes floating around in the operating room (from doctors, nurses) and these are predominantly skin bacteria. These bacterial differences between babies born by vaginal birth or C-section persist and are thought to explain some health differences between babies born vaginally or by C-section.

Dr. Dominguez-Bello has been doing a long-term study in which babies born by cesarean section are immediately swabbed with a gauze cloth soaked with the mother's vaginal fluids (which contain the mother's microbes). This resulted in the infants' skin and gut microbial community being more like vaginally born babies. These microbial changes persisted during the first year of life.

Such big changes from such a small procedure!

From The Scientist: Maternal Vaginal Fluids Mimic Microbe Transfer of Vaginal Birth

Babies born by C-section carry an increased risk of immune and metabolic disorders later in life, which studies have suggested may be associated with the communities of microbes on and in their bodies at the time of birth.  ...continue reading "Missing Birth Canal Bacteria Can Be Restored to Cesarean Birth Babies"