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In the News, Parenting, Patient Care, Pregnancy, Public Health, Women's Health

Low-tech yet essential: Why parents are vital members of care teams for premature babies

Low-tech yet essential: Why parents are vital members of care teams for premature babies

3297657033_081d4f3630_zThanks to recent advances in medicine, technology and research, most premature babies born in the United States face better odds of surviving than ever before. Yet, the number of premature births in the U.S. remains relatively high, with a rate that’s on par with that of Somalia, Thailand and Turkey.

For the parents of a premature baby, an early birth can transform what was supposed to be a happy event into a stressful one, says Henry Lee, MD, an assistant professor of pediatrics at Lucile Packard Children’s Hospital Stanford. In a recent U.S. News & World Report article penned by Lee, he discusses why it’s important for parents, and beneficial for the baby, when parents are active members of the child’s medical team:

Giving birth to a preemie, especially when it’s unexpected, leaves many parents feeling unprepared and helpless. But we make it clear very early. “You, the parent, are a critical part of our medical team.” That’s right. Even in the heart of Silicon Valley where we’re located, two of our biggest assets are decidedly low-tech workers: the baby’s mom and dad.

Including parents in the care of preemies is a standard that was unheard of in the early days of neonatology, but is now used in leading NICUs for one critical reason: It works.

Here’s an example of how parents contribute. Studies have shown that skin-to-skin care, also known as kangaroo care, can have beneficial effects on preterm neonates, including improved temperature and heart rate stability. In many NICUs, you will see babies – clad only in a diaper and covered by a blanket – placed prone position on the chest of either the mother or the father. This intimate method of care provides a preterm baby a natural environment for rest, growth and healing.

No matter when a baby is born, term or preterm, families know their children best. A parent’s contribution is critical to treating these most vulnerable of newborns.

Previously: How Stanford researchers are working to understand the complexities of preterm birthNew research center aims to understand premature birth and A look at the world’s smallest preterm babies
Photo by Sarah Hopkins

In the News, Media, Medical Education, Medicine and Society, Myths, Pregnancy, Research

Reality TV influences perspectives on pregnancy, study shows

Reality TV influences perspectives on pregnancy, study shows

272417047_806faa2243_zA new University of Cincinnati study on the influence that television programs have on pregnant women has found that most women are more affected by TV representations of childbirth than they think.

The study, funded by the NSF and conducted by Danielle Bessett, PhD, assistant professor of sociology, followed a diverse group of 64 women over the course of two years and investigated how they understood their television viewing practices related to pregnancy and birth. It found that class, as measured by education level, had the greatest influence on whether a woman acknowledged television as a significant source of pregnancy-related information. Highly educated women and those who worked outside the home were more likely to dismiss TV, while those with less education and who were unemployed or took care of children at home were more likely to report watching and learning from such shows as TLC’s “Baby Story” and “Maternity Ward” and Discovery Health’s “Birth Day.”

The particularly interesting finding is that TV portrayals affect women’s perceptions even when they don’t believe they have an influence. Bessett developed the term “cultural mythologies of pregnancy” to describe how TV, film, media, and word of mouth create expectations about “the way things are.” Most reality TV and fictionalized programming presents childbirth as more dramatic and full of medical interventions than the majority of births really are, and these images made a lasting impression on women.

As quoted in the press release, Bessett says, “Hearing women –– even women who said TV had no influence on them –– trace their expectations back to specific television episodes is one of the few ways that we can see the power of these mythologies.” Many women mentioned pregnancy representations they had seen long before they got pregnant.

Women who reported watching TV considered it part of a comprehensive childbirth education program and would often evaluate the programs’ reliability, while women who disavowed television saw it as entertainment or education for children, likely from a desire to be seen as valuing science and medical expertise.

“If we believe that television works most insidiously or effectively on people when they don’t realize that it has power, then we can actually argue that the more highly educated women who were the most likely to say that television really didn’t have any effect on them, may in the end actually be more subject to the power of television than were women who saw television as an opportunity to learn about birth and recognized TV’s influence,” hypothesizes Bessett.

“This research implies that many women underestimate or under-report the extent to which their expectations of pregnancy and birth are shaped by popular media,” concludes Bessett, suggesting that “scholars must not only focus on patients’ professed methods for seeking information, but also explore the unrecognized role that television plays in their lives.”

Previously: New reality shows shine harsh light on teen pregnancy and Study: TV dramas can influence birth control use
Photo by johnny_zebra

Mental Health, Pregnancy, Research, Women's Health

Study shows mothers receiving fertility treatments may have an elevated risk of depression

Study shows mothers receiving fertility treatments may have an elevated risk of depression

5088785288_9f7a23f17a_zAn estimated one in four couples in developing countries encounter difficulties trying to conceive. In the United States, more than 7 million women have undergone fertility treatments and, as a result, millions of babies have been born through in-vitro fertilization.

While many may assume that failed fertility treatments would increase a woman’s risk of depression more than successful attempts that resulted in a live birth, research recently published in the journal ACTA Obstetricia et Gynecologica Scandinavica shows that the opposite may be true.

In the study, researchers from the University of Copenhagen analyzed data on 41,000 Danish women who had undergone fertility treatments. PsychCentral reports that “investigators discovered women who give birth after receiving fertility treatment are five times more likely to develop depression compared to women who don’t give birth.”

Lead author Camilla Sandal Sejbaek, PhD, discusses the results in the story:

The new results are surprising because we had assumed it was actually quite the opposite. However, our study clearly shows that women who become mothers following fertility treatment have an increased risk of developing depression in the first six weeks after birth compared to women who did not have a child.

Our study has not looked at why the depression occurs, but other studies indicate that it could be caused by hormonal changes or mental factors, but we cannot say for sure. We did not find any correlation between the number of fertility treatments and the subsequent risk of depression.

Previously: Stanford-developed fertility treatment deemed a “top medical breakthrough” of the year, Ask Stanford Med: Expert in reproductive medicine responds to questions on infertility, Image of the Week: Baby born after mom receives Stanford-developed fertility treatment and NIH study suggests progestin in infertility treatment for women with PCOS may be counterproductive
Photo by Big D2112

Microbiology, Pregnancy, Research, Stanford News

Stanford microbiome research offers new clues to the mystery of preterm birth

Stanford microbiome research offers new clues to the mystery of preterm birth

preemie-holdinghandsPremature birth affects 450,000 U.S. babies each year and is the leading cause of newborn deaths. But in about half of cases, doctors never figure out what triggered premature labor in the pregnant mom.

Now, there’s a new clue: A Stanford study, published today, gives important details of how the microbiome – the body’s community of bacteria – behaves in women whose pregnancies go to the full 40-week term, and what’s different in women whose babies come three weeks, or more, early. A specific pattern of vaginal bacteria was linked to greater risk of preterm delivery, and the longer the pattern persisted, the greater the risk, the study found.

The work is one piece of a larger effort by the March of Dimes Prematurity Research Center at Stanford to bring experts from many branches of science together to work on preterm birth. The researchers collected weekly bacterial samples throughout pregnancy from four body sites for 49 pregnant women, of whom 15 delivered prematurely. Patterns of vaginal bacteria that were dominated by lactobacillus bacteria were linked to low prematurity risk. Such patterns had already been shown to be linked to health in non-pregnant women.

A pattern of high bacterial diversity, low lactobacillus and high levels of gardnerella and ureaplasma bacteria was linked to higher prematurity risk, the study also showed. This was especially true if the high-diversity pattern persisted for several weeks. From our press release about the new research:

“I think our data suggest that if the microbiome plays a role in premature birth, it may be something that is long in the making,” said the study’s lead author, Daniel DiGiulio, MD, a research associate and clinical instructor in medicine. “It may be that an event in the first trimester or early second trimester, or even prior to pregnancy, starts the clock ticking.”

The researchers also followed the women’s bacterial communities for up to a year after their deliveries and found that all new mothers shifted to the high-risk pattern, regardless of if their babies were born early or on time or if they had a c-section or vaginal delivery. This finding may help explain why women with closely-spaced pregnancies are more likely to have a preterm baby the second time around, however more work is needed to better understand this discovery, concluded researchers.

Ultimately, the research team hopes to use their findings to develop interventions that could prevent preterm birth. That would definitely be good news for moms and babies.

Previously: Counseling parents of the earliest-born preemies: A mom and two physicians talk about the challenges, Stanford/VA study finds link between PTSD and premature birth and Maternal obesity linked to earliest premature births, says Stanford study
Photo by bradleyolin

Patient Care, Pregnancy, Women's Health

“The Mama Sherpas”: Exploring the work of nurse-midwives and their collaborations with doctors

"The Mama Sherpas": Exploring the work of nurse-midwives and their collaborations with doctors

baby feetAs a doula, I’m pretty tapped into the birth community, and I’ve definitely noticed a trend toward midwifery care and low-intervention births. Indeed, a 2012 study showed that more babies than ever before are being delivered by midwives.

Now, a new film is documenting how midwives and obstetricians are increasingly teaming up to offer great maternity care. “The Mama Sherpas,” directed by Brigid Maher and produced by Ricki Lake and Abby Epstein (the same people behind the well-known “The Business of Being Born“), showcases the growing popularity of Certified Nurse Midwives (CNMs) in hospital births.

CNMs are registered nurses who have a master’s degree in midwifery and who adhere to the “woman-centered” Midwives Model of Care. According to the film, collaborative care between CNMs and obstetricians can lead to decreased C-section rates, increased VBAC rates (vaginal birth after cesarean), far lower health-care costs, and mothers who are more satisfied with their birth experience.

I had the chance to attend an advance screening, sponsored by the Nurse-Midwives of Monterey Bay, last week, and I was particularly impressed by the footage of the births of the women chronicled. While highly graphic, it provided beautiful portraits of calm and powerful vaginal births, a life-saving caesarian, and even a vaginal breech birth – which I and many in the audience of birth workers had never seen before! Afterwards, the panel of CNMs and obstetricians from hospitals in Santa Cruz and Davis called for more obstetricians to be trained in vaginal delivery of breech births, and in turning breech babies by performing external versions, so that those options can be offered to women.

Previously: In poorest countries, increase in midwives could save lives of mothers and their babiesA reminder that prenatal care is key to a healthy pregnancyUnneeded cesareans are risky and expensive and Tensions high in debate over safety of home births
Photo by Bridget Colla

Chronic Disease, Neuroscience, Pregnancy, Research, Women's Health

Women with epilepsy face elevated risk of death during pregnancy and childbirth – but why?

Women with epilepsy face elevated risk of death during pregnancy and childbirth - but why?

5987537049_ed5eff3b31_zWomen with epilepsy face a higher risk of death and a host of complications during their pregnancies than other women, according to a new study published today in the Journal of the American Medical Association Neurology.

The researchers found women with epilepsy had a risk of 80 deaths per 100,000 pregnancies, more than 10 times higher than the risk of 6 deaths per 100,000 pregnancies faced by other women.

That’s a big deal, neurologists Jacqueline French, MD, from NYU Langone Medical Center, and Stanford’s Kimford Meador, MD, write in an accompanying editorial.

“The study should sound a major alarm among physicians and researchers,” French and Meador write. But, it fails to answer an integral question, they say: Who exactly is at risk and why did the women die?

Women with epilepsy are more likely to have hypertension, diabetes and a variety of psychiatric conditions. Are those conditions responsible for the differences in death rates, the authors question.

The study also fails to distinguish between women with well-controlled epilepsy and those continuing to suffer seizures. “These are critical questions, and, without the answers, we are left in the unsatisfying position of having to advise all women with epilepsy that they may be at higher risk,” French and Meador write. The study “raises far more questions than it answers. Most women with epilepsy have uncomplicated pregnancies.”

The authors conclude: “Future studies need to confirm and build on the present findings to improve the care of women with epilepsy during pregnancy.”

Previously: Treating intractible epilepsy, Ask Stanford Med: Neurologist taking questions on drug-resistant epilepsy and How epilepsy patients are teaching Stanford scientists more about the brain
Photo by José Manuel Ríos Valiente

Behavioral Science, In the News, Medicine and Society, Pregnancy, Public Health

Walking on sunshine: How to celebrate summer safely

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Normally, I spend the Fourth of July on the shores of a Wisconsin lake, getting eaten alive by mosquitos, burning to a bright shade of pink, lighting sparklers and eating potato salad that has sat in the sun for hours. Heaps of fun, but also plenty of opportunities to fall ill.

This year, I’ve been barred from that fun trip by my oh-so-practical doc, who thinks unnecessary travel isn’t the smartest option for someone who is eight-months pregnant. Instead, I’ll have to be satisfied with reading a Washington Post article, published earlier this week, about all the summer health hazards I’m avoiding by celebrating the holiday in my coastal California home.

First is athlete’s foot, a fungus that “lingers on warm, wet surfaces such as poolside pavement and the floors of locker rooms and public showers” that produces an oozing pus. Or its relative, a toenail fungus that leads to yellow, thickened nails. And I thought a big belly was a bit of bother.

There’s also coxsackie virus, known for causing hand, foot and mouth disease, which thrives in kids’ wading pools courtesy of the occasional leaky diaper. The virus usually causes blisters; in rare cases it can lead to heart failure, says Stanford pediatrics professor Bonnie Maldonado, MD. Note to self: Keep baby out of unchlorinated kiddie pools.

We’re just getting warmed up here. There’s the summertime regulars of food poisoning, heat exhaustion and heat stroke. So yeah, that potato salad, while still yummy, probably isn’t a good idea, nor is the all-afternoon exposure to 95-plus degrees.

Don’t forget swimmer’s ear, an infection of the ear canal that, according to otolaryngologist Richard Rosenfeld, MD, from New York can “really, really, really hurt and ruin a vacation.” And a walk in the woods can quickly yield a ravaging rash from poison ivy or oak.

Throw in insect-borne plagues like West Nile and Lyme disease and gee, I guess my front porch isn’t looking so bad after all.

Previously: As summer heats up, take steps to protect your skin, This summer’s Stanford Medicine magazine shows some skin and Stanford nutrition expert offers tips for a healthy and happy Fourth of July
Photo by Jordan Richmond

NIH, Pregnancy, Research, Technology, Women's Health

Scientists create a placenta-on-a-chip to safely study process and pitfalls of pregnancy

Scientists create a placenta-on-a-chip to safely study process and pitfalls of pregnancy

2798127284_487b56b9cf_zThese days it seems that just about anything can be recreated on a microchip. But still, I did a double-take when I read about the new way that scientists are using technology to study pregnancy: They’ve created a “placenta-on-a-chip.”

A functioning placenta is critical for a healthy pregnancy because it regulates the flow of nutrients, oxygen and waste products between the mother and fetus. It also controls the fetus’ exposure to bacteria, viruses and other harmful substances. Researchers would like to learn more about how the placenta acts as a “crossing guard” and how it can regulate the body’s traffic so well. Yet, studying the placenta is hard to do because it’s highly variable, and tinkering with the placenta is risky for the fetus.

To overcome these challenges, an interdisciplinary team led by a University of Pennsylvania researcher created a two-chambered microchip that mimics the structure and function of the human placenta. The study was published online in the Journal of Maternal-Fetal and Neonatal Medicine and is reported on in this National Institutes of Health press release:

The device consists of a semi-permeable membrane between two tiny chambers, one filled with maternal cells derived from a delivered placenta and the other filled with fetal cells derived from an umbilical cord.

After designing the structure of the model, the researchers tested its function by evaluating the transfer of glucose (a substance made by the body when converting carbohydrates to energy) from the maternal compartment to the fetal compartment. The successful transfer of glucose in the device mirrored what occurs in the body.

As Roberto Romero, MD, chief of the perinatology research branch at the NIH’s National Institute of Child Health and Human Development, explains in the press release, this new technology could help researchers explore how the placenta works, and what happens when it fails, in ways that couldn’t be safely done before. This, the researchers say, could lead to more successful pregnancies.

Previously: NIH puts focus on the placenta, the “fascinating” and “least understood” organPlacenta: the video game, The placenta sacrifices itself to keep baby healthy in case of starvation, research showsThe placenta sacrifices itself to keep baby healthy in case of starvation, research shows and Program focuses on the treatment of placental disorders
Photo by Jack Fussell

AHCJ15, Ethics, Events, Patient Care, Pediatrics, Pregnancy

Counseling parents of the earliest-born preemies: A mom and two physicians talk about the challenges

Counseling parents of the earliest-born preemies: A mom and two physicians talk about the challenges

preemie toesWhen Juniper French was born in April 2011, her mom had been pregnant for 23 weeks and 6 days – a little more than half of a typical 40-week pregnancy. Shortly before her birth, doctors had to try to explain the possible consequences of her very early arrival to her parents.

“Prematurity is a very unusual condition because it can affect any corner of the body or the mind to any degree,” Kelley Benham French, Juniper’s mother, told a group of journalists at the Association of Health Care Journalism 2015 conference this past weekend. French and her husband were informed that, even with intense medical intervention at birth, their daughter had an 80 percent chance of death or morbidity. Not only was that staggering, but their doctors couldn’t be very specific about what this number might mean if Juniper did survive: “We asked, ‘Do you mean life on a ventilator or asthma? Do you mean blindness or a wheelchair?'” French recalled. “They said, ‘We don’t know.'”

These same uncertainties are faced by all parents of babies born near the edge of viability, between 22 and 25 weeks of gestation. French, a reporter, eventually wrote an award-winning series about Juniper for the Tampa Bay Times that explains the swirl of emotions and statistics she and her husband, Tom, had to navigate in deciding to ask their doctors to resuscitate Juniper at birth. As French told the conference attendees, the choice was excruciating; they desperately wanted to be parents but didn’t want their baby to suffer. They wondered if “it might be less selfish to just let her die.”

Two Stanford experts joined French in Friday’s presentation to discuss difficult conversations about very early preemies.

Neonatologist Henry Lee, MD, gave a sampling of the information he must present to parents when he has these conversations as part of his work at Lucile Packard Children’s Hospital Stanford: Not only are these babies at risk of dying, they face daunting early-life medical complications. Lee rattled off a list: retinopathy of prematurity; necrotizing enterocolitis; bronchopulmonary dysplasia; intraventricular hemorrhage. Referring to the last item on this list, he said “You can imagine, talking to a parent, telling them that ‘Your baby is at risk for having bleeding into their brain’ can cause a lot of anxiety. And often this is the patient’s first time meeting this doctor or nurse. They don’t have any relationship, but they’re talking about these weighty matters.”

Stanford obstetrician Amen Ness, MD, added that women in preterm labor are often asked to make critical medical decisions quickly. Do they want steroids to mature the baby’s lungs? Are they OK with receiving a classical c-section to deliver the baby, which produces a large vertical scar that increases the risk of placenta accreta in future pregnancies? How much fetal monitoring do they want?

Most of these decisions would feel more comfortable if the patient had a few days to think things over and could return for later conversations with more questions. “You really need that time but you don’t always have it,” Ness said.

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Evolution, Genetics, Microbiology, Pregnancy, Research, Science, Stanford News, Stem Cells

My baby, my… virus? Stanford researchers find viral proteins in human embryonic cells

My baby, my... virus? Stanford researchers find viral proteins in human embryonic cells

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One thing I really enjoy about my job is the opportunity to constantly be learning something new. For example, I hadn’t realized that about eight percent of human DNA is actually left-behind detritus from ancient viral infections. I knew they were there, but eight percent? That’s a lot of genetic baggage.

These sequences are often inactive in mature cells, but recent research has shown they can become activated in some tumor cells or in human embryonic stem cells. Now developmental biologist Joanna Wysocka, PhD, and graduate student Edward Grow, have shown that some of these viral bits and pieces spring back to life in early human embryos and may even affect their development.

Their research was published today in Nature. As I describe in our press release:

Retroviruses are a class of virus that insert their DNA into the genome of the host cell for later reactivation. In this stealth mode, the virus bides its time, taking advantage of cellular DNA replication to spread to each of an infected cell’s progeny every time the cell divides. HIV is one well-known example of a retrovirus that infects humans.

When a retrovirus infects a germ cell, which makes sperm and eggs, or infects a very early-stage embryo before the germ cells have arisen, the viral DNA is passed along to future generations. Over evolutionary time, however, these viral genomes often become mutated and inactivated. About 8 percent of the human genome is made up of viral sequences left behind during past infections. One retrovirus, HERVK, however, infected humans repeatedly relatively recently — within about 200,000 years. Much of HERVK’s genome is still snuggled, intact, in each of our cells.

Wysocka and Grow found that human embryonic cells begin making viral proteins from these HERVK sequences within just a few days after conception. What’s more, the non-human proteins have a noticeable effect on the cells, increasing the expression of a cell surface protein that makes them less susceptible to subsequent viral infection and also modulating human gene expression.

More from our release:

But it’s not clear whether this sequence of events is the result of thousands of years of co-existence, a kind of evolutionary symbiosis, or if it represents an ongoing battle between humans and viruses.

“Does the virus selfishly benefit by switching itself on in these early embryonic cells?” said Grow. “Or is the embryo instead commandeering the viral proteins to protect itself? Can they both benefit? That’s possible, but we don’t really know.”

Wysocka describes the findings as “fascinating, but a little creepy.” I agree. But I can’t wait to hear what they discover next.

Previously: Viruses can cause warts on your DNA, Stanford researcher wins Vilcek Prize for Creative Promise in Biomedical Science and Species-specific differences among placentas due to long-ago viral infection, say Stanford researchers
Photo of Joanna Wysocka by Steve Fisch

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