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Pregnancy, Research

Pregnant women may experience music more intensely, study shows

pregnant musicAt a shower recently, a few veteran moms exchanged tales of “super smell” they’d experienced during pregnancy. (One reported having detected a pizza inside an unmarked car driving along her street – through her closed window and the delivery man’s, plus exhaust from the car’s tailpipe.) Sensitivity to smell is but one possible heroic power of pregnancy, it turns out. A new study by scientists at the Max Planck Institute for Human Cognitive and Brain Sciences in Germany  found that when listening to music, pregnant women showed stronger physiological responses than women who were not pregnant but still experiencing elevated estrogen levels due to an oral contraceptive cycle.

Fifteen women who were pregnant and 17 who were not took part in the study, listening and responding to different qualities of music and having their blood pressure measured. From a release:

[The researchers] played short musical sequences of 10 or 30 seconds’ duration to female volunteers. They changed the passages and played them backwards or incorporated dissonances. By doing so, they distorted the originally lively instrumental pieces and made listening to them less pleasant.

The pregnant women rated the pieces of music slightly differently, they perceived the pleasant music as more pleasant and the unpleasant as more unpleasant. The blood pressure response to music was much stronger in the pregnant group.

The authors noted, “Such an enhanced physiological response in pregnant women could potentially facilitate prenatal musical conditioning.”

The study was published in the journal Psychophisiology.

Previously: The anxiety and pain reducing powers of Adele and Can music benefit cancer patients?
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Parenting, Pregnancy, Stanford News, Women's Health

A team of high-risk birth specialists intervene to remove a large lung cyst and save a newborn’s life

A team of high-risk birth specialists intervene to remove a large lung cyst and save a newborn's life

baby-elijah-fetal-maternal-stanford-childrens-200x200When Elizabeth Rodriguez-Garcia was six months pregnant with her first child, she received some frightening news about the development of her baby: The fetus had a large, fluid-filled cyst that was impeding growth of his lung, compressing on his esophagus and pushing on his heart. As the cyst grew larger, the baby developed fluid retention, a condition known as hydrops, and was at high risk of dying in utero.

A Lucile Packard Children’s Hospital Stanford press release explains how a team of high-risk birth specialists collaborated to intervene both before and after delivery to save the newborn’s life:

A week after the cyst was first found, Jane Chueh, MD, director of prenatal diagnosis and therapy at the hospital’s Johnson Pregnancy and Newborn Center and a clinical professor of obstetrics and gynecology at the School of Medicine, inserted a large needle into Elizabeth’s abdomen and into the fetus’ chest using ultrasound guidance, then threaded a small rubber shunt through the needle into the cyst. It was the first use of the procedure at Lucile Packard Children’s Hospital Stanford.

“It immediately started to drain,’’ Chueh said. “It’s like popping a water balloon. Most of the fluid came out in seconds.”

Relieving pressure from the cyst came at a critical time, said Chueh. The dangerous fluid retention that doctors worried was endangering the baby’s life improved dramatically.

After the intervention, mother and baby continued to be frequently monitored and it soon became clear that an emergency surgery would be necessary after delivery to make sure the newborn could breathe properly on his own. At 39 weeks, Rodriguez-Garcia had a scheduled C-section to simplify the transition between delivery and surgery. Nearly three dozen surgeons, obstetricians, anesthesiologists, neonatologists and respiratory therapists worked quickly to ensure mom and baby’s safety:

The operating team, led by surgeon Karl Sylvester, MD, the center’s executive director as well as an associate professor of pediatric surgery, stood by. Within minutes of birth, the baby was quickly moved into Sylvester’s operating room, where he and the surgical team, including assistant professor of pediatric surgery Matias Bruzoni, MD, removed both the cyst and more than two-thirds of the baby’s lung that was adversely affected by the cyst.

“Our ability to provide all these subspecialists in two rooms to care for both the mom and the baby is what led to the successful outcome for this family,” Sylvester said. “It made a huge difference in this young family’s life; without it, he may not have survived at all.”

Today, Rodriguez-Garcia and her husband have a happy, healthy 5-month-old named Elijah. His mother said, “If you see him, you’d never know what he went through and that he doesn’t have most of his left lung. The cyst is completely gone. I feel blessed.”

Previously: From womb to world: Stanford Medicine Magazine explores new work on having a baby, Special care to protect newborns’ fragile brains and A family’s grace in crisis

Complementary Medicine, Mental Health, Parenting, Pregnancy, Research, Women's Health

Ah…OM: Study shows prenatal yoga may relieve anxiety in pregnant women

Ah...OM: Study shows prenatal yoga may relieve anxiety in pregnant women

Desi_smallDuring a pre- and postnatal yoga module of my yoga teacher training, I was enchanted by instructor Desi Bartlett‘s reference to “pregnant goddesses” – our future students – as we learned how yoga could help them prepare for delivery day. (Think deep squats.) Methods to empower goddesses throughout and beyond pregnancy included modifications to traditional poses to stay fit while providing a safe “house” for the fetus, breathing and meditation to steady a busy mind, group activities to build community with other new parents and restorative poses to find calm during a period of change.

Now, a study (subscription required) has investigated how yoga can help relieve pregnancy-specific anxiety in mothers-to-be. Researchers at the University of Manchester and Newcastle University in the U.K. followed 59 women, each pregnant with her first child and receiving normal prenatal treatment during the late second to third trimester, and asked them to self-report their emotional states. A randomized group attended eight weekly prenatal Hatha yoga sessions, and researchers measured those participants’ saliva cortisol levels before and after the first and last classes of the intervention.

From a release:

A single session of yoga was found to reduce self-reported anxiety by one third and stress hormone levels by 14%. Encouragingly, similar findings were made at both the first and final session of the 8 week intervention.

“The results confirm what many who take part in yoga have suspected for a long time,” John Aplin, PhD, one of the senior investigators in Manchester and a yoga teacher, said in the release. “There is also evidence yoga can reduce the need for pain relief during birth and the likelihood for delivery by emergency caesarean section.”

The study was published in the Journal of Depression and Anxiety.

Previously: Toilets of the future, and the art of squattingA reminder that prenatal care is key to a healthy pregnancyPregnant and on the move: The importance of exercise for moms-to-be and Ask Stanford Med: Pain expert responds to questions on integrative medicine
Photo of Desi Bartlett by Natiya Guin

Bioengineering, Genetics, Neuroscience, Pregnancy, Research, Stanford News

Step away from the DNA? Circulating *RNA* in blood gives dynamic information about pregnancy, health

Step away from the DNA? Circulating *RNA* in blood gives dynamic information about pregnancy, health

blood on fingertip - 260

I read a lot of scientific papers. And while they’re all interesting, they don’t all make me snap to attention like the latest from Stanford bioengineer Stephen Quake, PhD. I even remarked to my husband that it’s rare to get the immediate sense that a discovery will significantly change clinical care.

If anyone’s going to shake up the status quo, however, it would be Quake. You may remember that Quake has made waves before with his pioneering discoveries involving the analysis of tiny bits of DNA circulating in our blood. His 2008 discovery that it’s possible to non-invasively detect fetal chromosomal abnormalities with a maternal blood sample has revolutionized prenatal care in this country. It’s estimated that, in 2013, hundreds of thousands of pregnant women used a version of this test to learn more about the health of their fetuses. And, in 2012, Quake showed its possible to sequence an entire fetal genome from a maternal blood sample.

Now he and his lab have gone one step further by turning their attention to another genetic material in the blood, RNA. Although information conveyed in the form of DNA sequences is mostly static (the nucleotide sequence of genes, for example), RNA levels and messages change markedly among tissues over time and at various developmental points. The difference in available information is somewhat like comparing a still photo with a high-resolution video when it comes to sussing out what the body is actually doing at any point in time.

The study was published today in the Proceedings of the National Academy of Sciences. As I explain in my release:

In the new study, the researchers used a technique previously developed in Quake’s lab to identify which circulating RNA molecules in a pregnant woman were likely to have come from her fetus, and which were from her own organs. They found they were able to trace the development of specific tissues, including the fetal brain and liver, as well as the placenta, during the three trimesters of pregnancy simply by analyzing blood samples from the pregnant women over time.

Quake and his colleagues believe the technique could also be broadly useful as a diagnostic tool by detecting distress signals from diseased organs, perhaps even before any clinical symptoms are apparent. In particular, they found they could detect elevated levels of neuronal-specific RNA messages in people with Alzheimer’s disease as compared with the healthy participants.

Quake and the lead authors, graduate students Winston Koh and Wenying Pan, liken their technique to a “molecular stethoscope.” They believe it could be broadly useful in the clinic. More from my release:

“We’ve moved beyond just detecting gene sequences to really analyzing and understanding patterns of gene activity,” said Quake. “Knowing the DNA sequence of a gene in the blood has been shown to be useful in a few specific cases, like cancer, pregnancy and organ transplantation. Analyzing the RNA enables a much broader perspective of what’s going on in the body at any particular time.”

Previously: Whole-genome fetal sequencing recognized as one of the year’s “10 Breakthrough Technologies” and Better know a bioengineer: Stephen Quake
Photo by Alden Chadwick

Cardiovascular Medicine, Emergency Medicine, Patient Care, Pregnancy, Research, Stanford News

Cardiac arrest in pregnancy: New consensus statement addresses CPR for expectant moms

Cardiac arrest in pregnancy: New consensus statement addresses CPR for expectant moms

pregnantbelly2When a pregnant woman’s heart stops, two lives are threatened. Yet few caregivers know how to modify their cardiopulmonary resuscitation technique for the expectant mom and her fetus, and few hospitals are optimally prepared for such an event.

To fill the knowledge gap, the Society for Obstetric Anesthesia and Perinatology commissioned a Stanford-led team of experts from several medical disciplines to write a consensus statement of expert recommendations, publishing in the May issue of Anesthesia & Analgesia, that describes best practices for CPR on a pregnant patient. The new statement is one of many examples of Stanford leadership in helping to save the lives of pregnant women around the world; our experts have also helped to develop widely-adopted protocols for dealing with massive hemorrhage during delivery and for treatment of pre-eclampsia, for example.

I asked two Stanford scientists who helped prepare the statement, lead author Steven Lipman, MD, and senior author Brendan Carvalho, MD, for their perspectives on the challenges of resuscitation in pregnancy. Both are obstetric anesthesiologists at Lucile Packard Children’s Hospital Stanford, where Carvalho is chief of obstetric anesthesia.

“The good news is that cardiac arrest in pregnancy is very rare, and also that rates of survival are higher than for the non-pregnant population,” Lipman said. Only about one in every 20,000 women with access to modern obstetric care experiences cardiac arrest while pregnant. Higher survival among pregnant patients may be partly due, he said, to the fact that many maternal cardiac arrests are witnessed: They tend to occur during labor or delivery, when the woman is already in a hospital and being closely monitored by trained medical staff who can begin CPR right away.

But rarity creates challenges. Because maternal cardiac arrests happen infrequently, obstetric caregivers have less experience in performing resuscitation than people who work in other parts of the hospital, such as the emergency room or intensive care unit. And it’s impossible to conduct randomized clinical trials – usually considered the gold standard for evidence-based medicine – on these emergencies to determine what works best.

“Also, in pregnancy, there is an asymmetry between people’s expectations and the reality of the risk,” Lipman said. “People think, ‘Oh, I’m just having my baby, it’s just natural.’ But if you look at third-world countries with no developed medical infrastructure, the rates of maternal mortality are extremely high. Yes, it’s natural and people expect an easy delivery and a healthy baby, but the reality is that it can be a risky process, and people can become critically ill very quickly.”

The physiology of pregnancy also presents challenges for resuscitation. During the second half of pregnancy, when a pregnant woman lies flat on her back, the fetus and the enlarged uterus compress the large vein that returns most of the blood to her heart. This decreases the amount of blood available to the heart and makes it harder to provide effective chest compressions in CPR. And resuscitators also must think about how to balance the needs of the mother with those of the fetus.

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Ethics, Fertility, Genetics, In the News, Pregnancy, Stanford News

Daddy, mommy and ? Stanford legal expert weighs in about “three parent” embryos

Daddy, mommy and ? Stanford legal expert weighs in about "three parent" embryos

3519855504_9000d95a2aIt’s an interesting question that got a lot of traction in the media last week. Does the contribution of a tiny amount of DNA from a third person during in vitro fertilization really mean that the resulting child would have three genetic parents? Researchers in Oregon have proposed the technique as a way to avoid genetic diseases arising from faulty mitochondrial DNA by replacing an egg’s mitochondria with one from a second, healthy woman either before or after fertilization with a man’s sperm. They’ve shown that it works in monkeys, and the FDA met last week to consider whether the technique is safe enough to be used in humans.

Yesterday, Stanford law professor and bioethicist Hank Greely, JD, posted a great analysis of the topic on the university’s Law and Biosciences blog, complete with an elegant explanation of the problem for women with mitochondrial DNA mutations:

The mitochondria (high school biology’s “energy powerhouses of the cell”) have their own very short stretch of DNA, separate from the 6.8 billion base pairs found on 46 chromosomes in the cell’s nucleus (the nuclear DNA).  The 16,569 base pairs of the mitochondrial DNA (hereafter “mtDNA”) hold 37 (some say 38) genes, providing instructions for making 13 (or 14) proteins and another 24 RNA molecules.  The full importance of these genes is unknown, but it is clear that some (happily rare) variations in the mtDNA cause quite severe illnesses. Unfortunately, each child gets all of its mitochondria (and hence its mtDNA) in the egg from its mother; if the mother’s mtDNA is dangerously flawed, so will be the mtDNA of all her children. With almost all other genetic diseases, no matter how inevitably the “bad” genetic variation leads to a disease (how “penetrant” the genetic variation is), a woman will have only a 50% or 25% chance of passing on the condition.  With these, her genes can give rise to no healthy children.

Greely gets at the heart of the matter when he compares the statistically minute contribution from the donated mitochondria to a hypothetical child he calls Heather:

I have DNA from four people in each of my cells:  my mother’s mother, my mother’s father, my father’s mother, and my father’s father. Actually, my DNA really came from all eight of my great-grandparents, and all 1024 of my great great great great great great great great grandparents, and all roughly one million of my great (18) grandparents. Yes, all that DNA passed through my (genetic) parents before coming to me, but why does that matter?

Heather gets her DNA from more than two people a bit differently from the way the rest of us do, but so what? How does getting what is, in effect, “gene therapy,” where the gene is delivered in a natural package called the mitochondrion, turn our hypothetical (and healthy) child into a powerful argument against the procedure?

It shouldn’t.  Heather will not be getting superpowers, she will not be in any meaningfully way “designed” (except to avoid a nasty genetic disease), and she will not be given a newly made DNA sequence never before found in the human gene pool. She will get mitochondria with mtDNA that will allow her to have normal health, not a grave disease. That mtDNA will have been taken from a woman, who, though not a source of Heather’s nuclear DNA, is certainly a participant in the human gene pool.

“Heather has three parents” is NOT an argument. It is an irrelevant but attention-getting slogan that is uncritically put forward as, and sometimes mistaken for, a real argument. Yes, the proposed process is a way of bringing forth living and healthy babies that is somewhat new and different, but so were obstetric forceps, (safe) C-sections, and in vitro fertilization. Novelty is not, in itself, a respectable argument against it.

Previously: Medical practice, patents and “custom children”: A look at the future of reproductive medicine, Five million babies and counting: Stanford expert offers conversation on reproductive medicine and Stanford researchers work to increase the odds of in vitro fertilization success
Photo by Christian Pichler

Pregnancy, Stanford News, Women's Health

Attending to signs of preeclampsia in late-stage pregnancy

preeclampsiaAs recently written about on Scope, the California Quality Care Collaborative organized a task force and produced a toolkit of recommendations for treating preeclampsia, a pregnancy complication marked by hypertension that can kill pregnant women and new mothers.

An article in the San Francisco Chronicle details one woman’s health emergency and stillbirth experience owing to the condition. “I wish I had known more about preeclampsia,” Elizabeth Barnett, the 33-year-old mother, told Stephanie M. Lee. “Not that the outcome necessarily could have been that much different because of how severe I had it, but I definitely would have gone into the hospital earlier and would have been more on top of it.”

The piece emphasizes why recognizing and treating preeclampsia and eclampsia – which may induce deadly seizures – is paramount for expectant mothers and their health care providers.

From the Chronicle:

“Nobody realizes it’s a problem. Preeclampsia is the most common medical complication of pregnancy essentially,” said [Maurice Druzin, MD], an obstetrics and gynecology professor at Stanford University School of Medicine and an attending physician at Lucile Packard Children’s Hospital. Druzin helped lead the group of clinicians that wrote the guidebook.

From 2002 to 2004 in California, 25 women died of preeclampsia or eclampsia, making up 17 percent of all pregnancy-related deaths in the state during that time, according to an analysis of the most recent data. The number of maternal deaths in California, in general, is relatively small. The numbers had, in fact, been declining for years, but increased between 1999 and 2010 because of chronic conditions among pregnant women, variety in quality of pre- and postnatal care and other factors.

Previously: New preeclampsia toolkit will help prevent maternal deaths and Could exercise before and during early pregnancy lower risk of pre-eclampsia?
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Health and Fitness, Pregnancy, Public Health, Research, Women's Health

Group sessions shown to help women maintain healthy pregnancy weight

Group sessions shown to help women maintain healthy pregnancy weight

pregnant_012214More than 50 percent of pregnant women, myself included, gain more weight than the recommended national guidelines. Personally, I had grand ambitions of maintaining my pre-pregnancy workout routine, or at least a modified version, and sticking to my usual healthy eating habits for the entire 40 weeks. But then I was sidelined for several months by unrelenting fatigue and an odd form of morning sickness where only Mexican cuisine agreed with my stomach. Although I resumed exercising and eating a more diverse diet, I wasn’t able to keep my weight gain within the suggested range.

Perhaps I would have been more successful if my prenatal check-ups had been structured as meetings with other women of similar gestational ages, rather than the traditional doctor visit. According to a growing body of research, women who received group prenatal care benefitted in a number of ways, including weight management. Futurity reports:

Researchers found that women who participated in prenatal care delivered in a group setting as opposed to the traditional approach—which typically involves a series of regular one-on-one visits with a healthcare provider—saw a 22 percent reduction in the risk of excessive gestational weight gain.

The beneficial effect of group prenatal care was even more pronounced for women who were overweight prior to pregnancy, who saw a 28 percentage points reduction in the risk of excessive gestational weight gain.

The post also notes that past studies have shown prenatal group check-ups can reduce the risk of infants being born with very low birth weights and increase the odds that  mothers will breastfeed their babies.

Previously: Eating nuts during pregnancy may protect baby from nut allergies, What’s in YOUR blood? A simple blood test may change the face of prenatal care and From womb to world: Stanford Medicine Magazine explores new work on having a baby
Photo by hugrakka

Patient Care, Pregnancy, Public Health, Stanford News, Women's Health

New preeclampsia toolkit will help prevent maternal deaths

New preeclampsia toolkit will help prevent maternal deaths

pregnant woman holding bellyCalifornia hospitals have a new tool to help reduce maternal deaths. Today, the California Maternal Quality Care Collaborative released a toolkit for the treatment of preeclampsia, a pregnancy complication that can kill pregnant women and new mothers. Although, fortunately, few women die in California during pregnancy or birth, preeclampsia is among the leading causes of such deaths. Importantly, many deaths caused by this disease can be prevented if doctors know what to do.

Preeclampsia is characterized by high blood pressure in late pregnancy. It can escalate without warning to full-blown eclampsia, in which the woman experiences potentially deadly seizures. The only cure is delivery of the baby.

To help California hospitals handle this obstetric emergency, the CMQCC convened a task force that reviewed scientific literature on the disease. The task force, c0-led by Stanford’s Maurice Druzin, MD, developed a package of materials that includes care guidelines, such as identification of clinical “triggers” that require immediate evaluation; a compendium of relevant research on the disease; and educational materials for physicians and patients.

From the CMQCC’s announcement about the toolkit:

The primary aim of the Toolkit is to guide and support obstetrical providers, clinical staff, hospitals and healthcare organizations to develop methods within their facilities for timely recognition and an organized, swift response to preeclampsia. “Every hospital that provides obstetric care should have current guidelines on early recognition and response to preeclampsia,” says Dr. Druzin. An expert in the field, Dr. Druzin also served on a national committee that made recommendations to the American College of Obstetrics and Gynecology on how to diagnose and treat preeclampsia.

I spoke with Druzin when the toolkit was in development, and he stressed that sharing this information could prevent tragic outcomes for women and their families. “The good news is that with a modern treatment approach, most women and their babies can have safe, healthy outcomes,” he said.

Previously: Could exercise before and during early pregnancy lower risk of pre-eclampsia?
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Infectious Disease, Pregnancy, Public Health, Women's Health

Text message reminders shown effective in boosting flu shot rates among pregnant women

Text message reminders shown effective in boosting flu shot rates among pregnant women

pregnant_textingInfluenza is now widespread in 35 states across the country. Changes to the immune system during pregnancy make expectant moms more susceptible to the flu, and these women also face a particularly high risk for complications if they get sick. But despite this, roughly half of pregnant women fail to get a seasonal flu shot.

In an effort to increase adherence rates among moms-to-be, Columbia University researchers recently examined the effectiveness of using text message reminders. Psych Central reports:

Women in the intervention group received five weekly text messages about the importance of the vaccine starting in mid-September 2011 and two text message appointment reminders.

Both the intervention group and a control group received standard automated telephone appointment reminders.

The results showed that text messaging was successfully used to increase vaccination coverage.

Adjusting for gestational age and number of clinic visits, women who received the intervention were 30 percent more likely to be vaccinated.

A subgroup of women early in the third trimester had the highest intervention effect – 61.9 percent of the intervention group was vaccinated versus 49 percent for the control group.

The study adds to a growing body of work that shows how mobile health initiatives can help improve public health.

Previously: Ask Stanford Med: Answers to your questions about seasonal influenza, Flu shots for moms may help prevent babies from being born too small and Examining the effectiveness of text4baby service
Photo by niXerKG

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