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

Women who have a stillbirth are more likely to experience long-term depression, study shows

Women who have a stillbirth are more likely to experience long-term depression, study shows

5614885964_e75f4261b2_zAny serious loss requires grieving time, and the birth of stillborn child is no exception. However, a recent study suggests that women who have experienced a stillbirth should be monitored for depressive symptoms well after the standard six-month grieving period – up to three years, in fact. Among women who have given birth and who have no history of depression, women who have had a stillbirth are at significantly higher risk of developing long-term depression.

The research was conducted by the NIH’s Stillbirth Collaborate Research Network (SCRN), which defines stillbirth as the death of a baby at or after the 20th week of pregnancy. It occurs in 1 out of 160 pregnancies in the United States, a surprisingly high ratio.

This study is the first to show definitively that women who have no history of depression may face a risk for it many months after a stillbirth

From 2006-2008, the researchers enrolled nearly 800 women from 59 hospitals across the U.S., around a third of whom had delivered a stillbirth (with the other two-thirds having had delivered a healthy baby). In 2009, the women were asked to complete a questionnaire designed to gauge whether they were experiencing symptoms of depression.

After accounting for other factors related to depression and stillbirth among the more than 76 percent of women who did not have a history of depression, the researchers found that women who had a stillbirth were twice as likely to have a high depression score compared to women who had a live birth. This difference was even greater among those responding to the questionnaire 2-3 years after they had delivered, at nearly nine times as likely.

In an NIH article, author Carol Hogue, PhD, director of the Women’s and Children’s Center at Emory University’s Rollins School of Public Health in Atlanta and first author of the study, said, “Earlier studies have found that women with a history of depression are especially vulnerable to persistent depression after a stillbirth, even after the subsequent birth of a healthy child,” but this study is the first to show definitively that women who have no history of depression may face a risk for depression many months after a stillbirth.

The study appears in the March issue of the journal Paediatric and Perinatal Epidemiology.

Previously: 2020 Mom Project promotes awareness of perinatal mood disordersLosing Jules: Breaking the silence around stillbirth, A call to break the silence of stillbirth and Pregnancy loss puts parents’ relationship at risk
Photo by Gates Foundation

Aging, Cancer, Emergency Medicine, Medical Education, Pregnancy, Stanford News

Stanford Medicine magazine reports on time’s intersection with health

Stanford Medicine magazine reports on time's intersection with health

Why is it that giant tortoises typically live for 100 years but humans in the United States are lucky to make it past 80? And why does the life of an African killifish zip past in a matter of months?

I’ve often mused about the variability of life spans and I figure pretty much everyone else has too. But while editing the new issue of Stanford Medicine magazine’s special report on time and health, “Life time: The long and short of it,” I learned that serious scientists believe the limits are not set in stone.

“Ways of prolonging human life span are now within the realm of possibility,” says professor of genetics Anne Brunet, PhD, in “The Time of Your Life,” an article on the science of life spans. My first thought was, wow! Then I wondered if some day humans could live like the “immortal jellyfish,” which reverts back to its polyp state, matures and reverts again, ad infinitum. Now that would be interesting.

Also covered in the issue:

  • “Hacking the Biological Clock”: An article on attempts to co-opt the body’s timekeepers to treat cancer, ease jetlag and reverse learning disabilities.
  • “Time Lines”: A Q&A with bestselling author and physician Abraham Verghese, MD, on the timeless rituals of medicine. (The digital edition includes audio of an interview with Verghese.)
  • “Tick Tock”: A blow-by-blow account of the air-ambulance rescue of an injured toddler.
  • “Before I Go”: An essay about the nature of time from a young neurosurgeon who is now living with an advanced form of lung cancer. (The neurosurgeon, Paul Kalanithi, MD, is featured in the video above, and our digital edition also includes audio of an interview with him.)

The issue also includes a story about the danger-fraught birth of an unusual set of triplets and an excerpt from the new biography of Nobel Prize-winning Stanford biochemist Paul Berg, PhD, describing the sticky situation he found himself in graduate school.

Previously Stanford Medicine magazine traverses the immune system, Stanford Medicine magazine opens up the world of surgery and Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions.

Mental Health, Parenting, Pediatrics, Pregnancy, Women's Health

“2020 Mom Project” promotes awareness of perinatal mood disorders

"2020 Mom Project" promotes awareness of perinatal mood disorders

3505373098_0c1961a29a_zHaving a baby is a huge life alteration – who wouldn’t be at least a bit anxious? The vast majority of women experience mood shifts surrounding pregnancy: Around 80 percent experience “baby blues,” and in up to 20 percent this develops into something more serious. But most of these women go untreated, and many undiagnosed.

The California Maternal Mental Health Collaborative (which is changing its name to “The 2020 Mom Project” as they expand outside California) is spearheading efforts to get the word out about perinatal mood disorders. Last Friday, they hosted a seminar on emerging considerations in maternal mental health. As a birth doula, I was particularly happy to listen in. The keynote speakers approached the issue from a pointedly broad perspective, considering the social, economic, and cultural factors that influence health problems and care provision. The take-home message was that to address perinatal mood disorders, we need to address the context in which they happen, including protecting tomorrow’s moms while they are children today.

Vincent Felitti, MD, professor of medicine at UC San Diego and founder of the California Institutes of Preventive Medicine, has done extensive research on how “adverse childhood experiences” affect health by correlating an “ACE score” of self-reported negative experiences such as abuse, neglect, or household dysfunction with incidence of disease. The top-10 causes of death in the U.S. are strongly correlated with high ACE scores. Moreover, so are their risk factors! Much abuse of alcohol, drugs, and food is a coping mechanism for prior traumas. “What we see as the problem turns out to be somebody’s solution to problems we know nothing about,” Feletti said. “Depression is considered a disease, but what if it was a normal response to adverse life experiences? ACE score statistics support this.”

In a similar vein, Calvin Hobel, MD, an obstetrician-gynecologist at Cedars Sinai Medical Center in Los Angeles, spoke about how maternal stress surrounding pregnancy causes complications and adverse child outcomes, including premature birth. Stress causes uterine irritability, which causes cervical changes that favor pre-term delivery. It signals to the placenta that things aren’t going well, and the baby better get out early. Just as soldiers with stressful backgrounds are more at risk for PTSD, moms who’ve had a rough life are more stress-reactive and less prepared to cope with the demands of motherhood.

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Big data, Events, Pediatrics, Pregnancy, Research, Stanford News

Stanford hosts inaugural Childx conference this spring

Stanford hosts inaugural Childx conference this spring

Chandler's 15 Month CheckupRegistration is now open for the first ever Childx conference, a TED-style conference focused on inspiring innovation in pediatric and maternal health. The conference will bring thought leaders from several disciplines to the Stanford campus April 2 and 3 for two days of conversation about how to harness many branches of medicine to solve the health problems of pregnancy, infancy and childhood.

“Pediatric medicine faces unique challenges,” said systems biology researcher Dennis Wall, PhD, who leads the conference’s scientific advisory board. “Most children are quite healthy, which can make it difficult to attract adequate research attention to severe pediatric diseases that affect relatively few children. At the same time, every child’s health status is influenced by a complex array of factors, which cause decades-long ripple effects as today’s children mature into tomorrow’s adults.”

The conference, developed and sponsored by Stanford’s Child Health Research Institute, has five themes:

  • Definitive stem cell and gene therapy for child health
  • The arc of fetal, developmental/cognitive, and adult health
  • Accelerating child and maternal health innovation
  • Precision medicine for rare and historically untreatable childhood disease
  • The health ecosystem and the impact of social, economic, political, environmental, and cultural issues on children’s health and well-being

Featured guests include Martin Andrews, who leads Glaxo Smith Kline‘s rare diseases team; Nadia Rosenthal, PhD, founding director of the Australian Regenerative Medicine Institute; Harvard’s Matthew Gillman, MD, an expert on early-life prevention of chronic disease; Sheena Josselyn, PhD, a neuroscientist at the University of Toronto and the Hospital for Sick Children who studies molecular processes behind learning and memory; and Donald Schwarz, MD, the director of the Robert Wood Johnson Foundation, as well as a large cast of Stanford stars from several areas of pediatric medicine.

“Pediatric medicine needs to turn its focus more to creating advanced, technology-enabled solutions that will increase our ability to detect, monitor and treat child health,” Wall said. “No pediatric conference to-date has combined these key themes of precision healthcare with the most pressing challenges and opportunities in child and maternal health. The inaugural Childx will be the first conference to do so.”

The conference will welcome maternal and child health researchers, clinicians, investors, industry experts and interested community members. Early bird registration is open through February 28.

Bioengineering, Ethics, Fertility, Genetics, In the News, Parenting, Pregnancy

And baby makes four? KQED Forum guests discuss approval of three-parent IVF in UK

And baby makes four? KQED Forum guests discuss approval of three-parent IVF in UK

newborn feet Scope BlogLast week, the U.K. House of Commons voted to legalize a controversial in vitro fertilization technique called mitochondrial donation, popularly known as the “three-parent baby” technique. The technique is intended for mothers who have an inherited genetic defect in their mitochondria – the fuel compartments that power our cells – and can help them from passing on the incurable disease that often entails years of suffering and ends in premature death.

Doctors replace the DNA from a donor egg with the mother’s DNA, use sperm from the father to fertilize it, then implant it into the mother’s uterus via IVF technology. The donor egg’s cytoplasm contains defect-free mitochondria and DNA from both parents. Proponents say the technique gives parents with mitochondrial disease the chance to have disease-free children, but critics say it brings us one step closer to the reality of genetically modified “designer babies.”

On Friday, Stanford law professor and biotechnology ethicist Hank Greely, JD, was among the guests on KQED’s Forum broadcast to discuss the issue. He’s in favor of the procedure, noting that when looking at genetic modifications, “the purpose, the nature, [and] the safety” should be considered. “There are some things that I think shouldn’t be done,” he said, adding that “things like this, which gives women who have defective mitochondrial DNA their only chance to have genetic children of their own… if the safety proves up… seems to be a good use.”

Previously:  Daddy, mommy and ? Stanford legal expert weighs in about “three parent” embryos and Extraordinary Measures: a film about metabolic disease
Photo by Sean Drelinger

Infectious Disease, Parenting, Pediatrics, Pregnancy, Public Health

Cocooning newborns against pertussis

Cocooning newborns against pertussis

Grandparent hand with babyAt my last prenatal visit, I got a booster shot for whooping cough (sometimes called pertussis). The Centers for Disease Control and Prevention recommends women get a booster in the third trimester of every pregnancy. Whooping cough has been on the rise for years, and there’s an outbreak happening in California, where we live.

Newborns are especially vulnerable to severe complications from the disease, so doctors suggest that anyone who’s going to be in close contact with newborns and isn’t up-to-date also get a booster: fathers, siblings and even visiting grandparents. The strategy is called “cocooning.”

But what do you do when a grandparent doesn’t want to get a shot? A lot of people don’t like getting vaccinations, either because they want to avoid the discomfort of a shot in the arm or they don’t believe vaccines are effective. (They are.) It’s a question that comes up more often than I expected in online communities. Many pregnant women insist that grandparents who won’t get pertussis shots won’t be allowed to see the new grandchild. Others argue that you can’t force a medical decision like that on someone else. Throw in the added complication that if you’re a first-time parent, it might be the first time you’ve had to confront your parents about how you plan to raise your child. What a mess.

I’m lucky that most of my daughters’ grandparents are already vaccinated for pertussis: My parents and my mother-in-law came to stay and help us with the baby a few years ago and all got vaccinated at the time. But with all the things occupying us as new parents, we didn’t even think to ask my father-in-law, who lives nearby but didn’t have any extended stays in our home. As it turns out, he’s not a fan of vaccinations, and he insists that he got the flu from his last flu shot. (He didn’t.) Obviously, he hadn’t gotten the pertussis booster.

For this baby, we’re planning on bringing up the shot with him, but we’re not expecting him to actually get one. So what will we do? I surprised myself by deciding that I won’t insist he get one in order to see the baby, as long as he doesn’t have any cold symptoms when he visits. (Pertussis usually starts as a mild cold that gets progressively worse; by the time most people are diagnosed, they’ve been sniffling and shedding pertussis bacteria for weeks since they first showed symptoms.) But, who knows? Maybe Grandpa Lesko will surprise us and get the shot for the baby’s sake – or just to avoid the sniffle quarantine policy.

We’ll see.

Previously: Failure to vaccinate linked to pertussis deathsCDC: More U.S. adults need to get recommended vaccinations, and Whooping cough vaccine’s power fades faster than expected
Photo by Ashley Grant

In the News, Medicine and Society, Parenting, Pediatrics, Pregnancy, Stanford News

Grandparents update their baby skills at children’s hospital

Grandparents update their baby skills at children's hospital

2057241787_0f89a0276f_zThe past century has been flooded with trends and new information surrounding pregnancy, birth, and infant care. From doctors Spock, Lamaze, and Bradley in the ’50s, to the promotion of new technologies such as epidural anesthesia and formula feeding in the ’60s, through various iterations of the natural birth movement in the 70’s and 80’s… From the licensing of non-hospital midwives in the 90’s, to the boom in doulas in the 2000s, through the proliferation of maternity apps in this decade, the “right way” to bring a baby into the world has evolved.

To get grandparents updated on their baby knowledge, Lucile Packard Children’s Hospital sponsors a “Grandparents’ Seminar” as part of its course offerings. As a recent San Francisco Chronicle article notes,”Hospitals commonly offer classes in labor, lactation and baby CPR. But adding grandparents to the mix is a modern twist. It used to be that grandparents didn’t go to classes for advice. They dispensed it.”

The two-hour course covers infant safety, sleep, and feeding. Though most of the class participants were conscientious and up-to-date when they were raising their own children, some accepted practices have changed – babies are now swaddled tightly like burritos, laid to sleep on their backs without pillows, and exclusively breastfed when possible. Umbilical cords are cleaned with water instead of alcohol, the specifications for car seats have changed dramatically, and there is a potentially overwhelming array of new products on the market. Medical communities are increasingly becoming aware of perinatal mood disorders, and informing patients about practices that were once “fringe” – like co-sleeping and intervention-free birth.

The course also touches on the complex emotional issues that come with becoming a grandparent, and offers advice on etiquette – which the course instructor, Marilyn Swarts, a labor and deliver nurse and nurse manager quoted in by the Chronicle, sums up with “Seal your lips.” Parents want their parents involved with the baby, but they also want autonomy and to incorporate modern care practices. Indeed, many people who take the course learned about it through their children.

Swarts has been teaching the course for the nearly ten years it has been offered. In a 2009 interview with a grandparenting blog, she said:

It’s so hard because we’re still in the parent mode and just want to help our children, but they must learn for themselves. Better to ask them: What do you think would be a good solution? I want grandparents to empower the new parents, help them believe they’re the best parents for their child and make them feel comfortable and confident in their new roles.

Related: Classroom catch-up for expectant grandparents
Photo by surlygirl

Emergency Medicine, Pediatrics, Pregnancy, Stanford News

Helping families navigate the NICU

Helping families navigate the NICU

Packard preemieEarly this morning, the baby girl that’s been growing inside me for 33 weeks decided to have a dance party in my belly. Not great timing, but it’s always a nice reminder to know she’s getting stronger every day and will soon be more than a pre-dawn percussionist in our lives. One of my biggest fears – as it is for many expecting parents – has been what might happen if I went into early labor or if something unexpected turns up when she’s born and she has to stay in the Neonatal Intensive Care Unit.

Those days, waiting for a baby to be well enough to come home from the NICU can be exhausting and confusing. And there’s often a lot to learn about the health issues many preemies suffer. So a new program at Stanford’s Lucile Packard Children’s Hospital, which admits 1,500 babies each year, aims to make that time a little less overwhelming.

The NICU Family Support Program was started last year and represents a new partnership between the hospital and the March of Dimes. The program is available at several hospitals nationwide and helps 90,000 families every year. Families gain access to print and online versions of educational materials to help them understand their babies’ health issues and treatments. A recent feature story describes the program’s holistic approach:

“We work very hard to take care of the whole family and not just the baby,” [hospital president Christopher] Dawes said in announcing the new partnership with the March of Dimes. “This program increases parents’ confidence and gives NICU staff the tools they need to support families and babies.”

. . .

“When you have a premature baby, you have to learn a whole new language. You are so inundated with terms, it’s easy to get mixed up,” said [mother of twin preemies Heather] Keller. “The March of Dimes website and written materials are a great reference that families can use throughout their journey. It’s accurate and written in a language that’s easy for families to understand, but is not complicated or condescending.”

In addition to the materials, the program offers iPads to NICU families, providing them with easy access to the March of Dimes materials and website without having to leave their babies’ bedsides.

The NICU Family Support Program is designed to help families become more involved in the care their young children receive. It’s an approach that can alleviate some of the burden parents of NICU patients feel at what is otherwise a harrowing time in their lives.

Previously: The year in the life of a preemie – and his parents, NICU trauma intervention shown to benefit mothers of preemies, Using the iPad to connect ill newborns, parents, Special care to protect newborns’ fragile brains and The emotional struggles of parents of preemies
Photo, of a Packard Children’s patient and his mom, by Doug Peck

Health and Fitness, Parenting, Pediatrics, Pregnancy, Public Health

Exercising during pregnancy may reduce children’s risk of hypertension

Exercising during pregnancy may reduce children's risk of hypertension

7619293834_c18e2bee15_zRegular physical activity during pregnancy has been shown to benefit both mom and baby: Past studies found that exercise can help expectant mothers manage weight gain, sleep better, improve circulation and reduce swelling or leg cramps and increase their endurance in preparation for childbirth. A growing body of evidence also suggests that maternal exercise can boost babies’ brain development and influence a child’s health into adulthood.

Now findings (subscription required) published in the Journal of Sports Medicine and Physical Fitness show that by exercising, moms may reduce their children’s risk of developing high blood pressure, or hypertension. The Michigan State University researchers say their findings are significant because earlier studies have shown babies with low birth weight are more likely to have poor cardiovascular health and an increased risk of hypertension. PsychCentral reports:

[Researchers] initially evaluated 51 women over a five-year period based on physical activity such as running or walking throughout pregnancy and post-pregnancy.

In a follow up to the study, they found that regular exercise in a subset of these women, particularly during the third trimester, was associated with lower blood pressure in their children.

“This told us that exercise during critical developmental periods may have more of a direct effect on the baby,” [said lead author James Pivarnik, PhD].

The finding was evident when his research team also discovered that the children whose mothers exercised at recommended or higher levels of activity displayed significantly lower systolic blood pressures at eight to 10 years old.

“This is a good thing as it suggests that the regular exercise habits of the mother are good for heart health later in a child’s life,” Pivarnik said.

Previously: Extreme pregnancy: A look at exercise and expectant moms, Could exercise before and during early pregnancy lower risk of pre-eclampsia?, Are women getting the message about the benefits of exercising during pregnancy? and Pregnant and on the move: The importance of exercise for moms-to-be
Photo by Nathan Rupert

Parenting, Pediatrics, Pregnancy, Technology, Women's Health

Stanford alumni aim to redesign the breast pump

Stanford alumni aim to redesign the breast pump

2014-11-21 15.02.36

Three Stanford graduates have an idea that could dramatically impact the daily life of active breastfeeding women: They plan to design and build a breast pump that is discreet, intuitive, and supportive of mothers. This may sound obvious, but nothing like it currently exists. In August of this year, Cara Delzer, MBA; Gabrielle Guthrie, MFA; and Santhi Analytis, PhD, founded Moxxly, “a consumer products company designing for women.” They’re in the final stretch of their 16-week incubation with Highway 1, which helps hardware startups move from a concept to a prototype ready for production.

“We’ve talked to women, hundreds of women, who have told us things like ‘pumping makes me feel like a cow,'” shares Delzer, Moxxly’s CEO, who I interviewed in late November. So she and her colleagues are aiming to re-imagine the pumping experience.

Delzer experienced the current, poorly-imagined pumps firsthand after the recent birth of her child: “I just remember watching my husband take piece after piece out of the pump box for the first time thinking, how in the world am I going to put this together? All those pieces, and clean them? I was already overwhelmed as a new mom, but completely overwhelmed by the pump.” Once she went back to work, she found that she was spending 25 percent of her day dealing with the logistics of pumping – mentally integrating it into her schedule, worrying about having all the parts. The experience is similar for many of today’s busy, mobile moms.

Meanwhile, Guthrie was at Stanford developing her passion for designing for women, Delzer recounts. “A lot of things that have been designed for women and girls in the past have followed this ‘shrink it and pink it’ trope where you literally make it smaller and bright pink and think, ‘Oh, now the girls will buy it.’ Well, Gabrielle doesn’t buy it.” For her masters’ thesis, Guthrie interviewed working moms, and the breast pump kept coming up as something that needed to be redesigned. She spent much of her last year at Stanford working on just that. At a hackathon, she and Analytis worked together to put the new designs into practice, and Analytis, whose PhD is in mechanical engineering, was hooked on solving this problem as well.

The three women “got together, looked one another in the eyes and said, ‘Do we believe this is a problem? Do we believe we can solve it? Do we believe the time is now?’ And it was yes, yes, yes,” said Delzer. They took on the challenge despite the fact that the breast pump is an FDA-regulated medical device and they will face a lengthy review process. They invented the name “Moxxly” with the intent of conveying spunkiness and strength, and incorporated XX to signify women.

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