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For women who are obese during pregnancy there is an associated increased risk of certain birth defects, such as spina bifida and neural tube defects, although the absolute increase in risk is likely to be small, according to an analysis of previous studies, reported in the February 11 issue of JAMA.

Obesity is a major public health and economic concern. In the United States, a third of women age 15 years and older were obese (body mass index [BMI] greater than 30) in 2004. There are significant health implications of pre-pregnancy maternal obesity for both mother and child. There is evidence that suggests that maternal obesity may be associated with the development of some congenital anomalies (abnormality present at birth). Congenital anomalies are a leading cause of stillbirth and infant death, accounting for one in five infant deaths in the United States, and are important contributors to preterm birth and childhood illnesses, according to background information in the article.

Dr. Katherine J. Stothard and colleagues from Newcastle University, Newcastle upon Tyne, U.K., conducted a review and meta-analysis of studies to assess the relationship between maternal overweight and obesity and the risk of congenital anomaly in newborns. The researchers identified 39 articles that were included in a systematic review and 18 articles in the meta-analysis.

"In women who were obese at the start of pregnancy, the meta-analysis demonstrated a significantly increased risk of a pregnancy affected by a neural tube defect [nearly twice the odds], including spina bifida [more than twice the odds]; cardiovascular anomaly, including a septal anomaly [heart defect]; cleft palate and cleft lip and palate; anorectal atresia [abnormality of the anus/rectum]; hydrocephaly [abnormal enlargement of the ventricles of the brain due to accumulation of cerebrospinal fluid]; and a limb reduction anomaly," the authors write.

The risk of gastroschisis (abdominal wall defect) among obese mothers was significantly reduced.

"An estimated 3 percent of all livebirths in the United States are affected by a structural anomaly with 0.68 per 1,000 births being affected by a neural tube defect and 2.25 per 1,000 births being affected by a serious heart anomaly," the authors write. "Given the findings of this review, and the BMI profile of the female population during the period when these estimates were generated, we calculate that the absolute risk of a pregnancy affected by a neural tube defect or a serious heart anomaly is respectively 0.47 per 1,000 births and 0.61 per 1,000 births greater in an obese woman than a woman of recommended BMI in pre-pregnancy or early pregnancy. This has health implications, particularly given the continued rise in the prevalence of obesity in many countries."

They add that further studies are needed to confirm whether maternal overweight is also implicated.

(2-24-09)

Starting on February 10, 2009, children's toys and child care articles cannot contain more that 0.1 percent of six phthalates (DEHP, DBP, BBP, DINP, DIDP and DnOPA) regardless of when they were manufactured. The CPSC will abide by a court decision issued on February 5, 2009, ruling that the prohibition on phthalates in the Consumer Product Safety Improvement Act of 2008 applies to products in inventory. Phthalates are a group of chemicals (oily, colorless liquids) that are used among other things to make vinyl and other plastics soft and flexible.

A "children's toy" is defined in the statute as a product intended for a child 12 years of age or younger for use when playing. The commission has previously stated that it will follow the definition of toy in the mandatory toy standard, which exempts such things as bikes, playground equipment, musical instruments and sporting goods (except for their toy counterparts).

The statute also prohibits phthalates over the limit in "child care articles," which include products that a child 3 and younger would use for sleeping, feeding, sucking or teething. By way of example, a pacifier/teether would be an item that would help a child with sucking or teething; a sippy cup would facilitate feeding; and a crib mattress would facilitate sleeping.

Companies must meet their reporting obligation under federal law and immediately tell the commission if they learn of a children's toy or child care article that exceeds the new phthalates limits starting on February 10, 2009. Companies also should know that the CPSIA generally prohibits the export for sale of children's products that exceed the new phthalates limits.

The agency will be issuing further guidance information next week.

(2-17-09)

Bobby Brown, 40, and his girlfriend, Alicia Etheridge, are expecting a baby together, according to People magazine. Brown has a 15-year-old daughter with ex Whitney Houston, two children with ex-girlfriend Kim Ward and one child with ex-girlfriend Melika Williams. This will be the first child for Etheridge.

(2-10-09)

Lenetix, Inc. has announced a significant step in the development of an improved first and second trimester non-invasive fetal chromosomal screening test to detect Down syndrome and other genetic fetal conditions. Lenetix presented preliminary study results at the 29th annual Society for Maternal-Fetal Medicine Conference in San Diego that indicate a potential breakthrough in testing quality and accuracy while preserving the safety of the mother and fetus.

The maternal serum test developed by Lenetix medical director Dr. Stephen A. Brown at the University of Vermont incorporates the use of methylation-sensitive amplification (MSA) of fetal nucleic acid markers. In the preliminary studies, more than 10 clinical plasma specimens of various ethnicities provided by clinical partners were tested with clinical partners using the MSA approach developed by Dr. Brown. Data from pilot studies indicate that highly accurate screening for common fetal autosomal (Trisomy 18, 21) and sex chromosomal (47, XXY) chromosome abnormalities is feasible, particularly in the first trimester of pregnancy when MSA features of early pregnancy-derived cells can be leveraged. This approach affords diagnostic confirmation by CVS, an invasive first trimester procedure, or genetic amniocentesis in the early second trimester.

"The technique described by Dr. Brown and his team at Lenetix will create a revolution in prenatal diagnosis," says study investigator Dr. Allan Fisher, FACOG, FACMG. "This testing will ultimately decrease the number of amniocenteses, and thus reduce the number of miscarriages caused by amniocenteses. It will also help us identify patients who will need an amniocentesis or CVS where we may have missed them before. A better test that produces fewer false positives and negatives drives better patient care, and that's exciting for the future."

"Our preliminary results are extraordinarily encouraging, and complement nicely the work of other investigators whose efforts have focused heretofore in the second trimester," says Lenetix president and CEO Leonard H. Kellner. "Such breakthroughs in improvements of current maternal serum screening for fetal aneuploidy, including fetal Down syndrome, will lead to better quality of screening and most certainly will result in less unnecessary, invasive diagnostic testing."

(2-10-09)

New research that may explain why taking progesterone to prevent preterm birth is only effective for some women was unveiled at the 29th Annual Society for Maternal-Fetal Medicine (SMFM) meeting – The Pregnancy Meeting™.

The drug, 17 alpha-hydroxyprogesterone caproate (or 17P), a synthetic form of the progesterone hormone naturally produced during pregnancy, has been demonstrated in clinical trials to prevent some recurrent preterm births – but not all.

"This study helps strengthen the theory that genetic variation in the human progesterone receptor plays an important role in the effectiveness of 17P," says Dr. Tracy Manuck, study author and SMFM member.

Women who have a spontaneous preterm delivery are at greatly increased risk of preterm delivery in subsequent pregnancies. Preterm birth is a leading cause of infant death in the United States and babies who survive face serious lifelong health problems. More than 543,000 babies are born too soon each year, and recent federal statistics show that the nation's preterm birth rate has risen to 12.8 percent – a 36 percent increase since the early 1980s.

"Dr. Manuck's research gives us a tantalizing clue as to why 17P works for some women, but not for others," says Dr. Alan R. Fleischman, senior vice president and medical director of the March of Dimes. "With further research along these lines, we hope to someday be able to prevent preterm birth from happening in the first place by screening women before they get pregnant, and identifying those whose babies could get a healthy start in life with the help of 17P."

(2-10-09)

Back pain is a very common complaint during pregnancy and into new motherhood – women are gaining weight, walking in new ways and hormones are relaxing the joints and ligaments throughout the body. Carrying a baby in one of the popular strap-on carriers can cause serious back discomfort as well. However, according to Dr. Jack Stern, a renowned neurosurgeon and widely recognized expert in lower back pain, women can often treat or prevent back pain during pregnancy and afterwards with simple self-care strategies or complementary therapies.

Here are tips from Dr. Stern, who has been named one of New York magazine's Best Doctors eight years in a row and is in private practice in Westchester, N.Y.:

1. Stay fit. Consider a regular exercise and stretching program to keep your back strong.

2. Good posture. As the baby grows, the center of gravity shifts forward. In order not to fall forward you may strain the muscles of your back. So tuck your buttocks under, pull your shoulders back and down and stand tall.

3. Lift properly. Squat when lifting. Don't bend at the waist or lift with your back.

4. Sleep on your side.

5. Do pelvic tilt exercises.

(2-10-09)

About 20 percent of perinatal deaths happen because of preterm premature rupture of membranes, called PPROM, or "water breaking" much too soon, which occurs in 2 to 3 percent of pregnant women.

Dr. Amy Murtha, director of Obstetrics Research at Duke University Medical Center, found that premature destruction of the chorion cell layer, the middle layer of the three fetal membranes, is more common in woman with PPROM than those with preterm labor, characterized by early contractions. Women who carry their fetuses to full term were least affected of the three groups studied, Dr. Murtha and colleagues reported at the annual Society for Maternal-Fetal Medicine conference January 30, 2009.

"A trend occurred in the thickness of the chorion, with PPROM women having the thinnest, while full-term women had the thickest cell layer and preterm labor patients were in the middle," says Dr. Murtha, an associate professor of Obstetrics and Gynecology at Duke.

The chorion is a more fragile cellular layer than the other layers, which protects the tough flexible amniontic layers around the fetus from the events occurring in the maternal (decidua) layer. "The chorion has important metabolic properties and its role is protective," Dr. Murtha says. "In PPROM you appear to lose the protective effect of the chorion."

The reasons for this fetal membrane layer thinning are still a mystery. People may respond differently to different exposures, like infections, cigarette smoke or bleeding during pregnancy that gives them an inflammatory response that may lead to a thinning or destruction of that cell layer, Dr. Murtha says. "Even when we analyzed the data and exclude severe infection in the fetal membranes, the results remained the same with the thinning of the chorion most prominent in cases of PPROM, which suggests that this finding may not be related to infections."

Murtha has spent 10 years studying the chorion and why it might become thinner in certain women as pregnancy progresses. "We are trying to find out why they rupture, and infection may be a primary cause, but identifying an infection is difficult to do," Dr. Murtha explains. "Half or more of the women with ruptured membranes we have studied had no evidence of infection as seen in cultures, no fever, and no clinical symptoms. I think a lot of them have no infection, which means there is something else making the cell layer thinner and causing the water bag to break early."

(2-10-09)

The American Academy of Pediatrics (AAP), which represents 60,000 pediatricians, praises President Barack Obama and Congress for reauthorizing the Children's Health Insurance Program (CHIP). After the U.S. House of Representatives passed the Senate version of the bill earlier this afternoon in a 290-135 vote, President Obama wasted no time in signing into law the critical legislation.

"Today's reauthorization of the Children's Health Insurance Program is a victory for the children of this country," says Dr. David T. Tayloe, Jr., president, American Academy of Pediatrics. "With the stroke of President Obama's pen, states now have the funds to provide insurance coverage to more than 11 million children nationwide. During uncertain economic times, the White House and Congress have come together to wisely prioritize children's health."

The reauthorization of CHIP means that more than $30 billion in federal funding will be available to provide health care for those currently enrolled in the program, and to enroll millions more children, the vast majority of whom are currently eligible for CHIP or Medicaid but unenrolled. The legislation also includes the Immigrant Children's Health Improvement Act (ICHIA), which will lift the five-year ban on eligibility for legally residing children and pregnant women in force since 1996.

"Leaders of both parties put partisanship aside and put children first today," says Dr. Jay E. Berkelhamer, chair of the AAP's Access Subcommittee, who attended today's White House signing ceremony. "Yet to be clear, CHIP reauthorization is not health reform for children – it is a bridge to what should rightly come thereafter, broader health reform to ensure that all children have access to affordable, high quality health coverage. The American Academy of Pediatrics looks forward to working with President Obama and leaders of both the House and Senate in the coming months on broader health care reform." (2-10-09)

Dr. Jennifer L. Howse, president of the March of Dimes, issued the following statement:

"Pregnant women who qualify can get critical maternity care, 11 million children can see a doctor and many millions of children will benefit from improved quality of care. All of this is included in the Children's Health Insurance Program Reauthorization Act (CHIPRA) approved tonight (January 29, 2009) by the U.S. Senate. And we are poised to move forward in promoting a culture of prevention, in responding to families' economic stress over health care costs, and in ensuring that the sickest, most at-risk children in our country have access to needed care.

"I particularly want to thank the thousands of moms and dads, grandparents, and friends who heeded the March of Dimes call to action and contacted their Senators urging passage of CHIPRA. They responded because they know both the criticality of having access to medical care and that, in these tough economic times, too many of us are one paycheck away from being unable to afford needed care.

"The March of Dimes applauds the Senate for its swift action to get states the resources necessary to strengthen their programs so that millions of uninsured women and children who qualify – whether citizens or legal immigrants – can get heath coverage. It will indeed be cause for celebration when the final bill reaches President Obama's desk for signature."

The March of Dimes is a national voluntary health agency whose volunteers and staff work to improve the health of infants and children by preventing birth defects, premature birth and infant mortality. Founded in 1938, the March of Dimes funds programs of research, community services, education and advocacy. For the latest resources and information, visit marchofdimes.com or nacersano.org.

(2-03-09)

Elisabeth Hasselbeck, 31, and her husband, Tim Hasselbeck, 30, are expecting their third child. Hasselbeck made the announcement on The View, saying she didn't even know she was pregnant for two months. The baby will join big sister Grace, 3, and big brother Taylor Thomas, 1. (2-03-09)