Tag Archives: Prenatal Care

University of Pittsburgh Schools of the Health Sciences study: Women, particularly minorities, do not meet nutrition guidelines shortly before pregnancy

20 Mar

The Ontario Ministry of Children and Youth Services explained why healthy babies are important. “Healthy babies are more likely to develop into healthy children, and healthy children are more likely to grow up to be healthy teenagers and healthy adults.” http://www.children.gov.on.ca/htdocs/English/topics/earlychildhood/health/index.aspx

Science Daily reported in Women, particularly minorities, do not meet nutrition guidelines shortly before pregnancy:

Black, Hispanic and less-educated women consume a less nutritious diet than their well-educated, white counterparts in the weeks leading up to their first pregnancy, according to the only large-scale analysis of preconception adherence to national dietary guidelines.

The study, published in the Journal of the Academy of Nutrition and Dietetics and led by the University of Pittsburgh Graduate School of Public Health, also found that, while inequalities exist, none of the women in any racial and socioeconomic group evaluated achieved recommendations set forth by the Dietary Guidelines for Americans.

Healthy maternal diets have been linked to reduced risks of preterm birth, fetal growth restriction, preeclampsia and maternal obesity.

“Unlike many other pregnancy and birth risk factors, diet is something we can improve,” said lead author Lisa Bodnar, Ph.D., M.P.H., R.D., associate professor and vice chair of research in Pitt Public Health’s Department of Epidemiology. “While attention should be given to improving nutritional counseling at doctor appointments, overarching societal and policy changes that help women to make healthy dietary choices may be more effective and efficient.”

Bodnar and her colleagues analyzed the results of questionnaires completed by 7,511 women who were between six and 14 weeks pregnant and enrolled in The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers to Be, which followed women who enrolled in the study at one of eight U.S. medical centers. The women reported on their dietary habits during the three months around conception.

The diets were assessed using the Healthy Eating Index-2010, which measures 12 key aspects of diet quality, including adequacy of intake for key food groups, as well as intake of refined grains, salt and empty calories (all calories from solid fats and sugars, plus calories from alcohol beyond a moderate level).

Nearly a quarter of the white women surveyed had scores that fell into the highest scoring fifth of those surveyed, compared with 14 percent of the Hispanic women and 4.6 percent of the black women. Almost half — 44 percent — of black mothers had a score in the lowest scoring fifth….   https://www.sciencedaily.com/releases/2017/03/170317082514.htm

Citation:

Women, particularly minorities, do not meet nutrition guidelines shortly before pregnancy

Date:       March 17, 2017

Source:    University of Pittsburgh Schools of the Health Sciences

Summary:

Black, Hispanic and less-educated women consume a less nutritious diet than their well-educated, white counterparts in the weeks leading up to their first pregnancy, according to the only large-scale analysis of preconception adherence to national dietary guidelines. The study also found that, while inequalities exist, none of the women in any racial and socioeconomic group evaluated achieved recommendations set forth by the Dietary Guidelines for Americans.

Journal Reference:

  1. Uma M. Reddy, MD et al. Racial or Ethnic and Socioeconomic Inequalities in Adherence to National Dietary Guidance in a Large Cohort of US Pregnant Women. Journal of the Academy of Nutrition and Dietetics, March 2017 DOI: 10.1016/j.jand.2017.01.016

Here is the press release from U Pitt:

Women, Particularly Minorities, Do Not Meet Nutrition Guidelines Shortly Before Pregnancy

PITTSBURGH, March 17, 2017 – Black, Hispanic and less-educated women consume a less nutritious diet than their well-educated, white counterparts in the weeks leading up to their first pregnancy, according to the only large-scale analysis of preconception adherence to national dietary guidelines.

The study, published today in the Journal of the Academy of Nutrition and Dietetics and led by the University of Pittsburgh Graduate School of Public Health, also found that, while inequalities exist, none of the women in any racial and socioeconomic group evaluated achieved recommendations set forth by the Dietary Guidelines for Americans.

Healthy maternal diets have been linked to reduced risks of preterm birth, fetal growth restriction, preeclampsia and maternal obesity.

“Unlike many other pregnancy and birth risk factors, diet is something we can improve,” said lead author Lisa Bodnar, Ph.D., M.P.H., R.D., associate professor and vice chair of research in Pitt Public Health’s Department of Epidemiology. “While attention should be given to improving nutritional counseling at doctor appointments, overarching societal and policy changes that help women to make healthy dietary choices may be more effective and efficient.”

Bodnar and her colleagues analyzed the results of questionnaires completed by 7,511 women who were between six and 14 weeks pregnant and enrolled in The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers to Be, which followed women who enrolled in the study at one of eight U.S. medical centers. The women reported on their dietary habits during the three months around conception.

The diets were assessed using the Healthy Eating Index-2010, which measures 12 key aspects of diet quality, including adequacy of intake for key food groups, as well as intake of refined grains, salt and empty calories (all calories from solid fats and sugars, plus calories from alcohol beyond a moderate level).

Nearly a quarter of the white women surveyed had scores that fell into the highest scoring fifth of those surveyed, compared with 14 percent of the Hispanic women and 4.6 percent of the black women. Almost half—44 percent—of black mothers had a score in the lowest scoring fifth.

The scores increased with greater education levels for all three racial/ethnic groups, but the increase was strongest among white women. At all levels of education—high school or less through graduate degree—black mothers had the lowest average scores.

When scores were broken down into the 12 aspects of diet, fewer than 10 percent of the women met the dietary guideline for the whole grains, fatty acids, sodium or empty calories categories.

Approximately 34 percent of the calories—or energy—the women consumed were from empty calories. Top sources of energy were sugar-sweetened beverages, pasta dishes and grain desserts. Soda was the primary contributor to energy intake among black, Hispanic and less-educated women. Women with a college or graduate degree consumed more energy from beer, wine and spirits than any other source.

Juices and sugar-sweetened beverages combined for a much larger proportion of vitamin C intake than solid fruits or vegetables for black, Hispanic and less-educated women. The opposite was true for white women or more-educated women.

For all groups, green salad was the only vegetable in the top 10 sources of iron. Green salad and processed cereals were the top two sources of folate for all groups except black women, whose second highest folate source was 100 percent orange or grapefruit juice. Folate and iron are important nutrients for developing fetuses and healthy pregnancies.

“Our findings mirror national nutrition and dietary trends.  The diet quality gap among non-pregnant people is thought to be a consequence of many factors, including access to and price of healthy foods, knowledge of a healthy diet, and pressing needs that may take priority over a healthy diet,” said Bodnar, also an associate professor of obstetrics, gynecology and reproductive sciences at Pitt’s School of Medicine. “Future research needs to determine if improving pre-pregnancy diet leads to better pregnancy and birth outcomes. If so, then we need to explore and test ways to improve the diets for everyone, particularly women likely to become pregnant.”

Additional authors on this research include senior author Uma M. Reddy, M.D., of the Eunice Kennedy Shriver National Institute of Child Health and Human Development; as well as Hyagriv N. Simhan, M.D., of Pitt; Corette B. Parker, Dr.P.H., and Heather Meier, both of RTI International; Brian M. Mercer, M.D., of Case Western Reserve University; William A. Grobman, M.D., and Alan M. Peaceman, M.D., both of Northwestern University; David M. Haas, M.D., and Shannon Barnes, R.N., both of Indiana University; Deborah A. Wing, M.D., and Pathik D. Wadhwa, M.D., Ph.D., both of the University of California Irvine; Matthew K. Hoffman, M.D., of the Christiana Care Health System; Samuel Parry, M.D., and Michal Elovitz, M.D., both of the University of Pennsylvania; Robert M. Silver, M.D., and Sean Esplin, M.D., both of the University of Utah; George R. Saade, M.D., of the University of Texas; Ronald Wapner, M.D., of Columbia University; and Jay D. Iams, M.D., of The Ohio State University.

This study is supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, as well as RTI International grant U10 HD06336, Case Western Reserve University grant U10 HD063072, Columbia University grant U10 HD063047, Indiana University grant U10 HD063037, Pitt grant U10 HD063041, Northwestern University grant U10 HD063020, University of California Irvine grant U10 HD063046, University of Pennsylvania grant U10 HD063048 and University of Utah grant U10 HD063053.

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http://www.upmc.com/media/NewsReleases/2017/Pages/bodnar-pregnancy-nutrition.aspx

Humans have free will and are allowed to choose how they want to live. What you do not have the right to do is to inflict your lifestyle on a child. So, the responsible thing for you to do is to get birth control for yourself and the society which will have to live with your poor choices. Many religious folks are shocked because moi is  mentioning birth control, but most sluts have few religious inklings or they wouldn’t be sluts. A better option for both sexes, if this lifestyle is a permanent option, is permanent birth control to lessen a contraception failure. People absolutely have the right to choose their particular lifestyle. You simply have no right to bring a child into your mess of a life. I observe people all the time and I have yet to observe a really happy slut. Seems that the lifestyle is devoid of true emotional connection and is empty. If you do find yourself pregnant, please consider adoption.

Let’s continue the discussion. Some folks may be great friends, homies, girlfriends, and dudes, but they make lousy parents. Could be they are at a point in their life where they are too selfish to think of anyone other than themselves, they could be busy with school, work, or whatever. No matter the reason, they are not ready and should not be parents. Birth control methods are not 100% effective, but the available options are 100% ineffective in people who are sexually active and not using birth control. So, if you are sexually active and you have not paid a visit to Planned Parenthood or some other agency, then you are not only irresponsible, you are Eeeevil. Why do I say that, you are playing Russian Roulette with the life of another human being, the child. You should not ever put yourself in the position of bringing a child into the world that you are unprepared to parent, emotionally, financially, and with a commitment of time. So, if you find yourself in a what do I do moment and are pregnant, you should consider adoption.

Children need stability and predictability to have the best chance of growing up healthy. Children will have the most success in school if they are ready to learn. Ready to learn includes proper nutrition for a healthy body and the optimum situation for children is a healthy family. Many of society’s problems would be lessened if the goal was a healthy child in a healthy family.

Unless there was a rape or some forcible intercourse, the answer to the question is a woman who gets preggers with a “deadbeat dad” a moron – is yes.

Learn more about prenatal and preconception care.

http://www.nichd.nih.gov/health/topics/preconceptioncare/Pages/default.aspx

http://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/Pages/prenatal-care.aspx

See, Prenatal care fact sheet http://www.womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.html

Our goal as a society should be a healthy child in a healthy family who attends a healthy school in a healthy neighborhood. ©

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©

http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©

http://drwildareviews.wordpress.com/

Dr. Wilda ©

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University of Bergen study: Smoking fathers increase asthma-risk in future offspring

3 Oct

There are numerous reasons why smoking is considered bad for an individual and there are numerous research studies which list the reasons. Studies are showing how bad second hand smoke is for children. A MNT article, Smoking During Pregnancy May Lower Your Child’s Reading Scores:

Babies born to mothers who smoke more than a pack of cigarettes a day while pregnant have lower reading scores and a harder time with reading tests, compared with children whose mothers do not smoke.
This is the conclusion of a recent study conducted by researchers at Yale School of Medicine and published in The Journal of Pediatrics in November 2012. The reading tests measured how well children read out loud and understood what they were reading.

This isn’t the first study to suggest that smoking in pregnancy may affect a child’s future health and development. A study released in August 2012 said that smoking during pregnancy increases a child’s risk of asthma. In addition, a 2009 study linked smoking during pregnancy to behavioral problems among 3 and 4 year olds boys…. http://www.medicalnewstoday.com/articles/253100.php

An Inserm and Pierre and Marie Curie University study adds behavior problems to the list of woes children of smokers suffer.

Science Daily reported in Early exposure to tobacco can cause behavioral problems in children:

Researchers from Inserm and Pierre and Marie Curie University (UPMC), in collaboration with the university hospitals of 6 French cities, have analysed data on pre- and postnatal exposure to tobacco in the homes of 5,200 primary school children. They show that this exposure is associated with a risk of behavioural disorders in children, particularly emotional and conduct disorders. The association is stronger when exposure takes place both during pregnancy and after birth. These data show the risk associated with smoking in early life and its behavioural repercussions when the child is of school-going age.These results are published in the journal PLOS ONE.

The consequences of tobacco exposure are widely documented. It leads to many illnesses, including asthma. However, the potential role of environmental tobacco smoke (ETS) is much less well known in terms of its link to behavioural problems in children. In this context, the team led by Isabella Annesi-Maesano, Inserm Research Director at Unit 1136, “Pierre Louis Public Health Institute” (Inserm/UPMC) examined the association between pre- and postnatal ETS exposure and behavioural problems in children….

These observations seem to confirm those carried out in animals, i.e. that the nicotine contained in tobacco smoke may have a neurotoxic effect on the brain. During pregnancy, nicotine in tobacco smoke stimulates acetylcholine receptors, and causes structural changes in the brain. In the first months of life, exposure to tobacco smoke generates a protein imbalance that leads to altered neuronal growth….. http://www.sciencedaily.com/releases/2015/09/150928103029.htm?utm_source=dlvr.it&utm_medium=facebook

Steven Reinberg reported in the Health Day article, Secondhand Smoke in Infancy May Harm Kids’ Teeth.  http://consumer.healthday.com/kids-health-information-23/cavities-and-dental-news-118/secondhand-smoke-in-infancy-may-harm-kids-teeth-704482.html

Science Daily reported in Smoking fathers increase asthma-risk in future offspring:

A Norwegian study shows that asthma is three times more common in those who had a father who smoked in adolescence than offspring who didn’t.

It is well known that a mother’s environment plays a key role in child health. However, recent research, including more than 24,000 offspring, suggests that this may also be true for fathers.

“Offspring with a father who smoked only prior to conception had over three times more early-onset asthma than those whose father had never smoked,” says Professor Cecilie Svanes at the Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen (UiB).

Early debut increases risk

The study shows that both a father’s early smoking debut and a father’s longer smoking duration before conception increased non-allergic early-onset asthma in offspring. This is equally true with mutual adjustment, and adjusting for the number of cigarettes smoked and years since quitting smoking.

“The greatest increased risk for their children having asthma was found for fathers having their smoking debut before age 15. Interestingly, time of quitting before conception was not independently associated with offspring asthma,” Svanes says.

Smoking fathers may influence gene control in children

Concerning mother’s smoking, the research found more offspring asthma if the mother smoked around pregnancy, consistent with previous studies. However, no effect of maternal smoking only prior to conception was identified. The difference from father’s smoking suggests effects through male sperm cells.

“Smoking is known to cause genetic and epigenetic damage to spermatozoa, which are transmissible to offspring and have the potential to induce developmental abnormalities,” explains Svanes.

It is previously known that nutritional, hormonal and psychological environment provided by the mother permanently alters organ structure, cellular response and gene expression in her offspring. Father’s lifestyle and age appear, however, to be reflected in molecules that control gene function.

“There is growing evidence from animal studies for so called epigenetic programming, a mechanism whereby the father’s environment before conception could impact on the health of future generations,” Svanes says….                                                                                                       https://www.sciencedaily.com/releases/2016/09/160928135903.htm

Citation:

Smoking fathers increase asthma-risk in future offspring

Date:         September 28, 2016

Source:     University of Bergen

Summary:

Offspring with a father who smoked prior to conception had more than three times higher chance of early-onset asthma than children whose father had never smoked. Both a father’s early smoking debut and a father’s longer smoking duration before conception increased non-allergic early-onset asthma in offspring. This suggests that not only the mother’s environment plays a key role in child health, but also the father’s lifestyle, shows a new study including 24,000 children.

Journal Reference:

  1. Cecilie Svanes, Jennifer Koplin, Svein Magne Skulstad, Ane Johannessen, Randi Jakobsen Bertelsen, Byndis Benediktsdottir, Lennart Bråbäck, Anne Elie Carsin, Shyamali Dharmage, Julia Dratva, Bertil Forsberg, Thorarinn Gislason, Joachim Heinrich, Mathias Holm, Christer Janson, Deborah Jarvis, Rain Jögi, Susanne Krauss-Etschmann, Eva Lindberg, Ferenc Macsali, Andrei Malinovschi, Lars Modig, Dan Norbäck, Ernst Omenaas, Eirunn Waatevik Saure, Torben Sigsgaard, Trude Duelien Skorge, Øistein Svanes, Kjell Torén, Carl Torres, Vivi Schlünssen, Francisco Gomez Real. Father’s environment before conception and asthma risk in his children: a multi-generation analysis of the Respiratory Health In Northern Europe study. International Journal of Epidemiology, 2016; dyw151 DOI: 10.1093/ije/dyw151

Here is the press release from the University of Bergen:

Smoking fathers increase asthma-risk in future offspring.

A Norwegian study shows that asthma is three times more common in those who had a father who smoked in adolescence than offspring who didn’t.

SMOKING FATHERS: If you smoke as a young man, your future offspring will have a higher risk of getting asthma.

By Kim E. AndreassenPublished: 22.09.2016 (Last updated: 28.09.2016)

It is well known that a mother’s environment plays a key role in child health. However, recent research, including more than 24,000 offspring, suggests that this may also be true for fathers.

“Offspring with a father who smoked only prior to conception had over three times more early-onset asthma than those whose father had never smoked,” says Professor Cecilie Svanes at the Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen (UiB).

Early debut increases risk

The study shows that both a father’s early smoking debut and a father’s longer smoking duration before conception increased non-allergic early-onset asthma in offspring. This is equally true with mutual adjustment, and adjusting for the number of cigarettes smoked and years since quitting smoking.

“The greatest increased risk for their children having asthma was found for fathers having their smoking debut before age 15. Interestingly, time of quitting before conception was not independently associated with offspring asthma,” Svanes says.

The study is published in the scientific magazine International Journal of Epidemiology

Smoking fathers may influence gene control in children

Concerning mother’s smoking, the research found more offspring asthma if the mother smoked around pregnancy, consistent with previous studies. However, no effect of maternal smoking only prior to conception was identified. The difference from father’s smoking suggests effects through male sperm cells.

“Smoking is known to cause genetic and epigenetic damage to spermatozoa, which are transmissible to offspring and have the potential to induce developmental abnormalities,” explains Svanes.

It is previously known that nutritional, hormonal and psychological environment provided by the mother permanently alters organ structure, cellular response and gene expression in her offspring. Father’s lifestyle and age appear, however, to be reflected in molecules that control gene function.

“There is growing evidence from animal studies for so called epigenetic programming, a mechanism whereby the father’s environment before conception could impact on the health of future generations,” Svanes says.

Welding increases risk

Svanes and her team also investigated whether parental exposure to welding influenced asthma risk in offspring, with a particular focus on exposures in fathers prior to conception.

The study shows that paternal welding increased offspring asthma risk even if the welding stopped prior to conception. Smoking and welding independently increased offspring asthma risk, and mutual adjustment did not alter the estimates of either.

“For smoking and welding starting after puberty, exposure duration appeared to be the most important determinant for the asthma risk in offspring,” says Cecilie Svanes.

FACTS

Smoking fathers study

  • Cecilie Svanes investigated whether parental smoking and exposure to welding influenced asthma risk in offspring, with a particular focus on exposures in fathers prior to conception.
  • The study was conducted on a population-based cohort from seven Northern European research centres (RHINE study).
  • The experiences of more than 24,000 offspring, of which over 6000 had smoking and/or welding fathers, were included in the study The participants were from Norway, Sweden, Denmark, Iceland, Estonia.
  • The researches wanted to identify  vulnerable periods during male reproductive development by addressing whether potential preconception effects were related to exposure age, exposure duration, and time from quitting exposure until conception.
  • This research is part of the ECRHS study, and contributes to the large EU funded project “Ageing Lungs in European Cohorts.

http://www.uib.no/en/news/100994/smoking-fathers-increase-asthma-risk-future-offspring

See, Prenatal care fact sheet http://www.womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.html

Our goal as a society should be a healthy child in a healthy family who attends a healthy school in a healthy neighborhood. ©

Resources:

  1. A History of Tobacco
    http://archive.tobacco.org/History/Tobacco_History.html
  2. American Lung Association’s Smoking and Teens Fact Sheet Women and Tobacco Use
    African Americans and Tobacco Use
    American Indians/Alaska Natives and Tobacco Use
    Hispanics and Tobacco Use
    Asian Americans/Pacific Islanders and Tobacco Use
    Military and Tobacco Use
    Children/Teens and Tobacco Use
    Older Adults and Tobacco Use
    http://www.lung.org/stop-smoking/about-smoking/facts-figures/specific-populations.html
  3. Center for Young Women’s Health A Guide for Teens http://www.youngwomenshealth.org/smokeinfo.html
  4. Kroger Resources Teens and Smoking
    http://kroger.staywellsolutionsonline.com/Wellness/Smoking/Teens/
  5. Teens Health’s Smoking
    http://kidshealth.org/teen/drug_alcohol/tobacco/smoking.html
  6. Quit Smoking Support.com
    http://www.quitsmokingsupport.com/teens.htm

Where information leads to Hope. Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

 

University of Alberta Medical School study: Prenatal fruit consumption boosts babies’ cognitive development

29 May

The Ontario Ministry of Children and Youth Services explains why healthy babies are important. “Healthy babies are more likely to develop into healthy children, and healthy children are more likely to grow up to be healthy teenagers and healthy adults.” http://www.children.gov.on.ca/htdocs/English/topics/earlychildhood/health/index.aspx

Science Daily reported in Prenatal fruit consumption boosts babies’ cognitive development: Study discovers previously unknown benefits of fruit consumption in expectant mothers:

Most people have heard the old adage “an apple a day keeps the doctor away.” It’s an old truth that encompasses more than just apples–eating fruit in general is well known to reduce risk for a wide variety of health conditions such as heart disease and stroke. But now a new study is showing the benefits of fruit can begin as early as in the womb.

The study, published in the journal EbioMedicine, found that mothers who consumed more fruit during pregnancy gave birth to children who performed better on developmental testing at one year of age. Piush Mandhane, senior author of the paper and associate professor of pediatrics at the University of Alberta’s Faculty of Medicine & Dentistry, made the discovery using data from the Canadian Healthy Infant Longitudinal Development (CHILD) Study–a nationwide birth cohort study involving over 3,500 Canadian infants and their families. Mandhane leads the Edmonton site of the study….

The study examined data from 688 Edmonton children, and controlled for factors that would normally affect a child’s learning and development such as family income, paternal and maternal education, and the gestational age of the child.

Using a traditional IQ scale as a model, the average IQ is 100 and the standard deviation is 15; two thirds of the population will fall between 85 and 115. Mandhane’s study showed that if pregnant mothers ate six or seven servings of fruit or fruit juice a day, on average their infants placed six or seven points higher on the scale at one year of age….

To further build on the research, Mandhane teamed with Francois Bolduc, an associate professor in the Faculty of Medicine & Dentistry’s Division of Pediatric Neurology, who researches the genetic basis of cognition in humans and fruit flies. Both researchers believe that combining pre-clinical models and epidemiological analysis is a novel approach that may provide useful new insights into future medical research.

“Flies are very different from humans but, surprisingly, they have 85 per cent of the genes involved in human brain function, making them a great model to study the genetics of memory,” says Bolduc. “To be able to improve memory in individuals without genetic mutation is exceptional, so we were extremely interested in understanding the correlation seen between increased prenatal fruit intake and higher cognition.”

According to Bolduc, fruit flies have a long track record in the field of learning and memory. Several genes known to be necessary in fly memory have now been found to be involved in intellectual disability and autism by Bolduc and others. In a subsequent series of experiments, he showed that flies born after being fed increased prenatal fruit juice had significantly better memory ability, similar to the results shown by Mandhane with one-year-old infants. He believes it suggests that brain function affected by fruit and the mechanisms involved have been maintained through evolution, and conserved across species.

While the findings are encouraging, Mandhane cautions against going overboard on fruit consumption as potential complications such as gestational diabetes and high birthweight–conditions associated with increased intake of natural sugars–have not been fully researched. Instead, he suggests that expectant mothers meet the daily intake recommended in Canada’s Food Guide and consult with their doctors…..                                                                                                         https://www.sciencedaily.com/releases/2016/05/160525161548.htm

Citation:

Prenatal fruit consumption boosts babies’ cognitive development

Study discovers previously unknown benefits of fruit consumption in expectant mothers

Date:      May 25, 2016

Source:  University of Alberta Faculty of Medicine & Dentistry

Summary:

The benefits of eating fruit can begin as early as in the womb. A new study, using data from nearly 700 Edmonton children, demonstrates that infants do significantly better on developmental tests when their mothers consume more fruit during pregnancy.

Journal Reference:

      Francois V. Bolduc, Amanda Lau, Cory S. Rosenfelt, Steven Langer, Nan Wang, Lisa Smithson, Diana Lefebvre, R. Todd Alexander, Clayton T. Dickson, Liang Li, Allan B. Becker, Padmaja Subbarao, Stuart E. Turvey, Jacqueline Pei, Malcolm R. Sears, Piush J. Mandhane.

Cognitive Enhancement in Infants Associated with Increased Maternal Fruit Intake During Pregnancy: Results from a Birth Cohort Study with Validation in an Animal Model

      .

EBioMedicine

      , 2016; DOI:

10.1016/j.ebiom.2016.04.025Cognitive Enhancement in Infants Associated with Increased Maternal Fruit Intake During Pregnancy: Results from a Birth Cohort Study with Validation in an Animal Model

Francois V. Bolduc  Amanda Lau1    Cory S. Rosenfelt1   Steven Langer

,Nan Wang, Lisa Smithson, Diana Lefebvre, R. Todd Alexander, Clayton T. Dickson,

Liang Li, Allan B. Becker, Padmaja Subbarao, Stuart E. Turvey  Jacqueline Pei,

Malcolm R. Sears, Piush J. Mandhane

, The CHILD Study Investigatorsi

1These authors contributed equally to this paper.

Open Access

DOI: http://dx.doi.org/10.1016/j.ebiom.2016.04.025

Article Info

Highlights

  • •Gestational fruit intake positively correlates with infant cognitive performance.
  • •Similar findings in a birth cohort and in Drosophila learning and memory scores
  • •Cyclic adenylate monophosphate (cAMP) pathway may be a major regulator of this effect.
  • •Postnatal fruit intake did not enhance cognitive outcomes in humans or Drosophila.

Fruits have been an important part of the human diet for thousands of years. We wanted to know if more fruit intake improves our ability to learn. Using data from the Canadian Healthy Infant Longitudinal Development (CHILD) study, we found that mothers who ate more fruit during pregnancy had children who did better on developmental testing at 1 year of age. Similarly, fruit flies had improved learning and memory if their parents had more fruit juice in their diet. In both humans and in the flies, there was no improvement in learning when only the babies were fed fruit.

Abstract

In-utero nutrition is an under-studied aspect of cognitive development. Fruit has been an important dietary constituent for early hominins and humans. Among 808 eligible CHILD-Edmonton sub-cohort subjects, 688 (85%) had 1-year cognitive outcome data. We found that each maternal daily serving of fruit (sum of fruit plus 100% fruit juice) consumed during pregnancy was associated with a 2.38 point increase in 1-year cognitive development (95% CI 0.39, 4.37; p < 0.05). Consistent with this, we found 30% higher learning Performance index (PI) scores in Drosophila offspring from parents who consumed 30% fruit juice supplementation prenatally (PI: 85.7; SE 1.8; p < 0.05) compared to the offspring of standard diet parents (PI: 65.0 SE 3.4). Using the Drosophila model, we also show that the cyclic adenylate monophosphate (cAMP) pathway may be a major regulator of this effect, as prenatal fruit associated cognitive enhancement was blocked in Drosophila rutabaga mutants with reduced Ca2+-Calmodulin-dependent adenylyl cyclase. Moreover, gestation is a critical time for this effect as postnatal fruit intake did not enhance cognitive performance in either humans or Drosophila. Our study supports increased fruit consumption during pregnancy with significant increases in infant cognitive performance. Validation in Drosophila helps control for potential participant bias or unmeasured confounders.

Here is the press article from the University of Alberta:

An apple a day

UAlberta study shows infants do better on developmental tests when their mothers consume more fruit during pregnancy

By Ali Dotinga and Ross Neitz on May 25, 2016

Piush Mandhane, senior author of the study, found that prenatal fruit consumption boosts babies’ cognitive development

Most people have heard the old adage “an apple a day keeps the doctor away.” It’s an old truth that encompasses more than just apples—eating fruit in general is well known to reduce risk for a wide variety of health conditions such as heart disease and stroke. But now a new study is showing the benefits of fruit can begin as early as in the womb.

The study, published in the journal EbioMedicine, showed that mothers who consumed more fruit during pregnancy gave birth to children who performed better on developmental testing at one year of age. Piush Mandhane, senior author of the paper and associate professor of pediatrics at the University of Alberta’s Faculty of Medicine & Dentistry, made the discovery using data from the Canadian Healthy Infant Longitudinal Development (CHILD) Study—a nationwide birth cohort study involving over 3,500 Canadian infants and their families. Mandhane leads the Edmonton site of the study.

“We wanted to know if we could identify what factors affect cognitive development,” Mandhane explains. “We found that one of the biggest predictors of cognitive development was how much fruit moms consumed during pregnancy. The more fruit moms had, the higher their child’s cognitive development.”

In the study, researchers examined data from 688 Edmonton children, controlling for factors that would normally affect a child’s learning and development, such as family income, paternal and maternal education, and the gestational age of the child.

Using a traditional IQ scale as a model, the average IQ is 100 and the standard deviation is 15; two-thirds of the population will fall between 85 and 115. Mandhane’s study showed that if pregnant mothers ate six or seven servings of fruit or fruit juice a day, on average their infants placed six or seven points higher on the scale at one year of age.

“It’s quite a substantial difference—that’s half of a standard deviation,” Mandhane explains. “We know that the longer a child is in the womb, the further they develop—and having one more serving of fruit per day in a mother’s diet provides her baby with the same benefit as being born a whole week later.”

To further build on the research, Mandhane teamed with Francois Bolduc, an associate professor in the Faculty of Medicine & Dentistry’s Division of Pediatric Neurology, who researches the genetic basis of cognition in humans and fruit flies. Both researchers believe that combining pre-clinical models and epidemiological analysis is a novel approach that may provide useful new insights into future medical research.

“Flies are very different from humans but, surprisingly, they have 85 per cent of the genes involved in human brain function, making them a great model to study the genetics of memory,” says Bolduc. “To be able to improve memory in individuals without genetic mutation is exceptional, so we were extremely interested in understanding the correlation seen between increased prenatal fruit intake and higher cognition.”

According to Bolduc, fruit flies have a long track record in the field of learning and memory. Several genes known to be necessary in fly memory have now been found to be involved in intellectual disability and autism by Bolduc and others. In a subsequent series of experiments, he showed that flies born after being fed increased prenatal fruit juice had significantly better memory ability, similar to the results shown by Mandhane with one-year-old infants. He believes it suggests that brain function affected by fruit and the mechanisms involved have been maintained through evolution, and conserved across species.

Though the findings are encouraging, Mandhane cautions against going overboard on fruit consumption, because potential complications such as gestational diabetes and high birth weight—conditions associated with increased intake of natural sugars—have not been fully researched. Instead, he suggests that expectant mothers meet the daily intake recommended in Canada’s Food Guide and consult with their doctors.

Mandhane also says he will continue work in the field, with plans to examine whether the benefits of prenatal fruit consumption persist in children over time. He will also be looking to determine whether fruit can influence childhood development related to executive functioning—in areas such as planning, organizing and working memory.

Funding information

Funding for Mandhane’s study was provided by the Canadian Institutes of Health Research and the Women and Children’s Health Research Institute at the U of A.

https://www.med.ualberta.ca/news/2016/may/an-apple-a-day

The key is regular prenatal care.

The Eunice Kennedy Shriver National Institute of Child Health and Human Development reports in What is prenatal care and why is it important?

Prenatal Care

Women who suspect they may be pregnant should schedule a visit to their health care provider to begin prenatal care. Prenatal visits to a health care provider include a physical exam, weight checks, and providing a urine sample. Depending on the stage of the pregnancy, health care providers may also do blood tests and imaging tests, such as ultrasound exams. These visits also include discussions about the mother’s health, the infant’s health, and any questions about the pregnancy.

Preconception and prenatal care can help prevent complications and inform women about important steps they can take to protect their infant and ensure a healthy pregnancy. With regular prenatal care women can:

  • Reduce the risk of pregnancy complications. Following a healthy, safe diet; getting regular exercise as advised by a health care provider; and avoiding exposure to potentially harmful substances such as lead and radiation can help reduce the risk for problems during pregnancy and ensure the infant’s health and development. Controlling existing conditions, such as high blood pressure and diabetes, is important to avoid serious complications in pregnancy such as preeclampsia.
  • Reduce the infant’s risk for complications. Tobacco smoke and alcohol use during pregnancy have been shown to increase the risk for Sudden Infant Death Syndrome. Alcohol use also increases the risk for fetal alcohol spectrum disorders, which can cause a variety of problems such as abnormal facial features, having a small head, poor coordination, poor memory, intellectual disability, and problems with the heart, kidneys, or bones.2 According to one recent study supported by the NIH, these and other long-term problems can occur even with low levels of prenatal alcohol exposure.3

In addition, taking 400 micrograms of folic acid daily reduces the risk for neural tube defects by 70%.4 Most prenatal vitamins contain the recommended 400 micrograms of folic acid as well as other vitamins that pregnant women and their developing fetus need.1,5 Folic acid has been added to foods like cereals, breads, pasta, and other grain-based foods. Although a related form (called folate) is present in orange juice and leafy, green vegetables (such as kale and spinach), folate is not absorbed as well as folic acid.

  • Help ensure the medications women take are safe. Certain medications, including some acne treatments6 and dietary and herbal supplements,7 are not safe to take during pregnancy.

Learn more about prenatal and preconception care.

http://www.nichd.nih.gov/health/topics/preconceptioncare/Pages/default.aspx

http://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/Pages/prenatal-care.aspx

See, Prenatal care fact sheet http://www.womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.html

Our goal as a society should be a healthy child in a healthy family who attends a healthy school in a healthy neighborhood. ©

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Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©

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Johns Hopkins Bloomberg School of Public Health study: Evidence that autism spectrum disorder risks may begin in utero

31 Jan

The number of children with autism appears to be growing. The Centers for Disease Control and Prevention provides statistics on the number of children with autism in the section Data and Statistics:

Prevalence

  • It is estimated that between 1 in 80 and 1 in 240 with an average of 1 in 110 children in the United States have an ASD. [Read article]

  • ASDs are reported to occur in all racial, ethnic, and socioeconomic groups, yet are on average 4 to 5 times more likely to occur in boys than in girls.  However, we need more information on some less studied populations and regions around the world. [Read article]

  • Studies in Asia, Europe, and North America have identified individuals with an ASD with an approximate prevalence of 0.6% to over 1%. A recent study in South Korea reported a prevalence of 2.6%. [Data table ]

  • Approximately 13% of children have a developmental disability, ranging from mild disabilities such as speech and language impairments to serious developmental disabilities, such as intellectual disabilities, cerebral palsy, and autism.  [Read article] http://www.cdc.gov/ncbddd/autism/data.html

In order for children with autism to reach their full potential there must be early diagnosis and treatment.

Science Daily reported in Obesity, diabetes in mom increases risk of autism in child:

Children born to obese women with diabetes are more than four times as likely to be diagnosed with autism spectrum disorder than children of healthy weight mothers without diabetes, new Johns Hopkins Bloomberg School of Public Health research suggests.

The findings, to be published Jan. 29 in the journal Pediatrics, highlight what has become a leading theory about autism, that the risk likely develops before the child is even born.

“We have long known that obesity and diabetes aren’t good for mothers’ own health,” says study leader Xiaobin Wang, MD, ScD, MPH, the Zanvyl Krieger Professor in Child Health at the Bloomberg School and director of the Center on the Early Life Origins of Disease. “Now we have further evidence that these conditions also impact the long-term neural development of their children.”

Autism spectrum disorder is a neurodevelopmental condition characterized by severe deficits in socialization, verbal and nonverbal communication and repetitive behaviors. Since the 1960s, the prevalence rates have skyrocketed, with one in 68 U.S. children now affected by it, according to the U.S. Centers for Disease Control and Prevention. Obesity and diabetes have also risen to epidemic levels in women of reproductive age over the same time period.

For the study, the researchers analyzed 2,734 mother-child pairs, a subset of the Boston Birth Cohort recruited at the Boston Medical Center at birth between 1998 and 2014. They collected data on maternal pre-pregnancy weight and whether the mothers had diabetes before getting pregnant or whether they developed gestational diabetes during pregnancy. They also followed up the children from birth through childhood via postnatal study visits and review of electronic medical records. They identified 102 children who were diagnosed with autism spectrum disorder over the course of the study. Those children with mothers who were both diabetic and obese were more than four times as likely to develop autism compared to children born to normal weight mothers without diabetes, they found.

“Our research highlights that the risk for autism begins in utero,” says co-author M. Daniele Fallin, PhD, chair of the Bloomberg School’s Department of Mental Health and director of the Wendy Klag Center for Autism and Developmental Disabilities. “It’s important for us to now try to figure out what is it about the combination of obesity and diabetes that is potentially contributing to sub-optimal fetal health.”

Previous studies had suggested a link between maternal diabetes and autism, but this is believed to be the first to look at obesity and diabetes in tandem as potential risk factors….                               http://www.sciencedaily.com/releases/2016/01/160129091631.htm

Citation:

Obesity, diabetes in mom increases risk of autism in child

Date:         January 29, 2016

Source:     Johns Hopkins Bloomberg School of Public Health

Summary:

Children born to obese women with diabetes are more than four times as likely to be diagnosed with autism spectrum disorder than children of healthy weight mothers without diabetes, new research suggests.

Journal Reference:

  1. Mengying Li; M. Daniele Fallin; Anne Riley; Rebecca Landa; Sheila O. Walker; Michael Silverstein; Deanna Caruso; Colleen Pearson; Shannon Kiang; Jamie Lyn Dahm; Xiumei Hong; Guoying Wang; Mei-Cheng Weng; Barry Zuckerman and Xiaobin Wang. The association of maternal obesity and diabetes with autism and other developmental disabilities. Pediatrics, January 2016 DOI: 10.1542/peds.2015-2206

Here is the press release from Johns Hopkins:

January 29, 2016

Obesity, Diabetes in Mom Increases Risk of Autism in Child

New study offers new evidence that autism spectrum disorder risks may begin in utero

Children born to obese women with diabetes are more than four times as likely to be diagnosed with autism spectrum disorder than children of healthy weight mothers without diabetes, new Johns Hopkins Bloomberg School of Public Health research suggests.

The findings, to be published Jan. 29 in the journal Pediatrics, highlight what has become a leading theory about autism, that the risk likely develops before the child is even born.

“We have long known that obesity and diabetes aren’t good for mothers’ own health,” says study leader Xiaobin Wang, MD, ScD, MPH, the Zanvyl Krieger Professor in Child Health at the Bloomberg School and director of the Center on the Early Life Origins of Disease. “Now we have further evidence that these conditions also impact the long-term neural development of their children.”

Autism spectrum disorder is a neurodevelopmental condition characterized by severe deficits in socialization, verbal and nonverbal communication and repetitive behaviors. Since the 1960s, the prevalence rates have skyrocketed, with one in 68 U.S. children now affected by it, according to the U.S. Centers for Disease Control and Prevention. Obesity and diabetes have also risen to epidemic levels in women of reproductive age over the same time period.

For the study, the researchers analyzed 2,734 mother-child pairs, a subset of the Boston Birth Cohort recruited at the Boston Medical Center at birth between 1998 and 2014. They collected data on maternal pre-pregnancy weight and whether the mothers had diabetes before getting pregnant or whether they developed gestational diabetes during pregnancy. They also followed up the children from birth through childhood via postnatal study visits and review of electronic medical records. They identified 102 children who were diagnosed with autism spectrum disorder over the course of the study. Those children with mothers who were both diabetic and obese were more than four times as likely to develop autism compared to children born to normal weight mothers without diabetes, they found.

“Our research highlights that the risk for autism begins in utero,” says co-author M. Daniele Fallin, PhD, chair of the Bloomberg School’s Department of Mental Health and director of the Wendy Klag Center for Autism and Developmental Disabilities. “It’s important for us to now try to figure out what is it about the combination of obesity and diabetes that is potentially contributing to sub-optimal fetal health.”

Previous studies had suggested a link between maternal diabetes and autism, but this is believed to be the first to look at obesity and diabetes in tandem as potential risk factors.

Along with pre-conception diabetes, children of obese mothers who developed gestational diabetes during pregnancy were also at a significantly higher risk of being diagnosed with autism.

The biology of why obesity and diabetes may contribute to autism risk isn’t well understood. Obesity and diabetes in general cause stress on the human body, the researchers say. Previous research suggests maternal obesity may be associated with an inflammation in the developing fetal brain. Other studies suggest obese women have less folate, a B-vitamin vital for  human development and health.

The researchers say that women of reproductive age who are thinking about having children need to not only think about their obesity and diabetes status for their own health, but because of the implications it could have on their children. Better diabetes and weight management could have lifelong impacts on mother and child, they say.

“In order to prevent autism, we may need to consider not only pregnancy, but also pre-pregnancy health,” Fallin says.

“The association of maternal obesity and diabetes with autism and other developmental disabilities” was written by Mengying Li; M. Daniele Fallin; Anne Riley; Rebecca Landa; Sheila O. Walker; Michael Silverstein; Deanna Caruso; Colleen Pearson; Shannon Kiang; Jamie Lyn Dahm; Xiumei Hong; Guoying Wang; Mei-Cheng Weng; Barry Zuckerman and Xiaobin Wang.

The parent study was supported in part by the March of Dimes, the National Institute of Environmental Health Sciences (R21 ES011666) and the National Institute of Child Health and Human Development (2R01 HD041702). The Pediatrics study is supported in part by the Ludwig Family Foundation; the National Institute of Allergy and Infectious Diseases (U01AI90727 and R21AI079872) and the Maternal and Child Health Bureau (R40MC27442).

# # #

Media contacts for the Johns Hopkins Bloomberg School of Public Health: Barbara Benham at 410-614-6029 or bbenham1@jhu.edu and Stephanie Desmon at 410-955-7619 or sdesmon1@jhu.edu.

One of the implications of this study is the necessity that women receive adequate prenatal care and women really should have pre-pregnancy counseling and care.

United Health Foundation reports Prenatal Care (1990 – 2011): Percentage of pregnant women receiving adequate prenatal care, as defined by Kessner Index:

Prenatal care is a critical component of health care for pregnant women and a key step towards having a healthy pregnancy and baby. Early prenatal care is especially important because many important developments take place during the first trimester, screenings can identify babies or mothers at risk for complications and health care providers can educate and prepare mothers for pregnancy.  Women who receive prenatal care have consistently shown better outcomes than those who did not receive prenatal care[1]. Mothers who do not receive any prenatal care are three times more likely to deliver a low birth weight baby than mothers who received prenatal care, and infant mortality is five times higher[2].  Early prenatal care also allows health care providers to identify and address health conditions and behaviors that may reduce the likelihood of a healthy birth, such as smoking and drug and alcohol abuse.                                                                                                                                                         http://www.americashealthrankings.org/All/PrenatalCare/2012

Given this recent study it is imperative that ALL women receive prenatal care particularly poor and those women at risk of difficult pregnancies.

Related:

Autism and children of color

https://drwilda.com/tag/children-of-color-with-autism/

Archives of Pediatrics and Adolescent Medicine study: Kids with autism more likely to be bullied

https://drwilda.com/2012/09/06/archives-of-pediatrics-and-adolescent-medicine-study-kids-with-autism-more-likely-to-be-bullied/

Father’s age may be linked to Autism and Schizophrenia

https://drwilda.com/2012/08/26/fathers-age-may-be-linked-to-autism-and-schizophrenia/

Chelation treatment for autism might be harmful

https://drwilda.com/2012/12/02/chelation-treatment-for-autism-might-be-harmful/

Journal of American Medical Association study: Folic acid may reduce autism risk

https://drwilda.com/tag/folic-acid-in-pregnancy-may-lower-autism-risk/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©

http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©

http://drwildareviews.wordpress.com/

Dr. Wilda ©

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Yale School of Public Health study: Mothers-to-be, babies benefit from group prenatal care

25 Dec

The Ontario Ministry of Children and Youth Services explains why healthy babies are important. “Healthy babies are more likely to develop into healthy children, and healthy children are more likely to grow up to be healthy teenagers and healthy adults.” http://www.children.gov.on.ca/htdocs/English/topics/earlychildhood/health/index.aspx

Science Daily reported in Mothers-to-be, babies benefit from group prenatal care, study finds:

Group prenatal care can substantially improve health outcomes for both mothers and their infants, a new study led by the Yale School of Public Health has found.

The paper was published online Dec. 21 in The American Journal of Public Health.

Women who received group — rather than individual — prenatal care were 33% less likely to have infants who were small for gestational age. In addition, group-care recipients had reduced risk for preterm delivery and low birthweight. Babies born to these women also spent fewer days in the neonatal intensive care unit. In addition, mothers with more group prenatal care visits were less likely to become pregnant again quickly after giving birth, an important outcome known as “birth spacing” that reduces the risk of having another baby at risk for preterm delivery.

“Few clinical interventions have had an impact on birth outcomes,” said Professor Jeannette R. Ickovics, the study’s lead author. “Group prenatal care is related to improved health outcomes for mothers and babies, without adding risk. If scaled nationally, group prenatal care could lead to significant improvements in birth outcomes, health disparities, and healthcare costs,” she added.

The research team conducted a randomized controlled trial in 14 health centers in New York City, and compared the birth outcomes of women who received CenteringPregnancy Plus group prenatal care to those who received traditional individual care. The more than 1,000 women in the study were placed in groups of 8 to 12 women at the same gestational point in their pregnancy, and were cared for by a clinician and a medical assistant. The study found that the higher the number of group visits attended, the lower the rates of adverse birth outcomes….             http://www.sciencedaily.com/releases/2015/12/151221193406.htm

Citation

Mothers-to-be, babies benefit from group prenatal care, study finds

Date:       December 21, 2015

Source:   Yale University

Summary:

Group prenatal care can substantially improve health outcomes for both mothers and their infants, a new study has found. Women who received group — rather than individual — prenatal care were 33% less likely to have infants who were small for gestational age, had reduced risk for preterm delivery and low birthweight, and babies born to these women also spent fewer days in the neonatal intensive care unit.

Journal Reference:

  1. Jeannette R. Ickovics, Valerie Earnshaw, Jessica B. Lewis, Trace S. Kershaw, Urania Magriples, Emily Stasko, Sharon Schindler Rising, Andrea Cassells, Shayna Cunningham, Peter Bernstein, Jonathan N. Tobin. Cluster Randomized Controlled Trial of Group Prenatal Care: Perinatal Outcomes Among Adolescents in New York City Health Centers. American Journal of Public Health, 2015; e1 DOI: 10.2105/AJPH.2015.302960

Here is the press release from Yale:

Mothers-to-be and babies benefit from group prenatal care, study finds

December 21, 2015

Group prenatal care can substantially improve health outcomes for both mothers and their infants, a new study led by the Yale School of Public Health has found.

The paper published online Dec. 21 in The American Journal of Public Health.

Women who received group—rather than individual—prenatal care were 33% less likely to have infants who were small for gestational age. In addition, group-care recipients had reduced risk for preterm delivery and low birthweight. Babies born to these women also spent fewer days in the neonatal intensive care unit. Additionally, mothers with more group prenatal care visits were less likely to become pregnant again quickly after giving birth, an important outcome known as “birth spacing” that reduces the risk of having another baby at risk for preterm delivery.

“Few clinical interventions have had an impact on birth outcomes,” said Professor Jeannette R. Ickovics, the study’s lead author. “Group prenatal care is related to improved health outcomes for mothers and babies, without adding risk. If scaled nationally, group prenatal care could lead to significant improvements in birth outcomes, health disparities, and healthcare costs,” she added.

The research team conducted a randomized controlled trial in 14 health centers in New York City, and compared the birth outcomes of women who received CenteringPregnancy Plus group prenatal care to those who received traditional individual care. The more than 1,000 women in the study were placed in groups of eight to 12 women of the same gestational age, and were cared for by a clinician and a medical assistant. The study found that the higher the number of group visits attended, the lower the rates of adverse birth outcomes.

CenteringPregnancy group prenatal care includes the same components as individual visits, but all care (with the exception of matters that require privacy) take place in the group setting. Group visits build in additional time for education, skill building, and the opportunity to discuss and learn from the experience of peers, as well as more face time with caregivers.

Despite the opportunity for frequent visits, many mothers in at-risk groups, such as adolescents or those from low-income areas, still experience a high rate of negative birth outcomes. The study focused on adolescent women, ages 14 to 21, in disadvantaged areas, with no other known health risks to their pregnancies.

Going forward, researchers need to identify the reasons why group sessions yielded better outcomes, whether it is the additional time for education, the built-in social support, or other factors.

Additional studies are also needed to understand what influences patients to stick to group care session schedules, and to analyze cost-effectiveness. Future studies could also reveal whether the positive results from this study indicate that the group care model could be broadened to include other types of patients. Ickovics and colleagues are currently working with the United Health Foundation, UnitedHealth Innovation Group, and collaborators at Vanderbilt University and the Detroit Medical Center/Wayne State University to address many of these issues and to identify factors that could impact efforts to scale up and sustainability with a new model of group prenatal care, called Expect With Me.

Other Yale School of Public Health study authors include Valerie Earnshaw, Jessica Lewis, Trace Kershaw, Emily Stasko and Shayna Cunningham; and Urania Magriples of the Yale School of Medicine. Other co-authors included Sharon Schindler of Rising from the Centering Healthcare Institute in Boston, Jonathan Tobin and Andrea Cassells from the Clinical Directors Network in New York, and Peter Bernstein from the Albert Einstein College of Medicine in New York.                                                                   http://publichealth.yale.edu/news/article.aspx?id=11746

The program is called “Expect With Me.”

United Health Foundation describes the program:

Expect With Me

Yale School of Public Health and United Health Foundation have partnered to develop a new model of prenatal care designed to improve mothers’ and babies’ health and well-being during pregnancy, birth and infancy.  Prenatal care is delivered to pregnant women in a group setting, providing valuable education, skills, social and emotional support.

While expecting mothers typically spend 10-20 minutes with their doctors at each visit in traditional prenatal care, Expect With Me features 10 two-hour care sessions during the second and third trimesters. Each care session includes a physical assessment by a health care provider, and a focused group discussion session.

Expect With Me also includes a secure web portal and social networking features that enable expectant mothers to stay connected between care sessions and have access to a strong support network. Incentives, gaming and videos help patients engage, follow care recommendations and promote better health for both mothers and babies.

“Our goal in piloting this new prenatal care model is to improve the health of mothers and babies, and to improve perinatal health outcomes and reduce incidences of low birth weight and preterm birth.”

—Kate Rubin, United Health Foundation president.                                                                                                 http://www.unitedhealthfoundation.org/Initiatives/HealthCommunities/ExpectWithMe.aspx

The key is regular prenatal care.

The Eunice Kennedy Shriver National Institute of Child Health and Human Development reports in What is prenatal care and why is it important?

Prenatal Care

Women who suspect they may be pregnant should schedule a visit to their health care provider to begin prenatal care. Prenatal visits to a health care provider include a physical exam, weight checks, and providing a urine sample. Depending on the stage of the pregnancy, health care providers may also do blood tests and imaging tests, such as ultrasound exams. These visits also include discussions about the mother’s health, the infant’s health, and any questions about the pregnancy.

Preconception and prenatal care can help prevent complications and inform women about important steps they can take to protect their infant and ensure a healthy pregnancy. With regular prenatal care women can:

  • Reduce the risk of pregnancy complications. Following a healthy, safe diet; getting regular exercise as advised by a health care provider; and avoiding exposure to potentially harmful substances such as lead and radiation can help reduce the risk for problems during pregnancy and ensure the infant’s health and development. Controlling existing conditions, such as high blood pressure and diabetes, is important to avoid serious complications in pregnancy such as preeclampsia.
  • Reduce the infant’s risk for complications. Tobacco smoke and alcohol use during pregnancy have been shown to increase the risk for Sudden Infant Death Syndrome. Alcohol use also increases the risk for fetal alcohol spectrum disorders, which can cause a variety of problems such as abnormal facial features, having a small head, poor coordination, poor memory, intellectual disability, and problems with the heart, kidneys, or bones.2 According to one recent study supported by the NIH, these and other long-term problems can occur even with low levels of prenatal alcohol exposure.3

In addition, taking 400 micrograms of folic acid daily reduces the risk for neural tube defects by 70%.4 Most prenatal vitamins contain the recommended 400 micrograms of folic acid as well as other vitamins that pregnant women and their developing fetus need.1,5 Folic acid has been added to foods like cereals, breads, pasta, and other grain-based foods. Although a related form (called folate) is present in orange juice and leafy, green vegetables (such as kale and spinach), folate is not absorbed as well as folic acid.

  • Help ensure the medications women take are safe. Certain medications, including some acne treatments6 and dietary and herbal supplements,7 are not safe to take during pregnancy.

Learn more about prenatal and preconception care.

http://www.nichd.nih.gov/health/topics/preconceptioncare/Pages/default.aspx

http://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/Pages/prenatal-care.aspx

See, Prenatal care fact sheet http://www.womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.html

Our goal as a society should be a healthy child in a healthy family who attends a healthy school in a healthy neighborhood. ©

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©

http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©

http://drwildareviews.wordpress.com/

Dr. Wilda ©

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Northwestern University study: Heavier babies do better in school

27 Oct

The Ontario Ministry of Children and Youth Services explains why healthy babies are important. “Healthy babies are more likely to develop into healthy children, and healthy children are more likely to grow up to be healthy teenagers and healthy adults.” http://www.children.gov.on.ca/htdocs/English/topics/earlychildhood/health/index.aspx

The New York Times reported in the article, Heavier Babies Do Better in School:
A study of children in Florida found that those who were heavier at birth scored higher on math and reading tests in the third to eighth grades.
Like so many other parts of health care, childbirth has become a more medically intense experience over the last two decades. The use of drugs to induce labor has become far more common, as have cesarean sections. Today, about half of all births in this country are hastened either by drugs or surgery, double the share in 1990.
Crucial to the change has been a widely held belief that once fetuses pass a certain set of thresholds — often 39 weeks of gestation and five and a half pounds in weight — they’re as healthy as they can get. More time in the womb doesn’t do them much good, according to this thinking. For parents and doctors, meanwhile, scheduling a birth, rather than waiting for its random arrival, is clearly more convenient.
But a huge new set of data, based on every child born in Florida over an 11-year span, is calling into question some of the most basic assumptions of our medicalized approach to childbirth. The results also play into a larger issue: the growing sense among many doctors and other experts that Americans would actually be healthier if our health care system were sometimes less aggressive.
The new data suggest that the thresholds to maximize a child’s health seem to be higher, which means that many fetuses might benefit by staying longer in the womb, where they typically add at least a quarter-pound per week. Seven-pound babies appear to be healthier than six-pound babies — and to fare better in school as they age. The same goes for eight-pound babies compared with seven-pound babies, and nine-pound babies compared with eight-pound babies. Weight, of course, may partly be an indicator of broader fetal health, but it seems to be a meaningful one: The chunkier the baby, the better it does on average, all the way up to almost 10 pounds.
“Birth weight matters, and it matters for everyone,” says David N. Figlio, a Northwestern University professor and co-author of the study, which will soon be published in the American Economic Review, one of the field’s top journals… http://www.nytimes.com/2014/10/12/upshot/heavier-babies-do-better-in-school.html?abt=0002&abg=0&_r=0

Citation:

The Effects of Poor Neonatal Health on Children’s Cognitive Development (WP-13-08)
IPR-WP-13-08
David Figlio, Jonathan Guryan, Krzysztof Karbownik, and Jeffrey Roth
This working paper makes use of a new data resource—merged birth and school records for all children born in Florida from 1992 to 2002—to study the effects of birth weight on cognitive development from kindergarten through schooling. Using twin fixed effects models, the researchers find that the effects of birth weight on cognitive development are essentially constant through the school career, that these effects are very similar across a wide range of family backgrounds, and that they are invariant to measures of school quality. They conclude that the effects of poor neonatal health on adult outcomes are therefore set very early.
David Figlio, Orrington Lunt Professor of Education and Social Policy and of Economics, and Director and Faculty Fellow, Institute for Policy Research, Northwestern University
Jonathan Guryan, Associate Professor of Human Development and Social Policy, and Faculty Fellow, Institute for Policy Research, Northwestern University
Krzysztof Karbownik, Visiting Scholar, Institute for Policy Research, Northwestern University
Jeffrey Roth, Research Professor of Pediatrics, College of Medicine, University of Florida
Download working paper PDF http://www.ipr.northwestern.edu/publications/docs/workingpapers/2013/IPR-WP-13-08.pdf

Other articles have questioned whether heavier babies are healthier:

Bigger Baby Trend Worries Doctors As Health Concerns Mount Over Supersized Deliveries http://www.huffingtonpost.com/2013/08/19/bigger-baby-trend_n_3780699.html

Everyday Research blog analyzes the study in Heavier babies do better in school:
Questions
a) How do we know this is a correlational study? What are its variables?
b) Here’s a quote from the article:
Mr. Figlio estimates that, all else equal, a 10-pound baby will score an average of 80 points higher on the 1,600-point SAT than a six-pound baby. Another way to see the pattern is to look only at top-scoring students: Among the top 5 percent of test scorers in elementary school, one in three weighed at least eight pounds at birth, compared with only one in four of all babies.
Does this quote address statistical validity? Construct validity? External validity? or Internal validity?
c) Here’s a great addition. Underneath the main figure in the article, are tables of results for education, race, and age. The caption reads:
The effect of being heavier is similar across many different types of mothers.
Is this caption addressing potential moderators? potential mediators? or potential third variable problems?
d) Here’s another quote from the piece:
Florida offers a window on the issue because the state tracks children from birth through college…. The authors of the new study….used the data to compare birth weight with test scores from third through eighth grades, as well as with kindergarten readiness scores. They controlled for, among other factors, the health and sex of the baby, the length of the pregnancy and the health, age, race and education of the mother
Looking at the last sentence of this quote, is this statement addressing potential moderators? potential mediators? or potential third variable problems?
http://www.everydayresearchmethods.com/2014/10/heavier-babies-do-better-in-school.html

The question many parents ask is what is a healthy weight range.

The What to Expect article, Your Newborn’s Weight: What’s Normal, What’s Not discusses healthy weight:

So just what is average for a newborn? At birth, the average baby weighs about 7.5 pounds — though the range of normal is between 5.5 and ten pounds (all but five percent of newborns will fall into this range).
What makes your baby weigh more or less than the newborn in the next bassinet? Several factors come into play:
• Your own diet and weight, both before and during pregnancy (If you’re overweight, you may have a heavier baby. If you don’t get enough nutrients while you’re pregnant, your baby may be smaller.)
• Your prenatal health, including whether you drink, smoke, or have diabetes
• Your own birth weight, plus genetics (your size at birth, plus your and your hubby’s size now, can both play a role)
• Whether your baby is a boy or a girl (boys tend to be heavier)
• Whether this is your firstborn (they tend to be smaller than subsequent children)
• Whether your baby is a twin or triplet (multiples tend to be smaller than singletons)
• Your baby’s race (Caucasian babies are sometimes larger than African-American, Asian, or Native American infants)… http://www.whattoexpect.com/baby-growth/newborn-weight.aspx

The key is regular prenatal care.

The Eunice Kennedy Shriver National Institute of Child Health and Human Development reports in What is prenatal care and why is it important?

Prenatal Care
Women who suspect they may be pregnant should schedule a visit to their health care provider to begin prenatal care. Prenatal visits to a health care provider include a physical exam, weight checks, and providing a urine sample. Depending on the stage of the pregnancy, health care providers may also do blood tests and imaging tests, such as ultrasound exams. These visits also include discussions about the mother’s health, the infant’s health, and any questions about the pregnancy.
Preconception and prenatal care can help prevent complications and inform women about important steps they can take to protect their infant and ensure a healthy pregnancy. With regular prenatal care women can:
• Reduce the risk of pregnancy complications. Following a healthy, safe diet; getting regular exercise as advised by a health care provider; and avoiding exposure to potentially harmful substances such as lead and radiation can help reduce the risk for problems during pregnancy and ensure the infant’s health and development. Controlling existing conditions, such as high blood pressure and diabetes, is important to avoid serious complications in pregnancy such as preeclampsia.
• Reduce the infant’s risk for complications. Tobacco smoke and alcohol use during pregnancy have been shown to increase the risk for Sudden Infant Death Syndrome. Alcohol use also increases the risk for fetal alcohol spectrum disorders, which can cause a variety of problems such as abnormal facial features, having a small head, poor coordination, poor memory, intellectual disability, and problems with the heart, kidneys, or bones.2 According to one recent study supported by the NIH, these and other long-term problems can occur even with low levels of prenatal alcohol exposure.3

In addition, taking 400 micrograms of folic acid daily reduces the risk for neural tube defects by 70%.4 Most prenatal vitamins contain the recommended 400 micrograms of folic acid as well as other vitamins that pregnant women and their developing fetus need.1,5 Folic acid has been added to foods like cereals, breads, pasta, and other grain-based foods. Although a related form (called folate) is present in orange juice and leafy, green vegetables (such as kale and spinach), folate is not absorbed as well as folic acid.
• Help ensure the medications women take are safe. Certain medications, including some acne treatments6 and dietary and herbal supplements,7 are not safe to take during pregnancy.
Learn more about prenatal and preconception care. http://www.nichd.nih.gov/health/topics/preconceptioncare/Pages/default.aspx
http://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/Pages/prenatal-care.aspx

See, Prenatal care fact sheet http://www.womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.html

Our goal as a society should be a healthy child in a healthy family who attends a healthy school in a healthy neighborhood. ©

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Study: Early stress in girls may be the source of later anxiety

13 Nov

Prolonged stress can have adverse effects on humans. Moi wrote about the Adverse Childhood Experiences Study in Study: Some of the effects of adverse stress do not go away:

Sarah D. Sparks writes in the Education Week article, Research Traces Impacts of Childhood Adversity:

Research from Dr. Shonkoff’s center and from other experts finds that positive stress—the kind that comes from telling a toddler he can’t have a cookie or a teenager that she’s about to take a pop quiz—causes a brief rise in heart rate and stress hormones. A jolt can focus a student’s attention and is generally considered healthy.

Similarly, a child can tolerate stress that is severe but may be relatively short-term—from the death of a loved one, for example—as long as he or she has support….

Toxic’ Recipe

By contrast, so-called “toxic stress” is severe, sustained, and not buffered by supportive relationships.

The same brain flexibility, called plasticity, that makes children open to learning in their early years also makes them particularly vulnerable to damage from the toxic stressors that often accompany poverty: high mobility and homelessness; hunger and food instability; parents who are in jail or absent; domestic violence; drug abuse; and other problems, according to Pat Levitt, a developmental neuroscientist at the University of Southern California and the director of the Keck School of Medicine Center on the Developing Child in Los Angeles…. http://www.edweek.org/ew/articles/2012/11/07/11poverty_ep.h32.html?tkn=QLYF5qldyT3U0BI0xqtD5885mihZIxwbX4qZ&cmp=clp-edweek

Here is information about the Adverse Child Experiences Study. The Centers for Disease Control and Prevention provides access to the peer-reviewed publications resulting from The ACE Study. http://acestudy.org/

https://drwilda.com/2012/11/09/study-some-of-the-effects-of-adverse-stress-do-not-go-away/

Waisman Laboratory for Brain Imaging and Behavior published a study which looks at the effects of stress on girls.

Science Daily is reporting in the article, Early Stress May Sensitize Girls’ Brains for Later Anxiety:

High levels of family stress in infancy are linked to differences in everyday brain function and anxiety in teenage girls, according to new results of a long-running population study by University of Wisconsin-Madison scientists.

The study highlights evidence for a developmental pathway through which early life stress may drive these changes. Here, babies who lived in homes with stressed mothers were more likely to grow into preschoolers with higher levels of cortisol, a stress hormone. In addition, these girls with higher cortisol also showed less communication between brain areas associated with emotion regulation 14 years later. Last, both high cortisol and differences in brain activity predicted higher levels of adolescent anxiety at age 18.

The young men in the study did not show any of these patterns.

“We wanted to understand how stress early in life impacts patterns of brain development which might lead to anxiety and depression,” says first author Dr. Cory Burghy of the Waisman Laboratory for Brain Imaging and Behavior. “Young girls who, as preschoolers, had heightened cortisol levels, go on to show lower brain connectivity in important neural pathways for emotion regulation — and that predicts symptoms of anxiety during adolescence….”

The current paper has its roots back in 1990 and 1991, when 570 children and their families enrolled in the Wisconsin Study of Families and Work (WSFW). All of the children were born in either Madison or Milwaukee. Dr. Marilyn Essex, a UW professor of psychiatry and co-director of the WSFW, said the initial goal was to study the effects of maternity leave, day care and other factors on family stress. Over the years, the study has resulted in important findings on the social, psychological, and biological risk factors for child and adolescent mental health problems. Subjects are now 21 and 22 years old, and many continue to participate.

For the current study, Burghy and Birn used fcMRI to scan the brains of 57 subjects — 28 female and 29 male — to map the strength of connections between the amygdala, an area of the brain known for its sensitivity to negative emotion and threat, and the prefrontal cortex, often associated with helping to process and regulate negative emotion. Then, they looked back at earlier results and found that girls with weaker connections had, as infants, lived in homes where their mothers had reported higher general levels of stress — which could include symptoms of depression, parenting frustration, marital conflict, feeling overwhelmed in their role as a parent, and/or financial stress. As four-year-olds, these girls also showed higher levels of cortisol late in the day, measured in saliva, which is thought to demonstrate the stress the children experienced over the course of that day. http://www.sciencedaily.com/releases/2012/11/121111152930.htm#.UKEogDfvMTo.email

Citation:

Nature Neuroscience | Article

Developmental pathways to amygdala-prefrontal function and internalizing symptoms in adolescence

Nature Neuroscience
(2012)
doi:10.1038/nn.3257
Received
23 July 2012
Accepted
11 October 2012
Published online
11 November 2012
Abstract

Early life stress (ELS) and function of the hypothalamic-pituitary-adrenal axis predict later psychopathology. Animal studies and cross-sectional human studies suggest that this process might operate through amygdala–ventromedial prefrontal cortex (vmPFC) circuitry implicated in the regulation of emotion. Here we prospectively investigated the roles of ELS and childhood basal cortisol amounts in the development of adolescent resting-state functional connectivity (rs-FC), assessed by functional connectivity magnetic resonance imaging (fcMRI), in the amygdala-PFC circuit. In females only, greater ELS predicted increased childhood cortisol levels, which predicted decreased amygdala-vmPFC rs-FC 14 years later. For females, adolescent amygdala-vmPFC functional connectivity was inversely correlated with concurrent anxiety symptoms but positively associated with depressive symptoms, suggesting differing pathways from childhood cortisol levels function through adolescent amygdala-vmPFC functional connectivity to anxiety and depression. These data highlight that, for females, the effects of ELS and early HPA-axis function may be detected much later in the intrinsic processing of emotion-related brain circuits.

Stress has negative effects on the body.

According to the Mayo Clinic article, Stress symptoms: Effects on your body, feelings and behavior:

Common effects of stress …
… On your body … On your mood … On your behavior
  • Headache
  • Muscle tension or pain
  • Chest pain
  • Fatigue
  • Change in sex drive
  • Stomach upset
  • Sleep problems
  • Anxiety
  • Restlessness
  • Lack of motivation or focus
  • Irritability or anger
  • Sadness or depression
  • Overeating or undereating
  • Angry outbursts
  • Drug or alcohol abuse
  • Tobacco use
  • Social withdrawal

Source: American Psychological Association’s “Stress in America” report, 2010

http://www.mayoclinic.com/health/stress-symptoms/SR00008_D

This study points to the need for quality prenatal care.

The March of Dimes discusses stress during pregnancy in the article, Emotional and life changes:

What types of stress can cause pregnancy problems?

Stress is not all bad. When you handle it right, a little stress can help you take on new challenges. Regular stress during pregnancy, such as work deadlines and sitting in traffic, probably don’t add to pregnancy problems.

However, serious types of stress during pregnancy may increase your chances of certain problems, like premature birth. Most women who have serious stress during pregnancy can have healthy babies. But be careful if you experience serious kinds of stress, like:

  • Negative life events. These are things like divorce, serious illness or death in the family, or losing a job or home. 
  • Catastrophic events. These are things like earthquakes, hurricanes or terrorist attacks. 
  • Long-lasting stress. This type of stress can be caused by having financial problems, being abused, having serious health problems or being depressed. Depression is medical condition where strong feelings of sadness last for long periods of time and prevent a person from leading a normal life. 
  • Racism. Some women may face stress from racism during their lives. This may help explain why African-American women in the United States are more likely to have premature and low-birthweight babies than women from other racial or ethnic groups. 
  • Pregnancy-related stress. Some women may feel serious stress about pregnancy. They may be worried about miscarriage, the health of their baby or about how they’ll cope with labor and birth or becoming a parent. If you feel this way, talk to your health care provider.

Does post-traumatic stress disorder affect pregnancy?
Post-traumatic stress disorder (PTSD) is when you have problems after seeing or experiencing a terrible event, such as rape, abuse, a natural disaster, a terrorist attack or the death of a loved one. People with PTSD may have:

  • Serious anxiety 
  • Flashbacks of the event 
  • Nightmares 
  • Physical responses (like a racing heartbeat or sweating) when reminded of the event

As many as 8 in 100 women (8 percent) may have PTSD during pregnancy. Women who have PTSD may be more likely than women without it to have a premature or low-birthweight baby. They also are more likely than other women to have risky health behaviors, such as smoking cigarettes, drinking alcohol or taking street drugs. Doing these things can increase the chances of having pregnancy problems. If you think you may have PTSD, talk to your provider or a mental health professional.

How does stress cause pregnancy problems?
We don’t completely understand the effects of stress on pregnancy. But certain stress-related hormones may play a role in causing certain pregnancy complications. Serious or long-lasting stress may affect your immune system, which protects you from infection. This can increase the chances of getting an infection of the uterus. This type of infection can cause premature birth.

Stress also may affect how you respond to certain situations. Some women deal with stress by smoking cigarettes, drinking alcohol or taking street drugs, which can lead to pregnancy problems.

Can high levels of stress in pregnancy hurt your baby later in life?
Some studies show that high levels of stress in pregnancy may cause certain problems during childhood, like having trouble paying attention or being afraid. It’s possible that stress may also affect your baby’s brain development or immune system.

How can you reduce stress during pregnancy?
Here are some ways to reduce stress:

  • Figure out what’s making you stressed and talk to your partner, a friend or your health care provider about it. 
  • Know that the discomforts of pregnancy are only temporary. Ask your provider how to handle these discomforts. 
  • Stay healthy and fit. Eat healthy foods, get plenty of sleep and exercise (with your provider’s OK).
  • Exercise can help reduce stress and also helps prevent common pregnancy discomforts. 
  • Cut back on activities you don’t need to do. 
  • Have a good support network, including your partner, family and friends. Ask your provider about resources in the community that may be able to help. 
  • Ask for help from people you trust. Accept help when they offer. For example, you may need help cleaning the house, or you may want someone to go with you to your prenatal visits. 
  • Try relaxation activities, like prenatal yoga or meditation. 
  • Take a childbirth education class so you know what to expect during pregnancy and when your baby arrives. Practice the breathing and relaxation techniques you learn in your class. 
  • If you’re working, plan ahead to help you and your employer get ready for your time away from work. 
  • If you think you may be depressed, talk to your provider right away. There are many ways to deal with depression. Getting treatment and counseling early may help.

Last reviewed January 2012 http://www.marchofdimes.com/pregnancy/lifechanges_indepth.html

See, The Importance of Quality Prenatal Care http://www.mdnews.com/news/2010_07/national_jul10_the-importance-of-quality-prenatal-care

Our goal as a society should be:

A healthy child in a healthy family who attends a healthy school in a healthy neighborhood ©

Resources:

The Effects of Stress on Your Body                                           http://www.webmd.com/mental-health/effects-of-stress-on-your-body

The Physical Effects of Long-Term Stress                              http://psychcentral.com/lib/2007/the-physical-effects-of-long-term-stress/all/1/

Chronic Stress: The Body Connection                            http://www.medicinenet.com/script/main/art.asp?articlekey=53737

Understanding Stress Symptoms, Signs, Causes, and Effects http://www.helpguide.org/mental/stress_signs.htm

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