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Birthzillas, Birthing Plans and Homebirths

Mon, 05/20/2013 By Dr.Amos

I found this interesting article describing the author's feelings about controlling pregnant women, birthing plans, homebirth, and birth experience here.

The authors describes "birthzillas" as women for whom it's all about the birth experience and not the baby. Or, as someone else describes it, throwing the baby out with the water, so to speak.

The authors goes on:

"At the extreme end of the Birthzilla spectrum are those women who put their birth experience above the health and wellbeing of their baby. And yes it happens. In fact the South Australian coronor recently found that three babies who died during homebirths would have certainly survived had they been born in hospitals.  In each case, their mothers knew the pregnancies were high risk and chose to give birth at home without medical support anyway. Their babies died. And for what? That is where Birthzilla behaviour can actually be a matter of life and death. "

Misinformation about Fertility and Pregnancy on the Internet

Fri, 04/12/2013 By Dr.Amos

Just because someone writes something and it's on the internet, that doesn't mean it's correct. Below we list some sites and information that publish incorrect information about fertility and pregnancy:

1. First Response Ovulation Calculator: This one gets it the "wrongest": 3 fertile days AFTER ovulation. What the ...?
2. WebMD Ovulation Calendar: INCORRECTLY calculates fertile days
3. Huffington Post: INCORRECT: "you can get pregnant on your period." CORRECT: You can only get pregnant if and when you ovulate, and ovulation does not happen when you have your period. You can however get pregnant later on (not on your period) if you have unprotected sex on your period. Sperm can survive for up to five days, and if you have unprotected sex on your period, they can survive up to five days and then fertilize an egg later on.
4. Huffington Post: INCORRECT: "You are most fertile before and around ovulation". CORRECT: "Around" implies before, during, and after. You are fertile only before and on the day of ovulation, not after ovulation. Making love after ovulation will not get you pregnant
5. Babyy2see: Incorrectly calculates conception days and fertile days
6. March of Dimes: I love the March of Dimes, but even they don't get it right all the time. 
7. American Pregnancy Calculator: Indicates 11 fertile days. Really? Really? 
8. Babyzone: They got it incorrect too.
9. The Bump: This ovulation calculator is another proof that just because it's on the web, that doesn't make it right but all wrong.
10. Justmommies - Gets it right. Finally.

Now go and get the correct and perfect calculation for your ovulation and fertility calendar and calculator on BabyMed.

Recurrence Risk of Preeclampsia in First and Subsequent Pregnancies

Fri, 04/12/2013 By Dr.Amos

Pre-eclampsia has been defined as a disease of first pregnancies. The association between primiparity and pre-eclampsia is so widely accepted that it is at the core of several pathophysiological theories. For example, it has been proposed that pre-eclampsia is the consequence of a maternal immune reaction against paternal antigens expressed in the placenta and that this reaction might result in defective trophoblast invasion and subsequent placental dysfunction.

The lower risk of pre-eclampsia among multiparous women has been attributed to desensitisation after exposure to paternal antigens in the placenta during previous pregnancies. The lower risk has also been attributed to smoother trophoblastic invasion after modification of maternal spiral arteries during the first pregnancy.

RESULTS:

1. The risk of pre-eclampsia is higher in first pregnancies (4.1%) than in subsequent ones (1.7%) The lower overall risk of pre-eclampsia among parous women is not explained by fewer pregnancies among women who experienced pre-eclampsia in a previous gestation
2. The risk of recurrence is around 15% for women who had pre-eclampsia in one previous pregnancy and around 30% when two consecutive previous pregnancies were affected
3. Recurrence is higher for pre-eclampsias associated with very preterm delivery

Source: Sonia Hernández-Díaz  Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study BMJ 2009;338:b2255  

Typical patient questions about lifestyle

Thu, 04/11/2013 By Dr.Amos

Many of my patients ask me about lifestyle issues and pregnancy, especially about exercise, alcohol, caffeine, and artrificial sweeteners. Here are my straight-forward answers:

Exercise

When there are no other medical contraindications, I would recommend in pregnancy regular moderate exercise but try to avoid more strenuous,  vigorous, sustained exercise. Exercise in pregnancy helps attain health benefits while minimizing complications. Women in the first trimester of pregnancy who are engaged in sustained, high-intensity activity might consider lessening their exercise until after 12 weeks’ gestation. 

Alcohol

Drinking alcohol while trying to get pregnant decreases fertility.  The American Society for Reproductive Medicine recommends limiting alcohol consumption to less than 2 drinks per day while attempting conception

Alcohol use in pregnancy increases risks of fetal complications. We don't know at which point alcohol is unsafe, so the safest recommendation is to not have any alcohol during pregnancy. 

Caffeine

While trying to get pregnant and during pregnancy it is recommended to limit caffeine to under 200 mg/day. One cup of coffee (8 oz) has up to  150 mg, and one cup of tea about 60 mg caffeine. A can of pepsi or Coke have aup to 50 mg caffeine. Read HERE more.

Artificial Sweeteners

Moderate amount of artificial sweeteners (eg, Aspartame, Sucralose, Stevia)  appear safe, but Saccharine should not be used in pregnancy. 

January Is Birth Defect Prevention Month

Tue, 01/08/2013 By Dr.Amos

January is National Birth Defects Prevention Month, a time to focus on raising awareness about the frequency with which birth defects occur in the United States 

Every 4 ½ minutes, a baby is born with a major birth defect in the United States. They are a leading cause of death among U.S. infants, accounting for about 20% of mortality in the first year of life. In addition, babies born with birth defects have a greater chance of illness and long term disability than babies without birth defects. January is National Birth Defects Prevention Month, a time to focus on raising awareness about the frequency with which birth defects occur in the United States and of the steps that can be taken to prevent them.  While not all birth defects can be prevented, there are things a women can do get ready for a healthy pregnancy.

• Be fit. Eat a healthy diet and work towards a healthy weight before pregnancy.
• Be healthy. Avoid alcohol, tobacco, and illicit drugs. Be sure to consume at least 400 micrograms of folic acid every day before and during early pregnancy.  Work to get health conditions, like diabetes, in control before becoming pregnant.
• Be wise. Visit a health care professional regularly. Consult with your healthcare provider about any medications, including prescription and over-the counter medications and dietary or herbal supplements, before taking them.

Managing health conditions and adopting healthy behaviors before becoming pregnancy can increase your chances of having a healthy baby. Follow these guidelines before and during pregnancy. 

PCBs and other Pollutants May Play a Role in Pregnancy Delay

Tue, 01/01/2013 By Dr.Amos

PCBs  (polychlorinated biphenyls) are chemicals that have been used as coolants and lubricants in electrical equipment.

Since PCBs are found throughout the environment, it is likely that everyone has been exposed to them. PCBs can enter the body by eating or drinking contaminated food, through the air we breathe, or by skin contact. PCBs are easily absorbed by the body and are stored in fatty tissue. PCBs are not eliminated well, so they can accumulate in the body.

Most people are exposed to PCBs by eating contaminated fish, meat, and dairy products. The highest PCB levels in fish are seen in:

• Catfish
• Buffalo fish
• Carp
• Walleye
• Tuna, bluefin
• American eel
• Croaker
• Flounder
• Wild sturgeon
• Blue crab
• Wild Alaska salmon

PCBs build up in fish and animal fat, and therefore proper cooking methods can help reduce your exposure:

• Before cooking, remove the skin, fat (found along the back, sides and belly), internal organs, tomalley of lobster and the mustard of crabs, where toxins are likely to accumulate.
• When cooking, be sure to let the fat drain away and avoid or reduce fish drippings.
• Serve less fried fish; frying seals in chemical pollutants that might be in the fish's fat, while grilling or broiling allows fat to drain away.
• For smoked fish, it is best to fillet the fish and remove the skin before the fish is smoked.

Read more in this list of seafood health alert.

Plants take up only small amounts of PCBs from the soil, so amounts in grazing animals and dairy products are generally lower than in fish. Dust contaminated with very small levels of PCBs may be found on the outer surfaces of fruits and vegetables.

They are part of a category of chemicals known as persistent organochlorine pollutants and include industrial chemicals and chemical byproducts as well as pesticides. In many cases, the compounds are present in soil, water, and in the food chain. The compounds are resistant to decay, and may persist in the environment for decades. Some, known as persistent lipophilic organochlorine pollutants, accumulate in fatty tissues. Another type, called perfluorochemicals , are used in clothing, furniture, adhesives, food packaging, heat-resistant non-stick cooking surfaces, and the insulation of electrical wire.

Pregnancy and fertility Links 12-31-2012

Mon, 12/31/2012 By Dr.Amos

The Americal Congress of Obstetricians and Gynecologists published a Committee Opinion on obesity in pregnancy and recommendations on weight gain during pregnancy.

ABSTRACT: In the US, more than one-third of women are obese, more than one-half of pregnant women are overweight or obese, and 8% of reproductive-age women are extremely obese, putting them at a greater risk of pregnancy complications. Therefore, preconception assessment and counseling are strongly encouraged for obese women and should include the provision of specific information concerning the maternal and fetal risks of obesity in pregnancy, as well as encouragement to undertake a weight-reduction program. At the initial prenatal visit, height and weight should be recorded for all women to allow calculation of body mass index (calculated as weight in kilograms divided by height in meters squared), and recommendations for appropriate weight gain should be reviewed at the initial visit and periodically throughout pregnancy. Nutrition consultation should be offered to all overweight or obese women, and they should be encouraged to follow an exercise program. Pregnant women who have undergone bariatric surgery should be evaluated for nutritional deficiencies and the need for vitamin supplementation when indicated. Obese patients undergoing cesarean delivery may require thromboprophylaxis with pneumatic compression devices and unfractionated heparin or low molecular weight heparin. For all obese patients, anesthesiology consultation early in labor should be considered, and consultation with weight-reduction specialists before attempting another pregnancy should be encouraged.

At which serum hCG level should you see the pregnancy on ultrasound?

Sun, 12/30/2012 By Dr.Amos

Up to one in three women experience vaginal bleeding during the firest few months of the pregnancy, and many wonder how they can make sure the pregnancy is viable.In a study published in the Obstetrics & Gynecology journal in January of 2013 the authors reviewed records of patients with first trimester vaginal bleeding who were evaluated with serum beta hCG levels and ultrasound.

Higher hCG levels were associated with a greater proportion of ultimately viable pregnancies.

The authors found that  90% of the time in viable pregnancies one would expect to see the gestational sac at 1,918 mIU/ml, the yolk sac at 5,412 mIU/ml and the fetal pole at 24,599 mIU/ml.

They found that  99% of the time one would expect to see the gestational sac at 3,510 mIU/ml, the yolk sac at 17,716 mIU/ml and the fetal pole at 47,685 mIU/ml.

The "threshold value" the lowest value at which one would expect to see something on ultrasound was:

• Gestational sac: 390 mIU/ml
• Yolk sac: 1,094 mIU/ml
• Fetal pole: 1,394 mIU/ml

This study showed that a viable pregnancy can be diagnosed at lower beta hCG levels and with better ultrasound equipment than previously published.

Figure: Predicted probability of detecting the gestational sac in viable pregnancies.

I took the 12/12/12 12:12 Baby Picture

Thu, 12/13/2012 By Dr.Amos

Wednesday 12/12/12 was a special day. And I was so lucky to take the picture of what seems to be the only baby born in the United States on 12/12/12 at 12:12 pm. The baby was born at the NewYork-Presbyterian Hospital where I am the chief of labor & delivery:

Amos Grunebaum, MD

The picture was published by many places including:

• New York Times
• New York Daily News
• Huffington Post

Exposure Before and During Pregnancy

Wed, 12/12/2012 By Dr.Amos

There are more and more studies that show that exposure before and during pregnancy can have a significant impact on fetal development and have an adverse effect on health. In a great review published in the December 2012 American Journal of Obstetrics and Gynecology journal, the authors reviewed agents that could negatively affect a pregnancy and they describe how to counsel patients.

These agents include:

• Mercury
• Lead
• Pesticides
• Endocrine Disrupting Chemicals (EDCs)