Preterm birth

Light drinking ‘is preterm risk’

Even moderate drinking during the earliest months of pregnancy may be damaging, say researchers in Leeds. Their study is the latest in a long debate over whether it is safe to drink at all during pregnancy.

The findings, published in the Journal of Epidemiology and Community Health, suggest the chances of premature birth increased. The NHS recommends people avoid alcohol during pregnancy or when trying to conceive.

But says if people choose to drink, then they should not have more than two units of alcohol (about one pint) twice a week.

Heavy drinking in pregnancy is known to be damaging as it can affect the baby’s development. But there is far more debate about drinking at the upper limit of the NHS guidelines.

Around seven in every 100 births in the UK is premature. The study on 1,264 women in Leeds showed drinking more than the two units limit doubled the risk of premature birth, but even drinking at the limit increased the risk.

Camilla Nykjaer, one of the researchers at the University of Leeds. “This is a very sensitive issue, we don’t want women who are pregnant now to panic, the individual risk is actually low.

“They shouldn’t drink, they should stop drinking if they have been drinking during the pregnancy.”

However, a study of more than 11,000 five-year-olds, conducted by University College London, showed drinking one or two units of alcohol a week during pregnancy did not raise the risk of developmental problems in the child.

Prof Yvonne Kelly who conducted that research told the BBC: “Heavy drinking is really very, very bad, but at low levels, in the work we’ve done we haven’t found any negative effects in childhood.

“It’s a massively charged area, getting the tone of this right is quite difficult.

“The guidelines are there, women are sentient beings and can choose – it’s hugely politically charged all of this, I guess people will make their own judgements.”

Dr Patrick O’Brien, a spokesperson for the Royal College of Obstetricians and Gynaecologists, said: “While the safest approach would be to choose not to drink at all, small amounts of alcohol, not more than one to two units once or twice a week, have not been shown to be harmful after 12 weeks of pregnancy.

“Pregnant women should always consult their midwives or doctors if they have any concerns about their alcohol intake.”

Source: BBC news

Diet during pregnancy linked to preterm birth

A new study on diet and pregnancy suggests that what you eat when you are expecting is as important as what you don’t.

Women who ate plenty of fruits and vegetables and who tried to drink water instead of soft drinks were less likely to have premature babies than women who ate more “Western” diets, a big study in Norway has shown.

It wasn’t that women who ate pizza, tacos and sweets were more likely than average to have premature babies, the researchers found. It was that healthier eating lowered the risk by about 15 percent.

Dr Linda Englund-Ögge of Sweden’s Sahlgrenska Academy and colleagues studied a big database of 66,000 Norwegian women who are taking part in a larger study. One of the things they did was fill out a food diary while pregnant.

Englund-Ogge’s team classified their diets into three broad types: a “prudent” diet with plenty of fruits and vegetables and not too much junk food; a “traditional” Nordic diet with boiled potatoes, fish and gravy; and a more typical modern “Western” diet with processed white flour, sweets and snacks.

“Our results indicate that increasing the intake of foods associated with a prudent dietary pattern is more important than totally excluding processed food, fast food, junk food, and snacks,” they wrote in their report, published in the British Medical Journal.

It makes sense, says Dr, Walter Willett, a nutrition expert at the Harvard School of Public Health who was not involved in the study. “It does fit with what we have learned about diet and pregnancy,” he told NBC News.

“Dietary pattern has been linked to a lower risk of diabetes. It has been linked to a lower risk of hypertension.” And high blood sugar and high blood pressure are both big risks in pregnancy that in turn contribute to the risk of pre-term birth.“Those are things that impair development of the fetus,” Willett said.

The U.S. infant mortality rate is higher than in most other developed countries at 6.14 infant deaths per 1,000 births. The average for the Organization for Economic Cooperation and Development, which groups developed countries, is around 4 per 100,000

Source: NBC news

Early `water breaking` linked to premature births

A high presence of bacteria at the site where fetal membranes rupture may be the key to understanding why some pregnant women experience their “water breaking” prematurely, researchers at Duke Medicine report.

bacterial presence is associated with thinning of the fetal membranes. More research is needed to understand whether bacterial presence is a cause or consequence of fetal membrane weakening.

“Complications of preterm births can have long-term health effects for both mothers and children,” said study author Amy P. Murtha, M.D., associate professor of obstetrics and gynecology at Duke University School of Medicine. “Our research focuses on why the fetal membranes, or water sac, break early in some women, with the overall goal of better understanding the mechanisms of preterm membrane rupture.”

Composed of two fetal cell layers, the amnion and chorion, fetal membranes play an important role in maintaining pregnancy through gestation. Nearly one-third of all early deliveries are associated with the water breaking in what’s known as preterm premature rupture of membranes, or PPROM.

Previous research from Murtha and her colleagues demonstrated that the chorion has more cell death when infection is present, and that this cell layer may be thinner in women who experience PPROM. Among PPROM patients with infection in the fetal membranes (chorioamnionitis), the cell death within the chorion layer was highest, suggesting that infection may play a role in causing PPROM.

In the current study, the researchers prospectively examined chorion membrane samples to identify a pattern of bacterial presence and association with chorion thinning. They collected membrane samples from a total of 48 women—including PPROM, preterm and term patients—after they gave birth. The researchers measured chorion thinning and bacterial presence in membrane samples collected from both near and far from the rupture site.

In all women, the chorion membrane was thinner at the rupture site than at the distant site. However, chorion thinning was greatest among PPROM patients and was not isolated to the rupture site, as the researchers observed a global chorion thinning even distant from where the membrane ruptured.

The researchers then looked to see if bacteria were present in the membranes and whether bacteria levels correlated with the thinning of the cell layers in the membranes. Interestingly, bacteria were present in all fetal membranes, refuting the traditional understanding that fetal membranes are sterile environments. The amount of bacteria present at the rupture site was higher, which the researchers were not surprised to find.

Among PPROM subjects, bacteria counts were highest compared to all other groups at both the rupture site and distant from the rupture site. Among all subjects, bacterial counts were inversely correlated with chorion thinning: the more bacteria present, the thinner the chorion.

It is unknown if this is a causal relationship, but the link between high bacterial presence at the membrane rupture site provides insight into possible mechanisms behind PPROM.

“We still know little about changes occurring within the fetal membrane in the presence of bacteria, but our data suggest the chorion and its thinning may be the battleground for these changes,” Murtha said.

The researchers are now working to identify the bacteria to determine if specific bacteria are found in PPROM patients. By identifying specific bacteria, the researchers can learn more about the role of bacterial presence, which could eventually lead to preventive treatments.

“For instance, if we think that certain bacteria are associated with premature rupturing of the membranes, we can screen for this bacteria early in pregnancy. We then might be able to treat affected women with antibiotics and reduce their risk for PPROM,” Murtha said. “Our research is several steps away from this, but it gives us opportunities to explore potential targeted therapeutic interventions, which we lack in obstetrics.”

Source: Medical Express