BEWARE plastics

When expectant mothers are exposed to plastics chemicals called phthalates during the first trimester, their male offspring may have a greater risk of infertility later in life, a new study in the journal Human Reproduction suggests.

Boys exposed to the chemical diethylhexyl phthalate (DEHP) may be born with a significantly shorter anogenital distance than those not exposed to these chemicals. Anogenital distance is the distance between the anus and the genitals. A shorter anogenital distance has been linked to infertility and low sperm count, the researchers explained.

“We saw these changes even though moms’ exposure to DEHP has dropped 50 percent in the past 10 years,” said lead researcher Shanna Swan, a professor of preventive medicine and obstetrics, gynecology and reproductive medicine at the Icahn School of Medicine at Mount Sinai in New York City. “Therefore, we have not found a safe level of phthalate exposure for pregnant women.”

DEHP is used to soften plastics. Most exposure results from eating foods that pick up the chemical during processing, Swan said.

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Tips on exercising during pregnancy

Almost all women can and should be physically active during pregnancy. Aim for at least 30 minutes of moderate-intensity physical activity (one in which you breathe harder but do not overwork or overheat) on most, if not every day of the week.

Do:

• Go for a walk around the block or through a shopping mall with your spouse or a friend.

Join a prenatal yoga, water aerobics, or fitness class, letting the instructor know you are pregnant before beginning.

• Follow an exercise video for pregnant women.

• Sign up for a fitness session for pregnant women at your gym, community center, YMCA or YWCA

• Stand up, stretch, and move at least once an hour if you sit most of the day, as well as during commercials when watching TV.

Don’t:

• Exercise outside during hot weather.

• Use steam rooms, hot tubs and saunas.

• Lie flat on your back after the 20th week of pregnancy while doing yoga.

• Engage in contact sports such as football and boxing.

• Play sports like tennis or basketball that make you jump or change directions quickly.

• Horseback ride, in-line skate, downhill ski or engage in activities that can result in falls.

Talk to your health care provider before starting to exercise, particularly if you have high blood pressure, diabetes, anemia, bleeding, or other disorders, or if you are obese or underweight.

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Good news for millions of women

A study of nearly 100,000 women over a 12-year period has found that common surgical procedures used to diagnose and treat precancerous cervical lesions do not decrease a woman’s chances of becoming pregnant. In fact, researchers found that women who had one of these procedures were actually more likely to become pregnant than women who did not have a procedure.

According to the Centers for Disease Control and Prevention, about 3 million women in the United States will have an unclear or abnormal pap test each year. Many will go on to have a diagnostic colposcopy and biopsy to determine if there are precancerous lesions on the cervix. If these lesions are found, the women may have a LEEP procedure, cryotherapy or another surgical procedure to remove the cells so they don’t progress to cervical cancer.

The new Kaiser Permanente study, published in the journal PLOS ONE, “is great news for the millions of women who have had one of these procedures and still want to have a family,” said Allison Naleway, Ph.D., lead author and senior investigator at the Kaiser Permanente Center for Health Research in Portland, Ore. “There was a fear that these procedures could weaken the cervix and reduce fertility, but our study suggests that this is not the case.”

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Better genetic testing

Fertility clinics like RSCNJ use pre-implantation genetic diagnosis (PGD) to find chromosomal abnormalities or genetic mutations passed on by parents to their in vitro fertilized (IVF) embryos. However, it is not possible to comprehensively scan the embryos genome to detect de novo mutations—those that arise spontaneously in the egg or sperm and are not inherited from either parent. But a study published in Genome Research reports that scientists developed a whole-genome sequencing approach using 5- to 10-cell biopsies from human embryos to detect these mutations.

Researchers sequenced three biopsies from two IVF embryos in attempt to detect de novo mutations. These types of mutations are thought to account for many disorders, including severe intellectual disability, autism, epileptic encephalopathies and others.

Since only 5 to 10 cells can be biopsied from a blastocyst embryo, the DNA is amplified before sequencing. This amplification process introduces thousands of errors that appear to be de novo mutations. Until now, it has been difficult to disentangle the sequencing errors from true de novo mutations. The researchers were able to remove more than 100,000 sequencing errors, reducing the error rate approximately 100-fold over previous studies.

Overall, the researchers detected 82 percent of all de novo changes in the IVF embryos; this is the first demonstration that a large majority of these mutations could be detected in a PGD test.

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Feeling depressed? Call someone

Postpartum depression, a period of emotional distress that typically affects a new mother within four weeks of delivery and can interfere with her ability to care for her newborn, affects up to 16 percent of women who give birth for the first time, according to the American Psychological Association, and up to 41 percent in subsequent pregnancies. Help for these women may be just a phone call away.

New research published in the Journal of Advanced Nursing reveals that telephone-based peer support may help reduce postpartum depression in new mothers. Findings also found that social support from peers may be effective for maternal depression up to two years after delivery.

Researchers recruited 64 mothers with depression up to two years after delivery who were living in New Brunswick, Canada. Peer volunteers who recovered from postnatal depression were trained as peer support and provided an average of nine support calls. At the start of the study all mothers were moderately depressed. After telephone peer support, this dropped to 8.1 percent in the middle of the study but rose to 11.8 percent at the end of the study, suggesting some relapse.

“Postpartum depression is a major health concern not only for the mother, but for the child as well,” says Nicole Letourneau, Ph.D., R.N., FCAHS, professor in the Faculty of Nursing and Cumming School of Medicine (Pediatrics & Psychiatry) at the University of Calgary in Alberta, Canada. “Treatments for postpartum depression are particularly important to prevent adverse effects on the mother-child relationship and limit the potential impact on child development.”

Did you experience postpartum depression? Share your experiences here.

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A way to avoid a C-section?

According to a new study by researchers at Banner Good Samaritan Medical Center in Phoenix, a peanut-shaped exercise ball can help accelerate the labor process for women with an epidural. The research shows women using the peanut ball were half as likely to undergo a cesarean surgery and delivered babies faster than those who did not use the ball. The results are published in the 2015 winter edition of the Journal of Perinatal Education.

Epidurals, along with size and position of the fetus, can prolong labor and are associated with an increased need to perform C-sections. The ability to change a woman’s position during labor is associated with multiple benefits that include decreased labor time, increased circulation, fetal descent, and improved quality of contractions. But women who use an epidural are usually limited in the number of and capacity to try different position changes during labor.

The nurse-led randomized, controlled trial examined differences in groups who used the peanut ball and those who did not, including decreased length of labor and increased rate of vaginal birth. The study findings suggest that labor is enhanced by optimally positioning the fetus to increase the pelvic diameter and allow more room for fetal descent.

Women using the peanut ball had a significantly shorter labor period during the first and second stages. Additionally, 21 percent of women assigned to the control group required cesarean surgery compared to only 10 percent of women who used the peanut ball.

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Understanding of birth defects

Researchers believe they may be closer to understanding why older mothers have an increased risk of giving birth to children with birth defects characterized by abnormal chromosome numbers.

A team from the Albert Einstein College of Medicine of Yeshiva University, New York, has found that the increased risk of conditions such as Down syndrome could be attributable to the genetic process of recombination, in which pairs of chromosomes exchange genetic material with each other before separating.

At present, maternal age is the only factor known to affect the probability of a child being born with Down syndrome, caused by the presence of an extra chromosome. The new study, published in Nature Communications, provides a clue as to the mechanism behind the increase in risk.

Cells normally contain 46 chromosomes arranged into 23 pairs. When sperm and egg cells are formed, a cell divides in a process called meiosis, forming a new sex cell comprised of 23 chromosomes – one from each pair. Before the pairs separate, genetic material is exchanged between the chromosomes. This chromosomal shuffling process is referred to as recombination and helps to ensure that sperm and egg cells have new combinations of genetic traits, protecting the species’ genetic diversity.

The new study has found that the process of recombination may be less regulated in older mothers, potentially leading to abnormal chromosome numbers in sex cells (aneuploidy) or large chromosomal rearrangements.

Down syndrome is the most common birth defect in the US, according to the Centers for Disease Control and Prevention (CDC). To understand more about the potential risk of having a baby with a birth defect, the CDC advises having a discussion with a clinical geneticist or a genetic counselor.

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The dangers of not vaccinating

A new analysis of the whooping cough epidemic in California finds that infants have been hit the hardest, and it calls for increased efforts to vaccinate pregnant women so their babies are protected.

In what state health officials are calling the worst outbreak in 70 years, 9,935 cases of whooping cough (pertussis) were diagnosed between Jan. 1 and Nov. 26, 2014. That translated into 26 cases per 100,000 people, according to a report from the U.S. Centers for Disease Control and Prevention.

“Pertussis incidence is likely to continue to increase in the United States due to the natural cycle of disease and the waning of immunity conferred by currently available vaccines,” says the CDC report. “Strategies to prevent the most severe cases of pertussis, which occur primarily in young infants, should be prioritized.”

Whooping cough is highly contagious, and it is typically spread through coughing and sneezing. The Tdap vaccine protects against this respiratory illness. While infants under the age of 1 year were the most susceptible to both the disease and its serious complications because they were too young to be vaccinated, Hispanic infants were 70 percent more likely to catch whooping cough, the report found. Overall, the disease rate among infants under the age of 1 year was 175 per 100,000 people.

Infants were also much more likely to wind up in the hospital after catching whooping cough. Of the 347 hospitalizations that were reported across the state, 275 were less than 1 year old, including 214 under the age of 4 months.

When the researchers looked more closely at the available data, they found that most of the mothers of the infants who caught whooping cough had not been vaccinated. Recent research has shown that vaccinating women in the third trimester of pregnancy confers protection on the fetus, and health care providers need to encourage pregnant women to get the vaccine, the report authors add.

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Dads have hormones, too

While women’s hormonal fluctuations during pregnancy are well known, new research shows that men experience swings of their own as their partner’s pregnancy progresses.

“There are hormonal changes going on with men as well, and they occur earlier than other studies have suggested,” says lead researcher Robin Edelstein, Ph.D., an associate professor of psychology at the University of Michigan, Ann Arbor. “What we found is there is a gradual decline in men’s testosterone.”

In the study published in the American Journal of Human Biology, Edelstein and her team followed 29 heterosexual couples, all expecting their first child together. They looked at four different times throughout the pregnancy, evaluating salivary testosterone, cortisol, estradiol and progesterone. They looked at the levels of those hormones at weeks 12, 20, 28 and 36.

As expected, levels of all four of the hormones increased in women. (Women’s testosterone declines after birth.) Meanwhile, men showed substantial declines in levels of both testosterone and estradiol but showed no changes in levels of cortisol or progesterone.

Edelstein can’t explain why the hormones change as they do in men, or what effect that might have. One idea, she said, is that lower testosterone might better enable men to be caregivers, as they would tend to be less aggressive. The changes detected, she said, “are very small,” and were not enough to label the men as having low testosterone.

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Understanding endometriosis

March is Endometriosis Awareness Month, which makes it a good time to talk about this little understood but serious medical condition.

Endometriosis is a condition where endometrial tissue that normally lines the inside of the uterus, grows outside the uterus and attaches to other organs in the abdominal cavity, such as the ovaries and fallopian tubes. Endometriosis is a progressive disease that tends to get worse over time and can recur after treatment. Symptoms include painful menstrual periods, abnormal menstrual bleeding, pain during or after sexual intercourse, and infertility. The cause of endometriosis is unknown, though there are a few theories that suggest possible causes.

Based on the stage of endometriosis, your physician will determine the best treatment plan for you, which may include medication, surgery or a combination of both. Dr. Ziegler is an expert in laparoscopic laser surgery, which minimizes adhesion due to a surgical procedure. Laser ablation is associated with a success rate of greater than 70% pain relief and improved fertility.

If you’d like to learn more, call us today for a free phone consultation, or contact us online. 

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