February 5th, 2010 
Waiting for natural birth is as effective as inducing labor in pregnant women with intrauterine growth restriction (IUGR), a new study shows.
IUGR, which affects about 10 percent of pregnant women, means that the fetus is much smaller than normal. At birth, these babies are more likely to have low blood sugar, an abnormally high red blood cell count and trouble maintaining their body temperature. These babies are also at increased risk for jaundice, infections and cerebral palsy.
Later in life, people who were restricted-growth babies may be more prone to behavioral disorders, obesity, heart disease, type 2 diabetes and high blood pressure.
Currently, doctors have two main approaches for women with suspected IUGR who are nearing delivery. Some doctors induce labor because they’re concerned about complications, while others await natural delivery.
This study compared the effectiveness of the two strategies among 650 women in The Netherlands. The researchers found that median birth weight was significantly lower among babies born after induced labor (2,420 grams) than among those in the spontaneous delivery group (2,560 grams). Both groups of babies had similar rates of adverse post-delivery outcomes.
The findings show that waiting for birth is equally as effective as inducing labor, the researchers concluded.
Related
- Pot smoking during pregnancy may stunt fetal growth
Women who smoke marijuana during pregnancy may impair their baby’s growth and development in the womb, a new study suggests.
Poor fetal growth and reduced head circumference at birth are linked to an increased risk of problems with thinking, memory and behavior in childhood. Cigarette smoking during pregnancy is known to impair fetal growth, but studies on the potential effects of marijuana have been inconclusive.
For the new study, researchers in the Netherlands followed more than 7,000 pregnant women, 3 percent of whom acknowledged smoking marijuana at least during early pregnancy. They found that babies born to marijuana users tended to weigh less and have smaller heads than other infants.
What’s more, the study found, the longer a woman had used marijuana during pregnancy, the stronger the impact on birth size – suggesting that the drug itself was to blame.
And while most marijuana users in the study also smoked cigarettes, the drug appeared to have effects over and above those of tobacco. In fact, marijuana showed stronger effects on birth size than tobacco, the investigators report in the Journal of the American Academy of Child and Adolescent Psychiatry.
The findings suggest that marijuana use, even restricted to early pregnancy, may have irreversible effects on fetal growth, write the researchers, led by Hannan El Marroun of Erasmus University Medical Center in Rotterdam.
The study included almost 7,500 pregnant women who were surveyed on their use of alcohol, tobacco and drugs, and had ultrasounds to chart fetal growth during the first, second and third trimesters.
Overall, 214 women said they had used marijuana before and during early pregnancy; 81 percent quit after learning they were pregnant, but 41 women continued to smoke marijuana throughout pregnancy.
The researchers found that, on average, marijuana users gave birth to smaller babies, particularly those who had used throughout pregnancy.
Women who had smoked only during early pregnancy had babies who were 156 grams — about 5.5 ounces — lighter than infants born to women who had not used the drug. Women who had continued to smoke past early pregnancy had babies who were 277 grams, or nearly 10 ounces, smaller.
Based on ultrasound, marijuana use only in early pregnancy impaired fetal growth by about 11 grams per week, while use throughout pregnancy slowed fetal growth by roughly 14 grams per week. That compared with a deficit of 4 grams per week with tobacco use, the researchers found.
Similar patterns were seen when the researchers looked at fetal head circumference.
According to El Marroun’s team, mothers’ marijuana use could stunt fetal growth for several reasons. Like tobacco smoking, it may deprive the fetus of oxygen. It is also possible that the byproducts of marijuana directly affect the developing nervous and hormonal systems of the fetus.
Finally, the researchers note, pregnant women who use marijuana may have other factors in their lives – such as a less-than-healthy diet or chronic stress — that could contribute to poor fetal growth.
- Pregnant women confront rise in cancer cases
The number of women diagnosed with breast cancer during pregnancy or soon after giving birth has more than doubled since the 1960s, and researchers say cases will continue to rise as women have children later in life.
The incidence of pregnancy-associated breast cancer rose from 16 in every 100,000 deliveries to 37.4 per 100,000 deliveries between 1963 and 2002, a study has found.
Breast cancer was under-diagnosed in pregnant and breastfeeding women because they and their doctors assumed breast firmness or lumps were a normal part of childbearing, said the chief executive of the National Breast and Ovarian Cancer Centre, Helen Zorbas.
She urged health professionals to assess all women the same way, regardless of pregnancy. ”While most breast changes won’t be cancer, early detection is vital for improving survival.”
Although pregnancy does not cause breast cancer, hormonal changes can accelerate its growth and tumours in pregnant women are often larger and more advanced by the time they are detected than those in women who are not pregnant.
The disease poses a dilemma for patients and their doctors. Pregnant women can have surgery but not radiotherapy. And chemotherapy is allowed only after the first trimester.
The study, published in the journal Obstetrics & Gynecology, reviewed more than 4.1 million deliveries in Sweden between 1963 and 2002.
The Karolinska Institute in Stockholm found the largest proportion of pregnancy-related breast cancers was among 25- to 29-year-olds.
But because the breast cancer risk rose with age and the average age of mothers had increased to about 30, its incidence during pregnancy was likely to increase, the institute said.
- Gum care smart, but it won’t curb preterm delivery
It’s been suggested that gum disease raises the risk of preterm birth in pregnant women and it was thought that getting rid of gum disease may potentially reduce the risk of preterm delivery.
Not so, according to a new study.
“(Our) study,” lead investigator Dr. Steven Offenbacher told Reuters Health, “showed that a standard dental visit to provide periodontal care during pregnancy did not impact pregnancy outcomes, nor did it stop maternal gum problems during pregnancy.”
Offenbacher of the North Carolina Oral Health Institute, Durham and colleagues draw their conclusion from a study involving 1806 pregnant women with periodontal (gum) disease, all of whom were receiving standard obstetric care.
The women were randomized to receive up to four sessions of gum care before the 24th week of pregnancy or after delivery.
According to the investigators, rates of preterm delivery were no different in the two groups. Preterm delivery rates were roughly 13 percent in the women who made the four trips to the dentist and nearly 12 percent in those that did not.
That’s not to say pregnant women should not get their teeth cleaned and treated as needed; they should, the researchers emphasize, noting that treating gum disease during pregnancy is safe.
Worsening of gum disease occurs in about 25 percent of pregnancies. The bacterial infection attacks the teeth-supporting tissues below the gum line. Left untreated, it can lead to tooth loss as well as a host of other problems.
- Mom’s Lifestyle in Early Pregnancy Affects Baby’s Size
The lifestyle habits you bring into pregnancy can have lasting effects on your baby’s health, new research shows.
A Dutch study found that women who smoked, had high blood pressure or low folic acid levels in early pregnancy had babies that were smaller in the first trimester of pregnancy and had a higher risk of complications later.
“Our study demonstrates that several maternal physical characteristics and lifestyle habits, such as smoking and non-use of folic acid supplements, affect first-trimester fetal growth,” said study senior author Dr. Vincent Jaddoe, a pediatric epidemiologist at Erasmus Medical Center in Rotterdam, the Netherlands.
“First-trimester growth restriction is associated with higher risks of adverse birth outcomes and accelerated postnatal growth rates. Thus, the first trimester of pregnancy seems to be a very critical period for fetal growth and development. This is important, since it suggests that the fetus is already affected before pregnant women visit their midwife or obstetrician,” he said.
For the study, published in the Feb. 10 issue of the Journal of the American Medical Association, the researchers followed 1,631 pregnant women from their first trimester through their pregnancies. The growth of their offspring was assessed until the children were 2.
The average age of the mothers was 31, and 71 percent were white. More than half had a higher than high school education. The average body mass index was 23.5, which is normal (over 25 is considered overweight). About one-quarter smoked at the start of the study.
The researchers found that certain factors affected the likelihood that a fetus would have a small crown to rump length (a standard way to measure babies using ultrasound). Babies whose mothers smoked or had higher diastolic blood pressure readings (diastolic is the bottom number in blood pressure) were more likely to be smaller. Women who didn’t use folic acid supplements and those with higher levels of red blood cells also had smaller babies, according to the study.
A small size during the first trimester translated to a higher risk of certain complications later in the pregnancy, such as preterm birth and low birth weight.
Babies that had first-trimester growth restriction had 7.2 percent odds of being born preterm compared to 4 percent for babies who weren’t growth-restricted. Odds of low birth weight were 7.5 percent for growth-restricted babies compared to 3.5 percent for other babies. And, the odds of being born small-for-gestational-age were 10.6 percent for babies who were growth-restricted compared to 4 percent for babies who grew normally during early pregnancy.
Jaddoe and Dr. Gordon Smith, author of an accompanying editorial in the same issue of the journal, believe that when a woman is exposed to poor lifestyle habits in early pregnancy, it may affect development of the placenta, which then affects the fetus’ ability to survive and thrive.
The bottom line for women is that it’s important to go to the doctor before getting pregnant to find out what steps to take to ensure that you’re in the best shape possible before you get pregnant, such as quitting smoking and taking folic acid supplements.
- Delivery mode not altered by pregnancy exercise
Women benefit from light-intensity resistance exercise during pregnancy and this type of physical activity is not apt to alter the way they deliver their baby, study findings hint.
Regular exercise during pregnancy offers overall health benefits, Dr. Ruben Barakat, at Universidad Politecnica de Madrid in Spain, and colleagues note in the American Journal of Obstetrics and Gynecology. However, few investigations have focused on the effects of resistance-type exercise during pregnancy and whether this alters actual childbirth.
Therefore, they compared delivery outcomes after supervised toning and resistance exercises for shoulders, arms, pelvis, and legs, plus toning and mobilization of associated joints, in 80 women during mid to late pregnancy, compared with 80 non-exercising peers.
All of the women previously obtained less than 20 minutes of exercise on 3 or fewer days each week, a low level of exercise the “controls” maintained. By contrast, the exercise group participated in 3 weekly toning and resistance sessions of less than an hour each from pregnancy week 12 or 13 through delivery.
There were no adverse effects noted in the 72 exercising women or the 70 controls that completed the study.
And, in contrast to a previous report of increased vaginal delivery associated with regular exercise during pregnancy, Barakat’s team found no differences in delivery mode between the groups.
Fifty-one exercisers delivered vaginally, another 10 had a delivery requiring instruments, and 11 had Cesarean, compared with 50, 9, and 11, respectively, in the non-exercisers.
The groups also similarly required epidural anesthesia and had similar average durations of complete dilation and delivery, and their newborns were similarly healthy.
“Women in the training group were rather pleased with the exercise training,” Barakat and colleagues note in their report.
This finding, coupled with the exercisers desire to be physically active during future pregnancies, and the lack of exercise complications, supports the overall benefits of supervised, light-intensity exercise during pregnancy, they conclude.
