Chapter 1. Prenatal Development

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You and {model.partnerName} have been talking about having children since you started dating. You are feeling a little off this month, and you have missed your period. You've dug out that home pregnancy test you've been hiding away, and you are anxiously waiting for the results...

You and {model.partnerName} have been talking about having children since you started dating. {model.partnerName} is feeling a little off this month, and she has missed her period. She’s dug out that home pregnancy test she’d been hiding away, and you are anxiously waiting for the results...

You have been living together for a while now, but you hadn’t really been planning on having a baby quite yet. But {model.partnerName} is feeling a little off this month, and she has missed her period. Sometime these things happen! She’s dug out that home pregnancy test she’d been hiding away, and you are anxiously waiting for the results...

You have been married for a while now, but you hadn’t really been planning on having a baby quite yet. But {model.partnerName} is feeling a little off this month, and she has missed her period. Sometime these things happen! She’s dug out that home pregnancy test she’d been hiding away, and you are anxiously waiting for the results...

You have been living together for a while now, but you hadn’t really been planning on having a baby quite yet. But you're feeling a little off this month, and you've missed your period. Sometime these things happen! You've dug out that home pregnancy test you've been hiding away, and you are anxiously waiting for the results...

You have been married for a while now, but you hadn’t really been planning on having a baby quite yet. But you're feeling a little off this month, and you've missed your period. Sometime these things happen! You've dug out that home pregnancy test you've been hiding away, and you are anxiously waiting for the results...

Remember all the time you’ve spent trying NOT to get pregnant? Apparently it’s harder than you thought. No matter how frequently you and {model.partnerName} try, you just couldn’t get pregnant.

It has taken {model.randnum2to5} cycles of fertility treatments but you get the distinct feeling that you are not alone these days. You’re completely exhausted. Are you ready to be a parent? You've dug out that home pregnancy test you'd been hiding away, and you are anxiously waiting for the results...

Remember all the time you’ve spent trying NOT to get pregnant? Apparently it’s harder than you thought. No matter how frequently you and {model.partnerName} try, you just couldn’t get pregnant.

It has taken {model.randnum2to5} cycles of fertility treatments, but you get the distinct feeling that {model.partnerName} is not alone these days. She's completely exhausted. Are you ready to be a parent? She's dug out that home pregnancy test she'd been hiding away, and you are anxiously waiting for the results...

Remember all the time you’ve spent trying NOT to get pregnant? Apparently it’s harder than you thought. No matter how frequently you and {model.partnerName} try, you just couldn’t get pregnant.

You have elected to use Assisted Reproductive Technology (ART) to become pregnant. It has taken a few cycles of fertility treatments, but you get the distinct feeling that {model.partnerName} is not alone these days. She's completely exhausted. Are you ready to be a parent? She's dug out that home pregnancy test she'd been hiding away, and you are anxiously waiting for the results...

Remember all the time you’ve spent trying NOT to get pregnant? Apparently it’s harder than you thought. No matter how frequently you and {model.partnerName} try, you just couldn’t get pregnant.

It has taken {model.randnum2to5} cycles of fertility treatments, but you get the distinct feeling that you are not alone these days. You're completely exhausted. Are you ready to be a parent? You've dug out that home pregnancy test you'd been hiding away, and you are anxiously waiting for the results...

Remember all the time you’ve spent trying NOT to get pregnant? Apparently it’s harder than you thought. No matter how frequently you and {model.partnerName} try, you just couldn’t get pregnant.

You have elected to use Assisted Reproductive Technology (ART) to become pregnant. It has taken a few cycles of fertility treatments, but you get the distinct feeling that you are not alone these days. You're completely exhausted. Are you ready to be a parent? You've dug out that home pregnancy test you'd been hiding away, and you are anxiously waiting for the results...

You hadn’t really been planning on having a baby quite yet. But you’ve been feeling a little off this month, and you missed your period. Sometime these things happen! You’ve dug out that home pregnancy test you’d been hiding away, and you are anxiously waiting for the results...

After careful consideration you have decided to become a solo mom! You have elected to use Assisted Reproductive Technology (ART) to become pregnant. It has taken a few cycles of the fertility treatments, but you get the distinct feeling that you are not alone these days. You’re completely exhausted. Are you ready to be a parent? You’ve dug out that home pregnancy test you’d been hiding away, and you are anxiously waiting for the results...

After careful consideration you have decided to become a solo mom! You have elected to use Assisted Reproductive Technology (ART) to become pregnant. It has taken a few cycles of the fertility treatments, but you get the distinct feeling that you are not alone these days. You’re completely exhausted. Are you ready to be a parent? You’ve dug out that home pregnancy test you’d been hiding away, and you are anxiously waiting for the results...

After careful consideration you have decided to become a solo dad! You’ve chosen a surrogate, {model.surrogateName}, who will carry the child who was conceived with your sperm through the use of Assisted Reproductive Technology (ART). It has taken a few cycles of the fertility treatments, but this morning you got this photo from {model.surrogateName} on your phone.

You and {model.partnerName} have been talking about having children since you started dating. You and {model.partnerName} have decided you are going to carry the baby. You have elected to use Assisted Reproductive Technology (ART) to become pregnant. It has taken a few cycles of the fertility treatments, but you get the distinct feeling that you are not alone these days. You’re completely exhausted. Are you ready to be a parent? You’ve dug out that home pregnancy test you’d been hiding away, and you are anxiously waiting for the results...

You and {model.partnerName} have been talking about having children since you started dating. You and {model.partnerName} have decided that for this first child, you are going to be the biological father. You’ve chosen a surrogate, {model.surrogateName}, who will carry the child who was conceived with your sperm and an egg from someone biologically similar to your partner. It has taken a few cycles, but this morning you got this photo from {model.surrogateName} on your phone.

Explain

More than four million babies are born in the United States every year, and you’re one of many expecting parents! Right now, your little blastocyst is just a tiny collection of cells that have implanted into the wall of the mother’s uterus. Click on 'Look Inside' to find out exactly what is going on with your little blastocyst. Click on 'Learn More' to see a video about conception, or to read an article from Scientific American about in vitro fertilization. Answer the quiz that follows each 'Learn More' item and earn tokens to use in the Store.

Look Inside

During ovulation, an ovum travels down Mom’s fallopian tube. If a sperm is able to penetrate it, fertilization occurs, forming a one-celled zygote. If more than one ovum is released, both may be fertilized, resulting in two zygotes—twins! Each sperm and each ovum carries 23 chromosomes. They unite to create a zygote with 46 chromosomes.

The one-celled zygote begins to divide rapidly as it travels down the fallopian tube, forming a hollow ball of cells called a blastocyst. When it reaches the uterus, the blastocyst implants itself onto the uterine wall. Only after implantation will a home pregnancy test begin to show that a woman is pregnant, as this is when her levels of hCG begin to change.

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Now that you’re pregnant, it seems like everyone has an opinion about what you should or should not do. Is it safe to enjoy your morning {model.MorningDrink}, or will it hurt the baby? What about a {model.EveningDrink}? Is it safe to eat sushi? Lunch meat? Can you get your nails done?

You want to take good care of this baby, but there are so many rules and so much that you can’t control! What’s fact, and what’s fiction?

Now that {model.partnerName} is pregnant, it seems like everyone has an opinion about what she should or should not do. Is it safe for {model.partnerHimHer} to enjoy her morning {model.MorningDrink}, or will it hurt the baby? What about a {model.EveningDrink}? Is it safe to eat sushi? Lunch meat? Can she get her nails done?

You want to help {model.partnerName} take good care of this baby, but there are so many rules and so much that you can’t control! What’s FACT, and what’s FICTION?

Now that your surrogate, {model.surrogateName}, is pregnant, it seems like everyone has an opinion about what she should or should not do. Is it safe for her to enjoy her morning {model.MorningDrink}, or will it hurt the baby? What about a {model.EveningDrink}? Is it safe to eat sushi? Lunch meat? Can she get her nails done? You want to help {model.surrogateName} take good care of this baby, but there are so many rules! What’s FACT, and what’s FICTION?

Look Inside

The embryonic stage begins about 14 days after conception. This critical period is the most vulnerable of all prenatal stages. About 20% of all embryos are miscarried, most often due to chromosomal abnormalities. The neural tube, which becomes the brain and spinal cord, develops 22 days after conception.

At 4 weeks past conception, the developing embryo is about 1/64th of an inch from one end to the other and its head has started to take shape. At five weeks, the embryo has grown twice the size it was at 4 weeks. Its primitive heart, which has been beating for a week now, is visible. Some facial features such as the eyes, ears, nose, mouth, and the nubs that will become the arms and legs are visible.

Six weeks after conception, the legs and arms begin to emerge from buds. A few days later, webbed fingers and toes start to form, and at 52-54 days after conception, tiny fingers and toes separate.

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She has agreed to let you come along.

You’re going to see a {model.PN2_Provider}, {model.PN2_providerName}.

Because you had fertility treatments, you’re currently seeing a specialist in higher risk pregnancies, {model.PN2_providerName}.

In the language of medical doctors, even though you don’t think of {model.yourself_partnername} as being an older parent, your doctors do and because of {model.your_her} age, {model.you_have_she_has} been assigned to a specialist in higher risk pregnancies, {model.PN2_providerName}.

You have a lot to talk about, and {model.you_pname_surrogate} will need a full exam to check {model.your_her} blood pressure and test for diseases like HIV. We want to keep {model.you_her} and the baby healthy throughout {model.your_her} pregnancy. Click on 'Learn More' for additional information on the do's-and-don’ts of a healthy pregnancy. One exciting part of the visit will be a chance to hear your baby’s heartbeat!

But one of the main things your {model.PN2_Provider} will be interested in is how many healthy choices {model.you_will_partnername_will} be making during the pregnancy. Remember that the 'Explain' button can help you make some more research-informed choices. After you’re done, {model.PN2_shortproviderName} will give you a report card on how healthy your choices are.

But one of the things your {model.PN2_Provider} will be interested in is how many healthy choices {model.you_will_partnername_will} be making about your health during the pregnancy. Remember that the 'Explain' button can help you make some more research-informed choices. After you’re done, {model.PN2_shortproviderName} will give you a report card on how healthy your choices are.

One of the things your doctor was interested in was how many healthy choices your surrogate has made about her health. She informed you both that she doesn’t drink or smoke, and she eats a healthy diet. The doctor then decided since you will ultimately raise this child that you should answer the same questions. The 'Explain' button can help you learn some more research-based information about a woman’s lifestyle choices during pregnancy. After you’re done, {model.PN2_shortproviderName} will give you a report card on how healthy your choices are.

One of the things your doctor was interested in was how many healthy choices your surrogate has made about her health. She informed everyone that she doesn’t drink or smoke, and she eats a healthy diet. The doctor then decided since you and {model.partnerName} will ultimately raise this child that you should answer the same questions. The 'Explain' button can help you learn some more research-based information about a woman’s lifestyle choices during pregnancy. After you’re done, {model.PN2_shortproviderName} will give you a report card on how healthy your choices are.

Look Inside

Figure Caption

By 7 weeks after conception, the embryo is just under half an inch long. Eyes, nose, the digestive system, and even the first stage of toe formation can be seen.

At 8 weeks after conception, the embryo has all the basic organs and body parts of a human, including elbows, knees, nostrils, toes and the indifferent gonad. Baby’s head is getting rounder and the features of the face are formed.

Explain

Many studies have linked alcohol use during pregnancy to physical and neurological problems in children that can eventually become fetal alcohol syndrome or a constellation of problems known as fetal alcohol effects. These disorders affect as many as 1% of children born within the United States. Fetal alcohol syndrome can result in mental retardation and any number of neurological issues from trouble with memory to hyperactivity. Research seems to indicate that the severity of the alcohol’s effect on the growing embryo or fetus depends on the timing of exposure during the pregnancy, how much alcohol was consumed, and the genetic vulnerability of the fetus. In the United States, experts advise pregnant women never to drink during pregnancy to avoid any risk to the growing fetus.

Smoking during pregnancy reduces the amount of oxygen the developing fetus gets—and exposes it to a variety of toxins from the cigarette smoke. Babies born to mothers who smoke are more likely to be born premature and at lower weights than babies born to non-smokers. They can also be at higher risk for some birth defects like cleft palate. A pregnant mother’s exposure to second-hand-smoke during pregnancy can lead to low birth weight, and second hand smoke in the environment after the baby is born can lead to a greater chance of SIDS, or Sudden Infant Death Syndrome, asthma, or breathing problems in infancy.

Eating healthy will help your growing baby get the nutrition he or she needs—and help mom stay healthy. Experts advise gaining about 25-35 pounds during the pregnancy—more or less depending on your pre-pregnancy weight. {model.pn3HighBMI} Typically, expecting women are advised to have a diet that is high in fiber, iron, calcium and protein—in addition to the prenatal vitamins they’re taking every day. {model.pn3LowSES}

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You thought {model.you_were_partnername_was} in the clear now that the morning sickness is over, but {model.you_have_she_has} started to feel the extra weight of the baby on {model.your_her} back and {model.you_she} can't find any position to get comfortable to sleep at night.

{model.surrogateName} has let you know that she’s still feeling terrific at {model.gestational_age_units}.

You’re now at {model.PN2_shortproviderName}'s office for your second trimester ultrasound. This is a chance to really have a good look at your growing baby, which is really starting to look like a baby. And you’ll also get to find out, if you want, whether you’re having a little boy or a little girl.

Explain

After covering the mother’s belly with ultrasound gel, the doctor, midwife or ultrasound technician uses a handheld transducer to generate sound waves that will produce a picture of the fetus. During this procedure, the technician will measure the baby—including its head circumference, the length of its leg bones, and size of its abdomen—to see whether it is growing as it should. Sometimes, due to genetics or environmental factors—like whether the mother is smoking or not getting enough nutrition—some babies are small for gestational age or too big for their gestational age, both of which could be risks for preterm birth.

Look Inside

Figure Caption

BABY: At 19 weeks, your baby measures about 5.2 to 6 inches from crown to rump and weighs about 7 ounces. Skin is developing and transparent, appearing red because blood vessels are visible through it. A creamy white coating, called vernix caseosa, begins to develop. This "cheesy" substance, thought to protect baby's skin from long exposure to the amniotic fluid, is shed just before birth.

Twenty weeks after conception, your baby is covered with lanugo, fine downy hair that helps to keep the vernix caseosa in place. This hair protects your baby and is usually shed at the end of the baby's first week of life. At 21 weeks, hair is beginning to grow on your baby's head.

Twenty-two weeks after conception, the baby’s muscles are getting stronger and the eyelids and eyebrows are developed. Your baby measures about 7.6 inches and weighs about 12.3 ounces. Your baby's acrobatics are pretty constant, and since he or she responds to sound, rhythm, and melody, you can try singing and talking to him or her. It is also the age of viability—a preterm newborn of 22 weeks can survive with advanced medical care.

MOM: At weeks 19-20, Mom may be feeling some mid-pregnancy aches and pains—lower abdominal achiness, dizziness, heartburn, constipation, leg cramps, mild swelling of ankles and feet, and backaches. Dilated blood vessels might cause tiny, temporary red marks on the face, shoulders, and arms.

The risk of bladder infections increases because the smooth muscles in the urinary tract relax. Mom’s breathing will become deeper and she may perspire more than usual from a more active thyroid gland. Mom might be feeling the baby move, called quickening, since the baby is developing muscles and exercising them.

By 22 weeks, Mom’s uterus is continuing to grow, but she’s probably feeling pretty good—no more morning sickness, and her abdomen isn't so large that it's getting in the way very much.

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Your surrogate, {model.surrogateName}, gave you a call in the middle of the night saying that she felt that the baby was coming. You and {model.partnerName} rushed to meet her at the hospital.

Your surrogate, {model.surrogateName}, gave you a call in the middle of the night saying that she felt that the baby was coming. You rushed to meet her at the hospital.

You haven’t been sleeping through the night for some time, but when you woke up at 3 o’clock this morning, you felt like you’d landed in a puddle. That dream you’d been having about getting to lounge in a hot tub wasn’t real. Your water broke! The amniotic sac that surrounds the growing fetus begins to leak or breaks before, or just as, labor begins. While this may be the dramatic start to labor many women worry about—and the stuff of movies—fewer than 15 percent of births begin this way.

In the middle of the night, when {model.partnerName} calls out to you that her water just broke, you can hardly believe it’s finally time. The amniotic sac that surrounds the growing fetus begins to leak or breaks before, or just as, labor begins. While this may be the dramatic start to labor many women worry about—and the stuff of movies—fewer than 15 percent of births begin this way. She is feeling a little nervous, so you give her a big hug and tell her how much you love her. You remind her that it will take a little bit before the actual hard labor will begin—it could even be days, so you help her take ten deep breaths to calm down. Next you both get on the phone to your {model.PN2_Provider}’s office and they recommend going to the hospital. As you settle in and wait, you are so nervous and excited!

{model.partnerName} was amazing—{model.partnerHeShe} stayed up all night with you and was with you every step of the way.

The whole thing was hard on {model.partnerName}, too—{model.partnerHeShe} was so worried about how things were going to turn out.

Now that it is over, all the stress is starting to be forgotten. Your little {model.baby_boy_girl} is in your arms looking up at you, lying on your chest for a little skin-to-skin contact.

Now that it is over, all the stress is starting to be forgotten. Your little {model.baby_boy_girl} is in {model.your_partners} arms looking up at you, lying on {model.your_partners} chest for a little skin-to-skin contact.

Explain

In the United States, about 30% of babies end up being born by cesarean section. A few are scheduled cesareans for what are called “convenience” reasons—which may not be as “convenient” as they may sound—perhaps because a partner is going to be deployed on a certain date, because the couple has only a specific amount of family leave that has to be used at a certain time—or perhaps to coincide with a special date that is important to the family. The rest of the babies are born vaginally after what is, for first time mothers, a period of active labor that can last a few hours—following a period of early labor contractions that may have lasted days, or more like 10 to 14 hours, depending on when you start counting. Typically, the “pushing” phase—as the baby passes through the birth canal—is relatively short, lasting only about 30 minutes (though sometimes as long as an hour or two!). For second time moms and lucky first time mothers, the whole process can be even faster.

Many women choose to take medication to manage pain during labor. A popular choice is a regional anesthetic often called an epidural, and spinal anesthesia. These can only be administered by an anesthesiologist in a hospital. Different types of epidural or spinal anesthesia can allow the mother to “feel” her contractions. Some even allow her to walk around, so called “walking epidural.” The downside of an epidural is that it can be uncomfortable getting it started—and some studies indicate that having an epidural may make labor longer.

Look Inside

BABY: At birth, much of the baby's skeleton is cartilage which will gradually turn to bone, a process called ossification.

Girls develop more quickly than boys throughout the prenatal period, infancy and childhood. At birth, girls' skeletons are between 4 and 6 weeks more mature as measured by degree of ossification.

MOM: Most mothers lose about 12 pounds immediately after birth: the weight of the baby, placenta, amniotic fluid, and some water content of the tissues and blood.

Within a week, the new mother loses an additional 4 pounds of water weight. Still, it is common for women to weigh somewhat more than their average weight before pregnancy.

When a baby is born, the uterus weighs 2 pounds—15 times heavier than it was before pregnancy. Within 4 to 6 weeks, the uterus shrinks to its original size and weight.

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Baby Avatar will load here.

You were scared when you saw that {model.babyName}’s first APGAR score was only 6. {model.baby_He_She_cap} has been taken to the special care nursery for some extra help support with breathing. They think this may have something to do with the fact that your baby was low birth weight (or LBW) at birth.

All is well! {model.babyName}’s APGAR score was {model.apgar_total1} at birth—which is really perfect since almost no babies score a perfect 10. And by 5 minutes, {model.baby_he_she} scored {model.apgar_total5}. Congratulations!

Explain

The APGAR test was developed by American anesthesiologist Virginia Apgar and is designed to measure whether a baby needs immediate medical intervention. At one minute after birth, the test is not usually very predictive of the future health of the baby, as it can reflect medication taken by the mother during labor and how the baby was born, and not the actual health of the baby. Between birth and the five minute interval, many babies’ health improves, as they start to breathe better. But at 5 minutes, a low score on the APGAR test—particularly an extremely low score below 4—can be predictive of whether a baby may have some long term challenges.

Look Inside

The newborn’s skull is composed of seven flat bones that are relatively soft and elastic at birth. These bones are flexible to accommodate the brain as it grows. The separations between the bones are called “fontanels,” also known as "soft spots."

In the brain, myelin—fatty substance that covers brain cell axons—makes the transmission of neural impulses faster and more precise. Very few of the brain’s neurons are myelinated at birth, but myelination accelerates soon after.

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Explain

Babies are born with some basic reflexes—some of which don’t seem to have a practical purpose (like the Babinski reflex, for example) and may just be a vestige of some evolutionary past. Others, like the sucking and rooting reflex, make sure that a baby, who can’t control its own head, can still get nourishment. So your baby may look helpless, but it has a set of survival skills. This is just an introductory list of reflexes—there are even more—like the swimming reflex, where a baby placed in water seems to display basic swimming movements.

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Baby Avatar will load here.

Explain

In the long run, breastfed babies tend to have less asthma, diabetes, intestinal diseases and even colds than formula-fed babies. They’re sick less frequently. And some studies even indicate that breastfed babies have higher cognitive development than formula-fed babies. Breastfeeding can be good for moms too, as it decreases the rate of diabetes, breast, and ovarian cancers. In the United States, the rate of breastfeeding at birth has been rising in recent years. This is due, in part, to an emphasis on rooming in—having newborns stay with their mothers rather than being taken care of in a hospital nursery—and skin-to-skin contact right after birth.

Rates of breastfeeding have been going up in the United States in recent years—as hospitals work hard to urge all mothers to try breastfeeding right after birth. Around the world, public health officials encourage exclusive early breastfeeding to keep babies from exposure to water-borne disease and reduce infant mortality. There is extensive regional and national variation in success of these efforts.

Look Inside

MOM: Within 48 to 72 hours after birth, a mother's breasts may become tender and firm. This is caused by an increase in the blood supply to the breasts, a change that helps produce a greater supply of milk.

A high-calorie milk called colostrum is produced in small quantities at birth and contains a high proportion of protein and antibodies. A mother's milk will begin to shift from colostrum to mature milk after three days.

Milk begins to flow ("let down") when the nipple and areola are stimulated, sending a signal to the pituitary gland, which releases the hormones prolactin and oxytocin. Together, these two hormones bring about physiological change that cause milk to flow from the breast.

Each nipple has between 15 and 20 openings for the flow of milk. The small bumps on the areola of a woman's breast are called Montgomery glands. They produce oils and enzymes that lubricate the nipple and keep it germ free during breastfeeding.

Newborns will want to feed every 2 to 3 hours for the first 2 to 4 weeks (i.e., 8 to 12 times a day). A mother's breasts will automatically adjust the supply of milk based on the amount the baby consumes each day.

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Video: The Prenatal Period: Conception to Birth

This video depicts prenatal brain development, including light animation of drawings and week-by-week depictions of brain development.

Conception

Token quiz:

Article: Conception

Whether or not you are a parent in the real world, you may not really know how life begins. Since you are going to be a parent in Developing Lives, let’s review the basics:

A woman typically ovulates or releases an ovum into one of her fallopian tubes in the middle of her menstrual cycle.

A male releases more than 40 million sperm cells each time he ejaculates.

Both sperm and ovum are referred to as reproductive cells, or gametes. These reproductive cells contain genes from the 23 chromosomes of each parent. Conception occurs when a man’s sperm combines with a woman’s ovum—typically in the woman’s fallopian tube, although in certain kinds of infertility treatments, it can occur outside of a woman’s body.

The sex of your soon-to-be-child is determined by the 23rd chromosome of the sperm that combines with the ovum. The 23rd chromosome from the ovum is always an X. The 23rd chromosome of sperm can be an X or a Y. If it is an X sperm cell, it’s a girl! If it is a Y sperm cell, it’s a boy!

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Scientific American Article: Better Baby-Making: Picking the Healthiest Embryo for IVF

Australian team uses genetic markers to identify the most viable embryos to eliminate risk of multiple pregnancies.

May 14, 2008

By Nikhil Swaminathan

There's new hope for the more than 7 million American women (and their partners) who long for a child and are plagued by infertility. Australian researchers have developed a method for screening embryos created through in vitro fertilization (IVF) to select the ones that have the best shot of developing into healthy babies.


The process, reported in Human Reproduction, utilizes DNA fingerprinting (an assessment of active genes in a given cell) to boost the success rate of IVF and lower the chances of risky multiple births by identifying which of several five-day-old embryos are most likely to result in pregnancy The new method, which will replace unproved alternatives such as choosing embryos based on their shape, is likely to up the success of women becoming pregnant and lower their chances of having multiple births.


In IVF, eggs from a woman are fertilized by male sperm in a Petri dish and allowed to grow for five days until they become blastocysts consisting of about 50 to 65 cells. Because there are currently no precise methods for selecting viable embryos, couples typically choose to implant multiple blastocysts to enhance their chances of conceiving, which may also result in multiple pregnancies.

According to the study, about 42 percent of women who go through in vitro fertilization today become pregnant; of those, 32 percent give birth to twins, triplets or even more babies, according to the Centers for Prevention and Disease Control.

A woman carrying multiple embryos has a greater risk of complications during pregnancy and delivery, which is more likely than a single birth to be by C-section. Their infants are more likely to be low weight or have birth defects.

"What we want this technology to achieve is confidence to switch to single embryo transfers instead of the practice of transferring multiple embryos without [an accompanying] reduction in pregnancy rate," study co-authors Gayle Jones and David Cram, senior research scientists in immunology and stem cells at Monash University in Australia, wrote in an e-mail. They stress that increasing success rates while also reducing the number of multiple pregnancies is a major hurdle in the IVF field.

In this study, the researchers removed eight to 20 cells from the trophectoderm (outer layer) of the blastocysts of 48 women undergoing IVF. The trophectoderm is a cluster of cells that matures into the placenta (the protective sack around an embryo that supplies it with nutrients from its mom and removes its waste). The scientists then scanned the samples using microarray technology, which cuts genetic material into segments to provide a snapshot of which genes are active and which are asleep inside the cells. Twenty-five of the study subjects became pregnant after their embryos were implanted and gave birth to 37 babies; nearly half of them had more than one child.


After the babies were delivered, researchers took blood from their umbilical cords and swabbed their cheeks for DNA samples to compare with those taken from blastocysts at implantation. They found that hundreds of genes active in the newborns were also active in the blastocysts from embryos that survived but not in those that failed. Some of those matching genes are vital for embryo survival, including several responsible for cell communication, cellular energy and adhesion to the lining of the uterus.

"We would like to get down to a panel of about 200 [genes] that we would prospectively test to see which are the most predictive of outcome," Jones and Cram said. "We would then ideally like to have a panel of five to 10 genes that could be tested" quickly in an IVF lab to finger the embryo with the best chance of ensuring a successful pregnancy.


James Adjaye, a biologist at the Max Planck Institute for Molecular Genetics in Berlin, Germany, says that further work needs to be done before scientists can be sure that the genes found in the new work actually indicate that an embryo will develop into a baby. "Once this has been achieved," he explains, "we will be seeing a new era of pre-implantation genetic diagnosis aimed at, identifying disease-free blastocysts, identifying developmentally competent blastocysts among a cohort developing in vitro and achieving single blastocyst transfer in order to avoid multiple births."

Token quiz:

Fact or Fiction Quiz

More information about the do’s and don’ts of pregnancy.

Drinking a few beers on the weekends won’t harm my growing fetus. Fact or Fiction?
Fiction. Many studies have linked alcohol use during pregnancy to physical and neurological problems in children, which can eventually become fetal alcohol syndrome or a constellation of problems known as fetal alcohol effects. These disorders effect as many as 1% of children born within the United States. Fetal alcohol syndrome can result in mental retardation and any number of neurological issues from trouble with memory to hyperactivity. Research seems to indicate that the severity of the alcohol’s effect on the growing embryo or fetus depends on the timing of exposure during the pregnancy, how much alcohol was consumed, and the genetic vulnerability of the fetus. In the United States, experts advise pregnant women never to drink during pregnancy to avoid any risk to the growing fetus.

Some kinds of sushi can be good for the developing fetus. Fact or Fiction?
Fact. This is a trick question. You will want to avoid uncooked fish during your pregnancy. But there is some sushi—like a California roll—that is actually cooked. Eating any raw or undercooked foods is hazardous during pregnancy because they may harbor bacteria that are usually killed off during cooking. And during pregnancy, a woman’s body is particularly susceptible to bacteria. Also, certain types of fish used in sushi should also be avoided due to high levels of mercury. Mercury consumed during pregnancy has been linked to serious neurological problems and brain damage. Certain fish like tuna, mackerel, and swordfish, have higher levels of mercury and other toxins. However, mothers are advised to eat fish that is low in heavy metals or mercury at least three times a week during pregnancy—these are fish like flounder and lobster or other shellfish—since consumption of fish during pregnancy has been tied to higher intelligence in children.

A pregnant woman should eat her steaks rare in order to increase her iron intake. Fact or Fiction?
Fiction. Super rare beef should be avoided because it could be contaminated with coliform bacteria, salmonella, and toxoplasmosis. You need to cook all your meat thoroughly while you are pregnant to kill off any bacteria that could cause serious health issues for a pregnant mother or the growing fetus.

Deli meats can be contaminated and can lead to infection. Fact or Fiction?
Fact. Deli meats, along with some hot dogs and smoked fish, can be contaminated with listeria, which is a type of bacteria that can grow even in cold temperatures. Listeria is able to cross the placenta and may infect the baby and cause miscarriage or a serious infection. Pregnant women who eat deli meats or hot dogs should reheat them until until steaming. After handling these meats, she should wash her hands thoroughly.

Not washing fresh vegetables can pass contaminants to a fetus. Fact or Fiction?
Fact. It is essential to make sure vegetables are washed to avoid potential exposure to bacteria that may be present in the ground where they were grown—this even applies to those pricey organic or farmers’ market veggies. Bacteria like toxoplasmosis may contaminate the soil where the vegetables were grown and can cause stillbirth, neurological damage, and other devastating disabilities to a fetus.

Some soft cheese such as brie, feta, and queso blanco can be hazardous. Fact or Fiction?
Fact. Some soft cheeses can be contaminated with listeria, which is a type of bacteria that can grow even in cold temperatures. Listeria is able to cross the placenta and may infect the fetus leading, to miscarriage or serious infection. Pregnant women should avoid soft cheeses like brie, camembert, feta, gorgonzola, roquefort, queso blanco, and queso fresco, unless the packaging says that they are made from pasteurized milk. Soft cheeses made in the United States with pasteurized milk are safe to eat. And in fact, they can be a great source of calcium during pregnancy.

Changing a cat’s litter box can be dangerous to a pregnant woman. Fact or Fiction?
Fact. This is a good time to pass this chore on to someone else! While there is only a slight chance your cat carries toxoplasmosis, a pregnant woman should recruit someone else to change the cat’s litter box. If that isn’t possible, wear gloves and wash your hands thoroughly afterward. Toxoplasmosis is a disease that can cause birth defects. Outdoor cats may get it if they eat animals that carried the disease.

It is safe for a pregnant mother to drink herbal, caffeine-free tea? Fact or Fiction?
Unclear. Herbal teas may be caffeine-free, but their safety for pregnant mothers is unclear. There are no human studies on the safety of products containing herbs, including supplements such as Echinacea and St. John’s wort, during pregnancy. The FDA also does not monitor the quality of herbal teas or dietary supplements. Check the label and the herbs with your medical provider before you drink a lot of it. Some teas like peppermint or chamomile seem to be safe during pregnancy—but others may have teratogenic or even labor-inducing qualities if consumed in large quantities.

It is safe for a pregnant mother to paint the baby’s room. Fact or Fiction?
Fiction. If a pregnant mother must paint, she should use latex paint and choose a paint that is low in Volatile Organic Compounds, or VOCs. Most latex paint doesn't contain solvents and is considered safe to use and be around during pregnancy as long as the area is well ventilated. Oil-based paint contains solvents and requires turpentine or mineral spirits for cleanup. Studies have shown that exposure to solvents may increase the risk of miscarriage, and heavy or long-term solvent exposure may raise the risk of birth defects and learning problems, so using oil-based paint or being around the fumes during pregnancy should be avoided.

Lead-based paint, commonly used before the 1970s, is no longer sold but is of particular concern because it was used in so many buildings. Scraping or sanding any kind of old paint, or being in a place while scraping or sanding is taking place, is definitely not advisable. The pregnant mother could inhale lead dust, which can be harmful to both her and the baby. Leave removal of lead-based paint to others and make sure the pregnant woman is out of the house. After the paint has been removed and the dust has been cleaned up, it's safe for her to be in that room again.

A pregnant woman can relax or color her hair without any concerns about the effect on her fetus. Fact or Fiction?
Fiction. You need to read the fine print and try to get your hair done as safely as you can. Hair straighteners, relaxers, or dyes that have high levels of chemicals like lye, ammonia, or formaldehyde and are going to be on your scalp for a long time are probably not the safest choice in pregnancy. In addition, breathing in the fumes from these products is probably not ideal for your fetus. Many health care providers err on the side of caution and recommend that pregnant women not have harsh hair treatments during the first trimester. But some believe that, if the chemicals are only on your scalp for a short period of time and they are used in a well ventilated room you and your fetus will be fine. In any case, check the labeling and consider getting your hair done less frequently during pregnancy. Or consider transitioning to going natural while you are pregnant.

It isn’t a good idea to smoke cigarettes, but marijuana won’t hurt my fetus. Fact or Fiction?
Fiction. Just like smoking cigarettes, when women smoke marijuana she reduces the amount of oxygen the developing fetus gets—and exposes it to a variety of toxins from the smoke. Babies born to mothers who smoke marijuana tend to be born prematurely and at lower weights than babies born to mothers who don’t smoke marijuana. And some studies seem to indicate that babies born to mothers who smoked marijuana during pregnancy are at higher risk for some behavioral problems later in childhood. In addition, since in most states marijuana is still unregulated, you don't know exactly what you are smoking when you smoke marijuana—you may be inadvertently exposing your fetus to something more toxic than pot.

Some birth defects are caused by hazards in the environment. Fact or Fiction?
Fact. Environmental hazards can be potent teratogens. Things like polluted water (which can happen when women in rural areas drink from wells that are contaminated with minerals like arsenic or when pollutants or chemicals get into public water supplies), chemicals used in some kinds of factory or industrial work, or the fertilizers, pesticides, and herbicides used on farms, can all harm a developing fetus. The effect on the fetus depends on when the fetus is exposed: Generally, exposure earlier in the pregnancy causes more potent physical damage, including potential miscarriage, while exposure later in pregnancy can cause more effects on the fetus’ brain. Effects can also depend on the type of chemical and amount of exposure.

Most doctors recommend avoiding most recreational and prescription drugs during pregnancy. Fact or Fiction?
Fact. Most doctors recommend completely avoiding recreational drugs—particularly alcohol, which has a high potential for harming the developing fetus—and limiting prescription and over-the-counter medications to when they are absolutely necessary. Prescription and common over-the-counter medications (like cold medicines), are mostly evaluated by the drug manufacturers and the Food and Drug Administration and categorized as to degrees of safety in pregnancy. Some, like Tylenol, seem to be basically safe to use while you are pregnant. But others, like ibuprofen, are not. The rule of thumb is typically that you should use the safest—or the least amount—of medication you can while you are pregnant.

Almost 15 percent of pregnant women take prescription anti-depressant medication. Fact or Fiction?
Fact. Around 15 percent of pregnant women take prescription anti-depressants during their pregnancies. Research is ongoing as to whether these drugs have any effect on the growing fetuses. Some early studies seem to indicate that the anti-depressant medications could cause serious birth defects. Some medical providers believe that the risks of taking women off these medications may be worse than any potential for birth defects—because depressed women may be a danger to themselves or their fetuses. Women who feel depressed should talk to providers about alternatives to prescription drugs for treatment of their depression—including specific kinds of therapy and regular exercise. But some women may decide that the benefits of anti-depressant medications are worth any potential risk to their future children.

Many kinds of bread are now fortified with folic acid, a mineral that protects against some birth defects, including spina bifida. Fact or Fiction?
Fact. In the United States and many countries around the world, many products that contain flour are automatically fortified with folic acid, a mineral that protects against neural tube birth defects, like spina bifida, in which the developing neural tube does not close correctly, which could cause an opening in the spinal cord or even cause the baby’s brain to form incorrectly. These neural tube defects can sometimes be detected through early screening during pregnancy—and sometimes treated with fetal surgery—but if untreated, they can cause lifelong complications. Since these neural tube defects happen in the first month of pregnancy, women who are planning to get pregnant should get 400 mcg (or 0.4 mg) of folic acid per day. But about half of pregnancies in the United States are unplanned, so fortification of common foods is a way of trying to make sure that women get the folic acid they need— even before they know they are pregnant.

My friends tell me the most dangerous thing I can do when I am pregnant is to get the flu shot. Fact or Fiction?
Fiction. Actually one of the most dangerous things for a pregnant woman is the seasonal flu. Pregnant women are particularly susceptible to the flu because their immune systems are repressed as a result of pregnancy. The effects of the flu virus on the fetuses are not clear—but the high fevers the flu causes in the pregnant women seem to cause greater numbers of birth defects, including neural tube defects, in their babies. Pregnant women who get the seasonal flu are hospitalized in much higher numbers than the adult population and can even die from the flu. All women who might be pregnant during flu season are recommended to get the annual flu vaccine and any pregnant woman who suspects she might have the flu should go directly to her medical provider. Some medications can be effective at reducing the severity of the flu and the possibility of birth defects in the fetus. In addition to preventing the seasonal flu for pregnant women, the vaccine also confers some protection on the baby until it is about 6 months old.

I teach in a preschool, and one of my students has come down with chicken pox. My friends tell me that my developing embryo is too small to worry about. Fact or Fiction?
Fiction. Communicable diseases like chicken pox can be serious for pregnant women and their fetuses. Depending on how far along you are, the chicken pox may have no effect on your fetus or may cause some serious complications—typically getting exposed in your last trimester causes the most serious complications. There is an easy way to prevent this, however. If you’re planning to get pregnant, check with your medical provider about making sure your vaccinations are up-to-date. You’ll want to make sure you’ve been vaccinated with the MMR vaccine that protects against measles, mumps, and rubella (which is one of the worst communicable diseases for your fetus), as well as chicken pox. Vaccination is the safest way to protect your growing fetus—and many vaccinations are safe to have while you’re pregnant, so if you’re already pregnant, it may not be too late to get your shots in order.

I like nothing better than relaxing in the hot tub or hitting the sauna at the gym after a work-out. But I’ve heard they aren’t safe during pregnancy. Fact or Fiction?
Fact. Research indicates that it isn’t safe to get too hot while you are pregnant. Sitting outside on a warm summer day won’t harm your fetus, but getting a high fever over a long period of time or sitting in a hot tub or sauna long enough to raise your body temperature significantly isn’t a good idea for your growing fetus. In some places, like Finland, pregnant women take saunas regularly—but it isn’t clear whether they are staying in the sauna for long enough to get really hot or whether there are any protective factors involved. In the end, most experts recommend avoiding hot baths, saunas, hot tubs, and steam rooms while you’re pregnant. But they’ll be terrific to help you relax during labor.

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Video: Challenges During Pregnancy

This video discusses the various forms of teratogens and their general effects on development during pregnancy.

Conception

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Scientific American Article: Toxins All around Us

Exposure to the chemicals in everyday objects poses a hidden health threat.

Sep 20, 2011

By Patricia Hunt

Susan starts her day by jogging to the edge of town, cutting back through a cornfield for an herbal tea at the downtown Starbucks and heading home for a shower. It sounds like a healthy morning routine, but Susan is in fact exposing herself to a rogue’s gallery of chemicals: pesticides and herbicides on the corn, plasticizers in her tea cup, and the wide array of ingredients used to perfume her soap and enhance the performance of her shampoo and moisturizer. Most of these exposures are so low as to be considered trivial, but they are not trivial at all—especially considering that Susan is six weeks pregnant.

Scientists have become increasingly worried that even extremely low levels of some environmental contaminants may have significant damaging effects on our bodies—and that fetuses are particularly vulnerable to such assaults. Some of the chemicals that are all around us have the ability to interfere with our endocrine systems, which regulate the hormones that control our weight, our biorhythms and our reproduction. Synthetic hormones are used clinically to prevent pregnancy, control insulin levels in diabetics, compensate for a deficient thyroid gland and alleviate menopausal symptoms. You wouldn’t think of taking these drugs without a prescription, but we unwittingly do something similar every day.

An increasing number of clinicians and scientists are becoming convinced that these chemical exposures contribute to obesity, endometriosis, diabetes, autism, allergies, cancer and other diseases. Laboratory studies—mainly in mice but sometimes in human subjects—have demonstrated that low levels of endocrine-disrupting chemicals induce subtle changes in the developing fetus that have profound health effects in adulthood and even on subsequent generations. The chemicals an expecting mother takes into her body during the course of a typical day may affect her children and her grandchildren.

This isn’t just a lab experiment: we have lived it. Many of us born in the 1950s, 1960s and 1970s were exposed in utero to diethylstilbestrol, or DES, a synthetic estrogen prescribed to pregnant women in a mistaken attempt to prevent miscarriage. An article in the June issue of the New England Journal of Medicine called the lessons learned about the effects of fetal human exposures to DES on adult disease “powerful.”

In the U.S., two federal agencies, the Food and Drug Administration and the Environmental Protection Agency, are responsible for banning dangerous chemicals and making sure that chemicals in our food and drugs have been thoroughly tested. Scientists and clinicians across diverse disciplines are concerned that the efforts of the EPA and the FDA are insufficient in the face of the complex cocktail of chemicals in our environment. Updating a proposal from last year, Senator Frank R. Lautenberg of New Jersey introduced legislation this year to create the Safe Chemicals Act of 2011. If enacted, chemical companies would be required to demonstrate the safety of their products before marketing them. This is perfectly logical, but it calls for a suitable screening-and-testing program for endocrine-disrupting chemicals. The need for such tests has been recognized for more than a decade, but no one has yet devised a sound testing protocol.

Regulators also cannot interpret the mounting evidence from laboratory studies, many of which use techniques and methods of analysis that weren’t even dreamed of when toxicology testing protocols were developed in the 1950s. It’s like providing a horse breeder with genetic sequence data for five stallions and asking him or her to pick the best horse. Interpreting the data would require a broad range of clinical and scientific experience.

That’s why professional societies representing more than 40,000 scientists wrote a letter to the FDA and EPA offering their expertise. The agencies should take them up on it. Academic scientists and clinicians need a place at the table with government and industry scientists. We owe it to mothers everywhere, who want to give their babies the best possible chance of growing into healthy adults.

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Video: Prenatal Animation: Fetal Development

Video: Prenatal Development

Video: Prenatal Period: 3D Ultrasound

Article: Having a Healthy Pregnancy

Congratulations on beginning prenatal care! More than 80 percent of new mothers are in prenatal care and it is strongly correlated with a healthier pregnancy—and a healthier baby.

Most pregnant mothers are prescribed a daily prenatal vitamin—high in folic acid. They are encouraged to drink lots of milk or yogurt—for calcium, every day. Eat a healthy diet with plenty of whole grains, proteins, leafy green vegetables, fruits and some dairy. Avoid undercooked or raw meats, fish and eggs to protect yourself from parasites or bacteria such as listeria. Of course, you’ll need to stop drinking alcohol. Most doctors also suggest you limit or cut your caffeine intake as well—some studies have shown that caffeine may cause miscarriage early in pregnancy.

You can keep exercising as before, except avoid activities that present a risk of falling like biking, skating and running. Swimming is excellent exercise for pregnant women—the water does most of the work of holding you up! Remember that now is not the time to start an ambitious exercise regimen if you have not been exercising regularly before the pregnancy. If this is the case, start slowly, and remember—walking is excellent exercise.

Try to avoid stress. This may be easier said, than done! Some studies show that children whose mothers suffered from stress while pregnant may be more susceptible to stress themselves. Avoid stressful situations and try prenatal yoga and meditation to decompress. Staying calm will help you—and your baby—feel better!

A lot of what’s good for you and your growing baby is common sense, but here are some recommendations to keep you safe and happy:

You are what you eat:

• CALORIES: Despite your cravings, you only need about 300 more calories per day than your pre-pregnancy diet. If you eat an additional 300 calories a day your weight gain will stay on track.
• ENJOY the good stuff! Talk to your doctor or midwife about adding the following to your diet: folic acid (or folate), omega 3 fatty acids, and calcium. Your prenatal vitamins include these, but make sure you are eating a healthy diet of protein, veggies, grains and fruit.
• DON’T consume the bad stuff:
  • Drugs: They’re bad for you and worse for the developing baby.
  • Nicotine: Smoking can decrease the amount of oxygen the baby receives. Low birth weight, premature birth, and other problems can result from smoking during pregnancy.
  • Alcohol: There’s no data on exactly how much alcohol will hurt the baby. To be safe, avoid alcohol entirely. Consuming large amounts can lead to serious birth defects, and children with FAS suffer from cognitive deficits, developmental delays and behavioral and emotional problems.
• Some more specifics:
  • Caffeine: Some studies have found that consuming large amounts of caffeine, especially in the first trimester, can increase the chances of miscarriage. Stop drinking coffee and other caffeinated beverages or limit the amount you consume to less than 200 mg per day.
  • Cheese: Stick to hard cheeses; soft cheeses can carry potentially dangerous bacteria.
  • Fish/meat: Some fish contain high levels of mercury, which can damage the fetus’ developing nervous system. Avoid processed lunch meats, which can contain harmful bacteria.

EXERCISE: It’s good for both of you! Maintain a regular exercise routine throughout your pregnancy to stay healthy and feel your best. Regular exercise during pregnancy can improve your posture and alleviate some common pregnancy discomforts such as backaches, fatigue, and swelling. Don’t exercise more than you did before you were pregnant, but do keep up your pre-pregnancy level of fitness. Walking and prenatal yoga are great ways to stay in shape while pregnant, and will make the birth easier, too!

Avoid exposure to toxins in the environment:

• Cat litter: Cat feces contain toxins that can be potentially harmful to the baby. If cleaning the litter box has traditionally been your chore, now is the time to ask for help!
• Gardening: Avoid using pesticides in the garden, and always wear gloves and wash your hands frequently to protect yourself.
• On the job: Do you work in a job where you’re exposed to chemicals or toxins? Talk to your supervisor and your medical provider about staying safe on the job.

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Scientific American Article: Quitting smoking during pregnancy may not be enough to prevent harm to baby

Study confirms that both active smoking and passive exposure to secondhand smoke in pregnant women leads to genetic damage in newborns.

July 4, 2010

By Nicholette Zeliadt

The views expressed are those of the author and are not necessarily those of Scientific American.

Cigarette smoke plays an undisputed role in the development of lung and other cancers. Carcinogens in the smoke damage DNA, which often results in mutations in genes that promote the development of cancer. It’s also well known that secondhand smoke can have effects indistinguishable from active smoking. While maternal tobacco smoking has been associated with low birth weight, premature delivery and brain and lung defects, only a few studies have found evidence of genetic mutations in the newborn resulting from exposure to tobacco smoke while in the womb.

A new study by Stephen Grant, professor of environmental and occupational health at the University of Pittsburgh, confirms that both active smoking and passive exposure to secondhand smoke in pregnant women lead to genetic damage in newborns. Importantly, the research shows that there was a similar frequency of mutations among smoking mothers, those exposed to secondhand smoke, and moms-to-be that quit smoking after they learned of their pregnancy. The authors conclude that quitting smoking during pregnancy without actively avoiding exposure to secondhand smoke may not protect the developing fetus. The results were published online June 30 in the Open Pediatric Medicine Journal.

"These findings back up our previous conclusion that passive, or secondary, smoke causes permanent genetic damage in newborns that is very similar to the damage caused by active smoking," Grant said in a prepared statement.

Grant looked for mutations in the gene known as GPA in red blood cells collected from the cord blood of babies born to mothers exposed to smoke. The results are in agreement with previous studies that analyzed white blood cells from newborn cord blood for mutations in HPRT, a different gene commonly used as a biomarker for exposure to carcinogens. Those studies also documented a correlation between maternal exposure to both primary and secondhand smoke and increases in the frequency of HPRT mutations.

"By using a different assay, we were able to pick up a completely distinct yet equally important type of genetic mutation that is likely to persist throughout a child’s lifetime," Grant said. He concluded that the assays for mutations in either gene should be considered complementary tests, reflecting mutations that occur through different mechanisms.

"Pregnant women should not only stop smoking, but be aware of their exposure to tobacco smoke from other family members, work and social situations," Grant said.

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Scientific American Article: The Brain—from Womb to Tomb

From IQ to mental illness, how prenatal life affects the brain.

October 12, 2010

By Carey Goldberg

It was on the cover of The New York Times Book Review. And the cover of Time Magazine. Suddenly, the obscure science of “fetal origins” is getting popular, in the pages of a new book called “Origins: How the Nine Months Before Birth Shape the Rest of Our Lives.”


Written by science journalist Annie Murphy Paul, "Origins" explores the still-murky but growing research into how the environment in the womb can affect a baby’s life ever after—including the life of the mind. A few questions for the author:


Q: In "Origins," you describe myriad ways that the prenatal environment appears to influence the fetus. What do we know about the effects of the womb on the brain?


A: Fetal origins is very much an emerging science, so we know less than we would like about the effects of the prenatal environment on the brain. We do know, of course, that the brain is formed during the nine months of gestation, and that a number of influences during this period—chemical exposures, stress, depression, drug and alcohol use, nutrition—can have effects on the brain, showing up in things like measures of neural conduction speed, tests of cognitive ability, and IQ scores.

Q: Many pregnant women worry that their own emotional state, particularly stress, will affect the fetus. How would you sum up the findings on that?

A: The findings on the effects of prenatal stress are twofold. It's fairly well established that traumatic stress—severe, life-threatening stress, like that experienced in a natural disaster or war—is associated with a higher risk of premature delivery, low birth weight, and in some studies, birth defects. Chronic stresses like those associated with poverty and discrimination may also have deleterious effects. Moderate stress, however—the everyday hassles experienced by your typical working woman or woman caring for other children—actually appears to accelerate fetal brain development, leading to faster neural conduction speed as infants and higher scores on tests of cognitive ability as toddlers.


Q: And what is known about the possible origins of mental illness in the womb?

A: A number of studies on different populations suggests that severe prenatal stress or malnutrition, particularly in the first trimester of pregnancy, is associated with a higher risk of schizophrenia among
 offspring. Higher rates of this mental illness have been found, for example, in individuals whose mothers were pregnant during the Nazi siege of Holland during World War II, during the famine that followed
 China’s “Great Leap Forward,” and during the Arab-Israeli War of 1967. A more speculative theory is that women's own mental states of depression or anxiety affect the offspring's own likelihood of
 developing mental illness, perhaps through the effects of the stress hormone cortisol. Dr. Catherine Monk at Columbia University is doing fascinating work, measuring the responses to stress exhibited by
 fetuses of depressed and non-depressed women. She believes that intrauterine conditions may be a "third way" that mental illness is passed down in families, along with genes and parenting behaviors.


Q: One fascinating theory suggests that the womb may be the arena of a fight between the fetus's heart and its brain for resources. How does that work?


A: A theory originally put forth by British physician David Barker (and long known as "the Barker hypothesis") proposes that when a fetus receives insufficient nutrition, it will "make the best of a bad job" by diverting most of the nutrients it does receive to the organ most critical to its survival: the brain. This act of triage allows it to survive to be born and perhaps even grow into middle age—but at some
 point the early deprivation experienced by the heart and other organs shows up in increased rates of heart disease and other illnesses.

Q: You mention that the prenatal environment may account for something like 20% of IQ. Really? And how best can we make smarter babies?


A: To be more precise, a study published in Nature by researcher Bernard Devlin and his coauthors found that in their analysis of twin studies of IQ, the intrauterine environment accounted for 20 percent of IQ similarity between twins, and genes for only 34 percent. Devlin's point was that in drawing conclusions from such studies (which were used to buttress the assertions in the book "The Bell Curve," for example), we must take into account not only genes and childhood environment, but also the very FIRST environment that twins share: the womb.


In terms of making smarter babies, the best advice to pregnant women is to eat a wholesome diet, refrain from drinking alcohol and using drugs, protect yourself from environmental toxins, and try to alleviate excessive stress. There's some preliminary evidence that physical exercise by the pregnant woman may promote offspring's intelligence, and it can't hurt. But forget about playing Mozart to the fetus and other "prenatal education" products—they won't increase intelligence and may even be harmful.

Q: There's also a theory that links the prenatal environment and homosexuality. How would that work?

A: It's a well-established finding that homosexual men are more likely to have older brothers. The theory—and it's still speculative—is that the body of a woman carrying a male child generates antibodies in response to her fetus which stay on in her body after she gives birth. When she becomes pregnant again with another male child, those antibodies affect the developing brain of the fetus in ways that incline the offspring towards homosexuality. It's an intriguing theory but one that needs a lot more substantiation.


Q: What do you say to mothers who protest that "fetal origins" research is just more reason for even more maternal guilt?


A: I would say, first: I totally sympathize. I was pregnant when I researched and reported "Origins," and I had to work through a lot of my own anxiety and guilt. What I came to realize is that the science of fetal origins is growing so rapidly that we are only going to hear more and more about how prenatal conditions affect later health and well-being—so we need to find a more positive and productive way of thinking and talking about these findings, one that neither dismisses them out of hand nor makes us crazy with worry. I also found the excitement and optimism of the fetal-origins researchers I talked to rather contagious: they see pregnancy as a scientific frontier, a wonderful new opportunity to head off public health problems like obesity and diabetes. So I came, over the months that I was writing "Origins," to see pregnancy in that light—as a physical, emotional, and intellectual adventure.

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Video: Brain Development Animation: Prenatal

Video: Brain Development Animation: Process of Myelination

Video: Prenatal Animation: Fetal Development

Video: Ultrasound

This video discusses the use of ultrasound technology during pregnancy.

Conception

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Scientific American Article: Mother's Pregnancy Weight Linked to Child's Obesity

As the obesity epidemic accelerates, more researchers are looking to prenatal risk factors

Aug 5, 2010

By Katherine Harmon

More than 26 percent of American adults were obese as of 2009—compared with less than 20 percent in 2000, according to a new report from the U.S. Centers for Disease Control and Prevention. And the number of U.S. states with more than 30 percent of their population topping a body mass index (BMI) of 30 tripled between 2007 and 2009. With this accelerating epidemic, researchers are looking for clues beyond daily diet and exercise to explain our propensity for extra poundage—and many are finding evidence in the very first stages of life.

A growing number of analyses have found a convincing link among a heavier mother-to-be, increases in her baby's birth weight, and the child's later risk of obesity. In many past observational studies, however, basic genetics or environmental factors could be blamed for this association.

A new study of 513,501 mothers and 1,164,750 of their children born across 15 years aimed to take genetics out of the equation by assessing maternal and infant weight only for those women who had more than one child. "By making comparisons of two or more infants born to the same mother, we were able to factor out the role of genetics," says David Ludwig, an associate professor of pediatrics, director of the Obesity Program at Children's Hospital Boston and co-author of the new study.

Women who gained more than 24 kilograms during a pregnancy (which occurred in about 12 percent of pregnancies) added an average of 147.4 additional grams to their baby's birth weight than those who gained about 7.5 to 10 kilograms. In other terms, pregnant women who gained 22.5 kilograms had double the risk of having an infant with a high birth weight compared with those who only gained about nine kilograms. And every kilogram gained during pregnancy increased a baby's weight by about 9.5 grams, according to the analysis, which published online August 4 in The Lancet.

Being heavier at birth increases the odds that an individual will be overweight or obese as a child—as well as an adult. And the excess weight has been linked to a range of chronic conditions, including asthma, diabetes and metabolic syndrome (a group of metabolic risk factors).

Although previous studies had correlated high BMI moms with heavier babies, "the direct effects of excessive weight gain on the fetus have never been conclusively demonstrated," notes Ludwig, who worked on the study with collaborator Janet Currie, a professor of economics at Columbia University.

The importance of grams

The ill effects of undernourishment on fetal development have been well documented. A pregnant woman who does not get ample calories for her and her fetus increases the risk the baby will have stunted physical growth, poor cognitive development, and be more susceptible to diseases. The health risks of too many calories, however, are just beginning to come to light.

To be sure, a heavier fetus will tilt the pregnant mother's scale slightly, and the amount of weight typically put on my moms gaining too much during pregnancy far exceeds the additional ounces their babies typically take on.

Nevertheless, although 0.2 kilogram of additional baby fat might not sound like much, in the context of a three- to 3.5-kilogram infant, every 0.03 kilogram changes the odds ratio, according to Ludwig.

Other research indicates that infant birth weight is also heavily determined by a woman's weight even before she becomes pregnant. A study published in June in the European Journal of Pediatrics reported that being overweight or obese before getting pregnant meant that a mother's future child was 1.4 times more likely to be overweight or obese by age four. "It means preconception health screening and intervention for overweight and obese [women] is extremely important," says Panagiota Kitsantas, an assistant professor of biostatistics and epidemiology at George Mason University's Department of Health Administration and Policy and lead author of the June paper.

Although her investigation did not specifically look at women with more than one child and thus could have been colored by other genetic and environmental factors, Kitsantas says that the results from her work and The Lancet report are complementary. "Both studies pointed to one direction: mothers' body weight affected their offspring's weight."

Underlying changes

Extra birth weight might not be the only change many of these infants face. Excessive maternal weight during pregnancy is also likely changing the metabolic and hormonal environment of the developing fetus, Ludwig says.

Even if an infant has a few extra ounces due to a mother's excessive gestational weight gain, "the infant developed in a metabolically abnormal intrauterine environment," Ludwig explains.

Excessive caloric intake by a pregnant woman can stimulate the overgrowth of fetal tissues, change hormonal balances, alter metabolic pathways, "and perhaps even structures in the brain that regulate appetite and metabolism," he says. And those changes might stay with an individual for life.

Many adults have a difficult time losing weight and keeping it off, and if the body is predisposed to putting on the pounds, fighting obesity on both individual and societal levels will be even more challenging.

Researchers are still working to understand just how some of these pathways and hormones can influence disease risk, primarily through animal studies in the lab. And until more chemical links are found, a direct cause-and-effect relationship cannot be established, Kitsantas notes.

She applauds the new work, noting that Ludwig and colleagues used apt statistical models to try to avoid confounding effects and excluded subjects with other risk factors such as gestational diabetes or extremely high birth weight. Kitsantas is not entirely convinced, however, that genetics can be erased from the picture, and asserts that more lab work remains to be done to parse out nature, nurture and nutrition.

Prepregnancy health

Not every baby born on the heavy side will battle obesity or related chronic diseases. But, Ludwig points out, "on a population basis, [increased birth weight] is shifting risk upward.

The amount of weight pregnant women are putting on has been growing—as has their prepregnancy weight in the past few decades, Ludwig notes. Alongside that trend are signs that average birth weight is also headed upward.

"If we don't stop the vicious cycle at some point, we'll just keep going and going," Kitsantas says. If female babies are born more prone to obesity, the likelihood of their gaining too much weight before or during pregnancy increases, thus putting their offspring at greater risk.

Even though the specific mechanisms at work remain poorly understood and there is still not enough evidence to draw a cause-and-effect conclusion between maternal weight and a child's risk for obesity, Kitsantas says that is not reason enough to delay action. "We really have to jump in based on the findings we have to create specific interventions to fix the problem."

Ludwig acknowledges that the challenge of getting Americans to stay fit is great but says that changing the habits of mothers-to-be might be a little easier. "Women tend to be especially motivated during pregnancy because it's not just their health [that is] at stake—it's their children's," he notes. "Almost every mother instinctively wants to give their children a healthy start in life."


And, along with physical activity, food quality is just as important as quantity, he says. "The higher quality of diet consumed, the easier it is to maintain a healthy body weight," says Ludwig, who has been working on a new study comparing the effects of two different diets on maternal and infant health. "The best time to begin obesity prevention efforts for the next generation is actually prior to birth," he says.


Kitsantas extends that recommendation, suggesting that all women of childbearing age establish healthy lifestyle habits and healthy weights: "The sooner the better," she says.


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Scientific American Article: Is a pregnant woman's chance of giving birth to a boy 50 percent?

On average, more boys are born than girls, but this isn’t a fixed number and the trends have changed over time.

Nov 15, 2004

Marc Weisskopf, a research associate at the Harvard School of Public Health, explains.

In most industrialized countries about 105 boys are born for every 100 girls, for a ratio of 1.05, known as the secondary sex ratio, or SSR; the primary sex ratio is the ratio at conception. This is often expressed as the percentage of boys among all births, or about 51.2 percent. Thus, the short answer to the question is: "On average, no." The percentage of males among all births is not fixed, however. Since the 1950s and 1960s the overall SSR has been declining in the U.S., Canada and several European countries, but some groups display different trends. In the U.S., the SSR is declining for whites, whereas among African-Americans and other races, the SSR has been increasing since the 1960s. Currently the SSR among African-Americans in the U.S. is only about 50.7 percent. There are also both personal and environmental factors that affect the average sex ratio.

The chance of having a boy appears to decline with the mother's age, the father's age and the number of children the family already has. These effects are small. One study in Denmark found that the SSR of children born to fathers younger than 25 was 51.6 percent, which decreased to 51.0 percent among children of fathers at least 40 years of age. Therefore it is unlikely that the declining SSR in many countries results solely from large-scale changes in such personal factors.

With regard to environmental factors, improved prenatal and obstetrical care during the first part of the 20th century is largely responsible for an increased SSR over this period in many countries. The male fetus is more susceptible to loss in the womb than is the female fetus, so with more conceptions reaching term, proportionally more males are born.

It is difficult to discern how much of the decrease in sex ratio since the 1950s arises from contaminants in the environment. What is known is that drug use, high occupational exposures and environmental accidents can affect SSR. For example, hopeful mothers taking clomiphene citrate (Clomid) for infertility bore babies with an SSR of only 48.5 percent. Workers producing 1,2-dibromo-3-chloropropane (DBCP), a chemical used to kill worms in agriculture, experienced even larger decreases in the number of male babies they welcomed into the world. Effects of DBCP on sperm quality were discovered incidentally when male workers found that they were unable to father children. After the exposure ended, male workers experienced some recovery of sperm quality and 36 children were born to 44 workers. Of these 36 children only 10 were boys—an SSR of just 27.8 percent. Decreases in the SSR of offspring from fathers exposed to dioxin and dioxinlike chemicals occurred following an explosion in an herbicide factory in Seveso, Italy, in 1976 and contamination of rice oil used for cooking in Yu-Cheng, Taiwan. The decreases were most extreme among the children of fathers who were exposed at earlier ages: an SSR of 38.2 percent was recorded for fathers exposed before age 19 in Seveso, and fathers exposed before age 20 in Yu-Cheng experienced an SSR of 45.8 percent.

These dramatic changes resulting from extreme exposures raise the concern that chemicals in the environment at lower concentrations may also change the SSR by exposing people over longer periods of time. For example, there are reports that parental exposure to polychlorinated biphenyls (PCBs) and mercury, each of which is widely distributed in the environment, can affect the sex ratio. Confirming such effects will take careful work on large populations, but the results may be quite important for other reasons as well. In the general population, sperm quality deteriorated and testicular cancer and abnormalities of male genitalia increased over the same period that SSR declined. Furthermore, for men who go on to develop testicular cancer, both their semen quality and the SSR of their children are significantly reduced, suggesting a possible biological link between these male reproductive characteristics. Thus, effects of environmental contaminants on the sex ratio may be only the tip of the iceberg.

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Scientific American Article: There Are More Boys Than Girls in China and India

Preference for sons could spell trouble for China and India.

Aug 4, 2008

By Jeremy Hsu

It's one thing to wish for a boy or a girl when pregnant; but it's something else entirely to take steps to guarantee your wish comes true. Enter China and India, where the ratio of boys to girls is so lopsided that economists project there may be as many as 30 to 40 million more men than women of marriageable age in both countries by 2020.

The question is: Why? It's more than just the historic birth ratio of 105 boys for every 100 girls. Both abortion and infanticide, largely triggered by a long-time limit of one child per family in China, each played a role. The skewed populations have prompted Chinese men, left with a limited pool of potential brides at home, to seek wives in other regions of their own countries as well as those abroad. But a dearth of mates isn't the only concern for population giants China and India, which together account for 2.4 billion of the 6.7 billion people on Earth.

There are 119 boys born for every 100 girls in China today, compared with 108.5 boys per 100 girls during the 1980s. Recent national data is less comprehensive for India, but census records show 115 boys born for every 100 girls in 2003. That represents a major leap from 104 boys per 100 girls in 1981. By comparison, the U.S. is closer to average: 105 boys for every 100 girls this year.

The growing imbalance slows in older age because women tend to outlive men, with the ratio in both countries falling to about 106 men per 100 women after age 60. But such figures are cold comfort for younger men who lack marriage prospects in their age groups.

China's lopsided population woes began in the early 1980s when its government began enforcing a one child per couple rule. The cap was first adopted in 1979 as part of a series of ongoing measures to curb population growth to help the government manage the country's still-limited resources. The move correlated with an attempt by Chinese authorities to improve healthcare that included taking portable ultrasound machines to the most isolated rural villages, which gave women advanced knowledge of the sex of her fetus.

The Chinese have traditionally preferred sons because of their potential to financially support their parents, carry on the family name, and lead ancestor worship, population experts say, and this holds particularly true for rural areas where sons provide much-needed labor. This cultural preference has led many women under the one-child rule to seek abortions, which are legal in China, if they discovered a fetus was a budding girl. The advent of abortion technology has largely replaced the practice of abandoning baby girls, which was more widespread when the one-child rule was first adopted.

Local officials now have flexibility to enforce the policy as they see fit. Rural Chinese are typically allowed to have two children instead of just one; in fact, only roughly 36 percent of the population, primarily in cities, is subject to the rule, according to the National Population and Family Planning Commission. In recent years, these urban Chinese also flout the rules and have more than one child, typically losing societal benefits and paying a fine based on how much the couple earns.

The existence of families with more than one child has allowed researchers to track the practice of sex selection before birth, particularly since hard data on abortion and infanticide is scarce.

Health policy expert Avraham Ebenstein of Harvard University examined China's 2000 census data and found that the sex ratio of first births for couples was close to the natural sex ratio, but it became increasingly skewed following the birth of one or more daughters. That suggests parents value firstborns regardless of sex, but practice sexual selection for later children if they do not yet have a boy. "The steep rise in sex selection rate between first and second births is responsible for 70 percent of missing girls," Ebenstein says.

There is not a one-child policy in India, but parents there apparently make similar decisions driven by cultural views of daughters as financial burdens—largely because of the dowries required before marriage. The sex ratio for second and third Indian births became increasingly slanted if the firstborn was a girl, but was roughly 50–50 if the first birth was a boy, according to a 2006 Lancet article. The situation led Indian Prime Minister Manmohan Singh to denounce the half-million annual abortions of Indian female fetuses as "a national shame" earlier this year. Killing or abandoning infants has historically existed in India and may also play a role.


Chinese, Korean, and Indian parents in the U.S. with children born in this country show a similar cultural bias according to a recent study in Proceedings of the National Academies of Science. This was particularly apparent in the 2000 U.S. census of the third of three children: boys outnumbered girls by 50 percent if there was no previous son.


Modernization typically leads to a drop-off in the number of children per family, but the preference for sons does not fall as quickly, Ebenstein says. That was evident in modernizing Asian countries such as South Korea and Taiwan, which both saw skewing in the ratio of girl and boy births during the 1980s.

Those countries have recently seen a shift back toward a balanced sex ratio, which spells hope for China and India further down the road. For instance, South Korea had a birth sex ratio of just 107.4 boys for every 100 girls in 2006, compared with 116.5 boys for every 100 girls in 1990. The reverse trend draws power from the strengthening social and economic status of women, as well as the parental desire to have a nuclear family consisting of one boy and one girl.

Baby boy bias is not as widespread in countries outside Asia—at least not enough to prompt parents to attempt to control the sex of their newborns. Studies show the birth sex ratio of males to females fell in North America and Europe during the latter half of the 20th century, although it was not significantly skewed to begin with. South American countries do not have widespread prenatal sex selection because of Catholic beliefs, according to political scientist Valerie Hudson of Brigham Young University, and Africans cherish the earning capacity of daughters. Only some other Central and East Asian countries such as Vietnam now see birth sex ratios near that of China or India.

The growing number of "bare branches"—as the Chinese call young men without the opportunity to marry—was deemed "a hidden danger" that will "affect social stability," according to a 2007 statement by the Central Committee of the Communist Party of China and the State Council. Hudson has also suggested that social instability such as rising crime and even rebellion historically follow any large number of "bare branches," although other social scientists such as Ebenstein remain reluctant to extend such parallels to modern China or India.


A more indisputable result has been Chinese bachelors joining South Koreans and others in searching for foreign wives, particularly from neighboring Asian countries such as Vietnam and even North Korea. That solution, however, may prove fleeting as Vietnam struggles with its own growing imbalance in birth sex ratio. All countries involved can only hope that their "bare branches" cross borders to make love, not war.


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Scientific American Article: Differences between Boys and Girls Evident Three Weeks After Conception

Hormonal changes that help determine the gender of a baby occur earlier in pregnancy than once thought.

Jan 30, 2002

By Sarah Graham

There are plenty of old wives' tales regarding how to tell whether a pregnant woman is going to have a boy or a girl. But one thing that doctors know for certain is that in the second and third trimesters, women having girls display higher levels of a hormone known as maternal serum HCG (MSHCG) than do women pregnant with boys. Now new research suggests that such hormonal differences appear less than three weeks after conception. The findings, published today in the journal Human Reproduction, may help explain how girls and boys exert control over their mother's hormones.

Yuval Yaron of the Genetic Institute at Sourasky Medical Center in Tel Aviv and colleagues followed 347 pregnancies achieved through in vitro fertilization. The researchers tested the mothers' MSHCG levels between 14 and 20 days after fertilization and detected some differences as early as day 16. Three weeks into pregnancy, women carrying girls exhibited hormone levels 18.5 percent higher than those of their boy-carrying counterparts, regardless of factors such as previous pregnancies or maternal age.

Finding this gender-related difference so early in pregnancy may help explain how it occurs. Previous research into the variance suggested that either some genes on the X chromosome that regulate protein expression may become over-expressed in the presence of a female fetus or hormones from male fetuses could suppress MSHCG. Because the glands that produce fetal hormones do not develop within the first three weeks of pregnancy, the authors conclude that "there is a differential expression of genes by the placentas of female compared with male fetuses."

Such differences alone cannot successfully predict the sex of a baby so early on, however. According to Yaron, the proportion of pregnant women with MSHCG levels either high or low enough to allow for a successful prediction at three weeks is small. "It would be possible to predict the sex of a fetus," he explains, "if we can identify other markers that also demonstrate early gender-related differences." Until then, parents-to-be will just have to wait a bit longer to find out what color to paint the nursery.

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Scientific American Article: Nipping Childhood Obesity in the Bud

Mothers' gestational diabetes might later tend to make their kids fatter.

Dec 6, 2007

By Lisa Stern

Add yet another reason for women to make sure they eat right and get plenty of exercise: if they don't, their children may be at greater risk for becoming obese.

Three to 8 percent of pregnant women in the U.S. each year develop gestational diabetes, a transient blood glucose condition that ends after delivery. As has long been known, those women are at higher risk for related health problems and for having abnormally large infants whose births may require either C-sections or potentially dangerous natural deliveries.

Endocrinologist Teresa Hillier and her colleagues at the Kaiser Permanente Center for Health Research (CHR) in Portland, Ore., and Honolulu analyzed the medical records of 9,439 women who gave birth between 1995 and 2000. They discovered that tots of pregnant women with untreated high blood glucose levels were 89 percent more likely to be overweight and 82 percent more likely to be obese by the age of five to seven years. (Plumping up during that period of childhood is considered one predictor of adult obesity.) “This suggests that you're metabolically programming your child to become obese because of being overfed in the womb,” Hillier says.

The good news in the CHR team's findings, however, is that controlling pregnant moms' gestational diabetes (with diet and exercise or with insulin injections) could significantly reduce the chances of their tykes becoming tubby. In fact, Hillier notes, the children of stricken women who were successfully treated had the same risk of becoming obese as the kids of women with normal blood glucose levels throughout pregnancy.

Hillier's advice to expecting mothers: make sure that your ob-gyn screens for high blood sugar levels (generally between the 24th and 28th weeks of pregnancy) and, if you are diagnosed with the condition, that you are treated and stick with the program. “It's the best thing you can do,” she says, “to reduce your child's risk of obesity.”

The study, the largest of its kind, was funded by the American Diabetes Association (ADA) and appears in the September issue of the ADA's journal, Diabetes Care.

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Video: The Prenatal Period: Ultrasound

Video: The Prenatal Period: Conception to Birth

This video depicts prenatal brain development, including light animation of drawings and week-by-week depictions of brain development.

Video: Birth

This video discusses birth in the U.S. and around the world.

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Scientific American Article: Childbirth Still a Risky Undertaking in Many Countries

A U.N. program has a goal of improving maternal health, especially in developing countries. The goals are difficult to achieve despite good knowledge on how to make childbirth safer.

Sep 20, 2010

By Melinda Wenner Moyer

Some 350,000 women die each year during pregnancy or soon after giving birth, with women in sub-Saharan Africa, Pakistan and Afghanistan facing the highest risks. Although global rates of maternal death have been dropping by about 1.5 percent each year since 1980, there is still a long way to go if countries hope to meet United Nations Millennium Development Goal (MDG) 5 by 2015—a 75 percent reduction in the number of maternal deaths per 100,000 live births from 1990 levels. Today, an average of 251 women die per 100,000 births, and only 23 countries are on track to reach the MDG, with some countries even moving in the wrong direction.

Approximately 15 percent of women everywhere develop pregnancy complications. These include infections (such as HIV), pregnancy-induced hypertension, obstructed labor and hemorrhage. Most can be managed with proper care, but many women simply do not receive it. "It's not that you require a scientific breakthrough to solve these situations—in developed countries the knowledge and technical tools have been available to women for many, many years," says Ana Langer, coordinator of the Dean's Special Initiative on Women and Health at the Harvard School of Public Health. In many places, however, "women do not have access to them."

In Africa, for instance, women often have to rely on the willingness of others to get obstetric care because of their low social status. "For women to have timely access to services that can help to save her life she still needs the community, husband and family to be able to provide access and transportation," explains Grace Kodindo, an assistant clinical professor of population and family health at Columbia University's Mailman School of Public Health.

Possibly as a result of these societal barriers, since 1980 the Ivory Coast and Zimbabwe have both experienced increases in maternal mortality rates—in Zimbabwe deaths have jumped by 5.5 percent each year in the past two decades, in part because of low female social status and ongoing political conflict. But even the wealthiest countries face problems in maternal health, including the U.S., where 17 women die per 100,000 live births. Inequalities, however, still leave the poorest and least educated women at the greatest risk. "The context may be different, but the bottom line is the same—they don't have timely access to care," Langer says.

Whereas maternal care seems to generally be improving—albeit slowly—statistics on women who die during pregnancy are notoriously fuzzy. Record-keeping is often poor, in part because many women die in their homes rather than in clinics—and even when deaths are noted pregnancy status is not always referenced. According to Kodindo, health care workers are sometimes afraid to report maternal deaths because they believe the information will be held against them. Governments need to "inform the community that the data will be used to improve the health system," she says, not to assign blame. In addition, some deaths that occur during pregnancy are not attributable to it, although records do not always reflect the distinction. Ultimately, it is unclear just how much trust researchers should put in the numbers when assessing progress in improving maternal health.

Researchers are confident, however, about which interventions help the most. Assisted delivery comes out on top because most pregnancy deaths, irrespective of region, occur during labor. "There are still many parts of the world where the mode of delivery is the home, and it's difficult to really deal with emergencies in that setting," says Robert Black, a professor of international health at the Johns Hopkins Bloomberg School of Public Health. If women cannot get to a clinic, they should be accompanied at home by a skilled attendant, he notes.

Another part of the goal is to ensure that women everywhere have access to family planning services, as this reduces the number of unplanned and potentially complicated pregnancies—especially in adolescent and older women. "If family planning reduces the high-risk, high-parity women who have had many children and are at higher risk of death, then certainly it should reduce the maternal mortality ratio," Black says. Such services would also prevent deaths associated with unsafe abortions, which, according to a 2009 editorial published in The Lancet, kill eight women around the world every hour.

Ultimately, three quarters of gestation-related complications are treatable, Kodindo says, but the risks linger in part because many governments have been slow to prioritize maternal health. The number of maternal deaths per 100,000 live births simply has not fallen by the targeted 5.5 percent each year, so most low-income countries are unlikely to reach the MDG target. But experts remain cautiously optimistic. "I hope that in 2015 there will be an assessment of progress and a commitment to make further progress," Black says. "After all, the 2015 targets, even if achieved, are not by any means the lowest possible mortality levels. Substantial effort will still be needed."

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Scientific American Article: Elective cesarean sections are too risky, WHO study says

Elective cesarean sections are too risky, WHO study says

January 11, 2010

By Katherine Harmon Courage

The views expressed are those of the author and are not necessarily those of Scientific American.

Despite medical advances and increasing access to improved obstetric care across the globe, surgical childbirths are still more risky for both mother and baby, according to an ongoing international survey by the World Health Organization (WHO).

A new report from the survey, which was published online today in the medical journal The Lancet, found that in Asia—in both developed and developing nations—cesarean section births only reduced risks of major complications for mother and child if they were medically recommended. Elected surgical deliveries, on the other hand, put both at greater risk.

"Cesarean section should be done only when there is a medical indication to improve the outcome for the mother or the baby," the authors of the report concluded. Common reasons for a recommendation for cesarean delivery included a previous cesarean section, cephalopelvic disproportion (when the baby’s head cannot fit through the mother’s pelvic opening) and fetal distress.

In the nine countries studied (Cambodia, China, India, Japan, Nepal, the Philippines, Sri Lanka, Thailand and Vietnam), more than a quarter of the 107,950 births analyzed (27.3 percent) were C-sections, and in China, which had the highest rate of operations, nearly half (46.2 percent) of the births in the survey were cesarean. With these surgeries comes increased risk of maternal death, infant death, admission into an intensive care unit, blood transfusion, hysterectomy or internal iliac artery ligation (to control bleeding in the pelvis) compared to spontaneous vaginal delivery, according to the report

But these risks have not necessarily been absorbed into popular, or even medical culture. The rates of cesarean section procedures are on the rise in many countries across the globe, the authors report, and in some countries they "have reached epidemic proportions." Among the nations studied, China had the highest rate of cesarean sections that were performed without medical indication—11.7 percent; the overall rate for the facilities studied had a rate of 1.9 percent.

Most cesarean sections (15.8 percent of births) were begun during labor, as opposed to before it starts. But these later procedures—both elected (0.5 percent) and medically required (15.3 percent)—also carry the most risks for adverse outcomes, the authors found.

In a commentary accompanying the report, Yap-Seng Chong of the National University of Medicine in Singapore and Kenneth Y C Kwek of the KK Women’s and Children’s Hospital also in Singapore call the results "surprising and chilling." The findings, they say "should help us to prioritize our strategies to reduce unnecessary interventions in childbirth," they wrote. "There is little wrong with medical interventions when indicated, but for those who are still inclined to consider caesarean delivery a harmless option, they need to take a cold hard look at the evidence against unnecessary cesarean section."

The investigators were able to analyze some 96 percent of the births reported in the 122 hospitals that participated in the survey over two to three months between 2007 and 2008. Facilities were located in the capital city of each country and two randomly chosen regions. To qualify for the survey, hospitals had to be delivering at least 1,000 babies a year and performing cesarean surgeries, so as the authors noted, "the results therefore cannot be generalized to smaller facilities" or to the countries overall.

Despite the increased risks associated with cesarean deliveries, no mothers or babies in the study died after an elected cesarean before hospital release. The most dangerous form of childbirth proved to be vaginal operative delivery, which includes using forceps or a vacuum to assist in delivery and is more rare, occurring in just 3.2 percent of the births analyzed.

The findings confirm a previous WHO report published in 2006 in The Lancet, analyzing the rates and safety of various childbirth approaches in Latin America, where the investigators found that "increasing rates of cesarean section do not necessarily lead to improved outcomes and could be associated with harm." Taking the two reports together, the authors concluded, lends "strong multiregional support for the recommendation of avoiding unnecessary cesarean sections."

Surgical childbirth also requires more resources than a natural vaginal delivery, the authors note. Especially in countries where money, medical practitioners or proper equipment is more limited, unnecessary cesarean sections can drain resources away from those cases in which it can improve the chances of a healthy mother and baby.

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Scientific American Article: Get This Baby Out of Me! On Induction and Ending #occupyuterus

This article explores natural ways to help induce labor and avoid pharmaceutical interventions.

November 30, 2011

By Kate Clancy

The views expressed are those of the author and are not necessarily those of Scientific American.

Summer 2001. I had just graduated from college with a joint degree in biological anthropology and women’s studies which, as my father pointed out, was not a degree with an obvious vocational angle. I was headed to graduate school in anthropology that fall, an experience for which I was woefully underprepared. I spent the summer loafing. It was the last summer I would ever have to just loaf around, so I was going to loaf, dammit.

But I did have one job. A dear friend was pregnant and asked me to attend her birth. I prepared like a champ: I watched A Baby Story twice a day while lounging on my boyfriend’s couch (I squeezed these in between yoga, George R. R. Martin novels, and trips to Whole Foods). I also read through some of my old textbooks, including books recommended to me by a few professors, The Woman in the Body, Birth as an American Rite of Passage and Immaculate Deception II.

One early morning in July, my friend called. “We’re on our way to the hospital. I’m in labor. It will be a while, so don’t hurry,” she said. I hurried. When I got there, conditions couldn’t have been worse: as it turns out, the nurses at the hospital were on strike, the doctor my friend hated the most was the one on call, and the epidural she got once active labor commenced slowed down her contractions. The doctor broke my friend’s water without her consent then began pressuring her and her husband to have Pitocin. Pitocin was the one intervention my friend had been adamant she wanted to avoid, but the doctor kept pulling the husband to the side telling him they were risking the baby.

The nurses were not familiar with the hospital or the doctor and so could offer little support. The husband was beside himself with worry. The doctor had the bedside manner of cardboard. I thought, This is my moment. My college degree will be useful for something!

“How about nipple stimulation?” I asked.

My friend and her husband looked at me blankly. The doctor had already left the room to attend to another patient.

“Pitocin is synthetic oxytocin. Oxytocin is produced by nipple stimulation, like when you breastfeed a baby. Maybe making your own oxytocin will bring back your contractions.”

My friend and her husband continued to stare at me

“Well, some people do use nipple stim…” one nurse said, sounding unconvinced.

That was all the endorsement the husband needed. Eyes wild, he reached across his wife’s body… and, er, stimulated her nipples. Aggressively.

My friend’s contractions started back up again, and didn’t let up for the remainder of labor. A few hours later she gave birth to a gorgeous, big baby boy.

* * *

Ten years later, I’m in the same position. My sister has asked that I attend her birth along with her husband. Her official due date was Sunday, so we’re within the window when he will be born and are playing a waiting game. Culturally, we consider the due date as a sort of deadline; if you are still pregnant after that deadline your baby is “overdue,” and you may feel you have failed as a mother (you haven’t). You may also just be sick of being pregnant, or eager to meet your new kid. Maybe your favorite midwife or obstetrician is about to go on vacation and you won’t be able to deliver with her.

Two issues contradict the notion that inducing labor when “overdue” is a good idea. First, due dates are notoriously inaccurate, as they are calculated by date of last period instead of by ovulation or implantation. This makes sense, of course, because women rarely know their ovulation or implantation days. The first half of the cycle, or follicular phase, is even more variable than the second half (Lenton et al., 1984.), meaning the assumption built into calculating a due date—that the follicular phase is fourteen days long—introduces a lot of error.

Second, if you are past your due date but your baby is happy inside of you, that means you have produced a healthy, hospitable environment for her or him. More hospitals are creating 39-week cutoffs before which doctors cannot schedule inductions; this is because birth before that point carries increased risks for the baby. Further, many researchers support the maternal crossover hypothesis, which suggests a fetal trigger for the onset of labor: once the fetus begins to starve, it sends a stress signal to the mother, which commences labor (Ellison, 2001.; Wildman et al., 2011.) The idea is that the mother has “crossed over” some point after which she cannot provide adequate nutrition for the growing fetus through the umbilical cord. If she or he wants to keep growing, then it makes more sense to be born and receive more energy dense food, and fat, through the nipple in the form of breastmilk.

This means a baby usually should be born when it wants to be born, rather than when you, your mother in law, your boss or *cough* your sister want him to be born.

However, the cervix of a woman who hasn’t had any children yet does take longer to ripen, and so first pregnancies can be longer than the second or third (Mittendorf et al., 1993.) And so the question is whether there is anything the mother can do safely to encourage the fetus to consider starting things up, or to help the cervical ripening so that any signal the fetus is sending will be more effective. Some of the most common interventions mothers try on their own include exercise, sex, and eating spicy foods (Chaudhry et al., 2011.)

I am about to share some of the literature on these and other interventions. I do not explicitly recommend any particular course of action, as I’m not a licensed midwife or obstetrician. As I learned when I had my own daughter, having book knowledge is not the same as practical knowledge.

Exercise certainly makes sense as a mechanism to induce labor: bouts of physical activity temporarily increase systemic inflammation biomarkers (Kasapis and Thompson, 2005.), which are associated with labor onset. Exercise also increases energy expenditure, which might increase fetal stress and cause it to decide it can get more calories out than in.

However, the evidence doesn’t seem to support exercise inducing labor or shortening pregnancy. Many studies support a role for exercise in supporting normal-weight babies (Bell et al., 1995.; Campbell and Mottola, 2001.; Klebanoff et al., 1990.; Leiferman and Evenson, 2003.), which is a great thing: have a too-big baby and birth complications can arise, and a small baby can have health issues. Exercise may also reduce the risk of cesarean deliveries in nulliparous women (that’s women who haven’t had any prior kids) (Bungum et al., 2000.) And, exercise reduces the incidence of pre-term birth (Hatch et al., 1998.; Hegaard et al., 2008.; Jukic et al., 2011.), though work-related and potentially stressful forms of physical activity may slightly increase the risk (Misra et al., 1998.) So it seems as though habitual physical activity has a very beneficial effect on mother and baby. But it doesn’t make the baby come out any faster.

Unprotected sex with a man can be fun if you’re straight or bi and it’s consensual, and its role in triggering labor has mixed support. Semen contains prostaglandins, and prostaglandins can bring on uterine contractions. Further, oxytocin is produced at orgasm, which ripens the cervix (and of course, you don’t need a consenting male partner for this one). I found one study that showed that women who were scheduled for an induction but had sex at term to avoid it had a shortened gestation length (Tan et al., 2006.) The same author also found, however, that both sex and orgasm were inversely correlated with spontaneous labor (Tan et al., 2009.)

Spicy foods? So far, no one has systematically looked at it, though intestinal distress may trigger contractions (Chaudhry et al., 2011.) And while a few herbal preparations may increase your chances, the side effects and lack of FDA regulation dictate caution without a licensed midwife or physician overseeing the process.

But there is one more intervention worth further study. Remember when my friend’s husband semi-publicly twiddled my friend’s breasts? Nipple stimulation is effective not only at helping contractions along once labor has started, but possibly also inducing labor. One paper I read reviewed the varying recommendations by midwives for inducing labor, and their nipple stimulation protocol included massaging with oil by hand until one feels contractions, or using an electronic breast pump for fifteen minutes on, fifteen off (Knoche et al., 2008.) One study demonstrated that nipple stimulation leads to greater cervical ripening than a control group (Adewole et al., 1993.) So the mechanism is there, the link between nipple stimulation and cervical ripening pretty well established, and cervical ripening is one of the major first steps to labor.

That said, think of late pregnancy as an #occupyuterus movement. If current events are any indicator, no good comes of forcing peaceful protestors to leave by violent means.

References

Adewole I, Franklin O, Matiluko A. 1993. Cervical ripening and induction of labour by breast stimulation. African journal of medicine and medical sciences 22(4):81.

Bell RJ, Palma SM, Lumley JM. 1995. The Effect of Vigorous Exercise During Pregnancy on Birth‐Weight. Australian and New Zealand journal of obstetrics and gynaecology 35(1):46-51.

Bungum TJ, Peaslee DL, Jackson AW, Perez MA. 2000. Exercise during pregnancy and type of delivery in nulliparae. Journal of Obstetric, Gynecologic, & Neonatal Nursing 29(3):258-264.

Campbell MK, Mottola MF. 2001. Recreational exercise and occupational activity during pregnancy and birth weight: a case-control study. American Journal of Obstetrics and Gynecology 184(3):403-408

Chaudhry Z, Fischer J, Schaffir J. 2011. Women’s Use of Nonprescribed Methods to Induce Labor: A Brief Report. Birth.

Ellison PT. 2001. On Fertile Ground. Cambridge, MA: Harvard University Press

Hatch M, Levin B, Shu XO, Susser M. 1998. Maternal leisure-time exercise and timely delivery. American Journal of Public Health 88(10):1528.

Hegaard HK, Hedegaard M, Damm P, Ottesen B, Petersson K, Henriksen TB. 2008. Leisure time physical activity is associated with a reduced risk of preterm delivery. American Journal of Obstetrics and Gynecology 198(2):180. e181-180. e185.

Jukic AMZ, Evenson KR, Daniels JL, Herring AH, Wilcox AJ, Hartmann KE. 2011. A Prospective Study of the Association Between Vigorous Physical Activity During Pregnancy and Length of Gestation and Birthweight. Maternal and Child Health Journal:1-14.

Kasapis C, Thompson PD. 2005. The Effects of Physical Activity on Serum C-Reactive Protein and Inflammatory Markers: A Systematic Review. Journal of the American College of Cardiology 45(10):1563-1569.

Klebanoff M, Shiono P, Carey J. 1990. The effect of physical activity during pregnancy on preterm delivery and birth weight. American Journal of Obstetrics and Gynecology 163(5 Pt 1):1450

Knoche A, Selzer C, Smolley K. 2008. Methods of Stimulating the Onset of Labor: An Exploration of Maternal Satisfaction. The Journal of Midwifery & Women’s Health 53(4):381-387.

Leiferman JA, Evenson KR. 2003. The effect of regular leisure physical activity on birth outcomes. Maternal and Child Health Journal 7(1):59-64.

Lenton EA, Landgren B-M, Sexton L, Harper R. 1984. Normal variation in the length of the follicular phase of the menstrual cycle: effect of chronological age. BJOG: An International Journal of Obstetrics & Gynaecology 91(7):681-684.

Misra DP, Strobino DM, Stashinko EE, Nagey DA, Nanda J. 1998. Effects of physical activity on preterm birth. American Journal of Epidemiology 147(7):628-635.

Mittendorf R, Williams MA, Berkey CS, Lieberman E, Monson RR. 1993. Predictors of human gestational length. American Journal of Obstetrics and Gynecology 168(2):480-484.

Tan P, Yow C, Omar S. 2009. Coitus and orgasm at term: effect on spontaneous labour and pregnancy outcome. Singapore medical journal 50(11):1062-1067.

Tan PC, Andi A, Azmi N, Noraihan MN. 2006. Effect of coitus at term on length of gestation, induction of labor, and mode of delivery. Obstetrics & Gynecology 108(1):134.

Wildman DE, Uddin M, Romero R, Gonzalez JM, Than NG, Murphy J, Hou ZC, Fritz J. 2011. Spontaneous Abortion and Preterm Labor and Delivery in Nonhuman Primates: Evidence from a Captive Colony of Chimpanzees (Pan troglodytes). PLoS One 6(9):e24509

About the Author. Dr. Kate Clancy is an Assistant Professor of Anthropology at the University of Illinois. She studies the evolutionary medicine of women’s reproductive physiology, and blogs about her field, the evolution of human behavior and issues for women in science.

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Scientific American Article: New hope for preventing pre-term births

Researchers have found that progesterone gel can help prolong pregnancy and supports better health for pre-term babies.

April 8, 2011

By Anna Kuchment

The views expressed are those of the author and are not necessarily those of Scientific American.

It’s one of the great frustrations of obstetric medicine: humans have been reproducing for hundreds of thousands of years, and yet doctors still haven’t unraveled the mystery of why some women give birth well before their babies have fully developed in the womb.

Despite researchers’ and physicians’ best efforts, the rate of preterm births—defined as babies born before 37 weeks of gestation—climbed 30 percent from 1981 through 2006. Since then, it has fallen slightly; in 2008, the most recent year for which figures are available, 12.3 percent of women delivered babies before 37 weeks, the time when a fetus’s lungs typically reach maturity. That’s down from 12.8 percent in 2006. Though the causes of this overall increase are not fully known, the high rate of multiple births, the fact that more women are having children later in life, and an uptick in the number of induced labors and voluntary scheduled C-sections are partly to blame.

A new study published online in Ultrasound in Obstetrics and Gynecology offers obstetricians and gynecologists some new options in caring for mothers-to-be. The research, conducted by the National Institutes of Health in conjunction with a pharmaceutical company, shows that a progesterone gel can help women at risk of premature birth extend their pregnancies and boost the health of their newborns. "This is a major breakthrough in maternal and child health," said Roberto Romero, chief of the perinatology research branch of the National Institute of Child Health and Human Development and a co-author of the paper. "The prevention of preterm birth has been the most difficult challenge facing obstetrics and prenatal care and has been a goal of NICHD of the last 50 years." The study followed 458 pregnant women who had been diagnosed via intravaginal ultrasound during their second trimester as having a short cervix, a major predictor of preterm delivery. Of those women, 235 were treated with a vaginal progesterone gel developed by Columbia Laboratories, a pharmaceutical company that collaborated on the study with the NIH, and 223 volunteers were treated with a placebo gel. In the progesterone group, 8.9 percent delivered babies prior to 33 weeks of gestation vs. 16 percent in the placebo group. By 37 weeks of gestation, 30 percent of women in the progesterone group had given birth, as compared to 33 percent in the placebo group. The babies born to the progesterone group were also less likely to suffer complications such as respiratory distress syndrome, a breathing problem caused by underdeveloped lungs.

While previous studies have shown that progesterone could prolong a high-risk pregnancy, this is the first major study to also demonstrate improved outcomes for newborns. Some obstetricians are beginning to call for all pregnant women to undergo ultrasound screening during the second trimester to check for a shortening of the cervix. "This is an important study since prior to this our best way of identifying those at highest risk for pre-term birth were those with a prior history [of preterm birth],” said Ronald Wapner, director of the division of maternal fetal medicine at Columbia University Medical Center, who was not involved in the research. “By screening patients with vaginal ultrasound to look a cervical length we can identify and treat at-risk pregnancies before they have a preterm baby.” In December 2010, a group of researchers publishing in the same journal reported that universal cervical-length screening of pregnant women would be cost-effective and may prevent 22 cases of neonatal death for every 100,000 women screened. The current standard of practice for ultrasound examination in the second and third trimesters is to examine the uterine cervix, as recommended by the Guidelines of the American Institute of Ultrasound in Medicine. However, the guidelines do not require measuring cervical length, perhaps because there was little that could be done about it. "I believe that the guidelines need to change to implement universal screening of cervical length in the midtrimester of pregnancy,” says Romero. "Women with a short cervix could then be offered vaginal progesterone to prevent preterm birth."

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Scientific American Article: Babies born early—even by a week—are more likely to have special education needs

A Scottish study reveals that babies born before 40 weeks are at a higher risk for later special education intervention.

June 9, 2010

By Katherine Harmon Courage

The views expressed are those of the author and are not necessarily those of Scientific American.

Premature infants have a known higher risk for poor neurological development, often leading to developmental and educational issues. However, these babies, born before 37 weeks, make up a small number of any generation, and new research shows that the 40 percent of babies born any more than a week before a full 40-week term are also at higher risk for having special education needs during childhood.

By analyzing the 2005 Scottish school census of 407,503 children and national birth records, researchers found that risk for special education needs steadily decreased with gestation duration all the way to 40 and 41 weeks—even though babies born between 37 weeks and 41 weeks are considered "at term." For the survey, special education needs included learning disabilities (such as autism, attention deficit hyperactivity disorder, dyslexia and others) and physical disabilities that can impair learning. The findings were published online June 8 in PLoS Medicine.

"The tendency of most previous studies to treat gestation as a binary factor (preterm versus term) has masked a dose-effect across the whole range of gestation," noted the researchers, led by Daniel MacKay, of the University of Glasgow’s Section of Public Health.

And the sheer number of children who were born before 40 weeks (but after 37 weeks) mean that they constitute a greater percentage of special education children. Whereas preterm births accounted for about 5 percent of deliveries, they made up 3.5 percent of children needing special education. After adjusting for other factors, such as maternal demographics and mode of delivery, early term infants (delivered between 37 weeks and 39 weeks), had a 5.3 percent higher risk (than full term babies) for needing special education later.

"Historically, preterm delivery has been the main focus of research and clinical efforts because of the high risk to the individual infant," the researchers noted. But, even though neuro-developmental differences in early term infants might be "too subtle to be observed" at an early age, "at a population level, they are a contributor to special educations needs."

MacKay and colleagues noted that even though the increased risk for special education needs with early term delivery is slight, the issue has significant public health implications. "Early term births account for an increasing proportion of deliveries, and many of these are elective deliveries," the authors noted, adding that in the U.S. early term deliveries has increased 8.9 percent in the past decade, "largely due to an increase in cesarean section upon request."

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Video: Birth

This video discusses birth, with a focus on babies born in the United States and includes footage of women giving birth, birthing practices in the US and in other countries, and includes footage of c-section births (30% of all US births) and discussion of c-section risks. It includes a discussion of midwives’ and doulas’ roles.

Video: The Prenatal Period: Conception to Birth

This video depicts prenatal brain development, including light animation of drawings and week-by-week depictions of brain development.

Scientific American Article: The Green Nursery

Given that some 25 percent of the world's pesticides and 10 percent of insecticides go on cotton crops every year, and that a baby's skin is less resistant to bacteria and harmful substances, is organic cotton the best bet for a healthy child?

May 13, 2010

Dear EarthTalk: I know that purchasing organic crib sheets, mattresses and baby clothes is better for the environment—but do they make any difference in terms of the baby’s health?

—B. B., Fairfield, Conn.

It’s true that conventional baby clothing and bedding—conventional referring to that made with cotton grown using synthetic pesticides and fertilizers and bleached and dyed with yet more harsh chemicals—hasn’t seemed to present a problem thus far for generations and generations of babies. But more awareness of chemical sensitivities has many environmentalists and public health advocates wondering if the clothes and bedding children are exposed to could be impacting their health negatively.

Some 25 percent of the world’s pesticides and 10 percent of insecticides go to cotton crops every year. In addition, petroleum scouring agents, softeners, brighteners, heavy metals, flame and soil retardants, ammonia and formaldehyde are used in the processing of cotton once it is harvested. Beyond the environmental impacts of this onslaught in the vicinity of production facilities, there is increasing concern that residues of some of these chemicals might rub off on baby. According to Rachel Birchler of Mooi, a Pittsburgh-based organic children’s clothing boutique, a baby’s skin is more porous and thinner than that of an adult, and as such absorbs stuff more easily. “This means that children are at greater risk for pesticide-related health problems than adults,” she says.

Johnson & Johnson, one of the world’s leading purveyors of baby products, states on its website that “a baby’s skin is thinner, more fragile and less oily than an adult’s” and is “less resistant to bacteria and harmful substances in the environment.” Lotus Organics, which makes organic clothing for both babies and adults, reports that “millions of children in the U.S. receive up to 35 percent of their estimated lifetime dose of some carcinogenic pesticides by age five through food, contaminated drinking water, household use, and pesticide drift.”

So if organic cotton is so much better all around, why aren’t we all swaddling our babies in it and wearing it ourselves? It’s all about cost. Clothing and bedding made from organic cotton is typically more expensive than similar products made with conventional cotton. Consumers watching their spending are often unwilling to pay more for a t-shirt or pants that are just going to get spilled on and beaten up.

But boosters for organic cotton say that paying less for conventional cotton items is penny wise and pound foolish. “Conventionally produced cotton material lasts 10-20 washes before it starts to break down,” reports Mooi’s Birchler. “An organic cotton material lasts for 100 washes or more before it begins to wear down.” How could that be? “Conventionally produced cotton take so much abuse in production because it goes through scouring, bleaching, dying, softeners, formaldehyde spray, and flame and soil retardants before it is even shipped to be cut for patterns,” she explains.

Also, with more and more organic cotton products becoming available every day, from specialty shops to major retailers like Wal-Mart and Target, the price premium for going organic is starting to shrink.

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Video: Newborn Reflexes

This video depicts infant reflexes (e.g., rooting, sucking, Moro, etc.) and discusses infant senses—all five of which are operating at birth.

Video: Nutrition in Infancy and Toddlerhood

This video discusses how feeding during infancy effects growth and development.

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Scientific American Article: Surety Bond: Breast Feeding May Increase Children's IQ

When it comes to brain development, the missing ingredient in bottle-feeding is a bond with the mother, not the chemicals in the milk.

Nov 16, 2011

By R. Douglas Fields

Children breast-fed longer than six months scored a 3.8-point IQ margin over those who were bottle-fed, according to a seven-year study by researchers at Jagiellonian University Medical College in Poland.

Medical epidemiologist Wieslaw Jedrychowski and colleagues followed 468 babies born to nonsmoking mothers. The children were tested five times at regular intervals from infancy through preschool age. The data showed that cognitive abilities of preschoolers who were breast-fed scored significantly higher than bottle-fed infants, and IQ score was directly proportional to how long the infants had been breast-fed: IQs were 2.1 points higher in children who were breast-fed for three months; 2.6 points higher when babies were breast-fed for four to six months; 3.8 points higher in children breast-fed longer than six months. The results were published in the May 2011 issue of the European Journal of Pediatrics.

This research confirms observations reported 70 years ago by Carolyn Hoefer and Mattie Hardy in JAMA, The Journal of the American Medical Association, as well as many subsequent studies. This body of research provides the scientific basis for the World Health Organization's recommendation that all infants should be exclusively breast-fed for the first six months of life. But what is the missing ingredient that undermines the cognitive development of bottle-fed babies?

Chemists searching for a specific compound in mother's milk have been overlooking the obvious difference between breast-feeding and bottle-feeding—something that could easily account for the difference in cognitive development, wrote Tonse Raju, a pediatrician and neonatalogist at the National Institute of Child Health and Human Development in the current issue of Breastfeeding Medicine, October 2011. (Raju was not involved in the Jedrychowski study.)

"Sometimes even the most obvious facts need to be reiterated," he wrote. "An infant suckling at his or her mother's breast is not simply receiving a meal, but is intensely engaged in a dynamic, bidirectional, biological dialogue." It is the physical and psychological bonding and interaction between infant and mother during breast-feeding that nurtures development of an infant's cognitive abilities.

Jedrychowski strongly agrees with Raju's statement, and adds: "I believe the IQ effect may in part be explained by this dynamic interaction between mother and child in the breast-feeding process."

Brain bulk and white matter in early life

During the first year of life, a baby's brain weight nearly doubles. Much of that increase comes from growth of white matter, the electrical insulation on nerve fibers that speeds transmission of electrical impulses at least 50 times faster than uninsulated fibers. New research provides insight into why formation of this insulation (myelination) takes place after birth—during childhood and adolescence. Early childhood experiences influence myelination and helps the developing brain adapt to its environment, rather than form along strict genetically determined lines.

Martin Teicher, a psychiatrist at Harvard Medical School and chief of the Laboratory of Developmental Psychopharmacology at McLean Hospital, says that his current research suggests that parental verbal affection is the most important factor affecting IQ early in life. And his previous research has showed that exposure to parental and peer verbal aggression is associated with alterations in white matter tracts. So it is not just brain bulk that increases in the first year of a baby's life; major developmental changes in visual, motor and voice-processing regions of the brain take place. These are the foundations for language acquisition, and all of them are influenced to a considerable extent by what a baby experiences.

Donna Ferriero, professor and chair of the Department of Pediatrics at University of California, San Francisco's Benioff Children's Hospital, agrees that experiences early in life can have a profound influence on children's cognitive development. "Certainly there is substantial preclinical and clinical literature arguing that early life stress negatively impacts brain development and future social and cognitive interactions," she says. "Conversely, there are data showing that environmental enrichment can reverse adverse effects of early brain injury."

Simply put, a bottle is a poor substitute for a breast when it comes to enriching a baby's brain. At such a critical time in an infant's development, the experience of suckling and engaging in a positive sensory exchange with the mother facilitates optimal nurturing of the growing brain.

Breast-feeding biochemistry

It is difficult to separate the nutritional and behavioral benefits of breast-feeding from epidemiologic data alone, Jedrychowski notes. There is a need for further experimental studies on mother–newborn interaction during breast-feeding.

Some of the links between that biochemistry and behavior are already worked out. "How a baby is fed versus what it is fed is an important factor that has been overlooked in many studies," Raju says. "Suckling at the breast results in changes in the mother's brain—increased blood flow and oxytocin release [a hormone promoting bonding between mother and infant], and probably in the baby's brain."

A study led by Terry Pivik at the Arkansas Children's Nutrition Center examining brain waves in infants and published last year in the journal Early Human Development supports Raju's conclusion. Electroencephalogram, or EEG, (brain-wave) activity was measured in infants who were either bottle-fed milk-based or soy-based formula or breast-fed to track neurodevelopment at three, six, nine and 12 months of age. The EEG changes reflect significant milestones in brain development, including increased myelination and synapse formation as well as development of connections between the left and right cerebral cortices. The research was motivated by contents in the formula and mother's milk, not the feeding method. The nutritionists were concerned that estrogenlike compounds in soy-based formula might have adverse effects on infant neuro-development, or that omega-3 polyunsaturated fatty acids, which are present in breast milk and absent from milk-based baby formula until recently, could explain why breast-feeding boosts a baby's cognitive development. The results were unexpected: Bottle-feeding, regardless of the formula used, accounted for the differences. Brain-wave development was similar in bottle-fed babies, regardless of whether milk-based or soy-based formula was used, but different in breast-fed infants "Mothers who must bottle-feed for work should use breast milk collected using a breast pump, but they should breast-feed at home at night," Raju advises.

Mothers who cannot breast-feed should not be alarmed; in fact if Raju's analysis is correct, they should be relieved. The missing ingredient may not be in the infant formula itself, but rather in the experience of an infant in a mother's arms feeding at her breast. This natural mode of feeding promotes the closest and most beneficial physical and emotional dialogue between mother and child, but recognizing the importance of this interaction, mothers and fathers of formula-fed infants can take care not to "overlook the obvious," and work to provide the ingredient that is missing in a baby bottle.

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Scientific American Article: Breast Milk Is Best for Newborns, but the Bottle Is Fine, Too

It is generally acknowledged within the medical community that breast milk is the ideal first food for babies, although modern formula brands can also get the job done.

Nov 6, 2009

Dear EarthTalk: What are the pros and cons of feeding babies formula versus breast milk? And if I purchase formula, should I spend the extra money on the organic variety?

—Suzy W., via e-mail

It is generally acknowledged within the medical community that breast milk is the ideal first food for babies, though modern formula brands can get the job done, too. Human breast milk naturally contains the vitamins and minerals a newborn requires. According to the website KidsHealth.org, breastfed infants have less difficulty with digestion than their formula-fed counterparts. And since breast milk is easily digested, breastfed babies have fewer incidences of diarrhea or constipation.

Also, researchers have found that infants fed with human breast milk have lower rates of hospital admissions, ear infections, diarrhea, rashes and allergies than bottle-fed babies. Meanwhile, a raft of studies suggest that infants who are fed breast milk may have lower incidences of asthma, diabetes, obesity and other health problems later on in life.

“Human milk is made for human infants, and it meets all their specific nutrient needs,” says Ruth Lawrence, M.D., spokeswoman for the American Academy of Pediatrics and professor of pediatrics and obstetrics at the University of Rochester School of Medicine in New York. “We’ve known for years that the death rates in Third World countries are lower among breast-fed babies,” she adds. “Breast-fed babies are healthier and have fewer infections than formula-fed babies.”

Another related upside to breast milk is cost savings—both for families and the larger health care system. Mothers who can’t or choose not to breast feed end up spending hundreds if not thousands of dollars per year on formula, and higher incidences of illness and disease down the road means higher costs for all.

One concern with breast feeding is that toxins present in mom’s bloodstream can make their way into baby. But a 2007 study by Ohio State and Johns Hopkins University researchers found that levels of chemicals in breast milk were far below U.S. Environmental Protection Agency maximum acceptable levels for even drinking water, and that indoor air in typical American homes contains as much as 135 times as many contaminants as mother’s milk. The U.S. Centers for Disease Control maintains that the benefits of breastfeeding far outweigh any chemical exposure risks. “To date, effects on the nursing infant have been seen only where the mother herself was clinically ill from a toxic exposure,” reports the agency.

Of course, not all mothers are able to breastfeed, and in such cases formula can be a healthy alternative. The U.S. Food and Drug Administration regulates all baby formulas to ensure purity and that they meet nutritional requirements. Parents should know, however, that they may not be avoiding chemical exposure by opting for formula. Non-organic formula can contain the same or higher amounts of chemical residues left over from its raw materials. One way around this is to buy organic formula. Leading makers include Nature’s One, Earth’s Best and Bright Beginnings. Enfamil and Similac also now offer organic varieties.

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Scientific American Article: Soy-Based Infant Formulas May Hinder Immune System

Research lends more credence to the ‘breast is best’ crowd.

May 21, 2002

By Rachael Moeller

In news that may provide advocates of breast-feeding with yet more ammunition, researchers report today that soy-based infant formulas may impair the developing immune system. Infants drinking such formulas take in 10 times as much of an immune-suppressing, hormone-like compound as do adults eating a high-soy diet and 200 times as much as infants consuming breast milk or cow's milk. The findings, published in the Proceedings of the National Academy of Sciences, raise questions about the suitability of soy products for children.

The immune system protects the body in two key ways: antibodies created by so-called B cells can attack bacteria and other toxic molecules (the humoral system), or T cells can interact directly with virus-infested cells (the cell-mediated system). In the new work, researchers at the University of Illinois found that genistein, an estrogenlike component of soybeans, compromises both of these vital branches of the immune system in mice. Mice injected with genistein exhibited an up to 80 percent decrease in the size of the thymus, the center of immune cell development, education and proliferation. In addition, genistein-injected mice possessed up to 86 percent fewer immune cells with which to fight foreign invaders, as well as significantly suppressed antibody production. Because infants receive genistein through their diet, researchers also administered the compound to mice through food instead of injection. Even then it reduced thymus size by 10 to 25 percent.

Used to feed up to 15 percent of infants in the U.S., soy-based formulas affect a significant proportion of children today. Adults taking high doses of soy supplements (as opposed to simply consuming a soy-rich diet) may also be at risk: serum levels of genistein in such adults resemble those of infants fed on soy-based formulas. "In light of our present results and other work suggesting potential immune, reproductive, and endocrine effects," the researchers conclude, "the use of soy formula for infant nutrition and high soy/isoflavone intake by adults through the use of supplements needs to be approached with caution."

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Scientific American Article: Does Mother's Milk Transfer Environmental Toxins to Breast-Feeding Babies?

Although breast milk tends to attract heavy metals and other contaminants due to its high-fat and protein content, some recent research has shown its toxic load to be smaller than that in the air most city dwellers breathe inside their homes.

January 26, 2010

Dear EarthTalk: I've read that human breast milk contains toxins from pollution and other causes. How serious is this and what affect will it have on my baby?

—Skylar S., New York City

Researchers have found that those of us living in developed countries—men, women and children alike—carry around quite a toxic burden in our bodies from the constant exposure to various chemicals in our urban, suburban and even rural environments. If this weren’t alarming enough, the fact that these chemicals end up in breast milk and are in turn passed along to newborns is even more troubling.

According to writer Florence Williams, whose groundbreaking 2005 article in the New York Times Magazine opened many women’s eyes to the environmental health issues with breastfeeding, breast milk tends to attract heavy metals and other contaminants due to its high-fat and protein content. “When we nurse our babies, we feed them not only the fats, sugars and proteins that fire their immune systems, metabolisms and cerebral synapses,” she reports. “We also feed them, albeit in minuscule amounts, paint thinners, dry-cleaning fluids, wood preservatives, toilet deodorizers, cosmetic additives, gasoline byproducts, rocket fuel, termite poisons, fungicides and flame retardants.”

In the wake of such kinds of news reports, four nursing mothers came together in 2005 to form Make Our Milk Safe (MOMS), a nonprofit engaging in education, advocacy and corporate campaigns to try to eliminate toxic chemicals from the environment and in breast milk. The group educates pregnant women and others about the impacts on children of exposure to chemicals before, during and after pregnancy, and promotes safer alternatives to products such as cleaning supplies, food storage containers and personal care products that contain offending substances.

“Along with its antibodies, enzymes and general goodness, breast milk also contains dozens of compounds that have been linked to negative health effects,” reports MOMS, which lists Bisphenol A (BPA, a plastic component), PBDEs (used in flame retardants), perchlorate (used in rocket fuel), perfluorinated chemicals (PFCs, used in floor cleaners and non-stick pans), phthalates (used in plastics), polyvinyl chloride (PVC, commonly known as vinyl) and the heavy metals cadmium, lead and mercury as leading offenders.

Despite these concerns, some recent research has shown the toxic load in breast milk to be smaller than that in the air most city dwellers breathe inside their homes. Researchers from Ohio State and Johns Hopkins universities measured levels of volatile organic compounds (VOCs) in breast milk and in the air inside the homes of three lactating Baltimore mothers, finding that a nursing infant’s chemical exposure from airborne pollutants to be between 25 and 135 times higher than from drinking mother’s milk.

“We ought to focus our efforts on reducing the indoor air sources of these compounds,” said Johns Hopkins’ Sungroul Kim, the study’s lead author. He concurs with the U.S. Centers for Disease Control and Prevention (CDC) and many other public health experts that, despite breast milk’s vulnerability to chemical contamination, the benefits of breast feeding—from the nutrition and important enzymes and antibodies it supplies to the mother/child bonding it provides—far outweigh the risks.

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Scientific American Article: Got Smarts? Mother's Milk May Pump Up Baby's IQ

According to new research, that's if the suckling infant has a certain version of a gene that helps process fatty acids

Nov 7, 2007

by Nikhil Swaminathan

The argument over whether intelligence is innate or environmentally influenced has raged for more than a century. One of the most recent issues in the nature versus nurture debate is the effect of breast-feeding on IQ.

Research shows that the fatty acids in human milk may influence brain development. Using that data as a springboard, a group of scientists, led by a team at the King's College London Institute of Psychiatry, set out to determine how the makeup of infants interacts with their mothers' milk to affect intelligence.

Their findings, published in Proceedings of the National Academy of Science USA: breastfeeding can boost a baby's intelligence quotient if the newborn has a certain version of a gene, called FADS2 (fatty acid desaturase 2), which affects how fatty acids are processed.

"We were searching for an empirical example that would allow us to show scientists that it is possible to use the environment as a tool, to uncover novel genes that are important for human outcomes—including diseases," says study co-author Terrie Moffitt, a psychiatry professor of at King's College. "Our chain of logic from environment to genetic marker allowed us to discover for the first time the link between the FADS2 gene and the IQ, an important child health outcome."

The genetic marker that Moffitt refers to is located in the FADS2 gene, which has two primary variations. The new study, based on 1,000 New Zealander children (a portion of whom were breast-fed) in the early 1970s as well as on more than 2,000 breast-fed kids who lived in the U.K. in the mid 1990s, showed that 90 percent of the subjects had at least one copy of the more common version of FADS2 and 50 percent of them had two copies.

The researchers found that breast-fed infants with at least one or more of the common variation had IQ scores that were, on average, six to seven points higher than those of nonnursed kids with similar genetics. But breast-feeding did not appear to affect those children (10 percent of the population) with only the less common variant. The scientists ruled out other factors, including birth weight and the mother's social class and IQ, finding that they had no impact.

"Those who were breast-fed scored on average three points above the population mean of 100 on the IQ test, whereas those who were not breast-fed scored about three points below the population mean," Moffitt says. In other words, breast-feeding led to a gain of a few IQ points, whereas those using baby formula in lieu of mom's milk led to a slight dip.

As for the study's implications on the nature / nurture debate, Linda Gottfredson, a professor of education at the University of Delaware, says that a person's DNA is not really a blueprint, as it is commonly portrayed. "[Genes] are more like playbooks," she says. "It's not nature or nurture, but your genes operate frequently by making you more susceptible or less susceptible to certain environmental conditions." Hence, the withdrawal of breast milk from the diets of babies with a certain genetic predisposition resulted in a negative effect on intelligence.

The exact mechanism by which the enzyme coded by FADS2 might influence IQ is not known, but Moffitt suggests two possible roles: The gene variants may affect the conversion of dietary precursors to long-chain polyunsaturated fatty acids, which aggregate in the brain in the early months after birth. Alternatively, the presence of long-chain polyunsaturated fatty acids may act on the gene itself, causing it to turn on or off, thereby affecting the metabolic pathway the acids use.

The authors note that since the time that study subjects were breast-fed, many baby formula manufacturers have begun adding fatty acid supplements to their products, potentially giving them an IQ boosting effect.

"What's critical about this paper is that we haven't known entirely what are the mechanisms by which breast-feeding supports higher IQ," says Joseph Hibbeln, lead clinical investigator at the Unit of Nutrition in Psychiatry at the National Institute on Alcohol Abuse and Alcoholism. "This really helps to dissect one of those mechanisms: that is…, if your body can't make [fatty acids] efficiently, you better get it through the breast milk to support optimal IQ."

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Scientific American Article: Mother's Milk

Does breast-feeding tune your brain to your baby?

Apr 3, 2008

By Rachel Dvoskin

Doctors agree that when it comes to feeding your baby, breast is best. Most research has focused on health advantages to the infant and, more recently, on physiological and psychological benefits for the mother. Now research highlights a mechanism by which nursing may influence the mother-infant bond: it seems the brain of a breast-feeding mother is especially receptive to signals from her baby.

Graduate student Pilyoung Kim and her colleagues at Yale University’s Child Study Center used functional MRI to scan the brains of 20 women while exposing them to their baby’s cry or image. Preliminary results suggest that three weeks after giving birth, breast-feeding mothers showed greater responses to indicators of their own infant (as compared with those of another baby) than formula-feeding mothers did, especially in limbic, hypothalamic and midbrain areas—brain regions involved in emotion and motivation.

Kim’s team believes this difference stems mostly from oxytocin, a hormone that has received much attention for its role in social bonding. Nursing stimulates the production of oxytocin, which is thought to facilitate a mother’s attentiveness to her baby.

Three to four months after they gave birth, the difference in the overall amount of brain activity between breast- and formula-feeding moms was smaller, suggesting that over time a mother’s reaction to her infant may start to depend more on experience than on hormone levels. The areas of the brain more strongly activated in formula-feeding mothers, however, were different from those activated in breast-feeding mothers. They included the prefrontal cortex and other regions typically linked to social and cognitive behaviors.

Because all the subjects in this study were healthy women from similar backgrounds, Kim warns that the specific patterns of brain activation found in this study may not generalize to a more diverse population. The results may be valuable, however, for mothers who have trouble with their newborns because of depression or environmental factors such as poverty. Breast-feeding could be one way for these mothers to tap into the positive cycle involving oxytocin and the early mother-infant relationship, which has long-lasting effects on a child’s development.

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