World of Health

Scientists and physicians have long known that the health of a mother during pregnancy affects the health of her offspring.  However, most of the direct causes and effects have been unclear up until now.  New research published this month in the journal Cell Death and Differentiation shows one way that poor nutrition in the womb contributes to a greater risk of type 2 diabetes and other diseases in later life.

The study by a team from the University of Cambridge and the University of Leicester compared the results of a low-protein diet given to pregnant rats to those of a full balanced diet given to a control group and found that the undernourished mothers produced offspring with less ability to correctly store fat cells.

Fat must be stored in the right areas of the body, which consist of the adipose tissue that is specialised to synthesise and contain fat.  When that tissue can’t store all of the body’s fat cells, those cells have to  go  somewhere else, and they get deposited in organs such as the liver, where they create problems that lead to disease.

The researchers isolated a molecule called miR-483-3P that they found controls the process of fat storage.  They discovered that in both rats and humans, that particular molecule was found in higher levels in the offspring of mothers who received poor nutrition during pregnancy.  That in turn resulted in smaller fat cells, which were unable to provide adequate storage in the right places.

They also found higher levels of miR-483-3P in people who were underweight at birth.  MiR-483-3P works by suppressing a protein they call GDF3, and low levels of that protein were found in adults with low birth weights.  Rats (and people) on high-calorie diets with low levels of GDF3 don’t appear to be fat because the fat cells are being stored in the right places, but they are at higher risk of diseases such as type 2 diabetes.

The British birthrate is rocketing, but a warning has come from the Royal College of Midwives that parts of England are potentially facing a dangerously high shortage of midwives. The shortfalls vary significantly between areas and the East of England and the East Midlands need another 41% more midwives the RCM has warned, and these shortages could put mothers and babies at risk.

Yorkshire has experienced a 20% rise in birthrates in the past decade, leaving the county needing a further 370 midwives. The College says that in total, England needed a further 4700 midwives to cope with the increasing pressures, which include a growing number of older and obese pregnant women. It also criticised the PM, David Cameron, for apparently abandoning his pre-election promise to recruit another 3000 midwives.

Cathy Warwick, the general secretary of the RCM, has said that these shortfalls and the fact the complex births are increasing is threatening the quality and safety of maternity care. She said that far too many maternity units in England are under resourced and under staffed to meet the demands placed on them.

She added that she was deeply frustrated that there was absolutely no action coming from the government for remedy the problem. The regional manager of the college, Jeanne Tarrant, has said that more investment and action are needed, and needed now. Without serious investment and attention she has real fears that services in certain regions are going to be really struggling to cope.

Despite modern technology and the greatly improved healthcare, there has been a worrying rise in the number of women who are dying during pregnancy or just after childbirth. This unprecedented and unwelcome phenomenon had led leading doctors to get together and try to address this.

Catherine Nelson-Piercy, the prof. of Obstetrics at Kings College and her colleagues have called for an increase in the numbers of obstetric physicians and also for GP’s to be better trained in Obstetrics. Their article calling for these changes appears in the British Medical Journal. The doctors say that a big increase in ‘high risk pregnancies’, including those of obese and older women, raises the potential for a greater number of health problems.

They do insist, however, that most of these tragic deaths are caused by conditions that are both preventable and treatable, and they warned doctors that they must be vigilant. The doctors conclude that most deaths are associated poor healthcare and 1/3 of cases have had substandard care.

Ultimately, serious problems are failing to be recognized at the regular check-ups all pregnant women have. Research has indicated that heart disease is the biggest cause of maternal deaths, followed by neurological diseases.

For years health authorities have paid the bills for NHS patients as it has been a common practice insisting that women are not smokers if they seek IVF treatment. It is certain that smoking not only reduces the chances of the implantation being successful but the developing baby can be harmed and there is evidence to that.

Now primary care trusts (PCTs) have raised the bar even though there is a limited amount of evidence that smoking before conception can damaged sperm. There are now requirements with men being mouth swabbed for evidence of smoking or asked to blow into a breathalyzer that analyzes the amount of carbon monoxide in the exhaled air.

The device is so sensitive that it can pick up CO from someone that has only the occasional cigarette. Women are refused treatment until their partners get a green signal to go. But many say it is almost impossible to determine whether or not biological damage was done in a child due to passive smoking during childhood or damage to egg DNA and sperm from parents smoking before conception.

There is not conclusive evidence that the effect of smoking on DNA was strong enough to cause any serious health problems in the child. Nevertheless it was clear smoking does cause epigenetic changes that could be potentially harmful in eggs and sperm.

Now the NHS organizations are insisting both of the parents do not smoke and some of those include; NHS Yorkshire and Humberside, East Midlands Specialist Commissioning Group and NHS South Staffordshire.

There are many reasons that medical professionals decide to induce labour, but regardless of the case it is not recommended unless a severe health risk exists to induce labour until the 39th week of pregnancy. While inducing labour at 39 weeks has become extremely popular, bear in mind that due dates are not always accurate based on each woman’s unique ovulation period and that the average length of pregnancy is considered to be 42 weeks making it worthwhile to consider waiting a few more weeks for birth to occur naturally.

However, in some situations inducing labour at 39 weeks cannot be avoided including if the baby or birth mother is facing a critical health situation that needs to be remedied. Hypotension, kidney disease, and diabetes in the birth mother are all viable reasons to induce the birth of a child. If your water breaks and labour does not begin many times a woman will be induced to reduce the change of infection to the baby and within the mother’s uterus.

If your doctor decides to induce labour at 39 weeks a variety of measures may be taken to encourage the start of labour including the use of medication or other techniques that have been proven to stimulate the body into beginning contractions. A doctor may choose to insert medication through prostaglandins into the vagina or via a Foley catheter that is filled with water to help strain the cervix so that it naturally dilates and labour contractions begin.

A healthy and balanced diet is important for the development of the unborn child. This includes an appropriate balance of carbohydrates, fats and proteins. Vegetarians should pay special attention to a balanced diet.  In addition, there are some special needs during pregnancy:
Folic acid

Folic acid (also known as vitamin B9), especially in early pregnancy is needed to prevent a neural tube defect. The risk of severe deformity can be minimized by taking folic acid as a dietary supplement.

Folic acid is found in whole grains, green leafy vegetables, spinach, broccoli, carrots, asparagus, brussels sprouts, tomatoes, egg yolks, nuts and liver.  It should be dispensed with on the liver during pregnancy because the high concentration of vitamin A could be toxic and there is the possibility of transmission of harmful substances stored in the liver. In several countries, including the United States there is artificially added folic acid flour and bakery products. For related discussion see article folic acid.
Calcium, iron and vitamin D
Calcium and iron to a high degree is required for the rapidly growing foetus. Calcium is present in particularly high concentrations of cheese and other dairy products.  Iron is found in meat, legumes and whole grain bread.  Although liver contains a lot of iron, the vitamin A content is so high that it can cause harm to the child.

With the threat of iron deficiency anaemia and iron supplements may also be taken.  Fatty fish meat (such as salmon) is a source of vitamin D. Lisa Bodnar and colleagues found deficits in a study in 80% of African American and almost half of white American women, even though 9 out of 10 of a total of 400 pregnant women needed vitamin supplementation.

Fluoride
Fluoride is considered not just as important to the hardening of tooth enamel, but also for bone growth. Foods with abundant fluoride content are saltwater fish, black tea and mineral water (those with a fluoride content higher than 1.5 mg per litre) provide fluoride.

In many regions the daily “needs” are a designated amount of about 1 milligram of fluoride not covered by the diet. In the trade therefore, fluoridated salt and fluoridated toothpaste is available. In some countries drinking water with fluoride added, should lead to better teeth.
Omega-3 fatty acids
Omega-3 fatty acids can not be formed by the body itself.  The omega-3 fatty acids are hormone-like substances that have an influence on the duration of the pregnancy, while another omega-3 fatty acid, docosahexaenoic acid, is used for the construction and function of the brain and eye (e.g. formation of Neuronal - membranes).

Saltwater fish such as salmon, anchovies, sardines, mackerel and tuna provide both long-chain omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid.  Predatory fish like tuna or swordfish however, often have relatively high mercury content, so they are not suitable for pregnant women. Raw fish should be avoided.

In the placenta sits a protein that ensures the supply for the growing child in particular of docosahexaenoic acid – at the expense of the mother. It provides the mother with omega-3 fatty acids particularly well, the pregnancy is slightly longer (up 1.6-2.6 days), and there is less chance of postpartum depression.

The child develops the functions of the eye and brain better (e.g. 4 points higher intelligence quotient at 4-year olds). Therefore, out of the major professional societies that have been developed, there are new recommendations for pregnant women. During pregnancy you should take at least 200 DHA / day, although it was pointed out that 2.7 g / day of omega-3 fatty acids in scientific trials did not have significant side effects.  Early pregnancy should have recognized deficiencies in the diet.

Iodine
Iodine deficiency during pregnancy can be the cause of goiter in the unborn, but also be the cause of poor growth, a disorder of brain development or miscarriages and stillbirths. Regular milk and dairy products to eat and to use only iodized salt. Often, an additional revenue of Iodine tablets are required.

New studies show that older women are now ignoring contraceptives out of a misguided perception that after a certain age they will no longer be able to get pregnant.

Although it is true that women slowly watch their fertility wane with age, women can still get pregnant throughout their thirties, forties, and fifties.  In fact, the abortion rates for women that fall between the ages of 40-44 are almost the same as those for women who are under 16 years of age according to figures from Wales and England.

The average abortion rate for women of these two groups is about one out of every thousand women.  The reasons they opt for abortion are varied and include possible birth abnormalities in a child which is a side effect that is more common in older mothers.

However, the Family Planning Association claims that some of their evidence shows that abortions occur at an older age many times because women think that they are too old to get pregnant and then are shocked when it happens.

In response to the growing problem the FBA has launched a new campaign that is titled ‘Conceivable?’ and is directed towards women using contraception at all times until menopause is over to prevent unwanted pregnancies.

Julie Bentley, the chief executive of the FPA stated that although it is important to be aware of the fact that fertility decreases with age, it is also important to remember that fertility is still possible up until menopause actually ends.