plus 3, Early-pregnancy weight gain linked to gestational diabetes - Los Angeles Times

Early-pregnancy weight gain linked to gestational diabetes - Los Angeles Times
Experts Call For Acceleration Of Research, Interventions For ... - Redorbit.com
Bristol Palin to make TV debut in teen pregnancy show - Reuters
Acupuncture Lowers Depression During Pregnancy - Redorbit.com

Early-pregnancy weight gain linked to gestational diabetes - Los Angeles Times

Posted: 23 Feb 2010 10:07 AM PST

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Women have long been told that gaining weight before becoming pregnant or being overweight at the start of pregnancy puts them at higher risk for gestational diabetes. But a new study finds that the first trimester is the most crucial time for weight gain that can increase the danger of developing the condition.

The study, released Monday in the journal Obstetrics & Gynecology, looked at data from an ethnically diverse group of women who had babies between 1996 and 1998; 345 women had gestational diabetes, and 800 who had not developed the disease served as a control group. Gestational diabetes is diabetes that starts during pregnancy; it can disappear after giving birth but has the potential to affect mother and child for years.

"When we looked at weight gain by trimester, we found that association [with gestational diabetes] was mainly due to excess weight gain during the first trimester," said Monique Hedderson, the study's lead author and a scientist at the Kaiser Permanente division of research in Oakland.

During that time, women who gained more weight than is recommended by the Institute of Medicine, or IOM, had a 50% greater risk of developing gestational diabetes than women who were within or below the IOM recommendations during that period.

The women in the highest category of weight gain -- those who gained between 0.6 pounds and 4 pounds per week in the first trimester -- had an 80% increased risk over women who were within or below the IOM recommendations.

The link between weight gain during the first trimester and gestational diabetes was stronger among women who were overweight at the start of their pregnancies. Obese women (those with a body mass index of 30 or more) in general gained the least weight in that time, yet that group was more at risk for developing gestational diabetes. There was no link between weight gain during the second trimester and gestational diabetes.

Hedderson and the study's other authors think that the early pregnancy weight gain may increase insulin resistance and in turn exhaust the pancreas' beta cells. Beta cells create and release insulin, which controls blood glucose levels.

"As all pregnancies progress," Hedderson said, "an increase in insulin resistance occurs. Most women's beta cells are able to compensate by releasing more insulin, but if a woman has reduced beta cell capacity caused by weight gain, she may not be able to compensate for this normal occurrence."

Obese women, she added, could be at such a high danger for developing gestational diabetes that any excess weight gain may push them into the disease.

In 2009, the IOM issued pregnancy guidelines that included some new recommendations for weight gain. For underweight women they suggested gaining 28 to 40 pounds, for normal-weight women 25 to 35 pounds, for overweight women 15 to 25 pounds, and for obese women 11 to 20 pounds.

Previously, it was suggested that obese women gain 15 pounds on the low end, with no ceiling noted.

However, Hedderson said, many women overestimate the amount they're supposed to eat during pregnancy. "Women only need an extra 100 to 300 calories a day during pregnancy," she said.

Gestational diabetes has long- and short-term consequences, including an increased risk for early delivery and C-section, and greater possibility for obesity and Type 2 diabetes later in life for the babies.

"After women deliver, we try to get them back to their ideal pre-pregnancy weight, so if they get pregnant again they'll be in good shape," said Dr. Lauren Golden, assistant professor of clinical medicine at the Naomi Berrie Diabetes Center at Columbia University Medical Center in New York City. She did not participate in the research.

"The study offers important information and a more formal way to now look at that. . . . It makes sense to tell women to look at their diet before pregnancy."

The study also has a strong message for women who are obese and contemplating pregnancy, said Dr. Mark B. Landon, professor and interim chairman of the department of obstetrics and gynecology at the Ohio State University College of Medicine in Columbus.

"If obese women were to modify their diet and thus lose weight prior to becoming pregnant, that would probably reduce the risk for gestational diabetes, even more so than a modest reduction in weight gain in the first trimester," he said.

jeannine.stein@ latimes.com

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Experts Call For Acceleration Of Research, Interventions For ... - Redorbit.com

Posted: 23 Feb 2010 09:09 AM PST

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Posted on: Tuesday, 23 February 2010, 11:15 CST

New GAPPS Repository of data, tissue specimens will be resource for researchers worldwide

A new report issued Feb. 22 identifies the enormous global impact of preterm birth and stillbirth—and what can be done to decrease it. Globally, an estimated 13 million babies are born preterm each year. Newborn deaths now account for more than 42 percent of mortality in children under the age of five, a rise from 37 percent in the year 2000. Additionally, an estimated 3.2 million are stillborn each year, and many of these losses are linked to maternal deaths.

The Global Report on Preterm & Stillbirth, published with the BMC Pregnancy and Childbirth's latest supplement (http://www.biomedcentral.com/bmcpregnancychildbirth/), identifies known causes and 21 proven interventions that could now be widely used to improve these extremely distressing yet under-addressed outcomes. Additionally, it outlines the urgent need for increased focus and attention on research. This is crucial for understanding the magnitude, causes, and consequences of preterm birth and stillbirth, and for speeding up the development of diagnostics, treatment and prevention strategies.

The report, led by the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), and supported by the Bill & Melinda Gates Foundation and Seattle Children's, is a collaborative effort undertaken by an interdisciplinary team of maternal, newborn and child health experts from around the globe.

"We can save more lives, but we urgently need more action and resources to better understand the causes of prematurity and stillbirth, and to guide development of cost-effective interventions," said Dr. Craig E. Rubens, executive director of GAPPS. "For the first time ever, experts from around the world have agreed to a comprehensive, evidence-based approach to solving these global tragedies."

"Tremendous progress has been made toward saving the lives of children under 5, except in the early neonatal period, the first week of life, when about 3 million newborns die each year, many with complications of prematurity," said Gary Darmstadt, director of the Family Health Division at the Bill & Melinda Gates Foundation. "Attention to this crucial stage of life will help make progress toward the Millennium Development Goals of reducing child mortality and improving safe motherhood, because maternal, newborn and child health is so intertwined, and a healthy start to life sets the stage for lifelong health."

Preterm Birth and Stillbirth Affect all Countries

Although the impact of preterm birth and stillbirth is most widely felt in low- and middle-income countries, preterm birth rates are also rising in high-income countries. Preterm birth is the number one cause of newborn deaths worldwide, and those who survive can experience serious short- and long-term health problems. One million stillbirths occur each year during childbirth that could be reduced with existing interventions.

In the United States, great disparities exist between racial and ethnic groups: the preterm birth rates in 2005 vary from 18.4% among African American women to 11.7% among non-Hispanic white women and 10% among Asian and Pacific Islander women. An even larger disparity exists between costs and research. In the United States, for example, preterm birth is the 7th leading U.S. health care expenditure ($26B), yet perinatal health research ranks 63rd in NIH funding.

"BMC Pregnancy and Childbirth is pleased to present this important report," said Melissa Norton, Editorial Director (Medicine) at BioMed Central. "To date there has not been enough attention given to preterm births and stillbirth, and this report will contribute considerably in reducing the 13 million preterm births and 3.2 million stillbirths worldwide."

"Preterm births and stillbirths are major health issues in rich and poor countries alike, a private loss to many families that should be on the public's priority list," said Dr. Joy Lawn of Save the Children's Saving Newborn Lives program and a co-author of the report. "With greater understanding of the causes of preterm birth and stillbirth, we can prevent many losses, and make every birth count."

New Repository of Tissue Samples will Contribute to Global Research

Researchers lack access to quality specimens linked with phenotypic data, which has been a major impediment to solving the complex problems of preterm and stillbirth. To better understand and reduce the numbers of preterm births and stillbirths worldwide, GAPPS is establishing the GAPPS Repository (http://www.gappsseattle.org/assets/pdf/2010-02-19_Repository_Fact_Sheet_gs.pdf), a unique large collection of prospective data and specimens from diverse populations of pregnant women and their newborns. This will serve as a critical resource for researchers to develop projects that strive to understand and prevent preterm birth and stillbirth.

GAPPS is partnering closely with hospitals, universities and research institutes in the United States and internationally to establish the repository. This resource, which has great potential for furthering advances in medical and public health research, will include a large pool of samples collected from a network of global sites in a systematic and scientifically standardized manner. This will enable the study of multiple factors at different points throughout pregnancy, necessary for predicting adverse outcomes and their relation to gestational age.

The GAPPS Repository will drive discovery science research on these important health issues and accelerate biomarkers that can lead to predicting, treating, and ultimately preventing preterm birth and stillbirth. The repository will also serve as a resource for studies aimed at understanding other poor birth outcomes and fetal origins of adult disease, both acute and chronic. The GAPPS data and samples will be available to researchers worldwide.

Global Action Agenda

The BMC report outlines the first-ever comprehensive review on preterm births and stillbirths. It also includes a Global Action Agenda that was developed by more than 200 stakeholders at the 2009 International Conference on Prematurity and Stillbirth. Global leaders outlined collaborative strategies to achieve four key goals:

* Increase awareness and understanding of the magnitude of the problem - Global health leaders typically are unaware of the magnitude of the health problems caused by preterm birth and stillbirth, and their relationships to maternal, child and adult health. Other global health leaders have been aware of the problem, but have not known what to do.

* Close the research gaps - The biology of pregnancy and childbirth is poorly understood, as are the causes of preterm birth and stillbirth. Additionally, it is difficult to calculate the magnitude of the problem as there are no global standards for data collection.

* Support the discovery, development and delivery of interventions - More research is needed to determine which interventions are most effective. Effective interventions that are already available in low-resource settings should be promoted for scale-up. Effective interventions that are only available in high-income countries should be adapted and evaluated for effectiveness in low-resource settings.

* Increase resources for research and implementation - Significant funding, commitment and a coordinated effort are needed to reduce preterm births and stillbirth.

"This call to action presents a unique opportunity to move the prematurity and stillbirth agenda forward," said Dr. Rubens. "GAPPS is forging a collaborative effort toward achieving common goals to prevent preterm birth and stillbirth. There is significant momentum and we look forward to raising visibility for these critical issues so that we can fuel investments, accelerate innovative research and interventions, and promote effective health policies that will improve maternal, newborn and child health worldwide."

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Bristol Palin to make TV debut in teen pregnancy show - Reuters

Posted: 23 Feb 2010 10:21 AM PST

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NEW YORK (Reuters) - Single teen mom Bristol Palin, the daughter of former vice presidential candidate Sarah Palin, will make her acting debut on a television show that centers around a teen pregnancy, the Disney-owned ABC Family channel said on Tuesday.

Bristol, 19, whose pregnancy caused a stir during her mother's 2008 campaign, will play herself on the popular drama series "The Secret Life of the American Teenager." The episode will shoot in Los Angeles and air in the U.S. summer when the series returns for its third season.

The eldest daughter of Sarah Palin's five children, Bristol gave birth to a son named Tripp in December, 2008, and split last year with the baby's father and her fiance, Levi Johnston.

Her pregnancy was an awkward moment for Sarah Palin, a staunch conservative who supported teaching abstinence in public schools as a form of sex education.

On the TV show, Bristol will play herself as a friend of the show's 16-year-old protagonist, Amy, who juggles motherhood and high school after a one night stand with a fellow student. Despite lukewarm reviews when it started in 2008, the drama is one of the most popular youth shows on U.S. television.

Since giving birth, Bristol Palin has become increasingly outspoken, urging young Americans to abstain from having sex to avoid becoming a teenage mother like herself.

"Having a baby is a huge responsibility and I think that teenagers should just wait to have sex," she told a panel in New York last year as the abstinence ambassador for The Candie's Foundation.

Last week Bristol responded to jokes on her mother's Facebook page about the animated TV show, "Family Guy" that appeared to mock her 22-month-old brother, Trig, who has Down syndrome.

(Reporting by Christine Kearney, editing by Jill Serjeant)

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Acupuncture Lowers Depression During Pregnancy - Redorbit.com

Posted: 23 Feb 2010 08:19 AM PST

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Posted on: Tuesday, 23 February 2010, 10:20 CST

Acupuncture appears to be an effective way to reduce depression symptoms during pregnancy, according to a first-of-its-kind study from Stanford University School of Medicine researchers.

The study authors, led by Rachel Manber, PhD, professor of psychiatry and behavioral sciences, said they hope the results will raise awareness of the problem of depression during pregnancy and provide patients and physicians an alternative to antidepressants. "This standardized acupuncture protocol could be a viable treatment option for depression during pregnancy," they wrote in a paper that will appear in the March issue of Obstetrics & Gynecology.

Up to 14 percent of pregnant women may have major depressive disorder, a condition characterized by feelings of dread, gloom and hopelessness, and a loss of interest in normally pleasurable activities. Some women suffer from depression before becoming pregnant, stop taking their medication and then experience a relapse; in other women, pregnancy itself may cause depression.

Clinicians aren't exactly sure how pregnancy leads to the disorder, but an influx of hormones could be the culprit. Some women might also feel overwhelmed by the major changes in their life, which could trigger depression. "Pregnancy just by its nature can bring out some underlying psychiatric and emotional issues," said co-author Deirdre Lyell, MD, assistant professor of obstetrics and gynecology.

Depression, if left untreated, can pose risks to both mother and baby. The mom-to-be could stop taking care of herself or her fetus, and might even engage in self-destructive behavior. Studies have also linked depression during pregnancy to poor birth outcomes and postpartum depression. "Treatment of depression during pregnancy is critically important so that a woman can maintain her sense of well-being and take good care of herself, her fetus and, someday, her child," said Lyell.

The use of antidepressants during pregnancy doubled between 1999 and 2003, according to a 2007 American Journal of Obstetrics and Gynecology study, but many women avoid taking medication because of safety concerns. In fact, Manber said, 94 percent of the depressed women involved in her study expressed reluctance to take antidepressants.

"Because there's this concern about medication among pregnant women and their physicians, it's important to find an alternative," said Manber.

For this study, the researchers recruited 150 women whose pregnancies were between 12 and 30 weeks gestation and who met the criteria for major depressive disorder. The women were randomized to receive one of three treatments: acupuncture specific for depression; control acupuncture, during which needles were inserted in points not known to help alleviate depressive symptoms; or massage. All of the women received eight weeks of therapy and were assessed for depression at the four- and eight-week marks by an interviewer who was unaware of the treatment each woman received.

The researchers found that women who received the depression-specific acupuncture experienced a bigger reduction in depression symptoms than the women in the other groups. The response rate — defined as having a 50 percent or greater reduction in symptoms — was 63 percent for the women receiving depression-specific acupuncture, compared with 44 percent for the women in the other two treatment groups combined.

The researchers weren't surprised by what they found — a pilot study yielded similar results, and other studies have shown acupuncture is an effective treatment for depression in the general public — but they were pleased with the results.

"I don't think that one-size-fits-all treatments are appropriate for everyone, but acupuncture should be considered as an option," said Lyell. "I hope that people will respect the rigorous methodology used in this blinded, randomized, controlled trial and accept the result: Traditional acupuncture was associated with a significant improvement in depression."

Both Manber and Lyell said they plan to continue their research on women's health during pregnancy and postpartum. Lyell recently presented work showing that practitioners under-identify and under-acknowledge depression during pregnancy, and she's now analyzing birth-outcome data to look for correlations between depression, treatment and obstetric outcomes.

This study was funded by the Agency for Healthcare Research & Quality. Other Stanford authors on the study include Rosa Schnyer, DAOM; Andrea Chambers, PhD; Maurice Druzin, MD; Erin Carlyle; Christine Celio; Jenna Gress; Mary Huang; Tasha Kalista and Robin Martin-Okada.

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