Maternal tea consumption during early pregnancy and the risk of spina bifida, Birth Defects Research, 06/07/2012

 

Yazdy MM et al. – The data do not support an overall association between tea consumption and spina bifida, but there is a suggestion of a possible interaction between higher levels of folic acid intake and tea consumption.
Methods

• Using data collected in the Slone Epidemiology Center Birth Defects Study, they examined whether tea consumption during early pregnancy was associated with an increased risk of spina bifida.
• Mothers of 518 spina bifida cases and 6424 controls were interviewed within 6 months after delivery about pregnancy events and exposures.
• Data on tea intake were collected during three periods (1976–1988, 1998–2005 and 2009–2010).

Results

• Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for study center. Intake of both periconceptional food folate and diet and supplemental folic acid were examined as a potential effect modifier.
• For 1976 to 1988, ORs were not elevated for daily tea intake.
• For 1998 and onward, ORs were also close to 1.0, but there was a modest increase for those who drank more than 3 cups/day (OR, 1.92; 95% CI, 0.84–4.38).
• Among women with total folic acid intake greater than 400 μg, consumption of 3 cups or more of tea per day was associated with an increased risk of spina bifida in 1976 to 1988 (OR, 2.04; 95% CI, 0.69–7.66) and in the later periods (OR, 3.13; 95% CI, 0.87–11.33).

Read more: http://www.mdlinx.com/obstetrics-gynecology/news-article.cfm/4089617/pregnancy#ixzz24IKBYOhK

Breast-Milk Compound May Shield Babies From HIV Only 10% to 15% of breast-fed infants get virus from infected mothers, researchers say

 

FRIDAY, Aug. 17 (HealthDay News) -- A compound found in breast milk may help prevent HIV-infected mothers from passing the virus on to their infants, a new study suggests.

"In developing countries, HIV-infected mothers are faced with the decision of whether or not to breast-feed their babies," study leader Lars Bode, an assistant professor of pediatrics at the University of California, San Diego, School of Medicine, said in a school news release. "Breast-feeding exposes the baby to the virus and increases the risk of the baby dying from HIV infection, but not breast-feeding increases the risk for the baby to die from other intestinal or respiratory infections."
Bode and his colleagues set out to find out why the vast majority of breast-fed infants -- estimated by the study authors to be between 85 percent and 90 percent -- don't acquire the AIDS-causing virus.
The team of international researchers said certain components in breast milk known as human milk oligosaccharides (HMO) may offer babies protection from HIV. HMO is a type of carbohydrate made up of several simple sugars that aren't digestible. They accumulate on the surfaces of infants' gastrointestinal tract, the researchers said.
The scientists analyzed HMO levels and composition in the breast milk of more than 200 HIV-positive women involved in a study in Zambia, Africa. The women's infants were followed from birth until they were 24 months old.
The study found that higher concentrations of HMO in breast milk were associated with greater protection against the spread of HIV to babies.
"HMO act as prebiotics that promote the growth of desirable bacterial communities in the infant's intestine," Bode said. They also are involved in immune cell responses and serve as decoys, preventing pathogens from binding to cells, he said.
The study uncovered a link between HMO levels and the risk of HIV infection, but did not prove that the compound blocks the virus.
The researchers suggested that more research on HMO might lead to better protection against HIV, and possibly the development of improved antiretroviral drugs.
The study was published in the Aug. 15 online edition of the American Journal of Clinical Nutrition.
SOURCE: University of California, San Diego, news release, Aug. 15, 2012

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Thyroid Disease During Pregnancy: Guidelines Updated

August 13, 2012 — The Endocrine Society's clinical practice guideline for the management of thyroid disease during pregnancy and after birth has been updated from its 2007 version.
                                   Revisions and additions to the clinical practice guideline include the following:

Thyroid Disease During Pregnancy

• Trimester-specific reference ranges for pregnant women, using a free T₄ assay, should be established. "The non-pregnant total T₄ range (5–12 μg/dL or 50–150 nmol/liter) can be adapted in the second and third trimesters by multiplying this range by one and a half-fold. Alternatively, the free T₄ index...appears to be a reliable assay during pregnancy," the authors write.
• Propylthiouracil (PTU) should be the first-line drug for treatment of hyperthyroidism during the first trimester of pregnancy. Methimazole (MMI) may also be prescribed if PTU is not available or not tolerated. Clinicians should change treatment of patients from PTU to MMI after completion of the first trimester because of the potential for liver toxicity.
• Breast-feeding women should maintain a daily intake of 250 μg iodine to ensure breast-milk provides 100 &um;g iodine per day to the infant.
• Once-daily prenatal vitamins should contain from 150 to 200 μg iodine in the form of potassium iodide or iodate, "the content of which is verified to ensure that all pregnant women                                                           taking prenatal vitamins are protected from iodine deficiency," the authors write.
• Thyroid receptor antibodies should be measured before 22 weeks' gestational age in mothers with "1) current Graves' disease; or 2) a history of Graves' disease and treatment with ¹³¹I or thyroidectomy before pregnancy; or 3) a previous neonate with Graves' disease; or 4) previously elevated [thyroid-stimulating hormone receptor antibodies (TRAb)]," according to the authors
• In women with TRAb at least 2- to 3-fold the normal level, and women treated with antithyroid drugs, "fetal thyroid dysfunction should be screened for during the fetal anatomy ultrasound done in the 18th–22nd week and repeated every four to six weeks or as clinically indicated. Evidence of fetal thyroid dysfunction could include thyroid enlargement, growth restriction, hydrops, presence of goiter, advanced bone age, tachycardia, or cardiac failure," the authors write.
• Women with nodules from 5 mm to 1 cm in size should be considered for fine-needle aspiration (FNA) if they have a high risk history or suspicious findings on ultrasound, and women with complex nodules from 1.5 to 2 cm in size should also receive an FNA. "During the last weeks of pregnancy, FNA can reasonably be delayed until after delivery. Ultrasound-guided FNA is likely to have an advantage for maximizing adequate sampling," the authors conclude.

The committee did not reach a consensus on screening recommendations for all newly pregnant women. "Some members recommend screening of all pregnant women for serum TSH abnormalities by the ninth week or at the time of their first visit. Other members recommend neither for nor against universal screening of pregnant women at the time of their first visit and support aggressive case finding to identify and test high-risk women. In some situations, ascertainment of an individual's risk status may not be feasible and in such cases, testing of all women by 9 weeks of pregnancy or at the first prenatal visit is reasonable," according to a written release from the Endocrine Society.

An audit about labour induction, using prostaglandin, in women with a scarred uterus

Cogan A et al. – Induction of labour after a previous caesarean section is still controversial. This study aims to analyse, the maternal, foetal and neonatal complications in a population of women who have a uterine scar in relation to the mode of labour and delivery. Although no increase in maternal or perinatal outcome was observed in relation to prostaglandin–induced labour after caesarean section, the authors concluded that this study was too underpowered to exclude an increased risk.
Methods

• Retrospective analysis of collected data from all the singleton deliveries of patients with a scarred uterus (N = 798), admitted to the hospital between August 2006 and March 2009.

Results

• Among 798 singleton deliveries, 36.1 % had a spontaneous labour, 12.6 % a prostaglandin–induced labour and 2.9 % an ocytocin–induced labour, and 48.4 % had an elective caesarean section.
• The chance of delivering vaginally was respectively 84.4 % for those who had a spontaneous labour, 75.2 % for those who were induced using prostaglandin, 82.6 % after induction using ocytocin.
• There were eight uterine ruptures, four after spontaneous labour (1.4 %), two after prostaglandin induction (2 %) and two at the time of an iterative caesarean section (0.5 %).
• There were no differences between groups, except the risk of haemorrhage (17.4 % after spontaneously induced labour, 34.8 % after ocytocin, 17.8 % after prostaglandin and 44.6 % after iterative caesarean section; p < 0.005) and the neonatal admissions when analysed by intention to treat only (8.3 % after spontaneously induced labour, 9.1 % after ocytocin, 12 % after prostaglandin and 16.8 % after iterative caesarean section; p < 0.009).

.Archives of Gynecology and Obstetrics, 08/10/2012

Nifedipine versus labetalol in the treatment of hypertensive disorders of pregnancy

Giannubilo SR et al. – Antihypertensive therapy in pregnancy with Labetalol may have the potential to impair fetal behavior in low degrees hypertensive diseases of pregnancy. Optimal care must balance the potentially conflicting risks and benefits to mother and fetus.
Methods

• A retrospective study in hypertensive patients treated during pregnancy with nifedipine or labetalol was conducted.
• After the charts review the patients were divided in the four groups: gestational hypertension (113 patients); mild preeclampsia (77 patients); severe preeclampsia (31 patients); HELLP syndrome (21 patients).
• The pregnancy and neonatal records were analyzed by paired and unpaired t test.

Results

• Authors found that there was an higher rate of intrauterine growth restriction infants among women treated with labetalol compared with those treated with nifedipine (38.8 vs. 15.5 %; p < 0.05), but only in the subgroup of women affected by Gestational Hypertension and Mild Preeclampsia.
• In this group was also higher the rate of fetal worsening assessed by fetal heart rate tracing (33.3 vs. 14.2 %; p < 0.05). No neonatal malformations and no differences in the rate of adverse side effects were observed. 
  

  Archives of Gynecology and Obstetrics, 05/17/2012  Clinical Article

  
  

Five-second rule

A common superstition, the five-second rule states that food dropped on the ground will not be contaminated with bacteria if it is picked up within five seconds of being dropped. Some may earnestly believe this assertion, whereas other people employ the rule as a polite social fiction that will allow them to still eat a lightly-contaminated piece of food, despite the potential reservations of their peers. 

 Dr. Jorge Parada, medical director of the infection prevention and control program at Loyola University Health System. Parada cautioned that as soon as something touches an unclean surface, it picks up dirt and bacteria.

"A dropped item is immediately contaminated and can't really be sanitized," said Parada in a health system news release. The amount of bacteria and what type of microbes are involved depend on the object that is dropped and where it falls, he added.

Rising off contaminated items with water may not clean them entirely, but it could significantly reduce the amount of bacteria on it, Parada noted.

"Maybe the dropped item only picks up 1,000 bacteria, but typically the inoculum, or amount of bacteria that is needed for most people to actually get infected, is 10,000 bacteria -- well, then the odds are that no harm will occur," he said.

That's not the case for items that are "cleaned" by licking them off or putting them in the mouth.

"That is double-dipping," Parada explained. "You are exposing yourself to bacteria and you are adding your own bacteria to that which contaminated the dropped item. No one is spared anything with this move."

     People who follow the "five-second rule" may be better off sticking to the phrase, "when in doubt, throw it out."