Tagged Pregnancy and Childbirth

Crossing Paths: A Baby and His Grandfather


Credit Josephine Sittenfeld and Thad Russell

In a photo essay, Thad Russell and Josephine Sittenfeld chronicle the end of life of a beloved father and the beginning of life of their new baby.

Nov. 20 – Thad

I’ve left my very pregnant wife, Jo, and our little daughter, Polly, to drive up to northern Vermont to retrieve my 86-year-old father and bring him back to Providence.

But when I get there, Dad is hunched over in his chair in the living room. He looks thin and tired, unshaven, confused, cold, short of breath.

In a weak voice he says that his lungs aren’t working and he can’t get enough air. With his arm hanging limply over my shoulder I move him toward his bedroom. I take off his shoes and glasses, turn off his light, and kiss him goodnight. I go to bed shaken to the core.

Dad grew up on a farm, played football in high school, went to M.I.T. to study engineering and architecture, and had a long career designing and building houses.

He became an expert skier back in the 1950s when downhill skiing was rebellious and dangerous.

And now, maybe for the first time ever, he doesn’t want to get out of bed.

I call my friend Bill, an emergency room doctor. He tells me quietly and firmly, “Call 911 and get him to a hospital ASAP. Don’t think about it. Just do it.”

This is the last time my father will ever see his land or be in his own house or sleep in his own bed. In fact, it is the last time he will sleep in any bed that isn’t in a hospital or nursing home. It’s the last time he will live without the assistance of a walker or a wheelchair, a professional caregiver or an adult diaper.

At the hospital, Dad’s cardiologist puts it bluntly. “Your father needs a new heart, and he’s not going to get one. I’ve used up my bag of tricks. Have you thought about hospice?”


Credit Josephine Sittenfeld and Thad Russell


That tiny, rapidly fluttering shape amid the gray static — even though I’ve been through ultrasounds before with my first child, the evidence of the life inside me is still awe-inspiring. I feel excited and tearful.

Nov. 28 – Thad

Dad’s vital signs are bad. He has trouble breathing and now needs oxygen full-time. It’s Thanksgiving morning, and Dad is taken by ambulance from the nursing home to the Miriam Hospital. I meet him in the emergency room, abandoning Jo to cook her first turkey and prepare for a house full of in-laws. The emergency room staff does a battery of tests and confirms what we already know: Dad is suffering from late-stage heart failure.

But after a few hours, he’s released, and I bring him home for Thanksgiving dinner.

Dec. 25 – Thad

Amazingly, Dad is able to be at our house on Christmas Day. He doesn’t believe in Santa Claus, or even Jesus for that matter. But he does like a good turkey dinner.


Credit Josephine Sittenfeld and Thad Russell

Jan. 9 – Jo

I wake up at exactly midnight with contractions. Around 6 a.m. the contractions get closer together. Polly wakes up and thinks it’s funny that I’m mooing like a cow. Thad and I take Polly to a neighbor’s house and head to the hospital.

I have another killer contraction in the lobby. I’m on all fours on the floor, moaning. People are staring.

Once we finally get to the room, I get into the tub. It feels good to be in the water, but the contractions are painful and intense — after the tub I’m on a ball, then on the bed, then standing, then on the toilet, then back on the bed.

Thad is on the phone in the next room trying to coordinate a urology appointment for his dad when all of a sudden things intensify. The baby’s head starts crowning, and it burns like hell. The nurse runs out to get Thad. And with a few more pushes our baby is out.

When they hand him to me, he’s big and grayish, but pretty quickly turns pink.

It’s intense and beautiful and crazy and amazing.

Baby Curtis lies on my chest, still connected through the umbilical cord, and Thad and I just take him in.


Credit Josephine Sittenfeld and Thad Russell

Jan. 13 – Thad

Dad is excited to meet his first grandson  —  and a little confused. He keeps calling him Matt, and asks when we have to give him back.


Credit Josephine Sittenfeld and Thad Russell

Jan. 24 – Thad

A nurse calls to tell me that Dad has fallen. I meet him in the E.R., again. He looks pretty beat up and has a big gash on the top of his head.

The test results worry the doctors.

And yet he survives  —  for days, then weeks, then months.

I visit Dad as often as I can and for as long as I can. I pick him up and we go on little field trips: to doctors’ appointments, to get new eyeglasses, to get his hearing aids cleaned, or to our house for dinner.


Credit Josephine Sittenfeld and Thad Russell

Occasionally, I find Dad asleep in his room, his face lit by the light of CNN Headline News. Some nights I stay with him for quite a while, rubbing his feet, watching him breathe and wondering what he is dreaming about.

I feel conflicted  —  it’s not that I want Dad to die, but I sometimes wonder if this is the way he ever wanted to live.

Dad can’t walk, get dressed or complete most basic daily routines without assistance, but his spirits are good.

In July, Dad has a bad fall, spends another week in the hospital. I call my siblings and tell them it’s time. We’re going to start hospice.


Credit Josephine Sittenfeld and Thad Russell

Aug. 8 – Jo and Thad

Dear Family & Friends –

We are sad to report that Sam died Friday evening. He was 87 years old.

For the past year, Dad continually impressed us with his dignity, toughness and overriding will to live. He  —  and we  —  were rewarded with some distinctly good days that we will never forget.

But last week, he and his heart decided it was time. He retired early one evening, declaring that his bed felt “wonderful,” and started his long sleep.

In the end, he passed quietly and gracefully, surrounded by his family (including his bouncy and bubbly baby grandson Curtis, who played happily at the foot of his bed), and a wonderfully compassionate team of rotating attendants and nurses.

Ever the solar animal, he waited until just after sunset to pass.

With love and thanks,

Thad & Jo


Credit Josephine Sittenfeld and Thad Russell

Thad Russell and Josephine Sittenfeld are photographers who live in Providence, R.I., and teach at the Rhode Island School of Design. More of their work can be found at thadrussell.com and josittenfeld.com.

Flu Vaccine in Pregnancy Offers Brief Protection of Babies


Unborn babies are temporarily protected by their mother’s flu shot, but that immunity fades within weeks after birth, a new study found.

In a randomized, double-blind placebo-controlled study, researchers measured the efficacy of the flu vaccine on the unborn children of vaccinated pregnant women by comparing rates of disease and levels of antibodies in 1,026 infants born to vaccinated women and 1,023 controls born to unvaccinated mothers. The study, which was paid for by the Gates Foundation, is online in JAMA Pediatrics.

The vaccine was about 86 percent effective until the babies were 8 weeks old. But between 8 and 24 weeks, its power dropped rapidly, and the effect of the vaccine became statistically insignificant.

The lead author, Marta C. Nunes, a researcher at the University of Witwatersrand in Johannesburg, stressed that vaccination during pregnancy is nevertheless essential.

“It’s still important to vaccinate women during pregnancy,” she said. “Pregnant women are a high-risk group, and vaccinating them protects them as well as their babies.”

Finding a vaccine for pregnant women that confers long-lasting immunity on the baby is important because no flu vaccine is approved for babies under the age of 6 months.

“We have to work on creating vaccines that work in babies or that are more immunogenic in the mother so that her antibodies last longer,” she said.

A Call for Action on Toxic Chemicals


Cosmetic and lotion bottles contain phthalates, a chemical that allows the plastic to be flexible. Absorption of phthalates are also linked to preterm births and impaired neurodevelopment in girls.

Cosmetic and lotion bottles contain phthalates, a chemical that allows the plastic to be flexible. Absorption of phthalates are also linked to preterm births and impaired neurodevelopment in girls.Credit Getty Images

Every day, children and adults are exposed to a variety of chemicals found in common household items. Now a growing body of research suggests that many of these chemicals — which are used to make plastic more flexible, fruits and vegetables more abundant and upholstery less flammable — may also pose a threat to the developing brain.

While the link between early chemical exposure and neurodevelopment disorders in children remains a matter of scientific debate, a unique coalition of top doctors, scientists and health advocates is calling for more aggressive regulation. The goal is to protect expectant mothers, infants and children from neurotoxic chemicals by stepping up efforts to curb air pollution, remediate old lead pipes, phase out certain pesticides, ban endocrine-disrupting chemicals used in food packaging and plastics and come up with a plan for getting rid of furniture laden with fire retardants.

The scientists note that neurodevelopmental disorders are complex and have multiple genetic, social and environmental causes. But most chemicals in use today were not adequately tested for safety before being allowed on the market, said Dr. Jeanne Conry, an obstetrician-gynecologist and a past president of the American College of Obstetricians and Gynecologists, which is part of the coalition.

“Before we can prescribe medicine, we have to prove it’s safe,” she said. “So how come with the chemical industry, we assume everything is safe and have to prove there’s harm?”

On Friday the coalition endorsed a first-of-its-kind consensus statement called Project Tendr, which stands for Targeting Environmental NeuroDevelopmental Risks. The statement was published in the scientific journal Environmental Health Perspectives, and related articles are being published over the next few months in endocrinology, nursing, pediatrics and epidemiology journals.

“We as a society should be able to take protective action when scientific evidence indicates a chemical is of concern, and not wait for unequivocal proof that a chemical is causing harm to our children,” the statement says.


This chart shows a list of common chemicals and their possible effects on the body. <a href="https://static01.nyt.com/images/2016/06/30/health/wellchart/wellchart-superJumbo.png">Click here to view the entire chart.</a>

This chart shows a list of common chemicals and their possible effects on the body. Click here to view the entire chart.Credit Centers for Disease Control and Prevention and Project Tendr

The call to action comes just one week after President Obama signed into a law a much-debated overhaul of the nation’s 40-year-old toxic chemical rules. The update to the 1976 Toxic Substances Control Act subjects some 64,000 existing chemicals to eventual safety testing. But critics say the changes don’t go far enough, and the testing of chemicals is far too slow — just 20 chemicals at a time with a deadline of seven years per chemical. And the new law doesn’t cover pesticides used in food production – which critics say are one of the largest sources of childhood chemical exposures.

An official with the American Chemistry Council, which represents companies that make flame retardants, plastics and phthalates, said the new law already addresses the concerns raised by the Tendr coalition. The new rules give more authority to the Environmental Protection Agency and require the agency to take into account vulnerable populations like pregnant women, children and the elderly, she said.

“This new law will give Americans greater confidence that chemicals in commerce are being used safely,” the American Chemistry Council said in a statement.

The Tendr coalition includes pediatric neurologists, several minority physician associations, nurses, learning disability advocacy groups, environmental organizations, and the Endocrine Society, which has compiled several scientific statements documenting adverse health effects linked to endocrine-disrupting chemicals that mimic or disrupt the hormones in our own bodies. Dozens of scientists and health providers have signed the statement, as has Linda Birnbaum, director of the National Institute of Environmental Health Sciences and the National Toxicology Program.

The bottom line: The group wants the chemical industry to prove a chemical is safe, rather than waiting on the medical and scientific community to prove it is harmful. “We’re saying, shift the burden of proof,” Dr. Conry said.

Wading into a potentially contentious issue like regulation of chemicals is unusual for ACOG, a professional medical association for doctors who care for pregnant women. The group has been alarmed by rising rates of neurodevelopmental disorders and other health problems in children, which it linked to toxic exposures in a 2013 scientific paper.

National health surveys show that 15 percent of children had a developmental disability in 2008, up from 12.8 percent in 1996. Researchers say changes in diagnostic criteria and a greater awareness of developmental disorders including autism, attention deficit disorders, and other learning disabilities may explain some of the increase in rates, but not all of it.

The chemicals singled out by the coalition are widely used, and manufacturers and some experts say more research is needed to demonstrate they have harmful effects. They include:

  • Organophosphate Pesticides: Although health concerns led to a ban on residential use of some of these pesticides, they are still permitted on crops like fruit, vegetables, wheat, soy and corn. In one study, women who were pregnant when they lived near areas where these pesticides were in use were up to three times more likely to have a child who developed autism or other developmental disorders. Janet Collins, a senior vice president at CropLife America, which represents pesticide manufacturers, said the studies show only an association between pesticide levels and autism disorders, not a cause-and-effect relationship.
  • Flame Retardants: Recent studies have found that children exposed prenatally to higher levels of flame retardants had lower I.Q.s and higher hyperactivity scores. Similar effects have been found in animal studies. Flame retardants are used in fabric and upholstery padding, plastic casings for televisions and computers and baby products. A major source of exposure is household dust, which can accumulate with residue from treated products. American retailers and manufacturers have phased out one commonly used flame retardant, some of which still lurk in old sofas and other items; some scientists worry that they are being replaced with similar chemicals that may not be any safer.
  • Lead: The government has banned leaded gasoline and household paint, but old homes and pipes often still contain lead that gathers in dust and leaches into water. Lead is so toxic that no level of exposure is considered safe, and even low blood levels are associated with lower intelligence and attention deficits. In 2010, an estimated 535,000 children were identified with alarmingly high levels of lead.
  • Phthalates: These chemicals cross the placenta during pregnancy, and prenatal exposure has been linked in studies to problems with attention and intellectual deficits. The Consumer Product Safety Commission has banned the use of six phthalates in toys and child care products, but they are still widely used in all kinds of products, from food packaging to personal care products and building materials.
  • Combustion-Related Air Pollutants – These include nitrogen dioxide, particulate matter (a mix of small solid particles and liquid droplets) and other toxic chemicals including benzene and formaldehyde, as well as polycyclic aromatic hydrocarbons (or PAHs). Air pollutants can cross the placenta, and prenatal and early childhood exposure to some pollutants has been linked with preterm birth and low birth weight, as well as developmental delays, inattention and reduced I.Q.

Studies show almost all American women have these chemicals circulating in their bodies during pregnancy. A recent study of about 300 women found detectable levels of pesticides, flame retardants, phthalates, PCBs and other chemicals in 99 percent to 100 percent of the women tested.

Gestation is a particularly vulnerable time for the developing fetal brain, because it is growing so rapidly, said Irva Hertz-Picciotto, co-executive director of Project Tendr and director of the MIND Institute Program in Environmental Epidemiology of Autism and Neurodevelopment at the University of California, Davis.

Many chemicals of concern are endocrine disruptors, which can interfere with the activity of the body’s own hormones, like thyroid hormones, estrogen and androgens. These hormones play an important role in healthy brain development, said Heather B. Patisaul, professor at the Center for Human Health and the Environment at North Carolina State University at Raleigh.

“The goal is not to demonize every chemical on the market,” Dr. Patisaul said. “We need to find the group that are harmful, and figure out why, and develop new chemicals that are significantly less harmful.”

How to Limit Your Exposure to Toxic Chemicals

A coalition of doctors, scientists and health advocates says you may be able to reduce your overall exposure to toxic chemicals by taking the following steps:

  • Reduce pesticide exposure by choosing organic strawberries, apples, nectarines, green beans, celery and spinach.
  • Choose seafood low in mercury like salmon, sardines, trout.
  • Breast-feed your baby if you can; if you use formula, make sure the water is lead-free.
  • When buying furniture with padding like a high chair, sofa or mattress, ask for products that are labeled free of toxic flame retardants.
  • Avoid exposing the family to tobacco smoke, wood smoke from fireplaces and wood stoves, idling car exhaust, cooking fumes from stoves and grills.
  • If you’re putting in a new floor, choose either phthalate-free vinyl flooring or wood, bamboo or cork.
  • Avoid plastic toys, backpacks, lunch boxes and school supplies made of polyvinyl chloride (PVC) which can be a source of phthalates.
  • Choose fragrance-free personal care products to avoid phthalates in fragrances .
  • When using stool softeners, laxatives and other time-release capsules, look for phthalates on the list of inactive ingredients so you can avoid them.
  • Use nontoxic alternatives to pesticides in your yard and on your pets.
  • Screen your house for lead. If it was built before 1978, lead paint may place your family at risk. If paint is chipping or peeling, it can build up in house dust and stick to children’s hands.
  • Reduce household dust that may contain lead, flame retardants, phthalates and pesticides. Take shoes off before you come into the house and use a doormat to trap dirt outside and inside the doorway. Damp mop, use a HEPA-filtered vacuum cleaner and dust with a microfiber cloth.

Could Environmental Chemicals Shape Our Exercise Habits?


Credit Getty Images

A disquieting new study finds that mice exposed prenatally to a common chemical found in many cosmetics and personal care products are less likely than other mice to exercise as adults, adding a new wrinkle to the mystery of exercise motivation. Although mice obviously are not people, the findings at least raise the possibility that exposure to environmental toxins before birth might change babies’ physiology in ways that affect their interest in exercise throughout their lives.

By now, we all know that we should work out to improve health and well-being. But a hefty majority of us never manage to exercise and many who do visit the gym do so reluctantly and sporadically.

The question of why some people are so loath to exercise is of pressing interest to exercise scientists. Work and family obligations of course play an outsize role, as do genes. Studies of the genetics of exercise suggest in fact that the will to exercise — or not — is mostly inherited.

But scientists also have begun to wonder about early physical development and whether differences in the environment within a mother’s womb might lead to changes in her baby that affect how much that infant moves around later in life.

A mouse study I wrote about recently suggested, encouragingly, that if a mother exercises during pregnancy, she might increase her offspring’s subsequent interest in working out.

But whether the environment within the womb might reduce a baby’s later desire to exercise has not been much studied.

So for the new study, which will appear next month in Medicine & Science in Sports & Exercise, scientists at Texas A&M University in College Station, Tex., decided to look at pregnancy, exercise behavior and phthalates.

Phthalates (THAL-ates) are a class of chemicals used as solvents and fixatives and to make plastic pliable. Found today in a boggling array of everyday products, from food containers to shampoos and perfume, they are virtually ubiquitous in the environment and in our bloodstreams.

They easily cross into a pregnant woman’s womb and accumulate in her offspring. Rather ominously, phthalates are known as endocrine disrupters, meaning that they can change the body’s production of the sex hormones testosterone and estrogen and, in animal studies, alter the onset of puberty in mouse pups exposed to high levels of the chemicals in utero.

The Texas scientists wondered whether phthalates might also influence how much exposed babies exercised, since varying levels of sex hormones, especially testosterone, are known to change how readily young animals move around.

To find out, they gathered healthy female mice, mated them with healthy males, and then fed half of the pregnant females benzyl butyl phthalate (B.B.P.), a common phthalate. The mice received the B.B.P. at the point in their pregnancies when their babies were rapidly developing organs and sex characteristics, which in human terms, would be near the end of the second trimester.

According to the scientists’ calculations, the exposure for each pup would be slightly higher than the amount that the E.P.A. has determined to be safe for humans.

The rest of the pregnant animals were fed a harmless oil to serve as a control group.

After birth, all of the pups were provided with running wheels and allowed to exercise as much or little as they chose.

The scientists checked the animals’ sex hormone levels at several points during the animals’ lives.

What the researchers found was that by young adulthood and continuing on into the mouse version of late middle age, the exposed animals were not moving much.

In fact, the male mice that had been exposed to B.B.P. in utero ran about 20 percent less during adulthood than the other animals, while the exposed females exercised about 15 percent less.

Interestingly, the exposed animals did not differ much from the other rodents in terms of body composition. They were not significantly fatter. Obesity and any accompanying disability had not discouraged them from exercising, the scientists concluded. They had been sedentary by choice, not necessity.

That choice, however, seems to have been influenced by disruptions in their sex hormones. Checking their data, the researchers found that the male mice exposed to B.B.P. in utero had notably lower levels of testosterone than the other animals in young adulthood, which is also when their running mileage cratered. Those differences lingered into middle age. The exposed females similarly developed during young adulthood low estrogen levels and other reproductive system abnormalities that then produced a profound desire, it seems, to sit for most of the day.

The implication of these findings is that, in mice, “exposure to the endocrine disrupter B.B.P. might affect lifelong physical activity,” said Emily Schmitt, a postdoctoral researcher at Texas A&M who led the new study.

It’s impossible at this point to say whether human babies would be similarly affected, Dr. Schmitt said.

Likewise scientists don’t know whether a father’s exposure to phthalates can affect his unborn offspring or if eating and dousing oneself in phthalates long after birth, including when you are fully grown, might dampen your subsequent enthusiasm for working out, although Dr. Schmitt and her colleagues hope to investigate some of those issues in future studies.

But even with many questions remaining unanswered, “it certainly seems like a good idea to try to avoid endocrine disruptors as much as possible, especially if you are pregnant,” Dr. Schmitt said.

You can find tips for reducing exposure to the chemicals at saferchemicals.org/.


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Folic Acid During Pregnancy May Lower Risk of Childhood Obesity


Pregnant women should take folic acid, a B vitamin, during pregnancy to prevent neural tube defects in their babies. Now a new study, in JAMA Pediatrics, has found that sufficient folic acid during pregnancy may reduce the risk for obesity in children.

Researchers studied 1,517 mother-child pairs, measuring the mothers’ folic acid blood levels at delivery and following the children through average age 6. After controlling for other variables in both mother and child, they found that compared with those mothers who had folic acid levels in the highest three-quarters, those with levels in the lowest one-quarter had a 45 percent higher risk for obesity in their children.

Folic acid may be especially beneficial for obese mothers. Among obese mothers with the lowest folic acid levels, the risk of obesity in their children more than tripled. But in children of obese mothers, the risk for obesity was 43 percent lower if their mothers were in the top three-quarters for folic acid levels than if they were in the bottom one-quarter.

Experts advise that all pregnant women take a 400-microgram supplement of folic acid daily. But the senior author, Dr. Xiaobin Wang, a pediatrician at Johns Hopkins, said that there is no perfect correlation between the supplement dose taken and blood levels. So “for an overweight mother, it’s probably worth the trouble to do a blood test,” she said. “It’s not an expensive test, and it’s important information. We try to make an individualized decision, and this is a more precise way to do it.”

Diet Soda in Pregnancy Is Linked to Overweight Babies


Drinking diet soda and other artificially sweetened beverages during pregnancy is associated with having overweight 1-year-olds, according to a new report.

Canadian researchers studied 3,003 mothers who delivered healthy singletons between 2009 and 2012 and had completed diet questionnaires during their pregnancies. They then examined the babies when they were a year old. Almost 30 percent of the women drank artificially sweetened beverages during pregnancy.

After controlling for maternal body mass index, age, breastfeeding duration, maternal smoking, maternal diabetes, timing of the introduction of solid foods and other factors, they found that compared with women who drank no diet beverages, those who drank, on average, one can of diet soda a day doubled the risk of having an overweight 1-year-old.

The study, in JAMA Pediatrics, found no association with infant birth weight, suggesting that the effect is on postnatal, not fetal, growth. The mother’s consumption of sugar-sweetened drinks was not associated with increased risk for overweight babies.

“This is an association, and not a causal link,” said the lead author, Meghan B. Azad, an assistant professor at the University of Manitoba. “But it certainly raises the question of whether artificial sweeteners are harmless. It’s not time to ban them or tell everyone not to consume them, but there’s no great benefit to consuming these drinks, so there’s no harm in avoiding them.”

Flu Shots Protect Babies, Too


Here’s one more reason pregnant women should get a flu shot: It not only protects mothers, but a large study suggests it prevents flu in the infant, too.

Giving babies under 6 months old a flu vaccination does not work. Their immune systems are too immature to mount an effective response. But infants can get the flu, and it can have serious, even deadly, consequences.

Researchers used data on live births among women in a large health maintenance organization, including 23,847 babies born to mothers who had been vaccinated against the flu and 225,540 born to mothers who were not vaccinated. The study, published in Pediatrics, was carried out during the H1N1 flu pandemic of 2009-10.

Babies of unvaccinated women were 70 percent more likely to have a laboratory-confirmed case of flu, and 81 percent more likely to be hospitalized for flu before they were 6 months old.

The lead author of the study, Dr. Julie H. Shakib, an assistant professor of pediatrics at the University of Utah, said that after the 2009-10 pandemic, rates of vaccination of pregnant women went up sharply. In the 2013-14 season, more than 50 percent of pregnant women were vaccinated.

“We were encouraged to see the increase after the pandemic,” she said. “That’s when the public became aware of how much of a risk there was, and when obstetrics practices started delivering the vaccine as a routine part of care.”

For a New Mom, Relentless Fatigue Could Signal a Thyroid Problem


Credit Stuart Bradford

For six weeks after delivering my son, I had postpartum thyroiditis. Every afternoon around the same time, I would shake uncontrollably. Anxiety about night feedings and colic (which my son didn’t have) plagued my thoughts all evening. One night while my husband put our son, Jackson, to sleep, my sister put me to sleep. We watched “Romancing the Stone” and she rubbed my back until I drifted off — as if I were the baby.

Moreover, I lost all the baby weight within weeks. At my two-week checkup with my obstetrician, I had lost over 25 pounds. I left that appointment proud, feeling like I could be on the cover of Us Weekly. It must be the breast-feeding, pumping and healthy eating. But I was kidding myself. I breast-fed for all of three days. Sure, I pumped a few bottles, but Jackson got mostly formula. And I wasn’t eating healthfully. I was eating takeout.

About two months after Jackson’s birth, my thyroid burnt out. I didn’t know it at the time, but I later learned that mild hyperthyroidism had given way to Hashimoto’s disease, a potentially more serious, and chronic, thyroid condition in which the thyroid becomes underactive. Over the next few months, I gained about 30 pounds and became extremely lethargic. When I woke each morning, my first thought was: When can I take a nap today?

My body was just transitioning, I thought. And I had a baby now. Most new moms were tired, right? Still I sensed that something intense was happening: I was a different person.

My husband and I had some traumatic fights during those months. I feared that our marriage, the very foundation for loving this new child, was falling apart. He said things like “you’ve changed and “I can’t live like this anymore.” And the truth was that we really couldn’t live like this anymore.

To make matters worse, I felt that my internist largely dismissed my concerns. He ran my blood work for virtually everything except my thyroid hormone level. We spent the follow-up appointment discussing my elevated cholesterol (also a symptom of hypothyroidism). He offered me Xanax and suggested I talk to a therapist about postpartum depression. Even most friends and family members chalked up these physical changes to the stresses of being a new mom.

Finally, when Jackson was 6 months old, I saw my O.B. again. She, too, bet on postpartum depression but ran thyroid tests to rule it out. I vividly remember when the doctor called with the results, “I’m surprised you can get out of bed in the morning, much less work full-time and take care of a baby.” When I hung up, I wept. I wasn’t losing my mind. I wasn’t just having a hard time adjusting. My thyroid, this little butterfly-shaped gland in my throat that I last worried about in high school biology, was having a hard time keeping my body up and running.

The synthetic thyroid hormone Synthroid helped with losing weight and energy levels. And ever since, I’ve had routine blood work and sonograms to monitor my hormone levels and the small lumps on my thyroid. During my second pregnancy, I saw an endocrinologist and had blood taken every month. My endocrinologist told me that it was important that I have my medication adjusted every month during the pregnancy since the thyroid helps the body stay pregnant.

I was surprised to find that several of my women friends also turned out to have thyroid problems. They tell the same story about discovering their condition either later in life or surrounding a pregnancy. Toni had three miscarriages in one year because of a mismanaged thyroid. Lisa was diagnosed accidentally at 41 when she saw a doctor for a double ear infection and bronchitis. “He felt my neck and noticed that my thyroid was quite enlarged,” she writes.

All the women had weight troubles. Eat less carbs. Exercise more. Take the baby out for walks. You’re getting older so it’s harder. That was the advice I got, along with speeches about the American diet of processed foods and sedentary lifestyle. But I’ve never been sedentary, and becoming a mother certainly didn’t have me sitting on the couch eating potato chips. My friend Jen remembers being patronized at her doctor’s office. “I was literally patted on the leg and told it’s just going to be hard for you to lose weight, dear,” she said. Her endocrinologist prescribed her a medication for diabetes and told her to eat 1,100 calories a day.

My takeaway from those six months is this: Even amid the huge life change that is motherhood, I knew something was really wrong with my body. And if I had put my health first, I would’ve figured it out much faster and with much less heartache. But prioritizing yourself isn’t something many new moms do very well.

Of course the early weeks with a newborn are exhausting for all parents, but if you don’t start to feel normal once the baby’s sleep schedule stabilizes, it’s worth getting your thyroid checked. A simple blood test can make all the difference.

Kristin Sample is a writer, teacher and dancer. Her novel “North Shore South Shore” is available on Kindle. Follow her on Twitter and Instagram @kristinsample or check out her blog, kristinsample.com.


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Treating Pregnant Women for Depression May Benefit Baby, Too


Treating pregnant women for depression may benefit not just themselves but their babies as well.

A study, in the May issue of Obstetrics & Gynecology, included 7,267 pregnant women, of whom 831 had symptoms of depression. After controlling for maternal age, race, income, body mass index and other health and behavioral characteristics, the researchers found that depressive symptoms were associated with a 27 percent increased relative risk of preterm birth (less than 37 weeks of gestation), an 82 percent increased risk of very preterm birth (less than 32 weeks of gestation), and a 28 percent increased risk of having a baby small for gestational age.

They also found that among those who were treated with antidepressants for depression — about a fifth of those with the diagnosis — there was no association with increased risk for any of these problems. But they acknowledge that this group was quite small, which limits the power to draw conclusions.

Still, the lead author, Dr. Kartik K. Venkatesh, a clinical fellow in obstetrics and gynecology at Harvard, said that it was important to screen mothers for depression, not only for their health but for that of their babies.

“By screening early in pregnancy, you could identify those at higher risk and counsel them about the importance of treatment,” he said. “Treating these women for depression may have real benefits.”

Flu Shot During Pregnancy May Reduce Risk of Stillbirths



Flu vaccination during pregnancy may reduce the risk of stillbirth, a new study reports.

Researchers studied birth and maternal vaccination records for 58,008 pregnancies in Western Australia during the 2012 and 2013 flu seasons. There were 5,076 births to women who had had the flu vaccine at some point during pregnancy, and 52,932 births to unvaccinated mothers.

After adjusting for maternal age, socioeconomic status, diabetes, hypertension and other health and behavioral characteristics, they found that the risk of stillbirth was 51 percent lower in vaccinated women than in unvaccinated ones.

The researchers acknowledge that the study, in Clinical Infectious Diseases, is observational and does not prove cause and effect, and that the results may not be generalizable to other populations or other flu seasons.

The Centers for Disease Control and Prevention recommends the flu vaccine during pregnancy, but more than half of all pregnant women in the United States are unvaccinated.

The lead author, Annette K. Regan of the Western Australia health department, said that pregnant women go unvaccinated for two main reasons: they are unaware of its importance and their doctor does not recommend it, or they fear it will harm the baby.

“We hope,” she continued, “that these results show not only pregnant women but also their providers that flu vaccination is safe during pregnancy and has major benefits for both mother and infant.”

Does Exercise During Pregnancy Lead to Exercise-Loving Offspring?


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Mice born to mothers that run during their pregnancies grow up to be rodents that love to run as adults, according to a thought-provoking new animal experiment, while pups with sedentary moms had a less-enthusiastic attitude toward exercise. Though it’s a long way from mice to people, the study’s findings hint at the possibility that to some extent our will to work out may be influenced by a mother’s exercise habits during pregnancy, and begin as early as in the womb.

Most of us have probably observed that activity patterns tend to run in families, a situation that has been confirmed in studies involving both people and animals. Children whose parents are sedentary often tend to be inactive themselves, whereas parents who are physically active typically have children who move around and exercise often.

Logically, home environment and nurture influence familial activity levels; children learn from and mimic their parents.

Recent science, however, suggests that there are other, deeper biological influences at work as well, including genetics. A number of studies have identified various snippets of DNA that, if someone carries them, predispose that person to be quite active, while other gene variations may nudge someone toward being a couch potato.

But scientists also have begun to wonder about the role of a process known as developmental programming. According to this theory, a growing baby’s body and its very DNA can be changed by the environment it experiences in the womb and immediately after birth. These changes may, in turn, affect lifelong health and disease risk. Mouse pups born to mothers that become overweight and metabolically unhealthy during pregnancy, for instance, are more likely to be overweight and diabetic as adults than genetically identical mice born to mothers that maintain a normal weight during pregnancy.

To what extent developmental programming might affect someone’s willingness to work out, though, had rarely been explored.

So for the new study, which was published this month in the FASEB Journal, researchers from Baylor University and Rice University in Houston gathered genetically identical female mice and put them in cages with running wheels. Mice like running, and most of these animals jogged about six miles a day. After a week with wheels, the females were matched with male mice from the same genetic line. Pregnancies ensued.

At that point, half of the pregnant mice had their running wheels locked so that they could not run freely during pregnancy.

The other mice were allowed to continue running at will throughout their pregnancies, and they did keep running, although their distance and speed declined as they grew heavy with young.

After the babies were born and weaned, the pups were removed to their own cages, without wheels. Their cages were separated from those of the adult mice, so the young mice would not have watched their mothers working out and tried to emulate them.

But at multiple points throughout their lives, this second generation of mice was moved for several days to special cages equipped with unlocked running wheels and monitors that tracked how much they moved when not on the wheels.

During the pups’ childhoods, the scientists noted few differences in exercise behavior between the young mice. But as the animals entered adolescence, those born to running moms started to become enthusiastic runners themselves, putting in more miles on the wheels than the other mice and moving around more frequently in their cages when they were not running.

These differences accelerated as the animals aged, so that during the rodent equivalent of middle age, the animals born to runners were running and moving around significantly more throughout the day than the other mice, even though all of them were genetically the same and had had identical upbringings.

The clear implication of these results is that “a mother’s physical activity during pregnancy likely affects the physical activity of her offspring,” said Robert Waterland, a professor of pediatrics and genetics at Baylor who led with study with his colleagues Jesse Eclarinal and Shaoyu Zhu.

In essence, baby mice with active moms had literally been born to run.

Of course, mice are not people, and this study can’t tell us whether similar programming occurs in our babies if we are active during pregnancy.

The study also can’t explain how exercise during pregnancy affects a developing infant’s later urge to work out. It may be, Dr. Waterman said, that the mother’s physical movements jiggle the womb slightly in ways that alter fetal brain development in parts of the brain devoted to motor control and behavior; or that certain biochemicals produced by the mom during exercise pass through the placenta, affecting the baby’s physiology and gene activity lifelong.

He and his colleagues hope to study those issues in future experiments.

But for now, he said, it’s important that no mother interpret these results as a criticism if she didn’t exercise much during pregnancy. Those of us who have borne children know how exhausting the experience can be. But, he said, if a pregnant woman — with her doctor’s blessings — can walk, jog, swim or otherwise be physically active, she may improve her own health and also, just possibly, instill an incipient love of exercise in the child growing within her.


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Six Months Pregnant and Asking, ‘Am I Depressed?’


Credit Stuart Bradford

On a walk with my husband through Joshua Tree National Park in late January, I felt sad for no reason in particular. Or maybe for lots of really good reasons. I wasn’t sure which it was.

At the time, I was six months pregnant. My husband, Raj, asked me what was wrong. “Nothing,” I said, and kept walking, kept stewing, kept wiping away a few tears from under my sunglasses when he wasn’t looking.

“Are you depressed?”

The Times had recently published a story about updated guidelines calling for pregnant women to be screened for depression – both during the pregnancy and after giving birth. Raj must have read the article, too.

During my first pregnancy, when I was quite happy, Raj read all about postpartum depression. Soon after our baby arrived, the questioning began. Raj would get all serious, look me straight in the eye and say: “Do you have postpartum depression?”

Umm. No, hon, I am feeling pretty good.

But this time around, this pregnancy, things have felt different.

Did I have “pregnancy depression?” Would I pass the screening? What’s the difference between being pregnant – with a crazy amount of hormones flowing through your body – and being pregnant and depressed?

It can be so hard to tell. Like when there is a blizzard back home but you escaped just in time, and you are sitting by the pool at a beautiful hotel in Palm Springs, and the air feels just right, and your toddler has finally gone down for a nap, and yet, you are crying.

Or when you wanted to go pumpkin picking so your husband tried to cheer you up by returning from Home Depot with a large pumpkin and orange mums. You know he was just trying to help, but pumpkin picking at Home Depot? Pregnancy depression might be when you can’t see the pumpkin and mums on the front steps without bursting into tears.

Is that pregnancy depression, or just pregnancy?

Pregnancy depression could be when your toddler is playing on the balcony outside your hotel room and for a split second you think: If he falls, he falls; it would be an accident. And it doesn’t immediately occur to you just how disturbing that thought is.

That’s shocking, but is it depression?

I see doctors and nurses every four weeks for my pregnancy. But they haven’t once asked me how I’m doing emotionally. One time I arrived for an appointment visibly distraught. I hoped someone would ask, but nothing.

I don’t know why I haven’t raised the issue myself. Maybe it feels like they aren’t the right people to discuss this with. The nurses take my blood pressure. I trust my doctor to perform a C-section, if need be. What do they know about moodiness?

On the other hand, in recent years there has been a real increase in awareness about mood disorders during pregnancy. If the medical professionals seeing pregnant women and new mothers aren’t looking for these things, asking the right questions and identifying patients who need help, then who is?

When we returned from Palm Springs, I looked deeper into pregnancy depression and what it means. The episode with our toddler on the hotel balcony had scared me. My thought was fleeting, but I was horrified that I could even think such a thing.

The more I read about pregnancy depression, also called perinatal mood and anxiety disorder, the more I realized it might not just go away. I began to worry that I would struggle even more once I gave birth and was home with our baby – sleepless and overwhelmed with a newborn and toddler, especially when my husband was out of town on business.

I also wondered if our toddler could sense my mood. And what if when the baby came, my sadness affected my ability to bond with him?

Moodiness on its own I can manage. But depression that could affect my children and my relationship with them? That was something I wasn’t willing to tolerate.

It was time, I decided, to talk to my husband.

When I called Raj, who was traveling, he could hear something off in my voice. This time he asked, “Are you sad?”

Yes, I was sad.

I told him I was concerned that my sadness over the past few months was a real problem. That it wasn’t going away. That it might get worse.

It helped being so honest with him, and with myself. He didn’t judge me, which now I realize was my fear. He told me it wasn’t my fault. He said he’d watch our son, and I could see a therapist or support group available on the weekends. He said he was glad I had told him – and I was, too.

The next day I contacted Postpartum Support International, an organization that supports women facing mental health issues related to childbearing, and talked to a coordinator in New York City. She gave me a handful of therapists to call.

Something changed after I acknowledged that I was struggling, that I needed help: I started to feel better.

I found a therapist who was warm and understanding and let me go on and on about my concerns about taking care of two children while my husband was away, and my fears that I wouldn’t be able to manage.

The therapist didn’t have specific answers. (And unfortunately she didn’t offer to lend a hand with late-night feedings.) If anything, she told me what I already knew – that it can be really hard to tell the difference between a wave of pregnancy hormones and clinical depression. She said it seemed that I was suffering from the former.

But we also agreed that what I was experiencing was real. That hormone fluctuations can manifest in many different ways, and that it’s often not enough to just ignore them. In fact, sometimes, it’s the very act of addressing them head-on that makes all the difference.

Hanna Ingber is an assistant editor on the International desk at The New York Times.


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The Benefits of Spicing Up a Breast-Feeding Mother’s Diet


Credit Anna Parini

When I had my children I felt that there was a tendency by experts, including those in my own pediatric profession, to push certain principles that took all the fun out of life. This played out for me, in particular, after I gave birth to my first child, and was told as part of my breast-feeding “support” that I should avoid all spicy foods, because they would upset the baby. Like any good Cambridge, Mass., mother, I turned this into an argument about multiculturalism (“What about the mothers in Sichuan?”), but what I really thought was that it harked back to some old ideas about spices heating up the blood, and generally making life too interesting for the nursing mother.

Why are women told to avoid strong flavors when breast-feeding?

Twenty-five years ago, researchers asked a group of nursing mothers to load up on garlic. In the study, “Maternal Diet Alters the Sensory Qualities of Human Milk and the Nursling’s Behavior,” which ran in 1991 in the journal Pediatrics, nursing mothers who ate garlic produced breast milk with a stronger smell, as evaluated by researchers who didn’t know which sample was which. What was most interesting was how the milk tasted to the babies, those poetically named “nurslings.” When the garlic effect was there, the babies stayed longer on the breast, and nursed more vigorously.

Julie Mennella, a biopsychologist at the Monell Chemical Senses Center in Philadelphia, was the lead author on the 1991 study; she has continued to study the effect of early exposures on the development of taste. “Amniotic fluid and mother’s milk have a lot of sensory information,” she told me. “The baby gets the information when they feed on the milk.”

Another study, published in 2001, showed that babies who had been exposed to a flavor in utero or while nursing were more likely to like that flavor when they were weaned.

What goes into your stomach goes into your bloodstream, broken down into molecules of protein, carbohydrate, fat. The flavors cross as well, including potent molecules called volatiles, which carry scent, which in turn heavily influences taste, as you know if you have ever tried to eat something delicious when you have a bad head cold.

The variety of flavors that you eat during pregnancy go into your blood and then into the amniotic fluid, which the baby is constantly drinking, in utero, and the flavors that you eat while nursing cross from the blood vessels that supply the mammary glands into the breast milk. So instead of restricting the maternal diet, there’s now good evidence that by eating a wide variety of healthy and tasty foods during these periods, we are actually doing our babies a major favor.

“Breast-fed babies are generally easier to feed later because they’ve had this kind of variety experience of different flavors from their very first stages of life, whereas a formula-fed baby has a uniform experience,” said Lucy Cooke, a psychologist specializing in children’s nutrition, who is a senior research associate at University College London. “The absolute key thing is repeated exposure to a variety of different flavors as soon as you can possibly manage; that is a great thing for food acceptance.”

Her own research has included working with children at the age of weaning to increase the acceptance of vegetables by offering repeated exposures to them.

“Babies are tremendously adaptable and very accepting of all sorts of strange flavors,” Dr. Cooke told me.

What about the idea that some foods in the mother’s diet can make a baby fussy or gassy or colicky? By definition, the foods that cause gas in the mother do so because they are not absorbed, and sit in her intestine, making trouble. On the other hand, a number of studies suggest that some colicky babies do better if their mothers stay away from cow’s milk, so doctors may advise nursing mothers to cut that out for a 10- to 14-day trial, while making sure they still get plenty of calcium.

Caffeine is sometimes also a culprit, pointed out Dr. Pamela High, a professor of pediatrics at Brown University and medical director of the Infant Behavior, Cry and Sleep Clinic at Women & Infants Hospital of Rhode Island. But mothers of colicky babies often restrict their diets further and further, and many ultimately give up nursing, Dr. High told me in an email, even though this usually doesn’t help.

So yes, the flavors we eat when we’re pregnant, or when we’re nursing, go to the baby, aromatics and all. But this should be a positive message rather than a list of thou-shalt-nots, since it means that we are providing something beyond protein and calories; we’re actually letting our babies, unborn and born, into some of the joys of our human omnivory.

“A diet of the healthy foods she enjoys is modeling at its best,” Dr. Mennella said. “The baby only learns if the mother eats the foods.”

When, as a nursing mother, I ate the spicy foods that I love so well, I’ll have you know that I was actually modeling. My children, after all, were going to grow up in a family in which spicy food was part of every possible family occasion.

And if the flavors of the foods you love can make the experience of childbearing and child rearing a little tastier, or spicier, for mothers, that’s all to the good as well, and very much in line with what we hope our children are drinking in mother’s milk.

“Food gives pleasure,” Dr. Mennella said. “There’s a lot of biology underlying the pleasure of eating.

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Pollution Tied to Premature Births, Especially in Women With Asthma


Credit Stuart Bradford

A new study suggests that women with asthma exposed to air pollution, even before conception, significantly increase their risk of delivering a premature baby.

Researchers studied 223,502 pregnancies among 204,175 women in 19 hospitals across the United States, gathering data on air quality in each region.

The study, in the Journal of Allergy and Clinical Immunology, found that all women with asthma were more likely than those without to deliver preterm. But there were significant increases in preterm birth in asthmatic women exposed to air pollution, including traffic-related pollutants.

Air pollution also appeared to take a toll even before conception. Asthmatic women exposed to pollutants in the three months before conception were at a 28 percent higher risk for preterm birth than women without asthma exposed at the same time in the same conditions.

“That’s a window that hasn’t been studied before,” said the lead author, Pauline Mendola, an epidemiologist with the National Institutes of Health. “We saw the increase for both groups, but it was much higher for women with asthma.”

Air pollution may be unavoidable, but Dr. Mendola said that pregnant women should avoid outdoor activity when pollution levels rise.

The Environmental Protection Agency “issues air pollution advisories when conditions are bad,” she said. ”They’re not specifically for pregnant women, but pregnant women with asthma should be particularly aware of them.”

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Vaginal Delivery Tied to Higher Urinary Incontinence Risk


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Having a child through vaginal delivery increases the risk for long-term urinary incontinence compared to having a cesarean delivery, researchers report.

Scientists pooled data from 16 studies of women in nine countries. Some of the studies examined the effect of delivery mode on stress urinary incontinence, or the involuntary loss of urine that can occur on physical exertion or as a result of sneezing or coughing. Others looked at urge incontinence, marked by a sudden urgent desire to urinate. The analysis is in European Urology.

Tested at age 30, the risk for stress urinary incontinence was more than two and a half times as high for vaginal delivery as for cesarean section. The risk declined with age, and by age 60, the risk was 29 percent higher. Whether the vaginal delivery was spontaneous or assisted with instruments made no difference. The risk for urge incontinence was also slightly increased.

The pooled data has weaknesses. Only one of the studies, for example, was a randomized trial. And none of the studies distinguished between planned cesareans and cesareans that were performed after labor began.

“We are not advocating C-sections to prevent incontinence,” said the senior author, Dr. Kari A.O. Tikkinen, a urologist at Helsinki University Central Hospital. “The absolute risk is quite small. But women should know about this, and discuss the issue with their physicians.”

Getting Pregnant After a Miscarriage


Credit Alice Proujansky for The New York Times

A woman who miscarries early in pregnancy is often told to wait at least three months before trying to get pregnant again. But a new study suggests it can be fine to try again as soon as possible.

Researchers studied 998 pregnancies lost at 20 weeks gestation or less. (They included spontaneous losses only and excluded ectopic or molar pregnancies, which are known to require extended care.)

They followed the women for six menstrual cycles after the loss, or until pregnancy outcome for those who became pregnant, recording the time from pregnancy loss to the time of attempting a new conception. The study controlled for the prior number of pregnancy losses, age, B.M.I., smoking, alcohol use and other factors.

Among those who began to try in less than three months, 53.2 percent gave birth successfully, compared with 36.1 percent of those who waited longer. The study, in the February issue of Obstetrics & Gynecology, found no increased risk for pregnancy complications among women who began trying less than three months after a loss.

“Anyone who wants to become pregnant has to be emotionally ready,” said the senior author, Enrique F. Schisterman, an epidemiologist with the National Institutes of Health. “But if you’re emotionally ready, and there are no other complications, there is no physiological reason to wait.”

Support for Breast-Feeding, in a Multitude of Ways


Credit Paul Rogers

In 2001, when Dr. Alison Stuebe was pregnant with her first child, breast-feeding was a personal challenge that soon morphed into a professional research interest. Her son Noah was 3 months old when she began her residency in maternal-fetal medicine at Brigham and Women’s Hospital in Boston. Determined to nurse him for a year, she arrived at the hospital carrying a breast pump and, through sheer determination, more than met her goal. Noah was 2½ before he was weaned.

In the years since, with two more breast-fed sons, Dr. Stuebe has become a leading expert in the health value of breast-feeding for both mother and baby and a tireless advocate for new mothers trying to navigate its all-too-frequent challenges.

As the leading author of new guidelines from the American College of Obstetricians and Gynecologists, Dr. Stuebe insists that, given timely information, professional and workplace support, and hands-on help when needed, many more women would breast-feed their babies, and do so exclusively for the first half year of life, as recommended by the college, the American Academy of Pediatrics and the World Health Organization.

“Moms deserve better support, and obstetric providers can and must help, both by assisting their patients and by advocating for policies and practices that enable women to achieve their goals,” she said. And, the guidelines maintain, that support should begin as early as the first trimester of pregnancy.

To be sure, much has changed for the better since 1972, when breast-feeding by American women reached its nadir of 24 percent. Just three years prior, when my twin sons were born and a serious postpartum infection kept me in the hospital for 13 days, isolated from them, I had to beg for a breast pump every four hours. My desire to breast-feed was belittled by the nurse in charge: “You can always feed them formula,” she said dismissively as I dissolved in tears.

Today, more than three-fourths of women start to breast-feed, although more than half end up weaning their babies sooner than they would have liked, often short of six months. The target set byHealthy People 2020, a federal initiative to promote good health, would have nearly 82 percent of babies breast-fed initially, 60.6 percent at six months and 34 percent at one year.

Faced with financial and logistical stresses, many new mothers find it challenging to meet such a goal. Working women rarely get more than six weeks of paid maternity leave, and once back at work, the obstacles to expressing and storing breast milk can be daunting.

Accordingly, the new guidelines urge policy changes that “protect the right of a woman and her child to breast-feed,” including “paid maternity leave, on-site child care, break times for expressing milk,” and a place “other than a bathroom” to do so. Two decades ago, a former colleague of mine gave up her dream job after two frustrating months pumping milk in the office lavatory.

“Breast-feeding is optimal and appropriate for most women,” the new guidelines state. However, they add, while advice and encouragement by obstetric professionals are recommended, no woman should be coerced, pressured or unduly influenced to breast-feed.

Among the few medical contraindications to breast-feeding are infections in the mother – H.I.V., untreated tuberculosis, chickenpox or a herpes lesion on the nipple – and mothers being treated with cell-killing cancer drugs. Although clear-cut data are lacking on the effects of marijuana on breast-fed infants, the drug can get into breast milk and the guidelines discourage marijuana use by nursing mothers. Babies with the genetic disorder galactosemia, which impairs digestion of a sugar in milk, should not breast-feed.

During pregnancy, women trying to decide whether to breast-feed deserve to be informed about both its benefits and barriers and be given an opportunity and assistance to find ways around any obstacles, the guidelines state.

Both mother and baby benefit from breast-feeding. Women who breast-feed have a lower than average risk of developing breast cancer, ovarian cancer, diabetes, hypertension and heart disease later in life. Breast-fed infants enjoy greater protection from infections, sudden infant death syndrome and metabolic disease. Babies born prematurely especially benefit from breast milk, which lowers their risk of infections, especially necrotizing enterocolitis, a serious intestinal disease.

Assessing the health of a woman’s breasts and her prior experience with breast-feeding should be part of prenatal care, the guidelines urge. Past or anticipated difficulties and concerns should be discussed, ideally in conjunction with the woman’s partner, and strategies devised to make the desired feeding plan compatible with the needs and values of the woman and her family.

Ultimately, the obstetric guidelines conclude, a well-informed woman is best qualified to decide whether to breast-feed exclusively, combine breast with formula-feeding or feed only formula.

“Physicians should not be dogmatic,” Dr. Stuebe said. “Formula is not poison. Like antibiotics, if it’s needed, it should be used judiciously.”

I created my own plan when I could produce only a quarter of the milk my twins were consuming and faced conflicting advice from the obstetrician and pediatrician. I chose to combine the advice, first offering each baby the breast, then topping it off with formula. When I finally began producing enough milk, they all but gave up the bottle.

As in the past, the new guidelines disparage an all-too-common practice of outfitting new mothers at discharge with a “gift bag” that contains samples of formula, which can suggest that the hospital endorses formula feeding. Direct-to-consumer marketing of infant formula is also disparaged.

But even the most determined breast-feeder can sometimes have difficulty at first establishing successful nursing. Such women face an increased risk of developing postpartum depression “and should be screened, treated and referred appropriately,” the guidelines note.

Accordingly, there is now a growing legion of professional lactation specialists who can help. Some hospitals have them on staff. More good news: The services of a certified lactation consultant or counselor are now covered as preventive care under the Affordable Care Act.

A lactation specialist may also be helpful to women who stop nursing before they want to because of problems with pain, low milk supply or difficulty getting the infant to latch on to the breast.


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Tylenol During Pregnancy Tied to Asthma in Children


Credit Paul Sakuma/Associated Press

Taking Tylenol (acetaminophen) during pregnancy is associated with a slight increase in the risk for asthma in offspring, a new study has found.

Norwegian researchers used health data on 95,200 pregnant mothers between 1999 and 2008, and followed 53,169 of their children after birth. The mothers completed questionnaires on medication use for themselves and their children.

After controlling for various health and behavioral characteristics, they found that prenatal exposure to Tylenol was associated with a 13 percent increased risk for asthma at age 3. The more Tylenol the mother had taken during pregnancy, the higher the risk.

The study, in the International Journal of Epidemiology, was designed to minimize the possibility that the increased risk was caused by an illness rather than by the Tylenol itself. The association persisted whether the mother took the medicine for pain, fever, flu or any other respiratory tract infection.

“Based on this modest increased risk, there is no need to be concerned if a child has been exposed,” said the lead author, Maria C. Magnus, of the Norwegian Institute of Public Health. “It might be possible to limit the amount of Tylenol used, but mothers should not be afraid to use it when necessary.”

According to the Centers for Disease Control and Prevention, 65 percent of pregnant women use Tylenol.

Whooping Cough Booster Shot May Offer Only Short-Term Protection


The rapidly fading effectiveness of the pertussis booster vaccine may help explain recent widespread outbreaks of whooping cough.

The United States stopped using a whole-cell pertussis vaccine in the 1990s and began using an acellular version called DTaP. Five vaccinations are given during childhood, and a booster vaccine, called the Tdap, is given to adolescents and adults.

Researchers looked at 1,207 pertussis cases among children who had had the acellular vaccine in childhood. The study, in Pediatrics, found that when these children got the Tdap booster, it was 69 percent effective after the first year, then dropped to less than 9 percent two to three years later.

A new, more effective vaccine against whooping cough is needed, but according to the lead author, Dr. Nicola P. Klein, co-director of the Kaiser Permanente Vaccine Study Center, a change in schedule might be effective until one is developed.

“We need to think about whether we should have a targeted routine of vaccines instead of an age-based method,” she said. “There are a number of ways to do this. We’ve seen epidemics every four years in California, so maybe every four years would work. Or we could vaccinate whenever there is an outbreak.”

Dr. Klein added that the vaccination of pregnant women is effective in preventing pertussis in newborns, and that all pregnant women should get the Tdap vaccine in the third trimester of pregnancy.

Post-Cesarean Bacteria Transfer Could Change Health for Life, Study Shows


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The first germs to colonize a newborn delivered vaginally come almost exclusively from its mother. But the first to reach an infant born by cesarean section come mostly from the environment — particularly bacteria from inaccessible or less-scrubbed areas like lamps and walls, and skin cells from everyone else in the delivery room.

That difference, some experts believe, could influence a child’s lifelong health. Now, in the first study of its kind, researchers on Monday confirmed that a mother’s beneficial microbes can be transferred, at least partially, from her vagina to her baby after a C-section.

The small proof-of-principle study suggests a new way to inoculate babies, said Dr. Maria Gloria Dominguez-Bello, an associate professor of medicine at New York University and lead author of the report, published on Monday in Nature Medicine.

“The study is extremely important,” said Dr. Jack Gilbert, a microbial ecologist at Argonne National Laboratory who did not take part in the work. “Just understanding that it’s possible is exciting.”

But it will take further studies following C-section babies for many years to know to what degree, if any, the method protects them from immune and metabolic problems, he said.

Some epidemiological studies have suggested that C-section babies may have an elevated risk for developing immune and metabolic disorders, including Type 1 diabetes, allergies, asthma and obesity.

Scientists have theorized that these children may be missing key bacteria known to play a large role in shaping the immune system from the moment of birth onward. To replace these microbes, some parents have turned to a novel procedure called vaginal microbial transfer.

A mother’s vaginal fluids — loaded with one such essential bacterium, lactobacillus, that helps digest human milk — are collected before surgery and swabbed all over the infant a minute or two after birth.

An infant’s first exposure to microbes may educate the early immune system to recognize friend from foe, Dr. Dominguez-Bello said.

Friendly bacteria, like lactobacilli, are tolerated as being like oneself. Those from hospital ventilation vents or the like may be perceived as enemies and be attacked.

These early microbial interactions may help set up an immune system that recognizes “self” from “non-self” for the rest of a person’s life, Dr. Dominguez-Bello said.

In the United States, about one in three babies are delivered by C-section, a rate that has risen dramatically in recent decades. Some hospitals perform the surgery on nearly seven in ten women delivering babies.

An ideal C-section rate for low-risk births should be no more than 15 percent, according to the World Health Organization.

Dr. Dominguez-Bello’s study involved 18 babies born at the University of Puerto Rico hospital in San Juan, where she recently worked. Seven were born vaginally and 11 by elective C-section. Of the latter, four were swabbed with the mother’s vaginal microbes and seven were not.

Microbes were collected on a folded sterile piece of gauze that was dipped in a saline solution and inserted into each mother’s vagina for one hour before surgery. As the operations began, the gauze was pulled out and placed in a sterile collector.

One to two minutes after the babies were delivered and put under a neonatal lamp, researchers swabbed each infant’s lips, face, chest, arms, legs, back, genitals and anal region with the damp gauze. The procedure took 15 seconds.

Dr. Dominguez-Bello and her colleagues then tracked the composition of microbes by taking more than 1,500 oral, skin and anal samples from the newborns, as well as vaginal samples from the mothers, over the first month after birth.

For the first few days, ambient skin bacteria from the delivery room predominated in the mouths and on the skin of C-section babies who were not swabbed, Dr. Dominguez-Bello said.

But in terms of their bacterial colonies, the infants swabbed with the microbes closely resembled vaginally delivered babies, she found, especially in the first week of life. They were all covered with lactobacilli.

Gut bacteria in both C-section groups, however, were less abundant than that found in the vaginally delivered babies.

Anal samples from the swabbed group, oddly, contained the highest abundance of bacteria usually found in the mouth.

The results show the complexity of labor, said Dr. Alexander Khoruts, a microbial expert and associate professor of medicine at the University of Minnesota. “It cannot be simplified to a neat, effortless passage of the infant through the birth canal,” he said.

As the month progressed, the oral and skin microbes of all infants began to resemble normal adult patterns, Dr. Dominguez-Bello said. But fecal bacteria did not, probably because of breast or formula feeding and the absence of solid foods.

The transfer fell short of full vaginal birth-like colonization for two reasons, Dr. Dominguez-Bello said. Compared to infants who spent time squeezed inside the birth canal, those who were swabbed got less exposure to their mother’s microbes.

And all infants delivered by C-section were exposed to antibiotics, which also may have reduced the number and variety of bacteria colonizing them.

A larger study of vaginal microbial transfer is underway at N.Y.U., Dr. Dominguez-Bello said. Eighty-four mothers have participated so far.

Infants delivered both by C-section and vaginally will be followed for one year to look for differences in the treated and untreated groups and to look for complications. Thus far the swabbing has proved entirely safe.

The procedure is not yet recommended by professional medical societies, said Dr. Sara Brubaker, a specialist in maternal and fetal medicine at N.Y.U. Until more is known, physicians are hesitant to participate.

“But it has hit the lay press,” she said. “Patients come in and ask for it. They are doing it themselves.”

Dr. Brubaker is one of them. When her daughter was born three-and-half months ago, she arranged to have her baby swabbed.

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