Tag: Pregnancy and Childbirth

The Health Benefits of Coffee

Drinking coffee has been linked to a reduced risk of all kinds of ailments, including Parkinson’s disease, melanoma, prostate cancer, even suicide.

Americans sure love their coffee. Even last spring when the pandemic shut down New York, nearly every neighborhood shop that sold takeout coffee managed to stay open, and I was amazed at how many people ventured forth to start their stay-at-home days with a favorite store-made brew.

One elderly friend who prepandemic had traveled from Brooklyn to Manhattan by subway to buy her preferred blend of ground coffee arranged to have it delivered. “Well worth the added cost,” she told me. I use machine-brewed coffee from pods, and last summer when it seemed reasonably safe for me to shop I stocked up on a year’s supply of the blends I like. (Happily, the pods are now recyclable.)

All of us should be happy to know that whatever it took to secure that favorite cup of Joe may actually have helped to keep us healthy. The latest assessments of the health effects of coffee and caffeine, its main active ingredient, are reassuring indeed. Their consumption has been linked to a reduced risk of all kinds of ailments, including Parkinson’s disease, heart disease, Type 2 diabetes, gallstones, depression, suicide, cirrhosis, liver cancer, melanoma and prostate cancer.

In fact, in numerous studies conducted throughout the world, consuming four or five eight-ounce cups of coffee (or about 400 milligrams of caffeine) a day has been associated with reduced death rates. In a study of more than 200,000 participants followed for up to 30 years, those who drank three to five cups of coffee a day, with or without caffeine, were 15 percent less likely to die early from all causes than were people who shunned coffee. Perhaps most dramatic was a 50 percent reduction in the risk of suicide among both men and women who were moderate coffee drinkers, perhaps by boosting production of brain chemicals that have antidepressant effects.

As a report published last summer by a research team at the Harvard School of Public Health concluded, although current evidence may not warrant recommending coffee or caffeine to prevent disease, for most people drinking coffee in moderation “can be part of a healthy lifestyle.”

It wasn’t always thus. I’ve lived through decades of sporadic warnings that coffee could be a health hazard. Over the years, coffee’s been deemed a cause of conditions such as heart disease, stroke, Type 2 diabetes, pancreatic cancer, anxiety disorder, nutrient deficiencies, gastric reflux disease, migraine, insomnia, and premature death. As recently as 1991, the World Health Organization listed coffee as a possible carcinogen. In some of the now-discredited studies, smoking, not coffee drinking (the two often went hand-in-hand) was responsible for the purported hazard.

“These periodic scares have given the public a very distorted view,” said Dr. Walter C. Willett, professor of nutrition and epidemiology at the Harvard T.H. Chan School of Public Health. “Overall, despite various concerns that have cropped up over the years, coffee is remarkably safe and has a number of important potential benefits.”

That’s not to say coffee warrants a totally clean bill of health. Caffeine crosses the placenta into the fetus, and coffee drinking during pregnancy can increase the risk of miscarriage, low birth weight and premature birth. Pregnancy alters how the body metabolizes caffeine, and women who are pregnant or nursing are advised to abstain entirely, stick to decaf or at the very least limit their caffeine intake to less than 200 milligrams a day, the amount in about two standard cups of American coffee.

The most common ill effect associated with caffeinated coffee is sleep disturbance. Caffeine locks into the same receptor in the brain as the neurotransmitter adenosine, a natural sedative. Dr. Willett, a co-author of the Harvard report, told me, “I really do love coffee, but I have it only occasionally because otherwise I don’t sleep very well. Lots of people with sleep problems don’t recognize the connection to coffee.”

In discussing his audiobook on caffeine with Terry Gross on NPR last winter, Michael Pollan called caffeine “the enemy of good sleep” because it interferes with deep sleep. He confessed that after the challenging task of weaning himself from coffee, he “was sleeping like a teenager again.”

Dr. Willett, now 75, said, “You don’t have to get to zero consumption to minimize the impact on sleep,” but he acknowledged that a person’s sensitivity to caffeine “probably increases with age.” People also vary widely in how rapidly they metabolize caffeine, enabling some to sleep soundly after drinking caffeinated coffee at dinner while others have trouble sleeping if they have coffee at lunch. But even if you can fall asleep readily after an evening coffee, it may disrupt your ability to get adequate deep sleep, Mr. Pollan states in his forthcoming book, “This Is Your Mind on Plants.”

Dr. Willett said it’s possible to develop a degree of tolerance to caffeine’s effect on sleep. My 75-year-old brother, an inveterate imbiber of caffeinated coffee, claims it has no effect on him. However, acquiring a tolerance to caffeine could blunt its benefit if, say, you wanted it to help you stay alert and focused while driving or taking a test.

Caffeine is one of more than a thousand chemicals in coffee, not all of which are beneficial. Among others with positive effects are polyphenols and antioxidants. Polyphenols can inhibit the growth of cancer cells and lower the risk of Type 2 diabetes; antioxidants, which have anti-inflammatory effects, can counter both heart disease and cancer, the nation’s leading killers.

None of this means coffee is beneficial regardless of how it’s prepared. When brewed without a paper filter, as in French press, Norwegian boiled coffee, espresso or Turkish coffee, oily chemicals called diterpenes come through that can raise artery-damaging LDL cholesterol. However, these chemicals are virtually absent in both filtered and instant coffee. Knowing I have a cholesterol problem, I dissected a coffee pod and found a paper filter lining the plastic cup. Whew!

Also countering the potential health benefits of coffee are popular additions some people use, like cream and sweet syrups, that can convert this calorie-free beverage into a calorie-rich dessert. “All the things people put into coffee can result in a junk food with as many as 500 to 600 calories,” Dr. Willett said. A 16-ounce Starbucks Mocha Frappuccino, for example, has 51 grams of sugar, 15 grams of fat (10 of them saturated) and 370 calories.

With iced coffee season approaching, more people are likely to turn to cold-brew coffee. Now rising in popularity, cold brew counters coffee’s natural acidity and the bitterness that results when boiling water is poured over the grounds. Cold brew is made by steeping the grounds in cold water for several hours, then straining the liquid through a paper filter to remove the grounds and harmful diterpenes and keep the flavor and caffeine for you to enjoy. Cold brew can also be made with decaffeinated coffee.

Decaf is not totally without health benefits. As with caffeinated coffee, the polyphenols it contains have anti-inflammatory properties that may lower the risk of Type 2 diabetes and cancer.

Clinics Close, but Abortion Continues

Even as abortion is restricted, telemedicine allows some women to end unwanted pregnancies using legal medications.

Abortion is once again a prominent source of controversy, restrictive legislation and, for many, great distress. A little background may help put this in perspective.

Fifty years ago last fall, after New York State adopted the most lenient abortion law in the country, many out-of-state women with unwanted pregnancies sought help from New York doctors.

On assignment from The Times, I accompanied two such women from Minnesota through their newly legal New York abortion experience. One was a Catholic woman on birth control pills, the mother of three children all with serious birth defects whose husband threatened to abandon the family if she had another child. The other was a 17-year-old who didn’t know that she got pregnant after her high school prom, not weeks later at her graduation party. Both women had abortions safely performed by reputable New York gynecologists.

It was an emotionally fraught experience, but not nearly as harrowing as one I’d endured five years earlier when an unmarried friend with neither money nor access to a safe medical abortion tried in vain to terminate her pregnancy by drinking turpentine.

It is a different world today, with many more and better contraceptives and a 1973 Supreme Court ruling, Roe v. Wade, that protects a woman’s right to choose abortion, now becoming increasingly curtailed by state-imposed restrictions and subject to the possibility of being overturned by the court. At the same time, according to a recent report, more women with unwanted pregnancies are finding a safe way to end them on their own using medications licensed by the Food and Drug Administration.

Though dangerous methods — the proverbial coat-hanger abortions — are now relatively uncommon, they are by no means gone. Despite current availability of highly effective contraception covered for most women by the Affordable Care Act, the problem of unwanted or ill-timed pregnancies is still very much with us and likely always will be.

According to the Guttmacher Institute, a champion of reproductive rights that gathers solid data on abortion and related issues, nearly a quarter of women in the United States will have an abortion by age 45. The institute states that three-fourths of women seeking abortions are poor or low-income, and more than half are already mothers who for various reasons — monetary, medical, emotional, societal or professional — cannot now afford to have another child.

In the report, published in December in JAMA Network Open, a research team headed by Lauren Ralph, epidemiologist in reproductive medicine at the University of California, San Francisco, found in a nationally representative survey of 7,022 women aged 18 to 45 that 1.4 percent admitted to having tried to terminate a pregnancy without medical assistance. Such self-managed abortion attempts were more than three times as common among Black and Hispanic women than non-Hispanic white women, with finances playing an important role; 15 percent of respondents in the survey were living below the federal poverty level.

Adjusting for the known level of underreporting of abortion, the research team “estimated that 7 percent of U.S. women will attempt self-managed abortion at some point in their lives,” often using ineffective and sometimes dangerous methods. Dr. Ralph said that data from abortion clinics on how many women had first attempted to induce abortion on their own greatly underestimates the true number of self-managed abortions because more than one in four attempts were likely to have been successful.

Among women in the study, nearly half reported using the licensed abortion drug misoprostol or another medication in their most recent attempt to self-terminate a pregnancy, while 38 percent used herbs they heard could induce abortion, and nearly 20 percent used a physical method, such as being hit in the abdomen. Nearly 28 percent said they had succeeded in ending the pregnancy. Among those who had failed, 33.6 percent subsequently had abortions at a clinic (often 100 miles or more from home), and 13.4 percent continued the pregnancy. Eleven percent said they had suffered a complication following their self-attempt at abortion.

The most common reasons they gave for having tried to end a pregnancy on their own, without involving the health care system, were that it seemed easier or faster, that the procedure at a facility was too expensive and that the nearest clinic was too far away. Although this survey did not include adolescents, pregnant teens are often reluctant or unable to seek parental consent that many states require for a medically supervised abortion, which prompts some teens to attempt a self-induced abortion.

According to Dr. Ralph and co-authors, “abortion clinics and practitioners report caring for an increasing number of individuals who have attempted self-managed abortions.” The researchers predicted that efforts by women to induce abortions on their own will become increasingly common as access to facility-based abortion care continues to decline.

For instance, the last clinic in Missouri that provides abortions, operated by Planned Parenthood, could be forced to stop the practice in a dispute with state regulators. It won a reprieve to continue operating through next May. Missouri and Mississippi are among a number of states in which lawmakers have banned abortions in early pregnancy, and most recently Texas banned all abortions after six weeks of pregnancy, a point at which the vast majority of women don’t yet know they are pregnant. Last month, the Supreme Court accepted a case that could result in overturning Roe v. Wade.

“As more abortion clinics close and restrictions increase, the convenience of self-managed abortions will likely make them more prevalent,” Dr. Ralph said in an interview. “Just because states make abortion more difficult to access doesn’t mean the need for abortion will go away. We should make sure that women have the safest and most effective methods available.”

She noted that pandemic-induced limitations on in-person medical visits may have made it easier for women in many states to access self-managed abortion in their homes. More doctors are now willing to provide abortion counseling over the phone and may even “distribute abortion medication by mail or hand it to women in the parking lot,” she said.

Used correctly within 70 days of the start of a woman’s last menstrual period (10 weeks gestation), medical abortion is effective in ending pregnancy more than 95 percent of the time, the Guttmacher Institute has reported. There are two prescription drugs, best used in combination, that can induce abortion early in pregnancy. One, an oral drug called mifepristone, is taken first to block the hormone progesterone needed for pregnancy to continue; the other, misoprostol, is dissolved in the mouth or inserted vaginally one or two days later to induce contractions and expel the contents of the uterus, ending the pregnancy.

Mifepristone access is rigidly controlled and can be difficult for doctors to prescribe, but misoprostol, which was licensed as an ulcer drug, is readily available in pharmacies with a doctor’s prescription and is usually effective in ending an early pregnancy even without mifepristone. Some women have ordered misoprostol online or obtained it from Mexico or elsewhere.

Still, even with such drugs, if clinic access continues to decline or Roe is overturned, most women past 10 weeks of pregnancy might have no safe, legal access to abortion.

Modern Love Podcast: Meet Cute at Zero Years Old

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As her mind veered between visions of life and death, she turned to her only source of solace — prayer — and in doing so, came to a decision: The baby’s life had to be saved.

Brian Rea

Kadine Christie’s birth story is one that has been told to her time and again. She was born in the mountain town of Spalding, Jamaica, in the presence of two women: her mother, Lorna, and a stranger, Lurline, who was going into labor in the same open ward.

Lorna and Lurline were the first generation to have the option of giving birth in a hospital. They sat on adjacent beds — separated by a curtain, connected by their fear of childbirth.

This is a story that feels like fiction, but is far from it. It has high stakes, unexpected connections and a surprising ending. Something astonishing — even magical — was given birth to in April 40 years ago. Tune in to learn why Kadine’s birth story is also her love story.

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Kadine (green shirt) with her daughter Zuri and godparents, Jeral and Lurline Christie. This was taken in June 2005 at her mother Lorna’s house in Florida. Kadine’s godparents became her in-laws in the fall of that same year.

Kadine Christie

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    Kadine (green shirt) with her daughter Zuri and godparents, Jeral and Lurline Christie. This was taken in June 2005 at her mother Lorna’s house in Florida. Kadine’s godparents became her in-laws in the fall of that same year.

    Kadine Christie

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    Kadine and her family at her daughter Zuri’s graduation. From left to right: Zahara Christie, Ontonio Christie, Zuri Dwyer, Kadine and Markolee Christie.

    Monalisa DiSaverio

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    Ontonio and Kadine Christie in Daphne, Ala. in February 2021.

    Zuri Adia Dwyer

Today’s Tiny Love Story

The fateful crab onesie.

A onesie with a smiley crab captured the attention of Sarah Reynolds Weston when she accompanied a pregnant friend shopping for baby clothes.

“She found out she was pregnant right around the time that I found that I couldn’t have children,” Sarah told Miya Lee, a co-host of the Modern Love podcast. “And I think I tried to comfort myself by supporting her through her pregnancy.”

Eight days after spotting the onesie, Sarah said, her “world turned upside down.”

“I really believe that we were all meant to be together, that we were linked,” she said about her son’s entrance into her life.

Hosted by: Daniel Jones and Miya Lee
Produced by: Julia Botero, with help from Hans Buetow, Daniel Guillemette and Elyssa Dudley
Edited by: Sara Sarasohn
Executive Producer: Wendy Dorr
Music by: Dan Powell
Mixed by: Corey Schreppel
Narrated by: Shayna Small
Special thanks: Nora Keller, Mahima Chablani, Julia Simon, Bonnie Wertheim, Anya Strzemien, Joanna Nikas, Choire Sicha, Lisa Tobin, Sam Dolnick and Ryan Wegner at Audm.

Thoughts? Email us at modernlovepodcast@nytimes.com.

Want more from Modern Love? Read past stories. Watch the TV series and sign up for the newsletter. We also have swag at the NYT Store and two books, “Modern Love: True Stories of Love, Loss, and Redemption” and “Tiny Love Stories: True Tales of Love in 100 Words or Less.”

Covid Vaccines Protect Pregnant Women, Study Confirms

The shots may also have benefits for infants and do not seem to damage the placenta, according to the latest research.

When the coronavirus vaccines were first authorized in December, scientists knew little about how well they might work in pregnant women, who had been excluded from the clinical trials.

Since then, scientists have accumulated a small but steadily growing body of evidence that the vaccines are safe and effective during pregnancy. Preliminary results from two continuing studies provide additional encouraging news.

The Pfizer-BioNTech and Moderna vaccines produce robust immune responses in pregnant and lactating women, and are likely to provide at least some protection against two dangerous coronavirus variants, according to a study published in JAMA on Thursday. Vaccinated women can also pass protective antibodies to their fetuses through the bloodstream and to their infants through breast milk, the research suggests.

In a second study, published in the journal Obstetrics & Gynecology on Tuesday, researchers found no evidence that either the Pfizer or Moderna vaccines damaged the placenta during pregnancy.

“We can shift our framework from, ‘Let’s protect pregnant people from the vaccine,’ to ‘Let’s protect pregnant people and their infants through the vaccine,’” said Dr. Emily S. Miller, an expert in maternal-fetal medicine at Northwestern University and co-author of the placenta study. “I think that’s really powerful.”

Covid presents serious risks during pregnancy. Research has shown, for instance, that pregnant women with coronavirus symptoms are more likely to be admitted to the intensive care unit, require mechanical ventilation and to die from the virus than are symptomatic women of a similar age who are not pregnant.

Because of these risks, the Centers for Disease Control and Prevention has recommended that the vaccines at least be made available to pregnant people, many of whom have opted to receive the shots.

In the JAMA study, scientists at the Beth Israel Deaconess Medical Center in Boston and Harvard Medical School studied blood samples from 103 women who had received the Pfizer or Moderna vaccine between December 2020 and March 2021. Of these women, 30 had received the vaccine while pregnant, 16 while lactating and 57 while neither pregnant nor lactating.

The researchers analyzed the blood samples for signs that the shots had conferred some protection against the coronavirus. Immune responses are complex, and may involve both antibodies — proteins that can bind to and block the virus — and T cells, which help the body recognize the virus and destroy infected cells.

The vaccines produced similar responses in all three groups of women, eliciting both antibody and T-cell responses against the coronavirus, the scientists found. Of particular note, experts said, was the fact that the shots produced high levels of neutralizing antibodies, which can prevent the virus from entering cells, in both pregnant and nonpregnant women.

“Clearly, the vaccines were working in these people,” said Akiko Iwasaki, an immunologist at Yale University who was not involved in the research. “These levels are expected to be quite protective.”

The researchers also found neutralizing antibodies in the breast milk of vaccinated mothers and in umbilical cord blood collected from infants at delivery. “Vaccination of pregnant people and lactating people actually leads to transfer of some immunity to their newborns and lactating infants,” said Dr. Ai-ris Y. Collier, a physician-scientist at Beth Israel who is the first author of the paper.

The results are “really encouraging,” Dr. Iwasaki said. “There is this added benefit of conferring protective antibodies to the newborn and the fetus, which is all the more reason to get vaccinated.”

The scientists also measured the women’s immune responses to two variants of concern: B.1.1.7, which was first identified in Britain, and B.1.351, which was first identified in South Africa. All three groups of women produced antibody and T-cell responses to both variants after vaccination, although their antibody responses were weaker against the variants, especially B.1.351, than against the original strain of the virus, according to the study.

“These women developed immune responses to the variants, although the asterisk is that the antibody responses were reduced several-fold,” said Dr. Dan Barouch, a study author and virologist at Beth Israel. (Dr. Barouch and his colleagues developed the Johnson & Johnson vaccine, which was not included in this study.)

“Overall, it’s good news,” he added. “And it increases the data that suggests that there is a substantial benefit for pregnant women to be vaccinated.”

The researchers also found that 14 percent of pregnant women reported a fever after their second vaccine dose, compared to 52 percent of nonpregnant women. They did not observe any severe complications or side effects.

The study will continue, with researchers monitoring women’s longer-term immune responses. And larger epidemiological studies are still needed to confirm these lab-based results, Dr. Collier noted.

In the second study, a research team from Northwestern University and the Ann and Robert H. Lurie Children’s Hospital of Chicago examined the placentas from 200 women who gave birth between April 2020 and April 2021. Eighty-four of the women had received either the Pfizer or Moderna vaccine during pregnancy; the remainder had not received any coronavirus vaccine.

The placentas from vaccinated women were not any more likely to show signs of injury or abnormality than those from unvaccinated women, the researchers found.

“These data build upon the emerging data that’s come out about these vaccines and their safety in pregnant people,” Dr. Miller said. These are translational data that suggests the placenta doesn’t see any injurious impact of the vaccine. And that’s really fantastic.”

The findings have limitations, she acknowledged. Because the vaccines were only authorized recently, most of the women in the study were vaccinated in the third trimester of pregnancy, and many of them were health care workers, who were among the first people eligible for the shots.

Dr. Miller and her colleagues are continuing to collect more data, including from patients who were vaccinated earlier in their pregnancies and who received the one-shot Johnson & Johnson vaccine.

“This is ongoing work,” Dr. Miller said. But they wanted to publish their preliminary data as soon as they had it, she added, “to help people make the best decision they can.”

Parents’ Diet and Exercise Habits, Even Before Birth, May Contribute to Child’s Well-Being

Physical activity during pregnancy might have long-lasting benefits for a child’s health, new research suggests.

The lifestyles of soon-to-be mothers and fathers could shape the health of their unborn offspring in lasting ways, according to a surprising new animal study of exercise, diet, genetics and parenthood.

The study found that rodent parents-to-be that fatten on a greasy diet before mating produce offspring with sky-high later risks for metabolic problems. But if the mothers stay active during their pregnancies, those risks disappear.

The study involved mice, not people, but does suggest that when a mother exercises during pregnancy, she may help protect her unborn children against the unhealthy effects of their father’s poor eating habits, as well as her own. The findings add to our growing understanding of the ways in which parents influence children’s long-term health, even before birth, and suggest how physical activity during pregnancy might help to ensure that those impacts are beneficial.

Researchers have known for some time that parents, and especially mothers, begin influencing the health and behavior of their offspring well before conception. Studies involving both animals and people show that mothers with diabetes, obesity, insulin resistance or other metabolic problems before pregnancy tend to have babies with a predisposition to those same conditions as adults, even if the offspring follow healthy lifestyles. Mothers who are lean and physically active during pregnancy, meanwhile, tend to have children who, as adults, are active and metabolically healthy.

A hefty percentage of these differences are a result, no doubt, of nurture, since children readily adopt the diet and exercise habits of their parents. But some proportion of babies’ metabolic futures seem hard-wired, built into them as they develop in the womb, through a process that scientists call metabolic programming.

Metabolic programming is complex and still only partially understood, but involves the inner workings both of the womb and of parental DNA. Some aspects of the environment inside the womb can change, depending on a mother’s health and lifestyle, affecting the development of organs and biological systems in the fetus.

Ditto for parental genetics. The operations of certain of our genes shift in response to our diets, exercise habits, metabolic health and other lifestyle factors. These shifts, which are known as epigenetic changes, become embedded in our DNA and can be passed along to the next generation by mothers or fathers.

In this way, metabolic problems can be inherited, propagating across generations.

But there are hints that physical activity snips this cycle. In past rodent studies, if the soon-to-be parents ran before mating, they typically produced offspring without heightened risks for diabetes or obesity, even if the parents themselves experienced those conditions.

Most of these studies focused their attention on the impacts of the mothers’ health and habits, though. Less has been known about how a father’s metabolic health changes his children’s long-term metabolic prospects and whether a mother’s activities during pregnancy might counter any negative outcomes from a father’s way of life.

So, for the new study, which was published in March in the Journal of Applied Physiology, scientists at the University of Virginia School of Medicine and other institutions first gathered a large group of mice. Some of the animals, male and female, were allowed to gorge on a high-fat, high-calorie diet, inducing obesity and metabolic problems, while others remained on normal chow, at their usual weight.

Next, the mice hooked up, with obese animals of both genders mating with normal-weight mice, so that, in theory, one parent in each pairing could bequeath unhealthy habits and metabolism to the young. A few normal-weight animals without metabolic problems also mated, to produce control offspring.

Finally, some mothers, including the obese, jogged on little running wheels throughout the resulting pregnancies, voluntarily covering up to seven miles a week in the early stages of their three-week gestations.

Afterward, the researchers tracked the metabolic health and underlying genetic activity of the offspring, until they reached adulthood. This second generation ate normal chow and led normal, lab-mouse lives.

Many, though, developed multiple metabolic problems as adults, including obesity, insulin resistance and other disruptions of their blood-sugar control. These conditions were most pronounced in the male children of obese mothers and in both the male and female children born to obese fathers.

Interestingly, the underlying genetics of their conditions differed by parental gender. Mice born to obese mothers displayed unusual activity in a set of genes known to be involved in inflammation. Those born to obese fathers did not.

In other words, the genetic legacies from mothers and fathers “operate through different biological pathways,” says Zhen Yan, a professor of medicine and director of the Center for Skeletal Muscle Research at the University of Virginia School of Medicine, who oversaw the new study.

Perhaps most important, though, when the mothers ran during pregnancy, their children showed almost no undesirable metabolic outcomes as adults, whether the mother or father was obese. These offspring, metabolically and genetically, remained indistinguishable from animals born to healthy parents.

Of course, this was a rodent study and we are not mice, so it is impossible to know if we — as mothers, fathers or offspring — respond similarly to diets and exercise, or if the effects are amplified when both parents are affected. The study also does not show if it is obesity or a high-fat diet that most drives intergenerational harms or what the ideal timing, types and amounts of exercise might be by either mom or dad, to combat those effects.

Dr. Yan says he and his colleagues plan to investigate those questions in future experiments. But already, the current study and other research suggest, he says, that physical activity, before and during pregnancy, and by both the expectant mother and father, “should absolutely be encouraged.”

Is ‘Femtech’ the Next Big Thing in Health Care?

Start-ups and tech companies are creating products to address women’s health care needs. It’s still a small segment of the market, but growing.

This article is part of our new series on the Future of Health Care, which examines changes in the medical field.

Women represent half of the planet’s population. Yet tech companies catering to their specific health needs represent a minute share of the global technology market.

In 2019, the “femtech” industry — software and technology companies addressing women’s biological needs — generated $820.6 million in global revenue and received $592 million in venture capital investment, according to PitchBook, a financial data and research company. That same year, the ride-sharing app Uber alone raised $8.1 billion in an initial public offering. The difference in scale is staggering, especially when women spend an estimated $500 billion a year on medical expenses, according to PitchBook.

Tapping into that spending power, a multitude of apps and tech companies have sprung up in the last decade to address women’s needs, including tracking menstruation and fertility, and offering solutions for pregnancy, breastfeeding and menopause. Medical start-ups also have stepped in to prevent or manage serious conditions such as cancer.

“The market potential is huge,” said Michelle Tempest, a partner at the London-based health care consultancy Candesic and a psychiatrist by training. “There’s definitely an increasing appetite for anything in the world which is technology, and a realization that female consumer power has arrived — and that it’s arrived in health care.”

She said one reason women-related needs had not been focused on in the field of technology was that life sciences research was overwhelmingly “tailored to the male body.” In 1977, the U.S. Food and Drug Administration excluded women of childbearing age from taking part in drug trials. . Since then, women have been underrepresented in drug trials, Dr. Tempest said, because of a belief that fluctuations caused by menstrual cycles could affect trial results, and also because if a woman got pregnant after taking a trial drug, the drug could affect the fetus. As a result, she noted, “we do lag behind men.”

Ida Tin, co-founder of Clue, which offers a period and ovulation tracking app.
Ida Tin, co-founder of Clue, which offers a period and ovulation tracking app.via Clue

The term “femtech” was coined by Ida Tin, the Danish-born founder of Clue, a period and ovulation tracking app established in Germany in 2013. In an article on the company’s website, Ms. Tin recalled how she first had the idea for the app. In 2009, she found herself holding a cellphone in one hand and a small temperature-taking device in the other and wishing she could merge the two to track her fertility days, rather than manually having to note her temperature on a spreadsheet.

Clue allows women to do exactly that with a few taps on their smartphone. Today, the company has a lot of competition in the period- and fertility-tracking area. And plenty of other women-specific tools have come onto the market. Elvie, a London-based company, has marketed a wearable breast pump and a pelvic exercise trainer and app, both using smart technology. Another strand of femtech known as “menotech” aims to improve women’s lifestyles as they go through menopause, providing access to telemedicine, and information and data that women can tap into.

Clue’s period and ovulation app. Ms. Tin had the idea when she found herself holding a cellphone in one hand and a small temperature-taking device in the other.Clue

Finally, there are medical technology companies focused on cancer that affects women, such as cervical cancer and breast cancer.

According to the World Health Organization, cervical cancer is the fourth most common cause of cancer among women around the world. In 2018, about 570,000 women had it, and as many as 311,000 died. The W.H.O. in November announced a program to eradicate the disease completely by the year 2030.

MobileODT, a start-up based in Tel Aviv, uses smartphones and artificial intelligence to screen for cervical cancer. A smart colposcope — a portable imaging device that’s one and a half times the size of a smartphone — is used to take a photograph of a woman’s cervix from a distance of about a meter (3 feet). The image is then transmitted to the cloud via a smartphone, where artificial intelligence is used to identify normal or abnormal cervical findings.

A diagnosis is delivered in about 60 seconds — compared to the weeks it takes to receive the results of a standard smear test (which, in developing countries, extends to months.) In addition to this screening, doctors still use smear tests.

The technology was recently used to screen 9,000 women during a three-month period in the Dominican Republic as part of a government-led campaign, the company announced last month. Another 50,000 women are expected be screened in the next six months.

Leon Boston, the South African-born chief executive of MobileODT, said the privately owned company was selling into about 20 different countries including the United States, India, South Korea and Brazil, and is going into a fund-raising round to build on its initial seed money of $24 million.

But the leading cause of cancer among women all over the world is breast cancer. One French start-up is focused on dealing with its aftermath. Lattice Medical has developed a 3-D printed hollow breast implant that allows for the regeneration of tissue and is absorbed by the body over time.

How it works: Post-mastectomy, the surgeon harvests a small flap of fat from the area immediately around the woman’s breast and places it inside the 3-D-printed bioprosthesis. That piece of tissue grows inside the implant, and eventually fills it out. In the meantime, the 3-D-printed shell disappears completely 18 months later.

So far, tests on animals have been encouraging, said Julien Payen, the company’s co-founder and chief executive. Clinical trials on women are expected to start in 2022, with the aim of getting the product into the market in 2025, he added.

Asked why the global femtech market was so small for technology companies, Mr. Boston said it was partly because of the “high level of regulation” involved in medical technology.

MobileODT, a start-up based in Tel Aviv, uses smartphones and artificial intelligence to screen for cervical cancer. MobileODT

“If your technology is incorrect and comes up with the wrong result, a woman who thinks she’s not positive for cervical cancer is actually positive,” he said. As a result, “the world of medical technology is slow to move.”

Still, prospects are favorable, according to Mr. Boston. “It’s very rare to have a totally barren market open for full potential, as we have today in medical technology,” he said.

The data forecasts appear to back that up. According to a March 2020 report by Frost & Sullivan, a research and strategy consultancy, revenue from femtech is expected to reach $1.1 billion by 2024.

Mr. Payen explained that for the femtech market to expand and develop, there have to be many more tech companies offering genuine health benefits to women, not just well-being apps crowding the market and adding little in terms of health or medical value. He cited the example of Endodiag, a French medical technology company that allows early diagnosis of endometriosis and a better management of the condition.

Either way, said Mr. Payen, the industry showed promise.

“Over the last 10 years, thanks to #MeToo and other movements, women are being listened to and heard more than ever before,” Mr. Payen said. And “more and more women are running companies and investment funds,” he added.

“In 10 or 15 years from now, as a new generation takes over, things will have changed even more radically,” he said. “Femtech is clearly poised to grow.”

Why I Gave My Mosaic Embryo a Chance

‘It was like rolling the dice, except for someone you’ve never met.’

My husband and I were sitting in an Upper East Side office with deep-toned velvet couches and fluffy throw pillows, surrounded by photos of smiling babies, as the fertility doctor gave his spiel. He told us that after age 35, a woman’s chances of getting pregnant drop. Older women produce few normal embryos even with fertility treatment. But we’d have a healthy baby in our arms within a year — if we tested the embryos.

By testing the chromosomes in my embryos, he said, we could weed out the abnormal embryos that may lead to miscarriage or a child with disabilities and only use viable ones.

I’ve always been a late bloomer — I met my husband at 37 and married at 39. I was in good health but pushing 40, with diminishing egg count and quality. After six months of trying to conceive on our own, we wanted all the help we could get. My husband and I jumped at the embryo testing suggestion.

After two long rounds of in vitro fertilization, we had five embryos, but the genetic testing deemed four of them “abnormal,” meaning they contained extra or missing chromosomes. Our fifth embryo, a girl, was what our genetic counselor called “mosaic,” meaning it had both abnormal and normal cells.

Starting in the late 1990s, doctors testing fertilized eggs classified them as normal or abnormal, then added the classification “mosaic” in 2015. Mosaic embryos can be either low- or high-level, depending on the number of abnormal cells. Twenty percent of tested embryos are mosaic.

Ours was a low-level mosaic embryo, with a few cells having an extra 22nd chromosome. Scientists are still trying to understand mosaicism, but this meant our embryo could be normal and lead to a healthy baby; she could have genetic abnormalities that would lead to miscarriage; or she could be born with congenital heart defects, asymmetrical development (meaning one side of her body could look like it was melting while the opposite side looked normal) or other disabilities that would cause her to use a wheelchair for life. It was like rolling the dice, except for someone you’ve never met.

It turns out there are a lot of online communities for mosaic kids and their families, including one on Facebook dedicated specifically to mosaics with an extra 22nd chromosome. Some adults lived normal lives and only find they have mosaic +22 later in life. Some women who were pregnant with babies with mosaic +22 miscarried. Children — ranging from newborns to young adults — had varying developmental challenges.

What scared me most was that in girls, the extra 22nd chromosome could cause infertility. I felt selfish for wanting her so desperately that I would allow her into the world without this same opportunity.

We had to make a fast choice: do a third cycle of I.V.F., hoping to get a normal embryo, or risk transferring the mosaic. Should we first try the mosaic embryo or risk having more nonviable embryos to agonize over? Because of the risks to the fetus and the developmental challenges our baby might face, the genetic counselor advised us to not transfer.

I had always hoped my future children wouldn’t be short like me. My husband, who sprouts freckles in the sun, hoped they would inherit my darker skin. Otherwise, we had no lofty dreams of them going to Harvard or making any “world’s most beautiful baby” list. We picked a dog that was the runt of the litter, with a lopsided face, because we thought she was modern art. But that’s a lot different from bringing a child into the world knowing it had a risk of living a difficult life.

It was a lot to take in. I wasn’t scared that my life would be curtailed if I brought up a child with special needs — I was ready to dedicate myself to a child. But I worried that my wanting a child was blinding me to some of my potential shortcomings. Was I capable of giving up everything to concentrate on this person who would need me in ways I couldn’t even fathom yet? I was terrified that I couldn’t handle having a child with special needs and would take it out on her.

I was also a little embarrassed that I cared so much about having a “perfect” baby that fit the standard 46-chromosome human body. Who was I to make this life and death decision for another human?

But it turns out that I didn’t know as much as I thought I did. Because genetic tests of I.V.F. embryos are far from perfect.

“Labs only test five cells from around 150 that make up the fertilized egg,” said Dr. Hugh Taylor, chairman of the Department of Obstetrics, Gynecology and Reproductive Sciences at the Yale School of Medicine. “We’re fooling ourselves if we think we have full information on an embryo based on those few cells.”

A recently published study of 1,000 mosaic embryos found those that progressed into a late-term pregnancy and full term birth had similar odds of being born without any discernible genetic differences to a normal embryo. But there were no guarantees.

I didn’t want to try another I.V.F. cycle. In late February 2020, we decided to transfer the embryo into my uterus — just in time for New York City to shut down during the pandemic.

Five months later, I got a call from a physician who was filling in for my doctor; she canceled my appointment, claiming she was uncomfortable transferring a mosaic embryo. I was livid and overcome with grief.

“The larger question that emerges with embryo testing is who gets to take on the risk of possibly bringing a child with potential disabilities into the world,” Dr. Taylor said. “The decision should not be left to physicians. Patients should be given the freedom to decide, and properly counseled in cases where there are abnormalities that will inevitably lead to death.”

Parents I had met online described wheeling or driving their frozen abnormal and mosaic embryos in unwieldy metal tanks to other clinics when their physicians refused to transfer. Fortunately, my regular doctor came back and scheduled a new appointment for the following month.

My husband and I got lucky. Our beautiful, imperfect embryo attached to the uterine wall, mesmerizing us with her wild beating heart at biweekly ultrasounds. As each week brought on fresh worries — that I could miscarry, that the baby might have other abnormalities not caught at embryo testing — I found comfort in Dr. Taylor’s words: “Mosaicism is more common than we think. Many of us are mosaic without knowing it.”

At three months, my doctor recommended a blood test that checked the baby’s DNA fragments in my blood to see if she was at risk for genetic abnormalities. At this point, my husband and I had begun to notice families in the dog park whose children had genetic disabilities. We quietly found acceptance that we would add variety to the families in our community and decided that we wouldn’t terminate the baby — no matter the result.

They came back as normal. But like embryo testing, the blood test couldn’t diagnose a fetus’s genetic condition with certainty. Our doctor offered a more accurate amniocentesis test, but we had already made our decision. I decided to leave it there.

Now, during ultrasounds, our daughter hides her face behind her hands or presses hard against the placenta, as if asking us to let her grow in privacy. The last time I glimpsed her full profile, at five months gestation, her nose, long and sharp, was prominent and unmistakable. I wondered if it was one of the characteristics of the extra 22nd chromosome or if she’d simply inherited my husband’s nose. As my due date draws nearer, her genetic profile is less of a concern. I’m thrilled we’ve made it this far.


Jacquelynn Kerubo is a writer and public health communicator.

After Genetic Testing, I Took a Chance on an ‘Imperfect’ Pregnancy

‘It was like rolling the dice, except for someone you’ve never met.’

My husband and I were sitting in an Upper East Side office with deep-toned velvet couches and fluffy throw pillows, surrounded by photos of smiling babies, as the fertility doctor gave his spiel. He told us that after age 35, a woman’s chances of getting pregnant drop. Older women produce few normal embryos even with fertility treatment. But we’d have a healthy baby in our arms within a year — if we tested the embryos.

By testing the chromosomes in my embryos, he said, we could weed out the abnormal embryos that may lead to miscarriage or a child with disabilities and only use viable ones.

I’ve always been a late bloomer — I met my husband at 37 and married at 39. I was in good health but pushing 40, with diminishing egg count and quality. After six months of trying to conceive on our own, we wanted all the help we could get. My husband and I jumped at the embryo testing suggestion.

After two long rounds of in vitro fertilization, we had five embryos, but the genetic testing deemed four of them “abnormal,” meaning they contained extra or missing chromosomes. Our fifth embryo, a girl, was what our genetic counselor called “mosaic,” meaning it had both abnormal and normal cells.

Starting in the late 1990s, doctors testing fertilized eggs classified them as normal or abnormal, then added the classification “mosaic” in 2015. Mosaic embryos can be either low- or high-level, depending on the number of abnormal cells. Twenty percent of tested embryos are mosaic.

Ours was a low-level mosaic embryo, with a few cells having an extra 22nd chromosome. Scientists are still trying to understand mosaicism, but this meant our embryo could be normal and lead to a healthy baby; she could have genetic abnormalities that would lead to miscarriage; or she could be born with congenital heart defects, asymmetrical development (meaning one side of her body could look like it was melting while the opposite side looked normal) or other disabilities that would cause her to use a wheelchair for life. It was like rolling the dice, except for someone you’ve never met.

It turns out there are a lot of online communities for mosaic kids and their families, including one on Facebook dedicated specifically to mosaics with an extra 22nd chromosome. Some adults lived normal lives and only find they have mosaic +22 later in life. Some women who were pregnant with babies with mosaic +22 miscarried. Children — ranging from newborns to young adults — had varying developmental challenges.

What scared me most was that in girls, the extra 22nd chromosome could cause infertility. I felt selfish for wanting her so desperately that I would allow her into the world without this same opportunity.

We had to make a fast choice: do a third cycle of I.V.F., hoping to get a normal embryo, or risk transferring the mosaic. Should we first try the mosaic embryo or risk having more nonviable embryos to agonize over? Because of the risks to the fetus and the developmental challenges our baby might face, the genetic counselor advised us to not transfer.

I had always hoped my future children wouldn’t be short like me. My husband, who sprouts freckles in the sun, hoped they would inherit my darker skin. Otherwise, we had no lofty dreams of them going to Harvard or making any “world’s most beautiful baby” list. We picked a dog that was the runt of the litter, with a lopsided face, because we thought she was modern art. But that’s a lot different from bringing a child into the world knowing it had a risk of living a difficult life.

It was a lot to take in. I wasn’t scared that my life would be curtailed if I brought up a child with special needs — I was ready to dedicate myself to a child. But I worried that my wanting a child was blinding me to some of my potential shortcomings. Was I capable of giving up everything to concentrate on this person who would need me in ways I couldn’t even fathom yet? I was terrified that I couldn’t handle having a child with special needs and would take it out on her.

I was also a little embarrassed that I cared so much about having a “perfect” baby that fit the standard 46-chromosome human body. Who was I to make this life and death decision for another human?

But it turns out that I didn’t know as much as I thought I did. Because genetic tests of I.V.F. embryos are far from perfect.

“Labs only test five cells from around 150 that make up the fertilized egg,” said Dr. Hugh Taylor, chairman of the Department of Obstetrics, Gynecology and Reproductive Sciences at the Yale School of Medicine. “We’re fooling ourselves if we think we have full information on an embryo based on those few cells.”

A recently published study of 1,000 mosaic embryos found those that progressed into a late-term pregnancy and full term birth had similar odds of being born without any discernible genetic differences to a normal embryo. But there were no guarantees.

I didn’t want to try another I.V.F. cycle. In late February 2020, we decided to transfer the embryo into my uterus — just in time for New York City to shut down during the pandemic.

Five months later, I got a call from a physician who was filling in for my doctor; she canceled my appointment, claiming she was uncomfortable transferring a mosaic embryo. I was livid and overcome with grief.

“The larger question that emerges with embryo testing is who gets to take on the risk of possibly bringing a child with potential disabilities into the world,” Dr. Taylor said. “The decision should not be left to physicians. Patients should be given the freedom to decide, and properly counseled in cases where there are abnormalities that will inevitably lead to death.”

Parents I had met online described wheeling or driving their frozen abnormal and mosaic embryos in unwieldy metal tanks to other clinics when their physicians refused to transfer. Fortunately, my regular doctor came back and scheduled a new appointment for the following month.

My husband and I got lucky. Our beautiful, imperfect embryo attached to the uterine wall, mesmerizing us with her wild beating heart at biweekly ultrasounds. As each week brought on fresh worries — that I could miscarry, that the baby might have other abnormalities not caught at embryo testing — I found comfort in Dr. Taylor’s words: “Mosaicism is more common than we think. Many of us are mosaic without knowing it.”

At three months, my doctor recommended a blood test that checked the baby’s DNA fragments in my blood to see if she was at risk for genetic abnormalities. At this point, my husband and I had begun to notice families in the dog park whose children had genetic disabilities. We quietly found acceptance that we would add variety to the families in our community and decided that we wouldn’t terminate the baby — no matter the result.

They came back as normal. But like embryo testing, the blood test couldn’t diagnose a fetus’s genetic condition with certainty. Our doctor offered a more accurate amniocentesis test, but we had already made our decision. I decided to leave it there.

Now, during ultrasounds, our daughter hides her face behind her hands or presses hard against the placenta, as if asking us to let her grow in privacy. The last time I glimpsed her full profile, at five months gestation, her nose, long and sharp, was prominent and unmistakable. I wondered if it was one of the characteristics of the extra 22nd chromosome or if she’d simply inherited my husband’s nose. As my due date draws nearer, her genetic profile is less of a concern. I’m thrilled we’ve made it this far.


Jacquelynn Kerubo is a writer and public health communicator.

I Met My Husband on the Maternity Ward

Modern Love

I Met My Husband on the Maternity Ward

He needed someone to cuddle him.

Credit…Brian Rea

  • Feb. 26, 2021, 12:00 a.m. ET

My birth story, which is also my love story, began nearly 40 years ago in the mountain town of Spalding, Jamaica. It has been told to me time and again by the two women who were there that April day — my mother, Lorna, and a stranger, Lurline, who was giving birth in the same open ward.

My mother and Lurline lived in different towns far from each other and had traveled separately to the hospital in Spalding. At the time, men had no place in the maternity ward, so my father, Vivian, a farmworker, and Lurline’s husband, Jeral, a pastor, were not there for the deliveries. Lorna and Lurline were expected to handle labor alone, with the help of nurses and doctors, of course.

These young women were the first generation even to have the option of giving birth in a hospital; they both had been born at home in crude conditions. Percy Junor Hospital in Spalding boasted no modern amenities. There were no meals on sanitized trays. Patients had to bring their own food, or have it brought, preferably in thermoses if they wanted it to be hot. Expecting mothers also had to bring their own gowns, bedsheets, even cloth diapers for their newborns.

There were few if any locally trained doctors. Cuba had the nearest medical schools. These Cuban-trained doctors were assisted by Jamaican nurses who ruled the maternity ward, moving briskly between the sheer curtains that separated the beds. There was no privacy.

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Lorna and Lurline lay nervously in their adjacent beds. While curtains separated them, they were connected by their fear of childbirth, and it was that fear that led them to start talking.

My mother was the first to go into labor, which began with a piercing pain that only intensified. As Lurline tells it, my mother began to moan and groan and quickly escalated to her mouthing unintelligible words in agony.

Lurline was overdue and believed that she should have been the one to be in labor. Shifting in her bed, she maneuvered her swollen and wobbly feet to the floor and, cradling her protruding abdomen, waddled to Lorna’s bedside. With her pastor husband, Lurline was a religious woman, a praying woman. She and Jeral led a small church in the Cascade Mountains, so she prayed for my mother at her bedside.

She later told me that witnessing my mother’s agony was akin to watching a body being split in two; my mother moaned and thrashed as if possessed. Lurline was seeing childbirth for the first time and it truly terrified her. She not only prayed for her new friend but also for herself, for what she would soon have to endure, as she held my mother’s hand through each contraction and breathed with her in unison.

These women had grown up in a time when subjects like sexuality and childbirth were not discussed, not even between mothers and daughters, so she found herself neither mentally nor emotionally prepared. The nurses did not take pity on first-time mothers and offered no comfort.

The nurses failed to realize, however, that my mother was in grave danger. She was hemorrhaging and growing lethargic, her legs shaking. Lurline told me that the brown of my mother’s irises even rolled over to reveal pure white, and her mind seemed to ebb and flow from awareness to oblivion.

When my mother’s body went still, the nurses, finally aware of the danger, busied themselves around her as night fell. It would be many hours before my mother would hear her baby’s cry — my cry — for the first time.

On Monday, April 13, 1981, my mother awoke to the sight of me being placed in her arms, but she was desperately weak, and the nurses decided she would need to remain in the hospital an extra four nights for observation. My mother’s happiness knew no bounds; my safe arrival was enough to calm the fear that had brought her to the brink.

Now it was Lurline’s turn, and the weight of her pregnancy was starting to drain her. She had thought she was emotionally prepared to deliver her baby, but seeing what my mother endured made her reel at the thought of pushing life from her own body.

Then the doctor came with bad news: Her baby was breech and would need to be surgically extracted. Lurline hadn’t anticipated this, but the doctor explained that her life and the baby’s life were in danger; she might even have to choose between them. The words “your life or your baby’s” terrorized her.

Lurline wrestled with this choice as the doctor’s warning rattled through her mind. She thought of the tumultuous yet tender days of her marriage, the life blossoming within her, and the moment she expected that she finally would hold the physical manifestation of her and Jeral’s love. Would that still happen now? As her mind veered between visions of life and death, she turned to her only source of solace — prayer — and in doing so, came to a decision: The baby’s life had to be saved.

Lurline suffered alone with the gravity of this decision. Despite her husband’s absence at the hospital, they managed life together and had started building a home for the family they were creating. They maintained a farm and a church. Jeral had made the long journey to the hospital when it was time for his wife to deliver their child, but he was not allowed to stay, so he had returned home.

As Lurline lay in bed, she worried about how Jeral would react if he were to come to take his family home and learn that only his child had survived. She pictured his face, perplexed by the doctor’s words. She saw his hands reaching for her in desperation and denial, only to confirm that his wife was, in fact, absent from her body.

Lurline inhaled the present: her church, her husband and the life inside her. Then she exhaled, as if letting go of all that might have been: a long marriage, parenthood, their rightful future. Placing her hand on her Bible, she glimpsed her wedding ring. She had not removed it since Jeral had slid it onto her finger years before, but she decided to remove it now, which took great effort, as her fingers had swollen.

Once it was off, she whimpered at the sight of her Bible and wedding ring. In life they were her identity, but in death they would be a memory.

If she were to die, Lurline needed Jeral to know what had happened during her last moments. As she approached my mother, holding her Bible and wedding ring, she felt guilty encroaching on such happiness, but she had no other choice. She didn’t want to cry, but upon seeing my mother holding me, Lurline’s eyes filled with tears. She put the ring and Bible in my mother’s hands with the request that Jeral receive them if she did not make it out of surgery alive.

These symbols of love and commitment felt like cement in my mother’s hands. She took a deep breath and nodded yes. Even if my mother didn’t quite realize the extent of Lurline’s trouble, she knew how deeply she had come to appreciate their newfound friendship.

Lurline had one more request for my mother, which was to have her read her favorite scripture, Psalm 35. As the anesthesia traveled through Lurline’s body, my mother’s words filtered through Lurline’s consciousness: “Plead my cause, Oh Lord — ”

On Wednesday, April 15, two days after my mother had given birth to me, a new life safely emerged by cesarean section, a boy named Ontonio.

At 13 pounds, Ontonio was the talk of the ward — no one had ever seen a baby of such great weight. Sewn up with stitches, aching from her surgery and unable to sit up or move about, Lurline rested beside her new friend, Lorna. Lurline’s delivery had been so traumatic and physically taxing that she would need time to heal.

And so it happened that the nurse took Ontonio from his mother and handed him to mine, who rocked, cuddled and sang to us both — me, Kadine, and Lurline’s baby boy, who in time, although we lived hours apart, would become my occasional childhood playmate, then teenage lover and now husband of 15 years.

Together, Ontonio and I entered this world, and together, four decades later, with three children of our own, we continue to revel in its mysteries and miracles.

Kadine Christie lives in Fairhope, Ala. She is the author of the memoir “I Am Home Within Myself.”

Modern Love can be reached at modernlove@nytimes.com.

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When Vagisil Targeted Teens, the Backlash Was Swift

When Vagisil Targeted Teens, the Backlash Was Swift

Experts say the brand’s new intimate care line shames young people and might even pose potential health risks.

Credit…Getty Images
Dani Blum

  • Feb. 18, 2021, 11:46 a.m. ET

An oatmeal-infused anti-itch serum claims to soothe the “bikini and intimate” region. A scented body wash says that it is “gentle enough for your vaginal area.” A confetti-dotted package of cleansing feminine wipes is “small enough to fit in your locker or a backpack.”

These products make up a new line of vanilla- and clementine-scented intimate care items for teenagers called OMV! (a play on the expression “OMG!”). The sparkly new brand — which comes from the makers of Vagisil and includes personal wipes, a wash and a serum — has cutesy packaging and uses phrases on its website and social media that might sound familiar to younger generations. (Why not “level-up” your teen’s “self-care routine” and enhance their “glow-up”?)

But in recent weeks, OMV! has drawn the ire of gynecologists and other women’s health experts online, who have argued that the brand’s focus on “freshness” might be contributing to unhealthy body image issues for young people by promoting the idea that vulvas are “dirty” and that they should appear or smell a certain way.

“Hey @vagisil going to call you out here for this predatory line of products aimed at teen girls,” Dr. Jen Gunter, a gynecologist and contributor to The New York Times, wrote on Twitter.

“How many times have we talked about how this industry preys on the insecurities of women?” Dr. Staci Tanouye, a gynecologist in Florida, said about the product line in a TikTok video. “And now we are directly targeting teens to tell them that they’re dirty.”

As with other types of scented intimate care products that are marketed for use on or around the vulva, many experts also have concerns that these products might be harmful to vaginal health.

In a written statement to The New York Times, a representative from Vagisil said that their OMV! products are safe and were tested rigorously, “using board-certified gynecologists and dermatologists,” before the care line’s launch.

But Dr. Danielle Jones, a gynecologist in Texas, said that this phrasing could be misleading. “You’ll notice they’re very careful in their wording,” she said in an email. Saying that a product is “gynecologist-tested” isn’t the same as “gynecologist-approved,” she said, “and safe isn’t equivalent to necessary.”

For example, she said, if a company asks her to “test” their product and she says that it is “terribly irritating in some patients,” the company could still “claim ‘gynecologist tested’ in their marketing.”

In 2018, the global feminine intimate care market was valued at $1.1 billion, according to market research firm Grand View Research, with intimate washes accounting for nearly 40 percent of the share.

The OMV! brand, which launched last year, is just one of many personal care lines that advertise to young women by telling them they should feel “comfortable in your own body” by keeping it fresh and clean.

But that sends the wrong message, said Dr. Heather Irobunda, an ob-gyn at NYC Health + Hospitals, especially for teens who don’t have access to adequate sexual education.

“Not only does it teach girls at a young age that you should probably smell like a Creamsicle,” she said, “it also then has these young girls question what exactly is a normal smell down there.”

Dr. Gunter, who learned about the OMV! line after some of her Instagram followers sent her direct messages about it, said that after looking up the brand’s website, she was appalled by some of the language they used in their advertising. She was especially irked by the tagline on the landing page that implies that “period funk” is a nuisance to be eliminated, and that their “No-Sweat” vulva wipes are supposed to help teens “never worry about staying fresh again.”

“This is all purity culture,” Dr. Gunter said. “It’s infantilizing — you have to be pure, clean, fresh, natural. These products always make it sound like you’re supposed to be a contestant on a game show called ‘America’s Next Virgin Bride’ or something.”

At the same time, experts have said that for some, the damage from these and other types of scented intimate hygiene products can extend beyond the psychological.

Any product that is scented can potentially damage the skin, Dr. Tanouye said. And while not everyone may experience a reaction, or react immediately, experts said that certain health issues can emerge after prolonged use. “Fragrance is the No. 1 cause of allergic contact dermatitis,” Dr. Tanouye said, which is a condition in which the skin gets inflamed and becomes itchy, red and rashy after contact with an irritating substance.

Because these are some of the same symptoms that many of these products claim to soothe, health experts said they are concerned that, in an effort to get rid of symptoms like pain, itching or irritation — which could be signs of a larger problem, like a yeast or bacterial infection — women might keep using these products and potentially make their problems worse.

“If a person with a vagina has itching, the key isn’t to cover it up with an anti-itch cream,” said Dr. Jennifer Lincoln, an obstetrician in Portland, Ore. “We’re really concerned about people delaying care.”

Dr. Irobunda estimated that about 30 percent of the patients she sees in an average week come in with vaginal complaints like itching, pain and inflammation that they’ve tried to heal with over-the-counter products from brands like Vagisil or Summer’s Eve (which sells feminine hygiene items like douches, cleansing cloths and “freshening sprays”). She sees many patients who are underinsured or in low-income communities, and who opt to treat their symptoms with creams they can pick up at a pharmacy instead of seeking medical attention. “It doesn’t wash away the bacteria that causes an inflammation or smell,” she said. “If the area is already inflamed, using these products will irritate that area even more.”

Dr. Jones, who posted a YouTube video about the OMV! line under her channel “Mama Doctor Jones” (which currently has more than 320,000 views), said she is concerned that teens might develop a habit of using these products. “It catches them early where it becomes something they think they inherently need for the rest of their lives,” she said.

And when use of these kinds of intimate care products becomes more regular, said Dr. Monica Woll Rosen, an ob-gyn at the University of Michigan Medical School, that can potentially disrupt the healthy balance of bacteria in the vagina, which can increase the risk of bacterial infections, sexually transmitted infections and urinary tract infections in teens.

Using these types of products in the vagina can “damage lactobacilli and mucus,” Dr. Gunter wrote on Twitter, which could increase the risk of sexually transmitted infections if exposed.

The first thing Dr. Tanouye tells patients who complain about vaginal itching or irritation is to stop using any scented products.

If you have an odor that suddenly changes, or experience a change in the color of your vaginal discharge, it’s time to see a doctor, rather than reach for over-the-counter products, she said.

“The catastrophic consequences are probably uncommon but not impossible,” Dr. Gunter said. “But irritation from these products? Absolutely. I see that every day.”

Evidence Builds That Pregnant Women Pass Covid Antibodies to Newborns

Evidence Builds That Pregnant Women Pass Covid Antibodies to Newborns

A new study suggests that protective antibodies can be transferred through the placenta, and the baby may receive more of them if a mother is infected with Covid earlier in her pregnancy.

A woman  in McAllen, Tex., who tested positive for Covid-19 while she was pregnant. Studies suggest that pregnant women infected with the coronavirus can pass antibodies to their babies. 
A woman in McAllen, Tex., who tested positive for Covid-19 while she was pregnant. Studies suggest that pregnant women infected with the coronavirus can pass antibodies to their babies. Credit…Carolyn Cole/Getty Images
Christina Caron

  • Jan. 29, 2021, 9:04 p.m. ET

One of the many big questions scientists are trying to untangle is whether people who get Covid-19 during pregnancy will pass on some natural immunity to their newborns.

Recent studies have hinted that they might. And new findings, published Friday in the journal JAMA Pediatrics, provide another piece of the puzzle, offering more evidence that Covid-19 antibodies can cross the placenta.

“What we have found is fairly consistent with what we have learned from studies of other viruses,” said Scott E. Hensley, an associate professor of microbiology at the Perelman School of Medicine at the University of Pennsylvania and one of the senior authors of the study.

Additionally, he added, the study suggests that women are not only transferring antibodies to their fetuses, but also transferring more antibodies to their babies if they are infected earlier in their pregnancies. This might have implications for when women should be vaccinated against Covid-19, Dr. Hensley said, adding that vaccinating women earlier in pregnancy might offer more protective benefits, “but studies actually analyzing vaccination among pregnant women need to be completed.”

In the study, researchers from Pennsylvania tested more than 1,500 women who gave birth at Pennsylvania Hospital in Philadelphia between April and August of last year. Of those, 83 women were found to have Covid-19 antibodies — and after they gave birth, 72 of those babies tested positive for Covid-19 antibodies via their cord blood, regardless of whether their mothers had symptoms.

According to Dr. Karen Puopolo, an associate professor of pediatrics at the University of Pennsylvania and one of the senior authors of the study, about half of those babies had antibody levels that were as high or higher than those found in their mother’s blood, and in about a quarter of the cases, the antibody levels in the cord blood was 1.5 to 2 times higher than the mother’s concentrations.

“That’s fairly efficient,” Dr. Puopolo said.

The researchers also observed that the longer the time period between the start of a pregnant woman’s Covid-19 infection and her delivery, the more antibodies were transferred, a finding that has been noted elsewhere.

The antibodies that crossed the placenta were immunoglobulin G, or IgG, antibodies, the type that are made days after getting infected and are thought to offer long-term protection against the coronavirus.

None of the babies in this study were found to have immunoglobulin M, or IgM, antibodies, which are typically only detected soon after an infection, suggesting that the babies hadn’t been infected with the coronavirus.

Experts don’t yet know if the amount of antibodies that passed on to the babies were enough to prevent newborns from getting Covid-19. And because only a few of the babies in the study were born prematurely, the researchers can’t say whether babies who are born early might miss out on those protective antibodies. The study authors also noted that because their results were from just one facility, the findings would need to be further replicated.

The placenta is a complex organ, and one that has been understudied, said Dr. Denise Jamieson, an obstetrician at Emory University in Atlanta and a member of the Covid expert group at the American College of Obstetricians and Gynecologists, who was not involved with the study.

And more research is needed to better understand whether vaccine-generated antibodies behave comparably to antibodies from Covid-19 infection, said Dr. Andrea G. Edlow, an assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School.

In a study published in the journal Cell in December, for instance, Dr. Edlow and her colleagues found that Covid-19 antibodies from a natural infection might cross the placenta less efficiently than the antibodies produced after vaccination for flu and whooping cough (pertussis).

“What we really want to know is, do antibodies from the vaccine efficiently cross the placenta and protect the baby, the way we know happens in influenza and pertussis,” Dr. Jamieson said.

Experts do not know whether the Covid vaccine will work in this way, in part because pregnant women were excluded from the initial clinical trials.

“It’s plausible that the Covid vaccine will offer protection to both pregnant mothers and their infants,” said Dr. Mark Turrentine, a member of the Covid expert group at A.C.O.G. “To me,” he added, “this study highlights that inclusion of pregnant women in clinical trials such as the Covid-19 vaccine is essential, particularly when the benefit of vaccination is greater than the potential risk of a life-threatening disease.”

Pregnant Women Get Conflicting Advice on Covid-19 Vaccines

The W.H.O. and the C.D.C. provide differing views, and experts partly blame a lack of data because expectant mothers have been excluded from clinical trials.

A New Option for Morning-After Contraception?

A New Option for Morning-After Contraception?

An hormonal IUD may work as well as morning-after pills for preventing pregnancy, a new study suggests.

Nicholas Bakalar

  • Jan. 27, 2021, 5:04 p.m. ET

Only two forms of “morning-after” contraception are approved by the Food and Drug Administration, both hormonal drugs taken orally as pills: levonorgestrel (Plan B One-Step and other brands, available over the counter) and ulipristal acetate (Ella, available by prescription). Observational studies strongly suggest that a nonhormonal copper intrauterine device (ParaGard) may also be effective.

Now researchers have found that another type of IUD, one containing the hormone levonorgestrel (Liletta and other brands) works as well as the copper IUD, and perhaps even better than the F.D.A.-approved oral pills for preventing pregnancy.

The study, in the New England Journal of Medicine, tested the copper IUD against intrauterine levonorgestrel in a randomized trial. Researchers recruited 638 women seeking emergency contraception at three Utah family planning clinics, randomly assigning them to one device or the other.

After one month, there were no pregnancies among women who used the copper IUD, and one among those who used the hormonal IUD. The researchers calculate that the incidence of pregnancy with intrauterine levonorgestrel is 0.3 percent, compared with 1.4 to 2.6 percent with oral contraceptives.

Neither of the intrauterine devices is now approved for emergency contraception, but the lead author of the study, Dr. David K. Turok, an associate professor of obstetrics and gynecology at the University of Utah, expects professional guidelines to include them soon.

“The main thing is that this is another option that may be highly attractive,” he said. “Now we have a well-designed and executed study that shows it can be used.”

A ‘Baby’ Aspirin a Day May Help Prevent a Second Pregnancy Loss

A ‘Baby’ Aspirin a Day May Help Prevent a Second Pregnancy Loss

Women who have had a pregnancy loss and are trying to get pregnant again may benefit from a daily low-dose aspirin.

Nicholas Bakalar

  • Jan. 27, 2021, 12:07 p.m. ET

For women who have had a pregnancy loss and are trying to become pregnant again, a simple routine might increase their chances: taking one baby aspirin a day.

A previous randomized trial suggested that aspirin had no beneficial effect. But a re-analysis of the data, concentrating on women who were strictly adherent to the dosage, shows that a daily 81-milligram tablet taken while trying to become pregnant and throughout pregnancy is highly effective. The new report is in Annals of Internal Medicine.

The re-analysis included 1,227 women aged 18 to 40 who had one or two pregnancy losses and were trying to get pregnant again. The researchers found that compared with placebo, taking a baby aspirin five to seven days a week resulted in eight more pregnancies, 15 more live births, and six fewer pregnancy losses for every 100 women in the trial. The key was strict adherence to the aspirin regimen.

Women who were most adherent were more likely to be married, non-Hispanic white and of higher socioeconomic status, and less likely to be smokers. The association of daily aspirin use with successful pregnancy was apparent even after controlling for these factors.

The lead author, Ashley I. Naimi, an associate professor of epidemiology at Emory University, cautioned that the findings apply only to women who have lost one or two pregnancies, but those women, he said, “could consider low-dose aspirin provided there are no other contraindications for aspirin use.” Check with your doctor about taking a daily low-dose aspirin.

Celebrity Pregnancy Is Big Business

Celebrity Pregnancy Is Big Business

These days, content begins at conception.

Clockwise from top left, Instagram posts by Danielle Brooks, Nicole Polizzi, Iskra Lawrence (pictured with Philip Payne) and Audrina Patridge, all of whom teamed up with brands to produce pregnancy-related content.
Clockwise from top left, Instagram posts by Danielle Brooks, Nicole Polizzi, Iskra Lawrence (pictured with Philip Payne) and Audrina Patridge, all of whom teamed up with brands to produce pregnancy-related content.

  • Jan. 23, 2021, 5:00 a.m. ET

The year 1948 yielded one of history’s great non-announcements: an opaque statement from Buckingham Palace that Queen Elizabeth II would undertake “no public engagements after the end of June.” That she was pregnant with her first child, Prince Charles, went wholly unmentioned.

In the intervening decades, things have gotten a bit more explicit — and lucrative. The news that a public figure is pregnant often comes directly from the source, in a post that may also be an #ad.

The most obvious brand partners in this area are purveyors of pregnancy tests. Clearblue has worked with upward of 70 celebrities and influencers on endorsements of its products since 2013. First Response has sponsored pregnancy announcements, too, including ones by the singer Kelis and the ballroom dancer Karina Smirnoff.

Other companies, like Belly Bandit (which sells maternity wear), Enfamil (the formula maker) and CBR (a cord-blood banking company), also make deals with celebrities around pregnancy and other parenting milestones.

When Audrina Patridge of “The Hills” announced her pregnancy on Twitter in 2015, her words were accompanied by a photo reminiscent of a 1950s advertisement for laundry detergent: pleasant partial smile, product (a Clearblue pregnancy test) positioned on a diagonal with the model’s shiny eyes and, of course, some copy to hammer the point home (#babyontheway).

“It was a very clear, easy way to announce to the world and let everybody know at the same time that you’re pregnant, because it says ‘pregnant.’ You’re holding it,” Ms. Patridge said. (Still, it seemed to confuse her reality co-star Spencer Pratt, who was unsure whether the post was an ad or personal announcement. Today, we take for granted that celebrity baby posts can be both.)

Iskra Lawrence, a British model with four million Instagram followers, told her management team that she’d seen the paid announcement posts and was interested in doing one herself. She shared her news in late 2019 with First Response and donated $20,000 — most of the fee, she said — to two followers experiencing infertility; the post was, at once, a P.R. blast, an ad and an awareness campaign.

The amount of exposure a brand will get by sponsoring a pregnancy announcement is “exponential,” said Sarah Boyd, a vice president at Socialyte, which brokers marketing deals for influencers and celebrities. The fee depends on “their fame and their relevance at the time,” she said, and likely diminishes after their first child. Ms. Boyd estimated that someone like Kylie Jenner could ask for more than $1 million.

But for many stars, the decision to post at all is fraught with questions about control, influence, labor and privacy.

‘People Want More and More of You’

These brand partnerships reinforce the idea of motherhood as defined by consumption and spending, said Renée Cramer, a professor of law, politics and society at Drake University and the author of “Pregnant With the Stars: Watching and Wanting the Celebrity Baby Bump.”

In her book, she explains the way celebrity mothers become “branded exemplars of how ordinary people can and should live.” When we see a celebrity holding up a certain brand of pregnancy test or diapers, Dr. Cramer said in an interview, it reminds “average people that, well, this company belongs in your nursery, even if there’s no good reason for it.”

Ellis Cashmore, a visiting professor of sociology at Aston University in Birmingham, England, and the author of “Kardashian Kulture: How Celebrities Changed Life in the 21st Century,” noted that celebrities have already licensed their names to perfume lines, turned their lives into smartphone apps and sold their time on apps like Cameo. “It’s only logical to expect that they are monetizing a life before it becomes a life,” he said.

Nicole Polizzi, who came to fame as Snooki on the MTV show “Jersey Shore,” has watched the tide shift on celebrities navigating this part of their public lives. She announced her first pregnancy in 2012 on the cover of People magazine. “Back then it was such a big deal,” she said. “By the third, you’re just like, ‘Right, Instagram post. Here it is.’”

The public once wrestled with the notion of celebrity moms oversharing. Now, fans want to know the sex, the name, the due date. Paparazzi are stationed outside of maternity wards. In a world that is always on baby bump watch, the celebrity has two options, Dr. Cramer said: “I can try and control the image, or I can profit some way.”

Babies are expensive, said the actress Danielle Brooks (best known for her role on “Orange Is the New Black”), who ultimately felt joyful about teaming up with Clearblue to announce her pregnancy to the world in late 2019. “You have to do what is right for your family.”

There is also pressure as an online figure to “keep creating content” to build your following, said Ms. Lawrence, the model. After birth, she said she felt a “tug of war” between wanting to be present with her baby and wondering: “Is this something that I should capture just in case?”

“People want more and more of you,” said the author and actress Jenny Mollen, who is married to the actor Jason Biggs. She has talked about postpartum bladder leakage, Grave’s disease, Botox and her placenta; she announced her second pregnancy with a baby product company in a five-figure deal, she said.

Dr. Cramer said this continuing sharing is “double performative labor.” The celebrity not only carries out the reproductive and care-taking labor of motherhood, but also transmits a performance of that identity to followers.

Even celebrities who keep a lid on their pregnancies must strategize the eventual rollout of their child. On Aug. 26, UNICEF announced the birth of a baby to Katy Perry and Orlando Bloom on Instagram. (Ms. Perry had announced her pregnancy in a music video.) Ms. Perry then reposted the Unicef link; her post was liked by more than 5.5 million people.

The Private Becomes Public

Pregnant people famous and not grapple over the timing of these announcements. Conventional wisdom is to wait until at least 12 weeks before revealing a pregnancy, though second- or third-trimester pregnancy loss is still possible. When a publicly announced pregnancy is lost, it becomes a much bigger story, said Dr. Cashmore.

Takiema Bunche-Smith woke up in her Brooklyn home on Oct. 1 to direct messages from friends warning her that she may find social media triggering that day. Chrissy Teigen had just posted photos portraying the loss of her third child with John Legend, and social media was overflowing with both sympathy and criticism.

Ms. Bunche-Smith’s first child was stillborn at 37 weeks and two days in 2003; at the time, talking about such a loss felt taboo. She found Ms. Teigen’s post powerful. “The photos were so poignant and bittersweet and such a clear example of what every one of us experiences,” she said. (Ms. Teigen noted in a Medium essay that the responses she received from followers were overwhelmingly kind, and that they helped her through an impossible time.)

“You worry about upsetting other pregnant women, you worry about how your loss will affect them,” said Georgina Brackstone, a 40-year-old jewelry designer in London who lost her first daughter 33 weeks into pregnancy nine years ago. She said public figures like Ms. Teigen had “allowed people like me to talk about their experiences.”

Elizabeth Cordero, a Los Angeles hairdresser who has had multiple miscarriages and lost her baby seven days after birth, said there is no “safe” date after which to announce. She is halfway through a pregnancy and said that “this time around, we’ve decided that we’re just going to celebrate every damn day.”

In situations where there are birth complications, difficulties breastfeeding, perinatal mood and anxiety disorders, or bladder leakage, celebrities now seem more inclined to share this too, with the hope that their openness may help someone else.

“If they are doing a public service, or they believe that they are, in talking about a product, there are women who will benefit from that message, whether or not it’s paid,” Dr. Cramer said.

It is assumed that the sharing also benefits the author, something Ms. Mollen has begun to question. “The more of ourselves we give away, the more the more we’re sort of rewarded for it, and that’s a slippery slope,” she said. “It’s all performance, even the stuff that you’re saying: ‘This is real. This is my real life.’”

In April, Ms. Lawrence welcomed her baby with her partner, Philip Payne, who is a music executive. When her followers wanted to know about her at-home water birth, she shared a video of that. It seemed important, she said.

Now, she’s not as sure about putting it all on Instagram. “The aim is to be more in control of my life and future and career,” she said. “Having it so much reliant on social media feels unstable.”

The Eggs I Sold, the Baby I Gained

Ties

The Eggs I Sold, the Baby I Gained

Instead of lolling around in a lush pool of liquid, our baby was balled tight. Was there a connection to the eggs I had donated 10 years earlier?

Credit…Lucy Jones

  • Jan. 22, 2021, 5:00 a.m. ET

My son’s life began, as all babies’ lives do, with an egg.

Although, in my case, the egg that started it all — the egg that set off the Rube Goldberg machine leading to Finnegan’s life — was released not 10 months before his birth, but 10 years.

And released isn’t quite the right word. More like extracted. Because, those 10 years ago, I was an egg donor, and my eggs went to a wealthy Upper East Side couple. I, in return, got $8,000.

I used the money to pay rent on my East Village sublet. I used it to pay back taxes. And when my visa expired — I’m Canadian — and I needed to temporarily leave the United States, I used it to pay for a flight to Europe. It was there, in a 16-bunk room in a hostel in Prague, that I met my husband, Emmett. Still buoyed by my doctor’s comment, during a post-donation checkup, that she’d retrieved an “impressive” 29 eggs from me, I joked to Emmett, half-bragging and half-warning, that I was “aggressively fertile.” I was aware, even as the words left my mouth, of the dangerous karmic territory I was putting myself in.

A decade later, I was back on the Upper East Side, watching a sonographer slide a scanner across my slick stomach. On the screen overhead, our son surfaced, then slipped away, a grainy creature rising and receding from view.

At first, I thought the sonographer was just deep in concentration. A few minutes ago, she’d let us listen to our baby’s heartbeat, and having heard it, I’d relaxed. A heartbeat meant alive, after all. But I hadn’t considered another possibility — the space between “everything’s fine” and “we’re so sorry.” That in-between space was this silence, stretching from seconds into minutes as the sonographer arced and dipped, slid and burrowed, performing an artful slalom along the contours of my abdomen.

A lifetime of television and movie watching had taught me what to expect from an ultrasound image — bigheaded babies swimming in inky seas of amniotic fluid, extending their spindly limbs like in utero E.T.s. What we were looking at — it wasn’t that. Our baby didn’t float in space, because there was none. Instead of lolling around in a lush pool of liquid, he was balled tight, cloaked in something resembling Saran Wrap. Everything beyond that was static gray and solid. I stared hard, struggling to interpret what I was seeing. The technician left to get the doctor.

Amniotic fluid doesn’t seem like much. At that moment, the 16-week mark of my pregnancy, it was basically saline. But for unborn babies, that briny bath is everything — the air they breathe, the food they eat, the home they live in. And our baby was living with very little of it. The fact that he was living at all, the doctor explained to us, was a minor miracle.

“Your membranes have collapsed,” she said, the tip of her manicured nail indicating the thin layer that clung claustrophobically to our baby. “And we’re seeing very little amniotic fluid.”

“If your fluid levels fall any further,” she explained gently, “it’s likely the baby won’t be viable.”

The baby. Interesting that she didn’t say “your baby,” the way other doctors had before. It already felt as if he was slipping away from me.

Another thing that slipped away from me in that moment was certainty. Specifically, the certainty that having an abundance of something at 22 meant being able to count on it at 32. But bodies aren’t like that. And women’s bodies, understudied and misunderstood as they often are, frequently defy easy explanation.

Just as the American College of Obstetricians and Gynecologists reported that 50 to 75 percent of women who suffer from recurrent miscarriages will never know why, and the Obstetrical and Gynecological Survey found that as many as 30 percent of couples who struggle to conceive are diagnosed only with “unexplained infertility,” I couldn’t draw a definitive line between the eggs I traded so cavalierly and the baby barely surviving inside me.

But after my sonogram, as the cab carrying me and Emmett home came to rest, briefly, in front of the entrance to the egg donor clinic I had frequented so many years ago, I didn’t feel like being fair-minded. Instead, my eyes narrowed, as if looking askance at an enemy.

You did this, I thought. It was you who cranked up my hormones. You who sucked the stuff of life out of me. You who made me flippant about my fertility. I nearly hissed these accusations aloud.

But then I imagined the cool glass and chrome of the clinic’s revolving doors hissing back. Saying: Anything could have caused this. Saying: Without me you wouldn’t have met your husband. Saying: You should be thanking me that you’re pregnant at all. It was so vivid I could practically picture the revolving doors slinging words as they spun. And the doors would have been right.

I spent the next four months on bed rest — lying on my left side, drinking gallons of water a day. And though my fluid levels didn’t rise, they didn’t fall either. My son and I persisted in the liminal space between life and death, right on the razor-thin edge of viability, watching time tick away. I tracked the passage of that time not only by how far along I was, but also by how old my egg donor children might have been. They could have been in the fourth grade. They could have been old enough to ride the subway alone. They could have been clipping me with their bike wheels as they rounded a street corner near my home in Flatbush.

I made it to 33 weeks before Finnegan arrived. He was born folded and twisted like a street cart pretzel, with knee, hip and elbow dislocations. He was born with lungs so weak he needed the help of machines to breathe for nearly two months. But he was born. And as I stared down at him in the NICU, noting his similarities to me — the blue eyes, the brown hair, the upturned nose that got me called Miss Piggy as a kid — I wondered: If Finnegan and I were out together someday and we saw kids who shared our same constellation of features, would I notice? Or, having been mixed with some unknown Y-chromosome, would my egg donor children be unrecognizable even to me?

Recently, I listened to a podcast about the children of a serial sperm donor. Each of them innocently submitted swabs to 23andMe, expecting to find out what part of the world they were from and what diseases they were susceptible to. Instead, they discovered they had dozens of donor siblings (or “diblings,” as they called each other). This floored me. I’d never imagined there would be a line — traceable and discoverable for a mere $199 — from Finnegan to the children who might have been born from the eggs I sold. The cloak of anonymity under which I donated my eggs couldn’t have predicted the rapid rise of consumer DNA tests. Which meant I couldn’t predict how the decision I made 10 years before Finnegan’s birth might reverberate for the rest of his life.

As Finnegan, now 2, gets healthy at home — ditching his medications, outgrowing his casts and walking on his own — I’ve begun to consider how Emmett and I will talk to him about his possible part-siblings someday. It’s forced me to question, after all these years, how I see my egg donation.

Was it a means to an end, simply a way to supplement my meager intern’s salary?

Was it the ultimate gift, making the dreams of would-be parents possible?

Was it the thing I’ll always suspect damaged my womb and endangered Finnegan’s life?

Or was it, as I imagined those revolving doors saying, the necessary precursor to everything in my life that I love? Not so much a revolving door as, to borrow a Gwyneth Paltrow rom-com metaphor, a sliding one?

Yes. Yes. Yes. And, yes.

And so, when we eventually tell Finnegan his birth story, it will be a story of circumstances, close calls, a fateful meet cute, and so much love. A story with at least one happily ever after. Or maybe as many as 29.

Justine Feron is a writer and advertising executive who lives in Brooklyn with her husband and son.

Hypertension During Pregnancy Tied to Later Cognitive Decline

Hypertension During Pregnancy Tied to Later Cognitive Decline

Pregnant women with blood pressure readings above 140/90 had deficits on tests of mental agility 15 years later.

Nicholas Bakalar

  • Jan. 20, 2021, 2:46 p.m. ET

Women who develop gestational hypertension — high blood pressure during pregnancy — may have reduced cognitive abilities later in life, a recent report suggests.

The study, in Neurology, included 115 women with a history of gestational hypertension between 2002 and 2006. They measured their mental agility an average of 15 years later using well-validated tests of verbal fluency, processing speed, memory and visuospatial skills. Then they compared their results with those of 481 women whose blood pressure remained normal during their pregnancies.

After controlling for ethnicity, educational level, pre-pregnancy B.M.I. and other factors, they found that women who were hypertensive during pregnancy had significantly lower scores on tests of working memory and verbal learning than those whose blood pressure was normal.

The lead author, Dr. Maria C. Adank, a researcher at Erasmus University in Rotterdam, pointed out that the effect was driven mainly by the 70 percent of women in the study who had only mild hypertension — readings above 140/90 — and not by the 30 percent who had pre-eclampsia, the extremely high blood pressure that, untreated, can lead to organ damage and death in both mothers and babies.

“These are women with only mild hypertension. They’re healthy. But even at age 45 they have impaired cognition,” she said. “They and their clinicians should be aware of the risk, and they should be followed up. We think that hypertension is going to persist beyond pregnancy, and it should be treated.”

Weekly Health Quiz: Exercise, Body Temperature and a Covid Vaccine Mystery

1 of 7

An 11-minute program of calisthenics and rest, done three times a week for six weeeks, had this effect on out-of-shape young men and women:

It increased their fitness levels

It improved their endurance by 7 percent

It increased their leg power slightly

All of the above

2 of 7

Which statement about body temperatures is not true?

Worldwide, average body temperatures seem to be decreasing

Body temperatures tend to rise during and after exercise

Older people tend to have lower body temperatures than younger people

Body temperature tends to be higher in the morning than in the evening

3 of 7

Health authorities are investigating the death of a 56-year-old doctor in Florida who developed this blood clotting disorder days after receiving the Covid vaccine:

Hemophilia

Pernicious anemia

Acute immune thrombocytopenia

Myelodysplastic syndrome

4 of 7

Creutzfeldt-Jakob disease, sometimes called mad cow disease, is thought to be caused by this type of infectious organism:

Bacteria

Virus

Fungus

Prion

5 of 7

Which statement about throat cancers is not true?

Most throat cancers are caused by human papillomavirus, or HPV

Having oral sex at a young age increases the risk of developing throat cancer

HPV-associated throat cancers are more common in women than men

HPV-associated throat cancers are more common in whites than in African-Americans

6 of 7

Being overweight during pregnancy was tied to this fertility issue, Danish researchers report:

Mothers who are overweight during their first pregnancy are at increased risk of fertility problems during subsequent pregnancies

Daughters born to overweight mothers were at increased risk of having fertility problems

Sons born to overweight mothers were at increased risk of being infertile

All of the above

7 of 7

Diets rich in this vitamin were tied to a lower risk of developing Parkinson’s disease:

Vitamin A

B vitamins

Vitamins C and E

Vitamin D