Good advice for a healthy pregnancy
Women can increase their chances for a healthy pregnancy by eating right, exercising, not smoking, and getting early medical care, says a podcast featuring a National Institutes of Health obstetrician who oversees research on pregnancy and birth.
A healthy pregnancy, in turn, may help to reduce the chances of early labour and preterm birth.
The NIH's Office of Research on Women's Health monthly podcast, "Pinn Point on Women's Health," provides updates on women's health research. The podcast is hosted by Vivian W. Pinn, M.D., director of NIH's Office of Research on Women's Health. This month's podcast (May 2009) focuses on ways to reduce the risk of giving birth prematurely by getting a pregnancy off to the healthiest start possible.
Premature can be problematic
"Being born too soon poses a number of health risks," Dr. Pinn said. "We all know children who were born prematurely who turn out all right. Others are not so lucky."
Many preterm infants die within the first year of life, Dr. Pinn explained. Others may develop heart problems, blindness, deafness, or severe learning disabilities.
"There are treatments for all of these conditions," Dr. Pinn said. "But it's far easier to do everything possible to carry a pregnancy to term than it is to fix the things that can go wrong when a pregnancy ends too early."
This month, Dr. Pinn interviewed Catherine Y. Spong, M.D., chief of the Pregnancy and Perinatology Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Dr. Spong offered advice on getting a pregnancy off to the best start possible. Preterm birth is not well understood and can occur in apparently healthy women. But adopting good habits and taking care of yourself increases the chances that a pregnancy will be healthy and the chances that it will proceed to term. Dr. Spong described current treatments to reduce the risk of preterm birth in certain categories of at risk women, and provided updates on NIH pregnancy research.
Early preparation is best
Dr. Spong noted that 1 in 8 pregnancies in the United States ends with a preterm birth. Moreover, the number of preterm births has increased by 16% in the past decade.
"The best time to start preparing for pregnancy is before that pregnancy even occurs," Dr. Spong said. "About half of all pregnancies, in fact, are unintended. So it is really important for women who could become pregnant to have optimized their health during this time."
Dr. Spong identified eight steps women can take to help ensure healthy pregnancies and healthy babies.
• Take a supplement containing folic acid, which can be found in prenatal vitamins or eat a breakfast cereal fortified with folic acid and other vitamins. All women of child-bearing age should have 400 micrograms of the vitamin each day. Folic acid reduces the chances that a baby will have a neural tube defect, a class of birth defects that could result in partial paralysis or damage to the baby's brain.
• Don't drink alcohol. Don't take illicit drugs. Don't smoke. Smoking and taking illicit drugs are not good for you or your baby. Smoking and exposure to smoke increases the risk of preterm birth and for small babies. Drinking alcohol during pregnancy could cause birth defects and medical conditions that include mental retardation, learning deficits along with specific facial characteristics.
• Eat a varied, healthy diet. Proper nutrition is important for you and the baby. Obesity can complicate pregnancy. Information on proper nutrition during pregnancy is available at http://mypyramid.gov.
• Exercise regularly and continue your exercise routine during pregnancy
• Take a Vitamin B12 supplement if you eat little or no animal products. Lack of this vitamin can also increase the chances of neural tube defects
• Make sure your immunizations are up to date. It is best to do this prior to pregnancy because some vaccinations are best given prior to pregnancy
• Notify your doctor as soon as you know you're pregnant so you can schedule the best time to be seen
• Let your doctor know if you have any medical conditions. Ideally, get them under control prior to pregnancy.
Progesterone decreases risk of another premature birth
A normal pregnancy lasts 40 weeks, Dr. Spong said. Doctors consider delivery before 37 weeks to be preterm. Women who have had previous preterm deliveries are most likely to give birth early.
Doctors may prescribe the hormone progesterone to pregnant women carrying a single baby and who have had a previous preterm delivery, Dr. Spong said. Taking progesterone decreases by one-third a woman's risk of having another preterm birth.
Women younger than 17 or older than 35 also have a high risk of giving birth prematurely. A woman's risk of an early birth increases if she has medical problems involving her cervix or if she is carrying twins, triplets, or other multiple pregnancies.
Research has shown that smokers and obese pregnant women also are at higher risk of preterm delivery, Dr. Spong said.
Magnesium sulphate brings benefits
Multiple births are common among women who use fertility treatments to become pregnant, Dr. Spong said. The increasing use of fertility treatments could help explain the increase over the past decade in preterm births.
Even if they stay healthy and follow doctors' advice, some women still may go into labour early, Dr. Spong said. Doctors may give women a drug to try to stop preterm labour. A recent NICHD network study found that magnesium sulphate, a treatment used to try to delay labour, also reduces preterm babies' risk for cerebral palsy, she said.
A woman in premature labour may also receive a corticosteroid to improve the baby's health if the baby is born preterm. Corticosteroids are hormones that cause the baby's lungs to mature. This treatment will help to prevent respiratory problems if labour can't be delayed and the baby is born prematurely.
Preterm labour is difficult to diagnose. Women who experience four to six painful contractions in an hour should contact their doctors, she said.
NIH-funded researchers are continuing to investigate why some women go into preterm labour and how to stop it once it starts.
Dr. Spong also described another important study on pregnancy, involving women carrying a baby with spina bifida.
Spina bifida
Spina bifida, or myelomeningocele, is a rare birth defect that occurs when the spinal cord does not form properly. Spina bifida is one of the neural tube defects, which affect the brain and spinal cord. With spina bifida, the spine fails to develop normally and paralysis may occur below the spinal defect. Women who have low levels of the vitamin folic acid in the weeks before and after conception are most at risk. Babies with the condition often need surgery a few days after birth to repair the spine.
Dr. Spong said that NICHD is seeking volunteers pregnant with a child with spina bifida for a study that will look at whether performing surgery on the foetus while it is still in the womb is more effective than the current practice of waiting until after the baby is born. Half will undergo the surgery during pregnancy and the other half will receive the standard surgery after birth. The study will determine which technique is better for the baby's health.
The study, known as MOMS, or the Management of Myelomeningocele Study, is looking for new participants. More information about the study and how to volunteer is available at http://www.spinabifidamoms.com.
To hear Dr. Pinn's podcast, visit the Office of Research on Women's Health home page at http://orwh.od.nih.gov and click on "Preterm Birth" under "Podcasts." Information on how to use podcasts is available at http://videocast.nih.gov/faq/podcast/default.asp.
