Seeding and Feeding a Baby’s Microbiome

What is the microbiome?

The collection of bacteria, viruses, fungi, and other organisms that live in and on the body. We have about 10 trillion human cells in our bodies, and about 100 trillion microbes. We have evolved in tandem with this microbiome for thousands of years. The balance of microbiomes varies throughout our body, and the bacteria found in our mouths is different than on our skin, which is different than in our intestines.

Why does the microbiome matter?

  • A balance of microbes leads to optimal health. An imbalance can lead to disease. For example, a vaginal yeast infection may occur when the healthy bacteria are reduced by antibiotics, allowing yeast to overgrow.
  • Good bacteria can aid digestion, provide vitamins (K and B12), regulate the bowels, stimulate the development of the immune system, and protect against infection.
  • An overgrowth of harmful bacteria can lead to infectious disease.
  • Disruption of the gut microbiota has been linked to inflammatory bowel disease, diabetes, obesity, allergies, asthma, and some cancers.
  • Many studies have shown that the presence of absence of specific microbes can cause life-long changes in immunity.

How does a baby’s microbiome develop?

  • During pregnancy
    • In the past, the womb was believed to be a sterile environment. However, microbes are found in the placenta, amniotic fluid, and in meconium. (The waste that accumulates in the fetal bowels.)
    • Maternal fecal microbes have been found in the uterine environment, leading to hypotheses that microbes from throughout the body are transferred through the bloodstream. And from there into the placenta, then the umbilical cord and the amniotic fluid.
    • Placental microbes are similar to the microbes in the mother’s mouth – especially types of bacteria that aid in the metabolism of food.
    • Healthy bacteria may benefit baby. For example, if the mother lived or worked on a farm, that might protect against allergies and asthma.
    • Others worry that unhealthy bacteria may affect baby. For example, obese women tend to have abnormal gut microbiota. This may be transferred to the baby.
    • Maternal diet affects the baby. E. coli bacteria (an unhealthy bacteria) was less common amongst babies whose mothers ate primarily organic foods.
  • At birth
    • During a vaginal birth, a baby is exposed to the microbes in mother’s vagina. In the third trimester, these are especially high in lactobacilli, which help the baby to digest milk.
    • When a baby is placed skin-to-skin on a parent, they are exposed to the parent’s skin microbiome. The baby’s skin, mouth, and digestive tract are “seeded” by whatever and whomever they first have contact with.
  • Through feeding
    • Breastmilk exposes the baby to more microbes. Several are gut microbes that influence digestion.
    • Breastmilk contains sugars (oligosaccharides) which are not digestible by babies, and whose role appears to be to nourish / feed a healthy microbiome in baby’s gut. These are also referred to as prebiotics. By helping healthy bacteria to grow, there is less room for unhealthy bacteria.
    • When solid food is introduced, the microbiome begins to evolve to a more adult-like combination of microbes.
  • Through the environment
    • As baby is held by various people, their microbiomes influence it.
    • As the baby starts to explore his world, crawling on the floor, playing outdoors, petting animals, and putting everything in his mouth, his microbiome shifts and evolves, becoming quite diverse by age 3. The “hygiene hypothesis” states that babies who are exposed to more symbiotic organisms have lower risks of asthma and allergies, and stronger immune systems.

What can interfere with the establishment of a healthy microbiome?

  • During pregnancy and labor
    • Antibiotics given to mom can affect the mix of microbes in the placenta, amniotic fluid and vagina. This disrupted microbiome is inherited by the baby.
  • At birth
    • Babies born by cesarean, and thus not exposed to vaginal bacteria, are at increased risk of asthma, allergies, obesity, diabetes, and celiac disease. Studies comparing the microbiomes of vaginally born babies with those born via cesarean have shown differences in their gut bacteria as much as seven years after delivery. (Salminen)
    • After cesarean birth, instead of skin-to-skin contact with the parents, the baby’s first exposures are to hospital bacteria and the bacteria of hospital staff. (Babies in NICU were found to be colonized by bacteria from the health care staff, from medical equipment, and from the counter-tops in the NICU. – Brooks)
  • Newborn care
    • After any birth, if baby is wrapped in a blanket, and placed on a clothed parent, rather than skin-to-skin, the transfer of skin microbes is not complete.
    • Early baths remove / reduce protective vernix, vaginal microbiome, and baby’s own newly seeded skin microbiome. Those are replaced by hospital microbes.
    • If baby is given antibiotics, it reduces microbial diversity, and the number of both harmful and helpful bacteria. The impact lasts over 8 weeks. The longer the duration of antibiotics, the harder it is for the microbiome to recover. Early use of antibiotics, or prolonged use, can have long-term side effects, increasing risk of obesity or inflammatory bowel disease in later life.
  • Feeding
    • Formula-fed babies (even those who just had short-term formula feeding in the first few days) had increased harmful bacteria and decreased helpful bacteria.

What can parents and health care providers do to foster a healthy microbiome?

  • During pregnancy:
    • A mother can increase exposure to diverse healthy bacteria. Taking probiotic supplements may improve gut diversity (for mom and baby), may reduce gestational diabetes, and may reduce risk of allergy and eczema for the baby. (Research cited in Collado) You can eat probiotic foods which introduce healthy bacteria, such as fermented foods and foods with live cultures. And you can eat prebiotics – foods with oligosaccharides which feed healthy bacteria – see the list at the end of this article. (Reed)
    • Minimize exposure to unhealthy bacteria, such as food-borne illnesses.
  • During pregnancy and labor: Minimize exposure to antibiotics. If they are needed, consider consuming probiotics or prebiotics after the course of antibiotics is complete.
  • If baby will be delivered by cesarean, a baby’s initial seeding is from hospital bacteria and skin microbes rather than vaginal microbes. You can expose the baby to vaginal bacteria by swabbing. Although swabbing does not colonize the baby as well as vaginal birth, it helps. (Swabbed babies had twice as much maternal bacteria as babies who were born by cesarean but not swabbed. Babies who were born vaginally had six times as much maternal bacteria.) Here’s the process:
    • Sample mom’s vagina: make sure the mother is HIV-negative, strep-B negative, and has an acid, lactobacillus-dominated vagina.
    • Place sterile gauze in the mother’s vagina. Incubate gauze for one hour. Remove prior to surgery.
    • After birth, wipe baby’s mouth, face and hands with the gauze.
    • Note: If the caregiver will not do this procedure, the mother and partner can do it themselves.
  • After birth, baby should go straight onto the mother’s body, skin-to-skin. (Consider bringing a blanket from home to cover baby, rather than using a hospital blanket.)
  • In the first hours, encourage people other than the parents to look but not touch.
  • Wait 24 hours after birth to bathe the baby.
  • Feed baby only breastmilk for as long as possible.
  • If a breastfeeding mother develops mastitis or a yeast infection, ask a lactation consultant about treatment with lactobacillus probiotics.
  • Giving probiotics to a baby can treat antibiotic-induced diarrhea, prevent eczema, reduce colic symptoms, and possibly reduce obesity in later life. (Studies cited in Arrieta and Collado.)
  • Let your child explore their world, with plenty of time outdoors, digging in gardens, and exposure to animals, both pets and animals at petting zoos.
  • Offer your child diverse foods, including: fermented foods and foods with live cultures (Yogurt, buttermilk, sour cream, kefir, sauerkraut and other fermented vegetables, tempeh, miso, soy sauce, kimchi, dosas and sourdough breads, kombucha, etc.) and prebiotic foods that are high in oligosaccharides (onions, garlic, legumes,  asparagus, starchy vegetables like sweet potatoes, squash, turnips, parsnips, beets, and plantains)

Note: While many of those recommendations are supported by scientific research, not all have been adequately researched.

Here is a 2 page handout of this information to share with clients.

Sources:

To learn more about practically any topic related to the perinatal period, check out Pregnancy, Childbirth, and the Newborn: The Complete Guide.

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Health Care Coverage for Pregnancy and Birth

Having a baby can be expensive, and different kinds of maternity care have different costs. In the United States, a licensed midwife may charge as little as $3000 for prenatal care and attendance at an uncomplicated home birth. Using a midwife for prenatal care and a birth center for the birth may cost $4,000 to $5,000. (Note: These estimates don’t include the costs of prenatal tests, such as ultrasound scans and blood tests.) Using an obstetrician for prenatal care, having prenatal tests and having an uncomplicated vaginal birth in a hospital yields average charges of $30,000. A complicated cesarean birth can increase that cost to more than $50,000.. (Source.) Most health insurance plans are required to cover the basic costs for maternity care, but the details of what each plan covers varies.

The Affordable Care Act requires all Americans to obtain basic health insurance or pay a tax. Expectant parents (or those planning a pregnancy) have five main options for obtaining health insurance:

  • Through their employer. They can get this coverage even if they are already pregnant, and they won’t pay more than 9.5% of their income towards coverage.
  • Through their spouse’s employer. They should check costs carefully. It might be cheaper  to choose another option.
  • Through their parents’ insurance, if they are under 26 year old. They should check to see if the plan covers pregnancy for a dependent, as about 70% do NOT.
  • Individual coverage from a state exchange. They can go to the Marketplace at healthcare.gov or call 1-800-318-2596 to check their eligibility and compare their options. Lower middle-income families may qualify for tax credits, lower deductibles, or subsidies to help pay the insurance premiums. They must enroll during the open enrollment period, which lasts from November 15 through February 15 of each year.If they got pregnant after this period, they will not be able to get health insurance for that calendar year through the exchange.
  • Medicaid or CHIP – the Children’s Health Insurance Program for low income families. Expectant parents can apply for these at any time, via healthcare.gov or through their state’s agency directly. Note: Medicaid recipients may not have as much choice about caregiver and hospital. Because Medicaid does not reimburse providers as fully as private insurance companies to, many providers accept only a limited number of Medicaid clients, or none at all.

If they’re shopping for insurance options, they can ask each company for a copy of their “Summary of Benefits and Coverage” and look on page 7 in the “Having a Baby” section to learn what common costs are paid by the insurance and what deductibles and co-pays they may be responsible for.

Whether they’re researching existing health insurance or choosing a new plan, they should also look at the detailed information about what care is covered. Visit our web site, http://www.PCNGuide.com, to download a work sheet of questions to research. If they don’t understand the extent of their coverage, contact an insurance company representative for clarification. That way, if they decide to have an uncovered or partially covered service, they’ll know how much they’ll pay out of pocket.

Some insurance plans cover—but don’t directly pay for—such services as midwifery care, childbirth preparation classes, birth or postpartum doulas, home birth, and breastfeeding assistance. Instead, parents pay for these services and the insurance company reimburses them.

Parents may also use a flexible spending account (FSA) or health savings account (HSA) to pay for uncovered or partially covered services. Both accounts allow someone to set aside money before paying taxes on it, to use for qualified medical expenses. FSAs are employer-established benefit plans. HSAs are available for employees or individuals with high-deductible insurance policies..

When the baby is born, a parent can choose to add the baby to their existing health insurance, or they can apply for new insurance through the health exchange, even if it’s outside the normal time frame for open enrollment.

Gestational Hypertension Update

ACOG issued a report on Hypertension in Pregnancy in November 2013. Key points:

Proteinuria is no longer required for a diagnosis of preeclampsia – It can be diagnosed if mom has high blood pressure (gestational or chronic hypertension) plus

  • lowered platelets
  • impaired liver function
  • renal insufficiency
  • pulmonary edema
  • new onset of severe headaches or vision disturbances

Women with a history of early onset preeclampsia and preterm delivery may benefit from daily low-dose aspirin. None of these are recommended to reduce hypertension: low salt intake or vitamin C or E.

Mild gestational hypertension (BP 140/90) and mild preeclampsia is treated with: daily kick counts, twice-weekly blood pressure checks (at home or clinic), weekly blood tests and possibly fetal monitoring. (Note: not hypertensive medication.) Bed rest is not recommended, though some caregivers may recommend reduced activity and reduced stress. Ultrasounds may be done to assess fetal growth, and if IUGR is detected,more testing may be done.

Delivery at 37 weeks is recommended for all women with hypertension.

For severe cases (BP 160/110), she’ll be hospitalized and given hypertensives plus magnesium sulfate to reduce risk of seizures.

If baby is past 34 weeks, they will deliver baby as soon as she is stabilized.

If baby is under 34 weeks, she will be transferred to a hospital with a NICU, given corticosteroids to prepare baby for birth, and then deliver as soon as mom is stable.

Other indications for delivery, even before 34 weeks are: very low platelets, liver enzymes twice the normal value, increasing renal dysfunction, fetal growth restriction (under 5th percentile), very low amniotic fluid (AFI <5 cm).

For women with preeclampsia, cesarean need not be the presumed mode of delivery. Mode of delivery should be determined by gestational age, fetal presentation, cervical status, and maternal and fetal conditions.

Women who continue to have high blood pressure more than 24 hours after birth should avoid non-steroidal anti-inflammatories (e.g. ibuprofen) for pain relief.

Prenatal screening for birth defects

Birth professionals who have been in the field a long time are well acquainted with the diagnostic tests for Down syndrome and other conditions (amniocentesis and CVS) and the challenges of explaining to clients: “Before you have the test, think about what you’ll do if you have a positive result.” Over the past 15 – 20 years, there’s been huge improvements in screening tests for these conditions, and those need to come with their own patient education and precautions about how to respond to a “screen positive” result.

Vocabulary: Before we talk about the tests, let’s talk about some terms:

  • Screening test – assesses how likely it is that baby has the condition being tested for.
  • Diagnostic test – determines whether the baby actually has the condition.
  • False negative is the chance that a test will come up negative when the baby actually DOES have the condition being tested for. This is obviously distressing for parents if they had tests done and were told the baby was fine, and then discover at birth that it’s not as they expected. A test with a detection rate of 90% would catch 90% of the cases, and have a false negative rate of 10%.
  • False positive is the chance that a test will come up positive when the baby does NOT have the condition. This could lead someone to take actions or have procedures that are not necessary. (See below.)
  • Screening threshold or “cut-off” – the answer to a screening test is not really Positive or Negative / Yes or No. It’s really “If we say you’re screen positive, that means you exceed the threshold at which we think it’s a good idea for you to have diagnostic testing to determine for sure whether or not you have that condition. If we say you’re screen negative, that means we don’t think it’s worth having more testing because we don’t think it’s likely you have the problem.” For example, if a test showed you had less than 1 in 50 chance of a problem, then it doesn’t make to have a test that has a 1 in 20 chance of creating a problem.
  • It is helpful to learn from a caregiver not just the screen positive or screen negative answer, but also what are your chances. For example, they might say you’re screen positive for something if the cut-off was that your risk was greater than 1 in 200. But, if your risk is estimated at 1 in 190, the recommended diagnostic test is not that likely to show you have the condition (though it’s probably still a good idea to have it.) If your risk is estimated at 1 in 10, not only will they recommend that diagnostic test, but it’s pretty likely it will turn up positive.
  • Aneuplody. Chromosomal abnormalities, such as trisomy 21 – Down Syndrome and trisomy 18 – Edward syndrome.

Should anyone skip screening tests and go straight to diagnostic tests?

In the past, often the recommendation for amniocentesis was made solely on the basis of the mother’s age (typically, for those over 35). The risk of aneuplodies goes up with age, so caregivers recommended the test when her risk of having a baby with a chromosomal condition was greater than the risk of miscarriage caused by amniocentesis. (At that time 1 in 200 risk.) Age is no longer considered reason enough for diagnostic testing. Most caregivers recommend that first a pregnant person have a non-invasive screening test,and only do a diagnostic test if her risk is higher than the screening threshold.

Some women are considered high enough risk that they could go straight to the diagnostic testing. typically that’s: if the baby was conceived by IVF, if the woman or her partner has a history of a previous pregnancy with a chromosomal abnormality, or if both partners are carriers of a genetic condition that increases the risk of chromosomal birth defects.

What screening tests are available?

(Note: WordPress tables aren’t always easy to read, so here’s a PDF of the tables if you prefer to view that… )

Test Type of test When done What is test screening for? Detection rate and false positive rate for Down syndrome (DS) and neural tube defects (NFD) Turnaround time from testing to results
First trimester blood test Blood test 10 – 13 weeks, ideally at 10 Tests levels for PAPP-A and HcG. Down syndrome, trisomy 13 and 18 Blood test: 69% with a 5% FPR (SOGC)

 

Days
Nuchal translucency screening

(may also assess for presence or absence of nasal bone)

Ultrasound 11 – 14 weeks, ideally at 11 Measures the thickness of a clear space at the back of a fetus’ neck. Babies with chromosomal disorders, such as Down syndrome, accumulate more fluid in this area Ultrasound:

69 – 75%. FPR 5 – 8% (SOGC)

 

When combined with first trimester blood test:

82 – 87% (ACOG) 83%, 5% FPR (SOGC)

Immediate to days
Cell-free fetal DNA testing (e.g. MaterniT 21). Also known as non-invasive prenatal screening (NIPS). Blood test 10 – 13 weeks, ACOG recommends that it be done only if blood test or nuchal translucency showed high risk (there’s a discussion of this here…) Tests for placental DNA in mother’s blood. Screening for Down syndrome, other trisomies, and fetal sex aneuploidies. Also reveals gender and baby’s Rh factor. 99% / FPR 0.2% (Source) 7 – 10 days
Second trimester blood test (quad screen) Blood test 16 – 20 weeks ideally at 16 – 17 Tests levels of alpha-fetoprotein (AFP), estriol, human chorionic gonadostropin (hCG) and inhibin A. Screen for Down and Edwards, plus neural tube defects. 81% (ACOG)

75-80%, FPR 3 – 5% (SOGC)

 

For neural tube defects: 71 – 90% with 1- 3% FPR (SOGC)

7 – 10 days
Second trimester ultrasound Ultrasound scan 18 – 22 weeks Screen for neural tube defects and other anatomical defects For NTD: 68 to 86% for neural tube defects (SOGC2) Immediate to days

Often test results are combined to increase accuracy. Here are some of the common combinations.

Type Combines results from Detection rate and FPR for Down syndrome When are results reported to parents
Integrated screening First trimester blood test, nuchal translucency ultrasound, and second trimester quad screen 94 – 96% (ACOG)

85 – 87% with FPR of 0.8% to 1.5% (SOGC)

92% with 3% FPR (Quest)

Results not reported until after the second trimester results are in
Serum integrated screening First trimester blood test and second trimester quad screen 85 – 88% (ACOG)

88, with 6% FPR (Quest)

Same as above
Sequential integrated screening First trimester blood test and nuchal translucency scan are done.

Then second trimester screening or diagnostic testing, depending on risk level.

95% (ACOG)

92%, with 4% FPR (Quest)

After first trimester tests, if risk is high, diagnostic testing is recommended. Otherwise, second trimester screening is done before results are reported
Stepwise sequential First trimester blood test and nuchal translucency scan.

Then no further testing, second trimester screening, or diagnostic testing, depending on risk level.

95% (ACOG)

92%, with 4% FPR (Quest)

After first trimester tests, results are reported. If high risk, diagnostic testing is recommended. If moderate risk, second trimester screening is recommended as a follow-up. If low risk, no further testing.

Explaining Test Results to Clients

It’s very important for expectant parents to understand the difference between a screening test and a diagnostic test, and important to understand what false positives are.

If a screening test comes up positive, one of the first questions an expectant parent should ask their caregiver is: how certain are we that this test is correct? Are there other tests I could have to confirm this?

They can ask their caregiver to explain the false positive rate – the chance that although they screened positive, the baby does not actually have that defect.There’s two sides to that… 1) what’s the false positive rate for all people tested and 2) amongst people who test positive, what percent of those are false positives and what percent actually have the condition. (This latter number is called the positive predictive value of a test.)

For example, all the advertising for cell-free fetal DNA testing will talk about how it will detect 99% of cases, and has a false positive rate of 0.2%. This is true, and MUCH more accurate than other screening methods. But it’s still not perfect. One study showed that of 1909 patients screened, most people screened negative. 11 screened positive. After diagnostic testing, it turned out that 5 of the 11 babies had Down syndrome and 6 did not. So, for the whole population screened, only 0.3% were false positives. But of those who screened positive, 55% of those were false positives. (Source)

In another study of cell-free fetal DNA testing, of 41 patients who screened positive, 38 were true positives. 3 were false- positives. (Source) Better… but still 7% of the people who screened positive were not.

A parent who has heard the 99% accuracy advertising may not be aware of the subtleties of all this, and may not fully understand what a screen-positive result means.

The rates of false positives with other testing are much higher than that, and even more important for expectant parents to understand in order to interpret what a “screen positive” result means. (Note: screening results should not just be given as “positive” or “negative.” They should also be given in terms of probability. For example,  “you have a 1 in 150 chance of this condition.” The expectant parents can ask for this information if it was not given to them clearly.)

Responses to a False Positive Test

In the case of Down syndrome, some parents might use a positive screening test result as a reason to spend the rest of their pregnancy learning about Down syndrome and lining up resources to help them care for their child. If they found out at birth that the test was a false positive and the baby did not have Down syndrome, it is likely they would be relieved not to need to use those resources.

However, a majority of expectant parents choose to terminate a pregnancy if the baby is diagnosed with Down syndrome.

The Society for Maternal-Fetal Medicine states

all positive cell free DNA screening results require confirmatory diagnosis before an irreversible action, such as pregnancy termination, is undertaken.   (Source)

However, 6 – 17% of those who screen positive with cell-free fetal DNA testing are choosing to terminate the pregnancy based on those results alone without any further testing.

Before getting testing, and definitely before getting results, it is very helpful for expectant parents to understand that a screening test is not absolute, and what their options will be. If they screen positive, they could choose diagnostic testing to confirm the diagnosis – CVS can be done at week 10 – 12, in time for a first trimester termination decision. If for some reason, CVS is not an option for the parents, another option could be additional screening tests. The cell-free fetal DNA testing, first trimester blood tests, and nuchal translucency look at separate factors, and having results from more than one test could be illuminating information to have before making an irreversible decision.

Learn more

An interesting article on this topic is Oversold and Misunderstood.

Or click on any of the links above…

Resources on Hazards in Pregnancy

substancesDuring pregnancy, some women worry a lot about the potential harms they might expose their developing baby to – medications, smoking, environmental pollutants, workplace hazards and more. Others feel like they’re continuously bombarded with messages that ‘nothing is safe’ and ‘you can’t do / eat/ drink anything you want to do / eat / drink because you’re pregnant.’

If parents look in the popular media, they see a wide range of information: some accurate and research-based but hard to read, some easy to read but not so accurate. It helps to have good resources to point expectant parents to. These are in order from the ones that I think are most broad / helpful to parents to those which are less broad or less helpful.

The Mother to Baby website from OTIS (Organization of Teratology Information Specialists) has a large collection of fact sheets on specific hazards that are research-based and consumer friendly (though not for a low reading level). Topics include medications, herbal products, infectious diseases, illicit substances, and maternal medical conditions. http://www.mothertobaby.org/otis-fact-sheets-s13037

The March of Dimes http://www.marchofdimes.org/pregnancy/staying-safe.aspx is a very consumer friendly site with good summaries on lots of topics.

Center for Disease Control (CDC). Lots of helpful information and links on infectious diseases, medication, workplace hazards, and more. http://www.cdc.gov/pregnancy

LactMed – Drugs and Lactation Database. For info on medications and breastfeeding. “Information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided.” http://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm

FDA information for Expectant and New Parents. Info on food safety, breast pumps, ultrasounds, and more. http://www.fda.gov/ForConsumers/ByAudience/ForWomen/WomensHealthTopics/ucm117976.htm

The Environmental Working Group offers Consumer Guides on choosing healthier (for humans and the planet) products: pesticides in produce, cleaning products, cosmetics, genetically engineered foods, and lots more. http://www.ewg.org/consumer-guides

MotherRisk. The website includes a few fact sheets, plus links to research studies on medications, herbs, and infectious diseases. For Canadians, they offer phone hotlines for questions about medications exposures, nausea and vomiting in pregnancy, exercise in pregnancy, and HIV and pregnancy. http://www.motherisk.org/prof/index.jsp

Reproductive Health in the Workplace has info about workplace exposures and breastfeeding and on how not to take your workplace hazards home with you. http://www.cdc.gov/niosh/topics/repro/pregnancy.html

OSHA (Occupational Safety and Health Administration) Standards related to reproductive hazards in the workplace: https://www.osha.gov/SLTC/reproductivehazards/standards.html

The Environmental Protection Agency (EPA) lists hotlines consumers can call with questions on particular hazardous substances: http://www2.epa.gov/home/epa-hotlines

Safety and International Travel: http://wwwnc.cdc.gov/travel

How Expectant Parents Can Help

Part of the reason there is limited information on the safety of substances during pregnancy is because of limited research on pregnant women. Expectant parents can volunteer to be in a pregnancy registry. These studies just collect information from pregnancy parents who take medications and vaccines, and collect information on the baby. Outcomes are compared to those of parents who did not take that medication during pregnancy.

Participating parents are NOT taking experimental drugs or anything they wouldn’t otherwise take!! These registries are an opportunity for parents who are already taking medication or need to take a medication to share their experience with researchers. It might especially appeal to parents who are frustrated at how little information is available to them about their meds. This helps them help others moving forward.

Participating would typically involve a few phone calls (or possibly even online surveys): one or two during pregnancy, and one after the birth. I

Learn more here: http://www.fda.gov/ScienceResearch/SpecialTopics/WomensHealthResearch/ucm251314.htm and here: http://www.pregnancystudies.org/participate-in-a-study/participate-in-a-study/

If you are a professional who would like to encourage your clients to participate in registries, there are outreach materials (brochures, etc.) available here: http://www.fda.gov/ScienceResearch/SpecialTopics/WomensHealthResearch/ucm256789.htm

photo credit: G. J. Charlet III via photopin cc

Talking about Prenatal Mood Disorders in Birth classes

pregnancydepressionMost childbirth educators are covering postpartum depression in their classes. Some are also covering other postpartum mood disorders such as anxiety and obsessive compulsive disorder which are quite common. (Depression affects 10 – 20% of new moms, Anxiety or panic disorder affects ~10% and OCD affects 3 – 5%). And hopefully they’re also pointing out that a person can experience multiple disorders at once – for example, she can have depression AND anxiety.

A few educators are remembering to include partners – about 5% of new dads have a postpartum mood disorder.

But I wonder how many of us are talking about mood disorders in pregnancy?

Incidence of Mood Disorders in Pregnancy

Of women who experience depression after birth, a third say it started during pregnancy. (Source) Sometimes, depression is missed because symptoms can be mistaken for the fatigue or appetite disturbances associated with pregnancy. Estimates of incidence of depression in pregnancy range:

Rates determined by structured interview have ranged from 2 to 21% and up to 38% for women of low SES. Estimates derived from self-report questionnaires have ranged from 8 to 31% and 20 to 51%, respectively. Source.

Almost one third of women with manic depression (aka Bipolar disorder) report onset during pregnancy. OCD often begins in pregnancy (pre-existing OCD is usually exacerbated by pregnancy). Interestingly, pre-existing anxiety / panic disorder  may actually decrease in pregnancy due to hormonal effects. Source

How do we talk about this in childbirth classes?

I see multiple places we could address this:

1) when talking about discomforts of pregnancy and the physical changes of pregnancy, you could also address emotional changes and challenges

2) when discussing self-care in pregnancy, could include emotional self care and talk about mood disorders there

3) when talking about postpartum mood disorders.

I find it works well for me to cover it when talking about postpartum mood disorders.When I’m almost done with that topic I say “Although you may hear a lot of talk these days about postpartum mood disorders, we know that they begin in pregnancy for a third of the women who experience them. If you were just listening to my description of symptoms and thinking ‘I feel that way now’, then you may be experiencing a prenatal mood disorder. All the resources for support and techniques for self care I just talked about can also help with pregnancy mood disorders. I would encourage you to reach out for support now – the sooner someone gets support, the sooner they start feeling better. If you have concerns or questions, you can talk to me after class or by email.”

So, it works well for me to cover it near the end of the series when I’m talking postpartum. But, I could also make an argument that it would be better to cover it as early in the series as possible so that parents who are experiencing it get support as early as possible.

When do you (could you) cover it in your classes?

For more resources on perinatal mood disorders, see http://ppmdsupport.com/index.html
photo credit: Maria & Michal P. via photopin cc