Congenital Anomalies

Mamas on Bedrest: It’s World Autism Awareness Month!

April 3rd, 2014

World-autism-awareness-dayHello Mamas and Happy Video Wednesday!

April 2, 2014 is World Autism Awareness Day. April has been designated Autism Awareness Month. In this video blog, I review current statistics and information about Autism and what Mamas on Bedrest should know and keep in mind.

First of all, I was shocked to learn that the prevalence of Autism has risen since I last researched it. It currently affects 1 out of 68 children in the United States and affects boys 4-5 times more often than girls. The prevalence of autism in boys is 1 out of 42 boys. The prevalence in girls is 1 out of 189 girls. No matter how you look at it, autism is pervasive and becoming more so daily.

While physicians and scientists know more than ever before about autism, there is still much to learn. In particular, while it is know that autism has a genetic component and appears to cause gene mutations, most researchers and physicians agree that autism is the result of genetic mutations as well as environmental factors that influence early brain development. This caught my eye in light of my recent post on epigenetics. It seems that more and more chronic diseases in our society are either the direct result or the result at least in part of our environment. These evironmental influences are affecting us at the cellular level and causing disease.


If you would like to learn more about autism, visit

World Autism Awareness 

Autism Speaks

Autism Society

Autism Research Institute

The US Centers for Disease Control and Prevention

 

Mamas on Bedrest: Decongestants and Birth Defects

January 31st, 2014

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Hello Mamas!  With cold and flu season upon us, I wanted to take a moment and go over important information about taking medications for symptoms.

Being sick while you are pregnant is a bear because you are very limited in what you can take. So many medications are not good for your baby’s development that most healthcare providers advise mamas not to take anything. A recent article in the American Journal of Epidemiology noted that the use some nasal and oral decongestants during the first trimester can cause birth defects. In this study, Dr. Wai-Ping Yau at the Sloan Epidemiology Center in Boston looked at data from a birth defects study conducted from January 1993-January 2010. Studying 12,734 infants with birth defects and 7606 control infants (infants without birth defects) the researchers looked at those who had birth defects and then contacted the mothers regarding the use of medications during pregnancy.

Pseudophedrine has long been used by mamas during pregnancy and has been touted as being safe. However, there has been some question of suspected limb shortening when used in the first trimester. These researchers wanted to know if pseudophedrine and other decongestants did in fact cause any sort of birth defects and if so, what types. Dr. Yau and his colleagues found that phenylephrine use was associated with endocardial (heart) cushion defect (4 exposed cases), phenylpropanolamine was associated with ear defects ( 4 exposed cases), and phenylpropanolamine was associated with pyloric stenosis (narrowing and hardening of the passage from the stomach to the small intestine) (6 exposed cases). They also found elevated risks of 2 malformations with the use of intranasal decongestants (nasal sprays): pyloric stenosis and tracheo-esophageal fistula. In addition, renal collecting system anomalies potentially could be associated with second-trimester exposure to oxymetazoline.

The authors reiterated the fact that the numbers of infants affected were very small, for each products used birth defects occurred in less than 10/1000 births. Yet they suggested that further studies be done to make a definitive cause/effect statement for the medications. They also made specific note that most of the associations were the result of mamas using medications during the first trimester, so they suggested that health care providers reiterate to their patients the importance of not using any medications during that critical developmental time.

What is a mama to do if she becomes ill while pregnant? Well, after looking at this study, if she is in the first trimester, it looks as if she is going to have to tough it out. Since such a large amount of fetal development occurs in the first 12-16 weeks, refraining from the use of any medication during that time-except in cases of absolute necessity-appears to be the best course of action. How would mama know if treating her illness is an absolute necessity? She must consult with her health care provider.

Sometimes when mama is ill, the risk treating her illness is outweighed by the potential harm to her baby if she does not receive treatment. Case in point, when I was pregnant with my son, my asthma flared. I hadn’t had an asthma attack in year! But the change in my immune system with the pregnancy triggered something and there I was wheezing. I called my OB and was told to use my rescue inhaler and immediately scheduled to see a pulmonologist the next day. The pulmonologist started me on daily inhaled corticosteroids for the remainder of my pregnancy (about 4 months). His rationale was that if I was not getting enough oxygen neither was my baby. It was more important to keep my airways clear by eliminating inflammation and sensitivity with the inhaled steroid than for me to have low oxygen levels and potentially subject my baby to the same.

If you have questions about what medications (or even herbal/”natural” medicinal preparations) are safe to take if you are sick, please call and talk to your health care provider before you take anything. As Dr. Yau and his colleagues noted in the aforementioned study,

“It is not known whether any of the oral decongestants (pseudoephedrine, phenylephrine, and phenylpropanolamine) cross the placenta to exert any direct effect on the fetus.”

With that being the case, Mamas, if you become ill and feel that you need to take something for your symptoms (including home remedies!!), Please consult with your health care provider first!

 

References:

Wai-Ping Yau, Allen A. Mitchell, Kueiyu Joshua Lin, Martha M. Werler, Sonia Hernández-Díaz. Use of Decongestants During Pregnancy and the Risk of Birth Defects American Journal of Epidemiology. 2013;178(2):198-208.

MedScape OB/GYN Women’s Health

Mamas on Bedrest: Hypothyroidism in Pregnancy

June 19th, 2013

It’s video Wednesday! In today’s video blog, I answer the question,

“Should screening for hypothyroidism be a mandatory/routine part of prenatal testing?” 

In this video, I review the common causes of hypothyroidism in pregnancy, the effects of hypothyroidism on maternal health and on fetal growth and development. Personally, I think that prenatal screening for hypothyroidism should be a mandatory part of prenatal screening. It’s an inexpensive test, simple to do and yields pertinent information. While “evidence based medicine” doesn’t deem it cost effective, My personal opinion is that the potential consequences make these relatively inexpensive tests worthwhile.