Mamas on Bedrest: Untreated Asthma in Mamas Leads to Low Birth Weight (Girl) Babies

July 15th, 2011

I had an asthma attack when I was pregnant with my son in 2005. It was the weirdest thing because I had not had an asthma attack in years and didn’t even have a rescue inhaler available. I called my OB’s service (of course this happened over the weekend) and a rescue inhaler and steroid inhaler were prescribed and I was referred to a pulmonologist for evaluation.

To my surprise, the pulmonologist advised that I continue taking the steroid inhaler for the duration of my pregnancy and into the early post partum. I asked my pulmonologist if the steroid inhaler was safe for me and my son and he told me that it is very important that I breath easily and exchange adequate oxygen so the I can provide adequate oxygen to my son.

Just one day ago, I learned that there is another reason why it is important for asthmatic mamas to be placed on maintenance steriod inhalers.  Research studies show that asthmatic mamas who are not placed on maintenance steroid inhalers are at risk for delivering low birth weight infants and female babies are most often affected.

Dr. Norman Swan a physician and research  journalist at The Hunter Medical Research Institute Newcastle, New South Wales addressed this very topic in an  interview with Dr. Vicky Clifton, Researcher at the Mothers and Babies Research Centre, The Hunter Medical Research Institute Newcastle, New South Wales. In the interview, Dr. Clifton explained the link between maternal asthma and low birth weight infants.

“What we’re observing is that low birth weight is associated with female babies and it’s associated with asthmatic mothers that don’t use their inhaled steroids to control their asthma…Mothers who are not treated adequately usually have smaller female babies.”

At the time of the interview in 2005, Dr. Clifton and other researchers were not sure why female infants were more often affected and what other growth and development impairments occurred. The one thing that was sure is that children who are born to mothers with asthma grew on a different (slower) growth curve than childen born to non-asthmatic mothers. Furthermore, children born to asthmatic mothers who took maintenance steroid inhalers while pregnant were less likely to be born low birth weight and were less likely to grow on a slower growth curve than their asthmatic, non-treated counterparts. Follow up studiess on the children are being conducted to determine if any other effects of asthma occurred.

The explanation for the asthma link to low birth weight infants is as follows:

“You see these glucocorticoids are stress hormones. The cortisol from the mum gets into the baby’s blood stream and seems to affect the female foetus by making the baby reduce her own steroid production. Male foetuses on the other hand, seem to resist their mum’s steroids better…what seems to be happening is that an enzyme barrier in the placenta which stops maternal steroids getting into the baby remains up in males but drops in females of asthmatic mothers under this stress. Anyway, the result in females is that their organs don’t grow as well.”

The take home message from this interview is that any asthmatic pregnant mama should be taking maintenance steroid inhalers and her asthma should be monitored and managed closely. Here are Dr. Clifton’s final comments in the interview:

” Preventative treatment, the use of inhaled steroids by asthmatic women plays a very important role in protecting against the effects that we’ve observed on the foetus. It’s quite important for asthmatic women to have an asthma action plan specifically tailor-made for their pregnancy. We find that asthma does change as pregnancy progresses and that it’s important that women have an idea of how to treat it. There’s a great deal of fear about using inhaled steroids for what effect it may have on the developing baby but in fact our data is starting to say it’s important that they use it because the inflammatory effects of the disease have a greater effect on the baby than the actual treatment.”

Mamas on Bedrest: If you have asthma, Get evaluted and obtain and take maintenance steroid inhalers.

The full interview by Dr. Norman Swan of Dr. Vicky Clifton, “Asthma and the link with low birth weight babies” can be heard on ABC Radio’s The Health Report.

Mamas on Bedrest: Are You Vitamin D Deficient?

July 13th, 2011

Mamas on Bedrest, are you Vitamin D deficient? I am. Imagine my surprise when I learned that I was severely Vitamin D deficient and at risk for impaired calcium metabolism. Questions swirled through my head; Am I at increased risk for osteoporosis? Am I at increased risk of breaking my hip and lowering my mortality? Will I experience more dental cavities or worse, lose my teeth and need dentures? All of these health issues result from low calcium levels and calcium absorption is directly affected by the amount of Vitamin D present to aid in calcium metabolism. So it was a no brainer for me to add Vitamin D supplements to my multivitamin supplements. 

Unbeknownst to me at the time of my diagnosis (years after I had had my children) and to many pregnant women, adequate Vitamin D levels in pregnancy are essential for mamas health and proper develoment of a growing fetus.  According to a MedScape report, in recent years there is an increased understanding of the role that Vitamin D plays in regulation of cell growth, immunity, and cell metabolism. Vitamin D deficiency in pregnant women has been linked to:

  • Pre-Eclampsia
  • Insulin Resistance (Gestational Diabetes Mellitus)
  • Ricketts in the fetus (rare)
  • Impaired Bone Growth in the developing fetus and as it grows thru adulthood
  • Low Birth weight
  • Asthma in the children of mothers with low Vitamin D levels

More surprising to me, African American women are at least twice as likely to be Vitamin D deficient as white women. Vitamin D is absorbed through the skin from the sun and used to metabolize calcium. In African American women, especially dark skinned African American women, not as much Vitamin D is absorbed, partially due to repelling of the sun’s rays by their dark skin and partially because African American women are less likely to stay out in the sun. (At this time there is no indication that African American women absorb and process Vitamin D differently than their white counterparts.) The bottom line is that many pregnant women, and especially African American women, may be Vitamin D deficient and require supplementation.

So how much Vitamin D do pregnant women need? A recent article in the June 27, 2011 online Journal of Bone Mineral Research evaluated the Vitamin D needs of pregnant women, the current nutritional recommendations and based on their research, propose the following Vitamin D supplementation for pregnant women:

  • Vitamin D supplementation of 4000 IU/day for pregnant women was most effective in achieving Vitamin D level sufficiency in all women and their neonates, regardless of race 
  • Safety measures did not differ among groups, and no adverse event was thought to be caused by vitamin D supplementation or circulating Vitamin D levels
  • The study did not find any advantage of vitamin D supplementation on the risk of adverse pregnancy outcome, risk of cesarean section, or in respect to size of the newborn child

So Mamas on Bedrest, should you take Vitamin D supplements? Truthfully, there is no consensus on this. Many obstetricians refrain from Vitamin D (or any sort of) supplementation out of fear that excess may cause harm to the developing fetus. The current recommendations, 200 IU daily, were first proposed by Dr. Gilbert Forbes in 1963 with no scientific basis.  So while the current evidence would support supplementation up to 4000IU daily, many (most) women take far less.

Mamas on Bedrest, If you have concerns about your Vitamin D levels and how it may be affecting your pregnancy, discuss this with your doctor at your next prenatal visit and ask if you should supplement and by how much. Share the information in this blog with your OB and ask his/her opinion on Vitamin D supplementation. As always, If you have other questions or want more information e-mail us at info@mamasonbedrest.com. Please share your experiences and what you learn with our community in the comments section belwo!

Mamas on Bedrest: Lessons from the Casey Anthony Tragedy

July 11th, 2011

As I have previously written, Dr. Linda Burke-Galloway, an OB/GYN, author, speaker and Medical Malpractice examiner in Florida is one of my idols and unbeknownst to her, one of my mentors. When there is breaking news or pertinent information divulged in obstetrics and in the high risk pregnancy  in particular, I look to Dr. Linda for her sage wisdom and perspective.

In her latest blog post, Dr. Linda offers Lessons for Casey Anthony, Dr Linda provides some food for thought for all of us as well as Casey Anthony.

  1. Casey Anthony is young and presumeably fertile, and will likely get pregnant again. 
  2. Does Casey Anthony want other children? If not, what is she going to do to prevent pregnancy? Has she even given any thought to this and what she will do if she becomes pregnant again?
  3. How are those around Casey going to react if she does have other childen and what protection can be afforded to those children without encroaching on Casey Anthony’s personal rights?

This tragic case has brought so many issues to light. Mamas on Bedrest, we mamas who have had to struggle and fight to have the children that we have, cannot imagine harming these precious jewels that we’ve fought so ferverently to have.  

But as Dr. Linda reminds us and as I personally have experienced on many occasions, children can push buttons you weren’t even aware that you had. Motherhood can be the most exhilerating, frustrating, taxing, alienating, all encompassing and isolating experience-sometimes all at once. Because motherhood is all this and so much more, I implore you, as Dr Linda implores Casey Anthony, to get help, assistance and guidance.

  • As we have said, motherhood will stretch you in ways you never even imagined. Make sure that you have a support system
  • Join a mom’s group. Being around other mothers and sharing stories will help you realize that your situation is not so extraordinary afterall. Additionally, other mamas can help you with coping strategies and to reframe how you do things to help alleviate stress and strain.
  • Know your limits. While our society often seems to dictate the “right” number of children, there is no shame in having one or fifty children. The number of children you have is purely your  (and your partner’s) decision and needs to be made based on your ability to sustain your family, your physical status and your mutual desires for your family.
  • Take care of youself first and foremost. As I always say, you can’t give anyone a drink from an empty cup! Make sure you are getting adequate rest, nutrition. exercise and stress release as necessary. In this way you can do what is best not only for yourself but also for your child.

Always remember that there is help out there. While Mamas on Bedrest & Beyond focuses first and foremost on the needs of high risk pregnant women on bed rest, our ultimate goal is to help mamas have all the tools and resources that they need to have a healthy and safe pregnancy, labor and delivery, a healthy baby and a smooth transition to motherhood. If you have questions or need support, contact us, info@mamasonbedrest.com. We’re here to help.

Finally, we are gearing up for fall with a new series of workshops and seminars for Mamas on Bedrest. We’d love to hear from YOU! What topics would you like us to cover? Which topics would you like to speak about with other mamas? That’s right, our workshops are interactive so you’ll be able to chat with the other participants in realtime on line! Submit your comments and suggestions  below.