High Risk Pregnancy

Mamas on Bedrest: Your Baby’s Address Growing Up Helps Determine His Life Expectancy

May 26th, 2015

I just read a fascinating article about where you live and life expectancy.

Scientists looked at poor urban areas of Detroit Michigan and found that residents there had accelerated aging as noted by shortening of the Telomeres of their DNA strands. Telomeres are the tips of DNA that protect the strands from injury, disease and premature death. They are similar to the plastic tips on shoelaces. People living in depressed urban areas of Detroit were noted to have shortened telomeres which predispose them to chronic disease and premature death. The new study found that low-income residents of Detroit, regardless of race, have significantly shorter telomeres than the national average.

“There are effects of living in high-poverty, racially segregated neighborhoods — the life experiences people have, the physical exposures, a whole range of things — that are just not good for your health,”

noted lead researcher Dr.Arline Geronimus, a visiting scholar at the Stanford Center for Advanced Study, as she spoke with the Huffington Post. The co-author is Dr. Elizabeth Blackburn, a leading researcher who  helped to discover telomeres, an achievement that won her the Nobel Prize in physiology in 2009. 

But there is more interesting data to this article. Rates of accelerated aging were varied amongst ethnic groups and not in a predictable fashion. 

“White Detroit residents who were lower-middle-class had the longest telomeres in the study. But the shortest telomeres belonged to poor whites. Black residents had about the same telomere lengths regardless of whether they were poor or lower-middle-class. And poor Mexicans actually had longer telomeres than Mexicans with higher incomes.”

This is completely counter intuitive. One would think that higher income would confer longer telomeres and hence better health. But because this was not the case, the researchers looked at other possible answers. What they found is that health outcomes are not based solely on race, education or economic status as is often assumed. Other factors such as perceived discrimination and having a supportive community are also factors determining health outcomes. For example, Geraniums and her colleagues found that Mexican immigrants actually fare better than lower middle class Mexican Americans because despite their poverty, they live in fairly insulated communities where there is shared language, share tradition and shared culture. Although they may face discrimination outside the community, when they return home, they are once again validated so the discrimination is not as impactful. But for African Americans, lower middle class or poor, perceived discrimination is not offset by the community support. Job and income instability, family and social networks and segregation seem to account for the lack of differentiation between lower middle class and poor African American. And amongst whites, those of lower middle class status were most likely to separate out of these neighborhoods while poor whites were not able to move out of poverty and seemed to suffer greater stigma and shortest telomere length as a result.

So what does this mean for Mamas on Bedrest?

It means that where your child grows up and under what social circumstances will have a significant impact on his or her lifespan. In this country we are so used to quantifying things by race, educational status and economics. What this research shows is that the factors playing into our health are far more complex than we expected. Issues such as community engagement and interaction, discrimination and cultural norms have more influence on health and longevity than previously imagined. So while we may all agree that we want our children to be raised in nice homes in “good, safe neighborhoods”, we have to take other factors into consideration. The social determinants of health-issues such as racism, classism, discrimination, isolation, cultural norms and social support just to name a few- show that,

“So much of what makes people either well-being or not is not coming from within themselves, it’s coming from their circumstances. It makes me think much more about social justice and the bigger issues that go beyond individuals,” said Dr. Blackburn.

Not everyone who lives in a depressed area is able to move, and according to this study, it may not be in their best interest to do so. What this article says to me is that we have to include social and cultural norms in addition to race, education and economics when considering what is truly impacting someone’s health. We have to consider discrimination and its impact on health. We have to consider that for some groups, like Mexican immigrants in this case, the close knitted communities are actually protective of health, and rather than people working tirelessly to flee these depressed areas, perhaps it is in the best interest of the larger society to invest in these neighborhoods; fix the schools, stores and other structures and help the communities that are doing well to do even better because they have the support and services they need.

Every baby born in the United States should be able to grow up in a safe home, in a safe community in and be able to live to the age of “normal” life expectancy. We as a culture and society knowingly cannot allow poverty and depressed areas to persist, knowing that it is essentially causing chronic disease and premature death.  We have a moral obligation to at least try to help meet the needs of our fellow citizens to give them an equal shot at a long and full life. As Dr. Blackburn noted,

“When something’s really hard to assess, the easy thing is to dismiss it. They say it’s soft science, it’s not really hard-based science.”

Telomere data is providing a new way to quantitatively analyze some of these complex topics. Whether they have experienced severely negative experiences in childhood, and so on, their telomeres are substantiating their feelings and experiences. With this knowledge, we all have the moral obligation to make changes so that all children can reach their full life expectancy and their full individual potential.

What is your take on this ground-breaking research? Share your thoughts in the comments section below.

References

The Huffington Post: Scientists Find Alarming Deterioration in the DNA of the Urban Poor

Arline T. Geronimus, Jay A. Pearson,Erin Linnenbringer, Amy J. Schulz, Angela G. Reyes, Elissa S. Epel, Jue Lin, and Elizabeth H. Blackburn, “Race-Ethnicity, Poverty, Urban Stressors, and Telomere Length in a Detroit Community-based Sample” Journal of Health and Social Behavior 1–26. © American Sociological Association 2015 DOI: 10.1177/0022146515582100 jhsb.sagepub.com

 

 

Mamas on Bedrest: Become Immortal!

January 6th, 2014

Mamaonbedrest-on-the-phoneHappy New Year Mamas!

For 2014 we’re compiling an  e-book guide for Mamas on Bedrest.

This e-guide will contain no only the essential information every Mama needs to know when she is placed on bed rest, It will also contain first hand accounts of life on bed rest and the tips and tricks to making bed rest a success. Mamas on Bedrest are the best resource for navigating bed rest and while forums and chats are great, mamas new to bed rest often want something that they can refer to again and again.

So mamas, here’s your chance to become immortal! There are two ways in which you can participate in this process:

1. Ask a question or share a difficulty that you have being placed on bed rest

2. Share your bed rest story, and how you survived the hours, days, weeks and months on bed rest and now hold your precious little one.

Mamas, please share your stories! We are in particular need of mamas to share stories who had preterm labor, an incompetent cervix, pre-eclampsia, placenta previa, a premature infant or multiples. Hold nothing back! We’ll need you to share the good, the bad and the ugly!!! And for you new mamas, Ask your questions. There is no question too insignificant and rest assured (no pun intended), if you have this question, there is most likely at least one other mama out there with the same question.

If you are interested in participating, please send your name and your question or story to info@mamasonbedrest.com.

Mamas on Bedrest: Early Prenatal Care Lowers the Risk of Preterm Birth

December 13th, 2013

Early initiation of progesterone prophylaxis is associated with a reduction in spontaneous preterm births among women with a history of preterm delivery, a new retrospective cohort study shows.

So Begins a recent study published by Kara B. Markham, MD, from the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, The Ohio State University. Interestingly, the more important piece of the article is,

Special efforts to promote timely access to care and initiation of progesterone treatment are likely needed to lower the rate of prematurity.

For me, this is the crux, the real nugget of truth to this article. When prenatal care is initiated early, many necessary treatments can be initiated at times when they may actually be effective.

So let’s look at the article.

The investigators analyzed data on women with a history of preterm birth attending the Prematurity Clinic at The Ohio State University Wexner Medical Center between January 1, 1998, and June 30, 2012. Clinicians started in 2004 to offer high-risk women routine progestin prophylaxis, delivered as weekly injections provided by a clinic staff member, and, starting in 2008, women could opt for daily, self-administered vaginal suppositories..The greatest reductions in preterm deliveries were observed in birth rates before 37 and 35 weeks of gestation. No significant difference was seen in the odds of birth at less than 32 weeks’ gestation, although the study was not statistically powered to detect a difference at that point in pregnancy.

According to the authors, Our report suggests that progestin prophylaxis can reduce the rate of recurrent spontaneous preterm birth when barriers to care and treatment are aggressively removed and that the gestational age at initiation may affect the success of progestin prophylaxis.”

This is great. Yet it has already been esstablished the progesterone therapy is effective in the prevention of preterm labor. (see our previous blog posts on 17OHP/Makena Injections) But the real gem of this article isn’t the progesterone therapy, but the realization by the authors that if prenatal care is initiated early, progesterone therapy can be initiated early and effectively prevent preterm births.

According to this publication, many of the women at risk for preterm delivery were Medicaid recipients. Because of the laws governing Medicaid in Ohio, there is a lag time between when a women is approved to receive Medicaid and eligible to receive Medicaid benefits (i.e. about to go for prenatal care). So in 2008,

the clinic started a program designed to identify and address obstacles to the timely initiation of progestin therapy, such as delayed entry to prenatal care, late identification of patients most in need of progestin prophylaxis, barriers to obtaining insurance, and safe administration of progestin injections. 

This action resulted in

the mean gestational age at the first clinic visit dropped from 19.6 weeks in 1998 to 2003, to 17.4 weeks in 2004 to 2008, and to 15.5 weeks after 2008, a statistically significant reduction (P < .01 for trend)Compared with the period from 1998 to 2007, the odds ratios of preterm birth in 2008-2012, adjusted for race, cerclage, smoking, and number of prior preterm births, were 0.75 at less than 37 weeks’ gestation (95% confidence interval [CI], 0.58 – 0.97), 0.70 at less than 35 weeks’ gestation (95% CI, 0.52 – 0.94), and 1.21 at less than 32 weeks’ gestation (95% CI, 0.83 – 1.76).

The authors note that the reduction in preterm births could be attributed to some unknown factor, but from what they observe, aggressively getting women (who need it) approved for Medicaid and in for their first prenatal visit early greatly enhanced the likelihood that they would start progesterone therapy at a time when it would be most effective.

This is truly remarkable work. Not only did the researchers find Progesterone therapy effective in preventing preterm births, they also found that early prenatal care also plays a role in reducing preterm births. Since women were seen and evaluated earlier, if any medical treatments or interventions were needed, they were started sooner rather than later.

Early intervention is the crux of most medical therapies; breast cancer campaigns, infant vaccination programs, diabetes treatments….Is it any wonder, then that early intervention is also beneficial when it comes to prenatal care? I was unaware that iniital prenatal visits have been pushed out to 10 weeks and beyond. It seems to me that earlier is better-allowing time to get baseline laboratories and to educate mamas on much needed prenatal information.

In my opinion, this is another example of how insurance coverage-money- is dictating medical care. And once again, this is proving to be an inappropriate standard by which to practice medical care. What is it going to take for us, as a society, to understand that sometimes faster, cheaper, leaner isn’t better? It certainly isn’t the case when it comes to health care and it most certainly isn’t best when it comes to prenatal care. We now have “evidence” to this, so in this era of “evidence based medicine”, isn’t it time to practice what we preach?

Reference

Markham, Kara B. MD; Walker, Hetty RNC-OB, CCRC; Lynch, Courtney D. PhD, MPH; Iams, Jay D. MD “Birth Rates in a Prematurity Prevention Clinic After Adoption of Progestin Prophylaxis”  Obstetrics & Gynecology., POST AUTHOR CORRECTIONS, 6 December 2013.