Tag: Pregnancy

Investment Podcasts 2021 Jeffrey Althoff

Top Podcasts for Pregnancy and Birth

On April 23, 2021

In Child Health Care, Neonatal Care, Newborn Screening, Newborns

Navigating pregnancy and infancy is complex and very taxing. There are many things you need to be aware of at all times. If you are a first-time mother, it can be even more difficult and stressful. There is no one-size-fits-all how-to manual on entering motherhood, but there are helpful resources that exist to help put minds at ease. One of the best resources for those who are busy and do not have time to read a book or attend a class is listening to a podcast. You can play them in the background, on the go, and when you’re multitasking. Let’s take a look at some of the best pregnancy and birth podcasts available, as featured in an article on Big City Moms.

The Birth Hour

This podcast is a saving grace for those who are interested in everything related to birth stories. There are many experiences told by special guest speakers who have all had to go through the process of giving birth; some examples include giving birth in an RV, delivering breech twins, natural births, water births, and c-sections. Their website provides a quiz on which birth setting might be the best for you. Listeners have described this podcast as extremely helpful, and some have said it opened their eyes up to birthing possibilities they did not consider at first.

Informed Pregnancy

Hosted by doula Dr. Elliot Berlin, this podcast contains large amounts of information that new moms should take into consideration. Berlin is a chiropractic doctor and childbirth educator, so it is safe to say that she definitely knows what she is talking about. One of the best episodes on the show is her interview with Ricki Lake. She delves into a wide range of topics such as birth plans, CPR safety tips, and vaccinations so that moms can keep themselves and their babies safe.

40 Weeks Pregnancy

This podcast might be the coolest on our list. You can listen to an episode of this show every week throughout your pregnancy, and it updates you on what to expect and how to deal with particular challenges you might be experiencing. Each week you can tune in to how your baby is likely developing and how to guide yourself through the journey.

COVID-19’s Potential Impact on Newborns

By Dr. Allen Cherer

On July 6, 2020

In Child Health Care, Neonatal Care, Newborn Screening, Newborns

COVID-19 produces victims of all ages. Concern grows for pregnant women and unborn children. Facilities around the world continue studying the microbe and reveal their findings thus far. Some studies suggest that infants born to mothers having the virus have a high risk of suffering ill effects.

From January 20 to February 5, nine women gave birth to 10 infants in five different hospitals in China’s Hubei province. Eight of the expectant mothers tested positive for COVID-19 before delivery. One mother tested negative. However, a fever and a CT scan of her chest revealed pneumonia that could not be contributed to any other underlying cause but the virus.

The women suffered a variety of prenatal complications that included intrauterine distress, ruptured members prior to the onset of labor, amniotic fluid abnormalities and placenta previa. Seven of the mothers delivered their babies via cesarean section. The other two women had normal vaginal deliveries.

The mothers were treated with Tamiflu or a combination of the antiviral plus interferon following delivery. After birth, all of the infants were tested for COVID-19 via oral swabs. All of the tests were negative. Four of the babies were full-term and six were premature. All of the infants exhibited unusual symptoms that included fevers, difficulty breathing, elevated heart rates, inability to feed, vomiting, gastric bleeding and bloating from liver malfunction. Seven of the infants exhibited abnormal chest X-rays. Two of the premature babies died nine days after birth.

A team of researchers from Northwestern University in Illinois recently discovered that the virus damages the placenta in expectant mothers. The study involved 16 pregnant women who tested positive for COVID-19. Following delivery, the placenta tissues were evaluated. The team discovered that the blood vessels within the placentas exhibited abnormal development or were otherwise damaged. However, all of the infants tested negative for the virus and were in reported good health.

Researchers from the University of California San Diego expanded the MotherToBaby program to gain a better understand the short- and long-term effects of the virus on expectant mothers and infants. Previously, the program was designed to evaluate medications and environmental factors that might affect pregnant women, newborns and breastfeeding.

The study will involve the examination of medical records and phone calls to women who volunteer for the research. The program also includes monitoring the neurological development of children to determine possible emotional, learning or memory issues.

Top Pregnancy Myths: 2020

By Dr. Allen Cherer

On April 17, 2020

In Neonatal Care, Newborns, Research

Some of the information expectant mothers receive is often based on myths or old wives’ tales. Dispelling the myths may bring comfort and reassurance in addition to ensuring the health of the expectant mother and growing infant.

You’re Eating for Two

For decades, women were encouraged to substantially increase their dietary intake in order to ensure they were consuming enough nutrients for the growing infant. However, overeating leads to obesity, which leaves the mother and baby at risk. Being overweight increases the chances of developing gestational diabetes or hypertension. The excess weight also stresses the cardiovascular system. Health care providers suggest that increasing daily calorie intake by a mere 200 to 300 calories is more than sufficient to ensure a healthy pregnancy.

Belly Size and Shape Reveals Gender

Physicians rebuke the belief that external appearance correlates with the baby’s gender. Some women carry the baby high while others carry it lower. However, the difference is often equated with genetics and physical characteristics and not infant gender.

Moisturizing Prevents Stretch Marks

Cocoa butter has long been touted as being one of the solutions to prevent stretch marks. While moisturizing preparations are good for the skin, they do not prevent the physiological effects that a growing infant causes on external skin. Women develop varying degrees of marks depending on genetics and the extent that the abdomen needs to stretch to accommodate the infant.

Stay Away from Cats

There is no reason why expectant mothers cannot have and care for a feline companion. The danger lies in changing the litter box. Feline waste products commonly contain a parasite that has the potential for causing toxoplasmosis. While the mother may or may not experience flu-like symptoms, the illness has the potential of becoming serious in infants. Best to leave litter box duties to someone else. The disease can also be contracted by eating undercooked meat or unwashed fruits and vegetables.

Coronavirus and Pregnancy: What to Know

By Dr. Allen Cherer

On March 24, 2020

In Child Health Care, Neonatal Care, Newborns, Research

Historically, viral illnesses become more serious in the very young, the elderly and in individuals having a weakened immune system. Given that victims of all ages have become infected with the coronavirus, many are understandably concerned about the effect the illness may have on expectant mothers.

Pregnancy and Covid-19

The World Health Organization reports that in a study of 147 pregnant women, eight percent developed more severe forms of the illness. One percent required critical care.

A study of nine afflicted women who gave birth indicated that none of the infants tested positive for the virus. But, the women all became infected during the last trimester of pregnancy. It remains yet unknown how the virus might affect a fetus during the early months of development.

Another study involved 10 newborn infants who developed serious forms of the illness. According to a physician from the Northwestern University Feinberg School of Medicine, the amniotic fluid, breast milk, and cord blood were tested. But, all of the fluid was negative for Covid-19. So, physicians do not believe that the illness passes from the mother to the developing infant. Theories revolving how the babies became infected include that the women may not have undergone testing and found to be afflicted before delivery. The babies may have come in contact with their infected mothers shortly after birth.

An obstetrician affiliated with the American College of Obstetricians and Gynecologists advises that pregnant women should undergo testing at their initial appointment and separated from patients who tested negative. Pregnant women are advised to use the same precautions recommended for the general public.

About Covid-19

After exposure, individuals may develop symptoms in two days to two weeks. The majority of afflicted individuals suffer symptoms that are equated with the common flu. The experience may include fever, generalized fatigue and upper respiratory symptoms. Others suffer muscle aches and diarrhea. The World Health Organization reports that the virus causes serious illness in one out of every six patients. More severe cases exhibit difficulty breathing and shortness of breath. Individuals experiencing more serious symptoms are advised to seek medical attention.

Scientists recently revealed that the virus has two strains, one of which is more aggressive than the other. Health care providers also report that it is possible for individuals to suffer a relapse, which is often more serious.

Transmission occurs through airborne droplets or coming in contact with infected animals, surfaces or fecal matter.

Fine-tuning the Elimination of Perinatal Hepatitis B Infection

By Dr. Allen Cherer

On February 13, 2018

In Neonatal Care

Hepatitis B virus (HBV) infection is a serious illness in the newborn and young infant. The virus, first discovered in the mid-1960s, is transmitted through percutaneous (i.e., puncture through skin) or mucosal (i.e., direct contact with mucous membranes) exposure to infectious blood or body fluids. The virus is highly infectious, can be transmitted in the absence of visible blood, and remains viable on environmental surfaces for at least seven days. Once the virus enters the body, it is transported to the liver where it replicates. Although one generally thinks of the acute illness as a self-limited one in the adult with characteristic signs and symptoms, HBV infection in the infant is almost exclusively asymptomatic and hence, unrecognized. The devastating aspect of the infection is that the infant and young child frequently fail to clear the virus, and the illness becomes chronic. As many as 80-90% of infected infants progress to chronic infection, and chronically infected persons as adults are at increased risk of cirrhosis, hepatocellular carcinoma, and liver failure with approximately 25% dying from these serious complications.

Before 1982, an estimated 200,000-300,000 persons in the U.S. alone were infected with HBV annually, including approximately 20,000 infants. No effective pre-exposure prophylaxis existed, and only post-exposure prophylaxis in the form of hepatitis B immune globulin (HBIG) was available. However, the first hepatitis B vaccine was approved in the United States in 1981 and proved to be a real game changer. The availability of the vaccine set the stage for remarkable progress in the elimination of HBV infection among all age groups. With the advent of an effective vaccine, incurable hepatitis B infection had become preventable. The vaccine saves lives!

It is in this setting of disease prevention through widespread vaccination that an evolving strategy to eliminate perinatal hepatitis B infection was initiated over 30 years ago. Early epidemiological studies had demonstrated that a major contributor to perinatal HBV infection is mother-to-child transmission (MTCT) at the time of delivery. In utero infection is felt to account for less than 2% of infections. The risk of transmitting the virus was estimated to be 20-80% depending on the activity of the maternal infection. Initial attempts in the early 1980s to limit vertical HBV transmission were risk-based and aimed at identifying those pregnant women considered infectious by virtue of the serum marker, HBsAg. With reliable identification of mothers and expeditious treatment of their newborns with hepatitis B vaccine and HBIG, HBV infection could be prevented. However, it became clear within several years that such screening was inadequate with as many as 35-65% of HBsAg-positive women being missed. Consequently in 1988, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention recommended universal testing of all women early in each pregnancy such that at risk babies would receive appropriate post-exposure HBV prophylaxis. Throughout the 1990s, efforts were intensified to eliminate all HBV-related illness through widespread vaccination of children, adolescents, and at-risk adults. Studies showed that receipt of the 3-dose hepatitis B vaccine series produced a protective antibody response in approximately 98% of healthy infants. During 1990-2004, the incidence of acute hepatitis B in the U.S. declined by 75%. The greatest decline (94%) occurred among children and adolescents, most likely due to increasing hepatitis B vaccine coverage. As of 2004, over 92% of children less than 3 years of age had been fully vaccinated with the complete series.

Coupled with the remarkable success of the hepatitis B elimination strategy is the knowledge that the task is not complete. As a response to the persistence of perinatal HBV infection and aware that errors in testing as well as in communication of results may occur, ACIP has recommended a change in the administration of the initial hepatitis B vaccine dose over time. Initially, the first dose could be administered to an infant born to a HBsAg-negative mother any time from birth to 2 months of age. Subsequently the initial dose became the “birth dose” with the recommendation that it be given prior to discharge, and in 2017, the initial dose was to be administered within 24 hrs of birth. The previous permissive language that allowed the dose to be delayed “on a case-by –case basis and only in rare circumstances” was omitted. Based on the fact that the vaccine alone is 75% effective in preventing MTCT, these changes reflect reality and provide basic protection. Then too, the emerging concept that maternal viral load (HBV DNA) plays a significant role in risk of MTCT now plays a prominent role in management. Testing pregnant HBsAg-positive women for HBV DNA is now recommended to guide the use of antiviral therapy during the third trimester for the purpose of preventing perinatal HBV transmission.

Reflections on Cesarean Section Rates

By Dr. Allen Cherer

On May 9, 2016

In Child Health Care, Neonatal Care

Cesarean section delivery is among the most common surgical procedures. It is estimated that in 2012 alone, over 22 million cesarean deliveries were performed worldwide. Data from the National Vital Statistics show that the total cesarean section rate in the U.S. in 1996 was approximately 21%.

Since that time, there has been a rapid increase in the rate, such that in 2011, close to 1 in 3 mothers delivered by cesarean. Although the rate has leveled since then, there remains no evidence that such a significant increase has been accompanied by a concomitant decrease in maternal or neonatal mortality.

Although cesarean delivery can be life-saving for the fetus, the mother, or both in certain cases, the concern exists that cesarean delivery is overused. Hence, the matter is a global health issue. Since one of the main driving forces for the increased total cesarean rate has been a marked shift to repeat cesarean delivery following a previous primary cesarean section, a concerted effort over the past several years has been to examine closely the factors related to the safe management of the nulliparous pregnancy.

As early as 1985, the World Health Organization (WHO) stated there was no justification for any region to have a cesarean delivery rate greater than 10-15 /100 live births. Nevertheless, the rates continued to increase worldwide with no scientific evidence indicative of substantial maternal or perinatal benefit.

In fact, a number of studies have associated higher rates of cesarean deliveries with negative consequences, including increased maternal and neonatal morbidity and mortality as well as increased consumption of limited health resources by procedures without medical indications.

In March 2014, a consensus report was issued by the American College of Obstetrics and Gynecology and the Society for Maternal-Fetal Medicine on the safe prevention of the primary cesarean section. Among other points, it addressed management guidelines for the most frequent indications for primary cesarean deliveries, namely, labor dystocia, abnormal or indeterminate fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected macrosomia.

The report encouraged obstetricians to allow more time to progress through a vaginal delivery without intervention, recommended improved and standardized fetal heart rate interpretation and management, and advocated access to non-medical interventionsduring labor, such as continuous labor and delivery support.

A study by researchers at Harvard Medical School and the Stanford University School of Medicine published December 2015 in The Journal of the American Medical Association suggested that based on analyses of cesarean section rates and maternal and neonatal outcomes among 194 WHO member countries the ideal rate of childbirth by cesarean section approximates 19% of all births as opposed tothe previously considered optimal rate of 10-15%. Although the finding is higher than the former target, it remains significantly lower than the current rate in U.S. hospitals.

In its April 2015 position statement on cesarean delivery, the WHO moved away from any target rate. Rather, it emphasized that every effort should be made to ensure cesarean sections are provided to the women in need and only be performed when medically necessary.

It is gratifying that the concept of “target rate” is no longer tied to the delivery of quality medical care. Primarily due to the lack of a consistent classification system to monitor and compare different obstetric profiles, meaningful data relative to cesarean section rates is missing.

It is only when such systems as the Robson Ten Group Classification System are widely adopted by institutions that valid “risk-adjusted”cesarean section rates can potentially be developed and comparisons be made between institutions, regions, and countries.

Physical Trauma and Pregnancy

By Dr. Allen Cherer

On February 20, 2016

In Neonatal Care

Trauma is an important cause of maternal and fetal morbidity and mortality, and blunt abdominal trauma is a particular concern. Approximately 8% of pregnant women sustain some form of traumatic injury. Automobile accidents and falls account for most of the injuries.

Studies of pregnant women involved in automobile accidents have demonstrated increased rates of premature rupture of membranes, placental abruption, preterm birth, and stillbirth. A recent study examines pregnancies complicated by traumatic injuries and outcomes in relation to place of triage.

According to the retrospective study published in the Journal of the American College of Surgeons, pregnant women who sustained traumatic injuries and were triaged to trauma centers experienced improved pregnancy outcomes compared to women cared for in non-trauma hospitals. For the study, the researchers linked two databases, the Washington State Birth Events Records Database and the Comprehensive Hospital Abstract Recording System.

The method allowed them to assess the maternal and neonatal outcomes of all injured, pregnant women (3429 patients) who were hospitalized in Washington State between the years 1995 and 2012. The findings showed that after adjusting for a number of confounding factors, including injury severity score, pregnant women who were cared for in trauma facilities had better outcomes with significantly decreased odds of preterm labor, preterm birth, and low birth weight infants.

Since trauma centers are specialized medical facilities which have optimal processes and resources in place to monitor and treat injured patients, the study suggests that many injured, pregnant women may in fact be under-triaged and treated in non-trauma hospitals where their care may not be optimal.

According to the coauthors, John Distelhorst, DO, MPH and Vijay Krishnamoorthy, MD, the findings may lead to further analyses of state trauma systems and the triage of specific patient populations to improve quality of care and patient outcomes. To read more about this, please visit this site.

Approaching a Birth Plan

By Dr. Allen Cherer

On February 14, 2016

In Neonatal Care

Pregnancy is an exciting time for expectant parents, and childbirth is a miraculous event. Nevertheless,due to the innate unknowns, it can result in considerable anxiety and sense of loss of control. One means of combating these feelings is through thoughtful preparation of a birth plan based on realistic and trustful communication among all the parties who will be involved.

Since the early Roman period, pregnant women in labor had been attended by friends, relatives, or others experienced in aiding with childbirth. As time progressed, the management of the laboring woman became more involved and the advancement of technologies to better monitor the unborn child and the mother required a change in the birth place and the sophistication of the caregivers.

Currently,the vast majority (>98%) of deliveries in the U.S. occur in the hospital setting and are attended by midwives or physicians. In association with these changes came the option of operative delivery (cesarean section) which in 2012 accounted for close to 30% of all births in the United States, according to the Centers for Disease Control and Prevention (CDC). Cesarean sections are known to be medically indicated for a number of reasons to safeguard the well being of baby and/or mother.

At the same time, for most pregnancies that are low risk, cesarean section may pose greater risks than vaginal delivery, especially risks related to future pregnancies. Due to the recent rapid increase in the cesarean section rate and concerns that operative delivery is overused without clear evidence of improved maternal or newborn outcomes, the American College of Obstetricians and Gynecologists (ACOG) issued in 2014 new recommendations targeted at preventing women from having cesarean sections with their first birth and at decreasing the national cesarean rate.

Pain management is a significant component of the birth plan. Although most mothers report only mild discomfort during early labor, as contractions become stronger, longer, and more frequent, pain intensifies and may require relief with either spinal or epidural anesthesia.

Although the medications are generally considered safe, very rare complications can occur. For those women opting for a more natural childbirth, the participation in a yoga program during pregnancy or the use of hypnosis have been described.

Whatever birth plan is developed for an individual pregnancy, it should always be tempered based onthe saying “the best laid plans of mice and men often go awry”. The overriding goal should always be a safe birth for both mother and baby. If communication and trust exist among all parties, childbirth can be a magnificent process.

Eating Tips for Your Pregnancy

By Dr. Allen Cherer

On February 7, 2016

In Neonatal Care

The nutritional status of women when becoming pregnant and during pregnancy can have significant influence on infant and maternal health problems. Numerous studies of nutritional education and counseling before and during pregnancy have demonstrated beneficial effects in terms of improved gestational weight, increased head circumference, reduced risk of preterm birth, and reduced risk at birth of maternal anemia.

A pregnant woman needs to ensure that her diet provides enough nutrients and energy for her baby to grow and develop properly and also to make sure her body is capable of sustaining the multiple demands that come with pregnancy. Caloric intake grows with pregnancy and weight gain varies considerably. For the average healthy woman, ideal weight gain is 25-35 lbs during the nine month pregnancy.

Either excessive or insufficient weight gain can be deleterious to the health of both the baby and the mother. In general, mother’s diet needs to be balanced and nutritious, involving right proportions of protein, carbohydrate, and fat while consuming a wide variety of fruits and vegetables.

Specifically, fat should provide no more than 30% of daily calories with monosaturated fats being preferable. Examples are foods such as olive oil, peanut oil, sesame oil, canola oil, avocado, and many nuts and seeds. Excellent sources of carbohydrates are potatoes, rice, pasta, and bread.

Animal-sourced protein includes lean meat and fish, as well as eggs. Beans, lentils, and legumes are good sources of protein as well as being rich in iron. Quinoa is notable as a source of all the essential amino acids. As far as fruits and vegetables, fresh and frozen produce usually have higher vitamin and nutrient content as well as being excellent sources of fiber.

Micronutrient deficiencies can be addressed through diet as well as supplements. The value of prenatal vitamins cannot be overemphasized. Folic acid, iron, vitamin D, calcium, iodine, and zinc are especially important during pregnancy. Adequate folic acid before and during pregnancy is critical in preventing neural tube defects which affect the brain and spinal cord. Recommended daily intake is 400-600 mcg.

During pregnancy, maternal blood volume increases significantly and adequate iron supplementation is required to prevent anemia and promote adequate oxygen carrying capacity. Vitamin D deficiency is common even in the non-pregnant state. Adequate Vitamin D during pregnancy is critical for normal fetal skeletal development and may be beneficial in mother to prevent preeclampsia.

Recommended dose is controversial and ranges from 600-4000 IU/day. Iodine is important for normal fetal thyroid development and function.

Clearly, pregnancy places impressive metabolic demands on the mother’s body. Only through nutritional education and counseling can the best outcomes for both mother and baby be achieved.