Posts Tagged ‘ Pregnancy ’

Can Autism Be Diagnosed At Birth?

Friday, August 30th, 2013

Not yet. But someday it may be a possibility. 

Researchers are developing a technique that analyzes the placenta for troboblast inclusions (TIs) – which are folds and creases that can be observed at a microscopic level. Preliminary research is suggesting that a density of these may indicate risk for Autism Spectrum Disorder (ASD). Longitudinal studies will now track babies for a few years to determine the magnitude of that risk.

We often hear about exciting science that will not come to fruition for a long time. But what’s intriguing about this project is that the scientists argue that the biological screening will promote the earliest environmental intervention possible. This is a terrific perspective because we know early environmental intervention can have profound effects on the development of kids with ASD. So rather than waiting for biological cures that may never happen, it’s quite smart to think about using biological science to bolster our ability to deliver interventions that we know have positive and sometimes quite powerful benefits.

Scientist Using A Microscope Via Shutterstock.com

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Moms, Stress, and Depression

Thursday, August 15th, 2013

Moms who have young kids have lots of sources of stress – including unavoidable rites of passage of parenthood (sleep deprivation), everyday hassles (just can’t fit in that shower), and new responsibilities on top of old ones (how exactly do you take care of everything you need to do when you have to take care of a 6-month-old?). There are countless other streams of stress – including big “macro” society conditions like the economic recession – that impinge on everyday life  and influence parenting. Now, you may be thinking – and this is a reaction I frequently encounter – that if stress is inevitable, why bother discussing it? 

Well, there are four reasons.

First, stress takes its toll on moms. One of the strongest predictors of depression is high levels of stress. Given that women in general are at high risk for depression – some studies suggest nearly 1 in 3 women will experience clinical depression – the additional stresses of being a mom can have serious consequences. And keep in mind that one of the reasons that depression can become such a problem is that is a recurrent condition – it tends to come back after it subsides.

Second, children of depressed parents are at very high risk for early-onset depression as well as other behavioral problems. The process can start as early as infancy, accelerate in toddlerhood, and result in increased depressive symptoms in childhood, culminating with onset of clinical depression in the teen years. Chronic stress has other negative effects on childhood development that can lead to increased risk for health problems later in life. And there is some evidence that severe stress during pregnancy can have adverse effects on fetal development and contribute to things like low birth weight.

While stress and depression are insidious and impairing, there is, without question, hope. The third reason to reflect on all this is that depression is treatable. There is no one treatment, so it’s important to give yourself enough time to find the right mix of psychotherapy and/or pharmacology (antidepressants). The reality is that you can get a handle on depression and also lessen the risk of future depressive episodes with effective treatment.

Which leads to a fourth reason to talk about stress and depression – when moms get treated successfully, their kids improve as well. There have been large-scale studies showing that these positive effects can be long lasting, and include reductions in both child symptoms and actual diagnoses of depression and other disorders in the offspring. Other more fine-grained studies have shown how child symptoms of depression “mirror” parental levels – and when parental symptoms lessen with treatment, so do their kids’ symptoms. Note that no intervention needs to be done directly with the kids to gain a benefit – the effect comes simply from successfully treating the parent.

So, moms who are under lots of stress and feel like they are depressed should become aware of the symptoms of depression - and seek out well-qualified treatment. Doing this not only helps moms, but directly improves the lives of their kids.

Depressed Woman via Shutterstock.com

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5 Things Every Pregnant Woman Should Know (Though Your Doctor Won’t Tell You)

Wednesday, April 17th, 2013

Jennifer Margulis, Ph.D., an award-winning journalist and a Schuster Institute Fellow at Brandeis University, has just released a new book called The Business of Baby. In it she takes on a number of controversial issues facing those who are thinking of becoming pregnant, are pregnant, or are new parents. Here she offers a guest blog post with her take on 5 key things that every pregnant woman should know. 

1. Prenatal vitamins can make you sick: Not all prenatal vitamins are created equal. Some “natural” brands, whether over-the-counter or prescribed by a doctor, contain harmful additives, including petroleum-based dyes like Red 40. The nausea you’ve attributed to pregnancy hormones may actually be from the vitamins you’ve been told to take.

2. Ultrasounds are not medically recommended: Though some doctors do them at every visit, routine ultrasounds are not recommended by the American College of Obstetricians and Gynecologists for normal pregnancies. There is no evidence that ultrasounds improve pregnancy outcomes but there is an increasing body of evidence that prolonged exposure to ultrasound can cause harm.

3. How much weight you gain is not as important as what you eat: Every woman gains weight differently but all pregnant women need nutritious, fresh, high quality food. The fat your body stores during pregnancy is there for a reason: to give you reserves for breastfeeding after the baby is born. It’s much more important to eat high quality protein, healthy fats, fresh vegetables and fruits, whole grains, and unprocessed foods than to worry about the amount of weight you’re gaining. Doctors actually look down on nutrition as irrelevant and unimportant, says Michael Klaper, M.D., director of the Institute of Nutrition Education and Research in Manhattan Beach, California. “There’s an inherent contempt for nutrition built into Western medicine,” Klaper explains. “Nutrition is a sissy sport among physicians.”

4. You can avoid gestational diabetes and anemia: With a healthy whole food based diet and enough exercise, most women can avoid common pregnancy problems. According to Stuart Fischbein, M.D., a Los Angeles based obstetricians with 30 years experience, the key is to eat proactively, avoiding processed sugar and doing enough exercise (to prevent gestational diabetes) and eating iron-rich foods (like eggs, red meat, and green leafy vegetables) along with foods high in vitamin C to help your body absorb the iron (to prevent anemia).

5. Your doctor believes birth is an illness: Growing a human being inside your body may be the most magical, spiritual, awe-inspiring time of your life, but your obstetrician has been taught to look for worse case scenarios and view your pregnancy as an accident waiting to happen. If you want a care provider who shares your wonder and a gentle birth, pick a well-trained midwife over a doctor.

 

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Prenatal Exposure To Mercury And Childhood Risk For ADHD

Tuesday, November 27th, 2012

The role of prenatal influences on development can be profound. But it is still a very murky science, as was beautifully illustrated in Annie Murphy Paul’s “Origins: How The Nine Months Before Birth Shape The Rest Of Our Lives”. Case in point: a new study that looks at the role of prenatal exposure to mercury and risk for ADHD.

Forget about the study details – let’s cut to the two bottom lines of the study. First, documented mercury exposure during pregnancy (validated using gold standard methods) was indeed predictive of risk for ADHD in the offspring. Second, eating fish during pregnancy, which is sometimes thought to be a risk factor for mercury exposure, was protective with respect to ADHD.

So…what does a pregnant woman do with these findings?

Well, right now, not too much. This study did not identify the sources of mercury exposure, so it’s hard to say how to prevent it. And it’s not entirely clear which type of fish to eat, and what type to avoid.

Now, this is kind of where the science is at these days. It’s very important research, and not easy to conduct. But it’s worth keeping in mind, if you are following it, that it will be a long and winding road before the studies sort through all the complexities and possible contradictions and yield empirically validated guidelines.

Pregnant Woman via Shutterstock.com

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Flu, Pregnancy, Autism: What To Make Of Exploratory Studies

Tuesday, November 13th, 2012

On the one hand, the recently published paper suggesting a link between flu in pregnancy and risk for autism is an important one. Researchers continue to look for clues for any of the multitude of risk factors that might contribute as partial causes of autism. There is certainly interest in the prenatal period and exposure to many potential influences. 

On the other hand, as a scientist and parent, I start to cringe when I see studies like this one getting translated into hyperbolic headlines. Why? Simply put, what we’ve really learned from this study is that we might want to try to further study the associations between flu, pregnancy, and autism. That’s it.

Now, that might seem like a puny contribution. It isn’t. But what you need to know is that all studies reported in scientific journals do not have the same goal. Some hone in precisely on a given topic and try to cement knowledge with rigorous hypotheses. Others, however, provide an initial clue that something should be looked at closer. That’s where we are at with the flu, pregnancy, and autism link.

You should think of this study as exploratory. Why? There are a number of reasons, and I’ll list just a few. First – the study relied entirely on mother’s recollections. This isn’t the optimal way of studying the association – not because moms (or anyone else) are unreliable, it’s just that the most precise way would be to use a number of methods (including prospective in-person assessment and reporting, medical records, etc) to record data that are not easy to catalogue. Second, the study looked at a whole bunch of potential factors in a very large sample. This means that the findings that come out as significant can be due to chance. While this is always the case in science, it’s especially so when there is a really big sample (simply because a large sample means very small results can reach statistical significance) and lots of potential associations are tested – and it’s the reason that science demands replication across a number of studies before we agree that a finding is established. Third, this point is reinforced by the finding itself – the risk increased from 1% to 2%. Any explanation in science is important, but when you look at the numbers this way it’s a bit more realistic (and sobering) than headlines that scream that the risk is doubled. Yes it was – from 1% to 2%. Think about the “margin of error” you heard about all through the recent presidential election with respect to polling – the same principle applies here. This difference could be a systematic result – or just chance. And right now the effect is rather modest. The bottom line is that more studies are needed to build on this to figure out exactly what is going on.

I’m a big fan of parents – and anyone who is interested – getting closer to science, especially new studies as they come out. But if we are going to support that, we need to explain more about the studies and what we think they mean, and don’t mean, right now. So here you go. Right now, it’s certainly the case that physicians and public health experts continue to suggest that pregnant women get vaccinated for the flu. If you are pregnant, talk to your doctor about that right now. Right now, extrapolating from these findings and trying to figure out if a child is diagnosed with autism because the mom got the flu when she was pregnant is not a productive exercise. Pointing a finger at a pregnant woman who is sick and saying that her unborn child will be diagnosed with autism is certainly not productive and would be misguided (not to mention hurtful). These exploratory studies are done to help guide future practices, not assign blame or create panic. They only provide a guide to future scientific projects that might shed more light and someday deliver more helpful guidelines for preventing autism.

Question marks via Shutterstock.com (because that’s the take-home message right now)

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