Aspirin Lowers Preeclampsia: Birmingham Women's Hospital in England. Arri Coomarasamy 6/03 Obstetrics and Gynecology, analyzed studies of 12,000 pregnant women. Aspirin reduced risk of preeclampsia by 14%, premature labor by 21%, miscarriage by 14%, increasing the weight of babies by up to one half a pound. It is best to start in early pregnancy at 0.5 mg/kg/day in those at high risk for preeclampsia. Obstet Gynecol Surv. 2005 May;60(5):281-282.

Beta-Strep Detection at Birth in Mom Helps Kid: 0.6 infants per 1000 get disease from infection at time of delivery and 100 deaths per year in U.S. A new rapid PCR assay found 29% moms were positive and treated antibiotics. NEJM 2000;343:175-9

Borage-Fish Oils Supplement Helped Premature Infants: In a DB PC study of 238 premature infants (<35 weeks), infants on formula were randomly assigned for half to receive a fish oil and borage oil supplement in the formula for nine months. Mental functions, weight, and length all significantly favored the supplemented group. Randomized, double-blind trial of long-chain polyunsaturated fatty acid supplementation with fish oil and borage oil in preterm infants. Fewtrell MS, Abbott RA, et al. Royal Hospital for Sick Children, Glasgow. J Pediatr. 2004 Apr;144(4):471-9

Breast Stimulation Helps Induce Labor and Reduce Bleeding: In six random assignment trials covering 719 women, there was a significant reduction in the number of women not in labor at 72 hours (62.7% versus 93.6%, relative risk (RR) 0.67, ). This result was not significant in women with an unfavorable cervix. A major reduction in the rate of postpartum hemorrhage was reported (0.7% versus 6%, RR 0.16). No significant difference was detected in the caesarean section rate (9% versus 10%, RR 0.90). There were no instances of uterine hyperstimulation. When comparing breast stimulation with oxytocin alone the analysis found no difference in caesarean section rates (28% versus 47%, RR 0.60). Breast stimulation for cervical ripening and induction of labour. Kavanagh J, et al. University of London,  UK. Cochrane Database Syst Rev. 2005 Jul 20;(3):CD003392

C-Sections: See C-Sections. 

Calcium Supplement Prenatally Lowers Infant BP: One group of pregnant women took 2000 mg of calcium per day starting in the second trimester through delivery, and another took a placebo. Dr. Dan Hatton's team measured blood pressure in 260 of the children at the age of 3 months, and in 57 at age 2. Infants born to women who took calcium supplements had systolic blood pressure 2.2 mm Hg lower than those whose mothers received placebo. By age 2, the difference was even greater, with the supplement group having systolic blood pressure 4.8 mm Hg lower. Other studies similar results even with lower amounts and lasting up to 9 years. Am J Hypertens 2003;16:801-805

Castor Oil Induces Contractions: Fifty-two women received castor oil and 48 were assigned no treatment. Following administration of castor oil, 30 of 52 women (57.7%) began active labor compared to 2 of 48 (4.2%) receiving no treatment. When castor oil was successful, 83.3% (25/30) of the women delivered vaginally. Altern Ther Health Med 2000 Jan;6(1):77-9

CMV Immunity Protective: The rate of congenital CMV infection among infants born to women who were CMV seropositive at the time of the previous delivery was much lower than that among initially CMV seronegative women. JAMA 2/27/03

Cod Liver Oil by Mom Cuts DM-1 in Infants: When mothers took cod liver oil during pregnancy their offspring had a lower risk of diabetes. The unadjusted OR was 0.30, p = 0.01. This association changed very little and was still significant after adjusting for age, sex, breastfeeding and maternal education. Mothers taking multivitamin supplements during pregnancy [adjusted OR= 1.11, infants taking cod liver oil in the first year of life [adjusted OR = 0.82 and the use of other vitamin D supplements in the first year of life OR = 1.27. Study of over 1000 women in Norway. Case control study using 85 diabetics and 1023 controls. Diabetologia 2000 Sep;43(9):1093-8

Cod Liver Oil by Pregnant Mothers Makes Kids More Intelligent: Pregnant women were recruited in week 18 of pregnancy to take 10 mL of cod liver oil or corn oil until 3 months after delivery. 341 women in study with 262 taking until delivery with goal of continuing to three months post-partum. 90 kids tested at 4 years. All had been breastfed at least 3 months. IQ 106.4 vs. 102.3, favoring DHA and EPA cod liver oil group. Maternal supplementation with very-long-chain n-3 fatty acids during pregnancy and lactation augments children's IQ at 4 years of age. Helland IB, Smith L, et al. Pediatrics 2003 Jan;111(1):e39-44

Delivery: Patient-Controlled Epidural Analgesia: 220 ASA I-II women receiving epidural analgesia during active labor (cervical dilation <5 cm) were randomly assigned in a DB study to four treatment groups (n=30 in each). Analgesia was maintained with a Patient-controlled epidural analgesia/continuous infusion (PCEA/CI) pump using bupivacaine 0.0625%+sufentanil 0.35 mug/mL. PCEA settings were: group A: CI 10 mL/h, PCEA bolus 6 mL, 8-min lockout; group B: CI 10 mL/h, PCEA bolus 12 mL, 16-min lockout; group C: CI 15 mL/h, PCEA bolus 6 mL, 8-min lockout; group D: CI 15 mL/h, PCEA bolus 12 mL, 16-min lockout. In groups A, B, C and D, 76, 77, 75 and 85% of women, required no physician rescue boluses. Pain scores were low and maternal satisfaction was high in all groups, with minimal differences among them. Spontaneous vaginal delivery occurred in 78% of patients overall, instrumental (forceps or vacuum) delivery in 10% and cesarean section in 12%. "Ultra-light" patient-controlled epidural analgesia during labor: effects of varying regimens on analgesia and physician workload. Carvalho B, Cohen SE, et al. Stanford University. Int J Obstet Anesth. 2005 May 31

DHA in Pregnancy Probably Helps: A DB study with 291 women taking egg DHA 33 mg/d or 133 mg/d. After controlling for risk factors, gestation increased by 6.0 days (P =.009) in the higher docosahexaenoic acid group. Birth weight, length, and head circumference increased almost to statistical significance (P =.06-.18), although the increases could be clinically important indications of enhanced intrauterine growth. No safety concerns were found. U Kansas. A randomized trial of docosahexaenoic acid supplementation during the third trimester of pregnancy. Smuts CM, Huang M, et al. Obstet Gynecol. 2003 Mar;101(3):469-79. (Ed: This is a great study, but the levels of DHA could have been higher. Also, DHA from fish or fish oil is more available. Everyone from childhood should be eating fish and/or taking fish oil or its equivalent.)

Depression Common During Pregnancy: 3,472 women an average of 25 weeks pregnant. Slightly more than 20% signs of depression during the past seven days, Marcus, University of Michigan. 86% had not received any formal treatment, such as medication, psychotherapy or counseling. Only about one quarter of the women who reported being depressed during the past six months said they were currently being treated. May 22, ‘03 J Women's Health. 28% of all women had past history of major depressive episode, 40% of these were depressed when measured. These previously depressed were 5 times more likely to suffer depression with pregnancy than other women. 

Douching Dangerous: Douching increased low-birth-weight babies in a University of Rochester study of 4,665 women in US with about half douching regularly. Kevin Fiscella author says possibly due to vaginal infection arising when natural protective flora are killed. The percentage of low birth weight babies to  9.7% vs. 5.8% and controlled for income, race, martial, smoke, alcohol, and other. Other studies suggest douching increases ectopic pregnancy, infertility, and pelvic inflammatory disease. 27% US women douched regularly in 1995 (50% blacks, 21% whites). (12/98 ObGyn)

Exercise Reduces Preeclapsia: Exercise before and during pregnancy associated with 33% decreased risk. Faster pace of walking better than slower pace. 211 women with preeclampsia and 324 without studied. Hypertension 2003;41:1273-1280

Fish Helps Prevent Premature Delivery: 8,000 Danish women during pregnancy to determine if seafood had an impact on early births. "Low consumption of fish was a strong risk factor for pre-term delivery and low birth weight," Pre-term deliveries fell from 7.1 percent in women who never ate fish to 1.9 percent in expectant mothers who ate fish at least once a week. BMJ 2/20/02

Fish: Moderate Fish or Fish Oil Consumption Best in Pregnancy: In a study of 491 healthy Icelandic mothers, infants of women in the lowest quartile of fish consumption weighed less (p = 0.036), were shorter (p < 0.001), and had a smaller head circumference (p < 0.001) at birth than those of women consuming higher amounts of fish. Infants of women in the highest quartile of fish oil intake (>/=1 tablespoon (11 ml)/day), consuming threefold the recommended dietary allowance of vitamin A and twofold that of vitamin D, were shorter (p = 0.036) and had a smaller head circumference (p = 0.003) than those of women consuming less. Infant size at birth increased with fish consumption, especially for women in the lower quartiles of consumption. Smaller birth size was also linked to the highest levels of fish oil intake. Constituents of fish and fish oil might affect birth size differently depending on the amount consumed. Association of Fish and Fish Liver Oil Intake in Pregnancy with Infant Size at Birth among Women of Normal Weight before Pregnancy in a Fishing Community. Thorsdottir I, Birgisdottir BE, Halldorsdottir S, Geirsson RT. University of Iceland. Am J Epidemiol. 2004 Sep 1;160(5):460-5

Folic Acid Interfering Meds Increase Cleft Palates, Defects: Babies have 2-3 times heart, palate, urinary tract defects if mothers take interfering meds. Those on antibiotic trimethoprim or the high blood pressure medicine triamterene might be able to compensate by taking extra folic acid, but that may not help patients on phenobarbital, primidone, phenytoin or carbamazepine for epilepsy. NEJM 11/30/00.

Folic Acid Alone Did Better than Multivitamins: In a Johns Hopkins DB PC study of 4926 pregnant women and their 4130 infants in rural Nepal. In addition to vitamin A (1000 microg retinol equivalents), the intervention groups received either folic acid (FA; 400 microg), FA + iron (60 mg), FA + iron + zinc (30 mg), or multiple micronutrients (MNs; the foregoing plus 10 microg vitamin D, 10 mg vitamin E, 1.6 mg thiamine, 1.8 mg riboflavin, 2.2 mg vitamin B-6, 2.6 microg vitamin B-12, 100 mg vitamin C, 64 microg vitamin K, 20 mg niacin, 2 mg Cu, and 100 mg Mg). The control group received vitamin A only. None affected fetal loss and death of infants in the first three months of life was lowest with folic acid (RR 0.36) and highest with the multiple nutrients (RR 1.74).  Effects of maternal micronutrient supplementation on fetal loss and infant mortality: a cluster-randomized trial in Nepal. Christian P, West KP, Khatry SK, Leclerq SC, Pradhan EK, Katz J, Shrestha SR, Sommer A. Am J Clin Nutr. 2003 Dec;78(6):1194-202

Folic Acid Multivitamin Doesn't Affect Multimalformed Rate: In a very large DB PC Hungarian study of almost 11,000 women, there was no difference in multiple congenital deformities. Periconceptional multivitamin supplementation and multimalformed offspring. Czeizel AE, Medveczky E. Obstet Gynecol. 2003 Dec;102(6):1255-61

Ginger and B-6 Each Help Pregnancy Nausea: In a DB study of ginger 500 mg t.i.d. vs. B-6 10 mg t.i.d. for three days, 138 women with nausea in the first four months of pregnancy were studied.  There were decreases in nausea and vomiting in both groups.  B-6 did non-significantly better with nausea, and ginger did non-significantly better with vomiting. Both symptoms were on average cut by roughly one-third with each supplement.  A randomized comparison of ginger and vitamin B6 in the treatment of nausea and vomiting of pregnancy. Sripramote M, Lekhyananda N. J Med Assoc Thai. 2003 Sep;86(9):846-53

Ginger Helps Nausea and Retching: A DB PC study of 120 women less than 20 weeks pregnant with morning sickness daily treated for 4 days found ginger 1.5 g dry four times a day reduced nausea and retching but not vomiting. Follow-up of the pregnancies revealed normal ranges of birthweight, gestational age, Apgar scores and frequencies of congenital abnormalities when the study group infants. Effect of a ginger extract on pregnancy-induced nausea: a randomised controlled trial. Willetts KE, Ekangaki A, Eden JA. Aust N Z J Obstet Gynaecol. 2003 Apr; 43(2): 139-44

Iron Supplement May Be Helpful: In a DB PC study of adolescent women 18 years or less in their first pregnancy, and adult women 19 years or older, who were found to be healthy and iron sufficient at their first prenatal visit, participants were randomized to receive iron supplementation (60 mg/day elemental iron) or placebo. Serum ferritin of 12 ng/mL or less with simultaneous hemoglobin of 11 g/dL or less defined IDA. When IDA occurred at the second trimester, a therapeutic supplement of 180 mg of elemental iron per day was started. 47% of all placebo-supplemented and 16% of all iron-supplemented patients exhibited IDA (p<0.001); 59% of adolescent placebo-supplemented and 20% of adolescent iron-supplemented patients exhibited IDA (p=0.021). Nausea, vomiting, diarrhea, and constipation were not significantly different in the iron supplemented group compared to the placebo group, and no significant differences were seen in maternal or neonatal health, but the number of women studied was limiting for analysis of these adverse events. The incidence of IDA during adolescent and adult pregnancies is substantially reduced with 60 mg of elemental iron per day. However, there remains no clear evidence that maternal or neonatal health will benefit from correcting these deficits. Prevention of Iron Deficiency Anemia in Adolescent and Adult Pregnancies. Meier PR, Nickerson HJ, et al. Marshfield Clinic, Marshfield, Wisconsin. Clin Med Res. 2003 Jan;1(1):29-36.

In Vitro Maturation Better: Clinical trials in Denmark have shown that in-vitro maturation (IVM) has a success rate of 30%, comparable to standard IVF. The patient does not have to take expensive fertility drugs that can carry serious side-effects. Undeveloped eggs are taken from ovaries and matured in the laboratory before fertilisation. More than 400 healthy babies have so far been born using the technique, which could reduce the cost of fertility treatment by up to half. Professor Svend Lindenberg of the Nordica Fertility Center in Copenhagen has helped more than 1,000 women become pregnant using IVM, and calls the results “stunning”. They give a very low dose of a stimulating drug for three days early in the cycle and rescue up to ten eggs. For the first 24 hours a tiny amount of stimulating hormone is added to the culture, one hundreth of the dose the woman would receive, and after that the eggs go on to mature in the culture alone. It works best in those who are under 37 years of age, have regular cycles or polycystic ovary syndrome. It has been made easier by the development of finer needles to aspirate the eggs from an ovary and new scanning techniques that now show doctors the best follicles to select when seeking eggs to remove. http://www.timesonline.co.uk/article/0,,13509-2523195,00.html

IVF Better in Summer: In a retrospective analysis of 2709 standardised cycles of IVF/ICSI, there was significant improvement in assisted conception outcomes in cycles performed in summer (lighter) months with more efficient ovarian stimulation 766iu v880iu/per oocyte retrieved (p = 0.006). There was similarly a significantly improved implantation rate per embryo transferred 11.42% vs 9.35% (p = 0.011) and greater clinical pregnancy rate 20% vs 15% (p = 0.0033) during summer cycles. Seasonal variation in assisted conception cycles and the influence of photoperiodism on outcome in in vitro fertilization cycles. Wood S, et al. Chester, UK. Hum Fertil (Camb) 2006 Dec;9(4):223-9.

IVF Slightly More Birth Defects: According to a study of 61,208 deliveries in Ontario, Canada, the rate of birth defects was 2.62% for IVF vs. 1.87% for babies conceived naturally. GI abnormalities were most common, although IVF babies also had higher rates of bone, muscle, and heart defects. El-Claar D, et al. Univ Ottawa. New Sci 2/24/07. Ed: Whether this is due to the IVF process, the older age of the parents, or a higher rate of birth defects in infertile couples is unknown.

Labor Pain: Nitrous Oxide Leading in England: A 50:50 mixture of nitrous oxide and oxygen is available in all maternity suites in England with women self administering the gas which improves fetal oxygeneration and has a very short half-life. 85% of women find it helpful. Women cannot take too much as the flow stops before consciousness is lost. Opiates are used by only 5% and only if epidural analgesia is not available. It is often used after C-sections. BMJ ’99;318:927

Magnesium Sulfate Helps Preeclampsia: 10,000 women with pre-eclampsia DB placebo in 33 centers on four continents 58 percent lower risk of eclampsia. 5/28/02 Lancet.

Melanoma: Having More Children Protects Against Melanoma: A higher risk of reproductive system disorders, (which include benign tumors, endometriosis, dilation and curettage, hysterectomy, and other disorders requiring gynecologic biopsies) exist among women with cutaneous melanoma as compared to women with skin cancers: The odds ratio (OR) is 3.2, p = 0.049; as compared to a random sample of women with no melanoma or skin cancers, the OR is 3.9, p = 0.021. Confirming the observations of others, the authors found that melanoma was associated with red hair. The data also confirmed the finding that melanoma is associated with significantly fewer pregnancies. The mean numbers of pregnancies in the melanoma group is 1.83  compared to 2.99 in the skin cancer group and 2.93 in the random sample (p less than or equal to 0.05). Reproductive factors and melanoma of the skin among women. Wyshak G, Frisch RE, Albright NL, Albright TE, Schiff I. Harvard. Int J Dermatol. 1989 Oct;28(8):527-30

Misoprostol Speeds Childbirth: Cytotec pills cut in half or quarter and is becoming drug of choice for inducing labor. 60 studies with 6,000 women show very good results. Ob Gyn 6/02 had one study. One in five births now induced. Some say for doctor’s convenience. Amniotic fluid embolism has killed mother and fetus. Sold to protect stomach from ulcers. FDA with 35 uterine ruptures and 10 infant deaths since available in US in 1988. A NEJM review 2001 supported continued use in labor.

Misoprostol Speeds Childbirth and Avoids C-Section: A single 200 mcg dose with oxytocin 12 hours later if necessary was more successful than placebo in a DB PC of 156 women at 37-42nd week with fewer needing induction, fewer C-sections, earlier onset of uterine contractions (p<.001 for each). Iran. Cervical ripening with oral misoprostol at term. Beigi A, Kabiri M, Zarrinkoub F. Int J Gynaecol Obstet. 2003 Dec;83(3):251-5

Moxibustion Successful Correction Breech Presentation: Burning of herbs at the fifth toenail acupuncture point for one to two weeks increased fetal movements and 75% vs. 62% of breech positions were corrected even though 20% of control group had external cephalic version. JAMA 11/11/98

Motherhood Increases Rat Intelligence: Perhaps via hormone effects, female rats became better able to navigate a maze if they had had one or especially more than one litter. They also had lower levels of amyloid precursor protein in their hippocampal areas. Craig Kinsley, U Richmond, Reuters, 11/7/02

MS Not Increased by Pregnancy: Prospective study of 203 pregnant women with a history of Multiple Sclerosis showed a 70% decrease in risk of relapse in third trimester and 70% increase in risk in three months after birth. NEJM 1/30/99.

Nasal Strips Preferred by Women in Delivery: In a DB PC study of 150 primigravida women in active labor, those wearing a dilator spring-loaded nasal strip had a satisfaction rate was significantly higher in parturient women wearing nasal strips with a dilator spring than in parturient women wearing a placebo spring (P < 0.0001).  No differences were found between the study and the control group regarding rate of induction or augmentation of labor as well as Montevideo units reached, frequency of rupture of membranes, duration of the active phase and second stage of labor, usage of epidural analgesia, normal fetal heart pattern, meconium-stained amniotic fluid, and neonatal well being. Length of maternal and neonatal hospitalization also did not differ between the groups. The effects of an external nasal dilator on labor. Sadan O, Shushan S, et al. Tel-Aviv University. Am J Rhinol. 2005 Mar-Apr;19(2):221-4.

Nitroglycerin Effective for Retained Placenta: In a DB PC study of 24 women for whom intravenous oxytocin and controlled umbilical cord traction had failed to expel the placenta, 1 mg nitroglycerin was effective for all 12 women for delivery of placenta, while removal of placenta was successful in only one of the 12 women in the placebo group. No adverse effects of clinical importance were reported. Sublingual nitroglycerin for management of retained placenta. Bullarbo M, et al. Sahlgrenska University Hospital, Goteborg, Sweden.  Int J Gynaecol Obstet. 2005 Oct 13

NSAIDs Increase Miscarriage: 1055 women: newly pregnant patients (40 days on average at start) who took ASA were 60% more likely to miscarry. NSAID users were 80% more likely. Acetaminophen had not increased risk. Kaiser-Permanente, Calif., BMJ 2003;327:368 (16 August)

Nausea & Pregnancy: Anti-emetic medication appears to reduce the frequency of nausea in early pregnancy. There is some evidence of adverse effects, but there is very little information on effects on fetal outcomes. Of newer treatments, pyridoxine (vitamin B6) appears to be more effective in reducing the severity of nausea. The results from trials of P6 acupressure are equivocal. The results of the trial using adrenocorticotropic hormone to treat hyperemesis gravidarum show no evidence of benefit. Ginger may be of benefit, but the evidence so far is weak. Cochrane Database Syst Rev 2000;(2):CD000145

Nausea & Pregnancy: B-6, Ginger, Multivitamin, Doxylamine: Anti-emetic medication appears to reduce the frequency of nausea in early pregnancy. There is some evidence of adverse effects, but there is very little information on effects on fetal outcomes. Of newer treatments, pyridoxine (vitamin B6) appears to be more effective in reducing the severity of nausea. The results from trials of P6 acupressure are equivocal. The results of the trial using adrenocorticotropic hormone to treat hyperemesis gravidarum show no evidence of benefit. Ginger may be of benefit, but the evidence so far is weak. Cochrane Database Syst Rev 2000;(2):CD000145; Two randomized trials of vitamin B6 have shown a benefit in reducing nausea and vomiting of pregnancy (NVP). Women taking periconceptional multivitamins are less likely to have severe NVP. The combination of vitamin B(6) and doxylamine (previously marketed in the United States as Bendectin) has been shown to be safe for the fetus and effective in reducing NVP. Ginger was shown, in 2 studies, to reduce NVP. Vitamin B(1) (thiamine) deficiency can lead to Wernicke's encephalopathy in women with severe NVP. Replacement is needed for all women with vomiting of more than 3 weeks' duration. U Iowa. Am J Obstet Gynecol 2002 May;185(5 Suppl Understanding):S253.

Osteoporosis Not Increased by Pregnancy, Breast Feeding: Women even with moderate calcium intakes have no long-term harm to their skeletons or risk of osteoporosis from pregnancy and lactation. Lancet 8/15/98

Osteoporosis: Mothers Low in Vitamin D Affect Body Mineral Density of Offspring: In a 9-year follow-up study of 198 newborns, 31% mothers had insufficient and 18% had deficient circulating 25(OH)-vitamin D during late pregnancy. Low vitamin D in mothers during late pregnancy was associated with reduced whole-body (p=0.0088) and lumbar-spine (p=0.03) bone-mineral content in children at age 9 years. Both the estimated exposure to ultraviolet B radiation during late pregnancy and the maternal use of vitamin D supplements predicted maternal 25(OH)-vitamin D concentration (p<0.0001 and p=0.0110, respectively) and childhood bone mass (p=0.0267). Reduced concentration of umbilical-venous calcium also predicted reduced childhood bone mass (p=0.0286).  Vitamin D supplementation of pregnant women, especially during winter months, could lead to longlasting reductions in the risk of osteoporotic fracture in their offspring. Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study. Javaid MK, et al. University of Southampton, UK. Lancet 2006 Jan 7;367(9504):36-43.

Pitocin Increases Risk of C-Section: The rate of induced labor more than doubled between 1989 and 2001 according to the National Center for Health Statistics. There are reports that the pitocin induced labor is often for the convenience of the doctor or the patient. Sandra Fish, Scripps Howard News Service 2/13/04. 

Pre-Eclampsia Risk Reduced by Diet: In a case-control study of 172 preeclamptics and 339 normotensive pregnant women, fiber intake was inversely associated with the risk of preeclampsia. When extreme quartiles of total fiber intake were compared, the odds ratio (OR) for preeclampsia was 0.46, a 54% reduction in risk. The multivariate OR for preeclampsia for women in the top quartile of potassium intake (> 4.1 g/d) versus the lowest quartile (< 2.4 g/d) was 0.49. There was some evidence ofa reduced risk of preeclampsia with a high intake of magnesium and calcium, though these results were not statistically significant. Intake offruits and vegetables, low-fat dairy products, total cereal and dark bread were each associated with a reduced risk of preeclampsia. Dietary fiber, potassium, magnesium and calcium in relation to the risk of preeclampsia. Frederick IO, et al. Swedish Medical Center, Seattle. J Reprod Med. 2005 May;50(5):332-44

Progesterone Helps Prevent Preterm Birth: In a review of the 7 DB PC studies to date, women who received progesterone were significantly less likely to give birth before 37 weeks (seven studies, 1020 women, RR = 0.58), to have an infant under 5.5 pounds (six studies, 872 infants, RR = 0.62), or to have an infant diagnosed with intraventricular hemorrhage (one study, 458 infants, RR = 0.25). The effect on infant mortality has not been proven. Progesterone supplementation for preventing preterm birth: a systematic review and meta-analysis. Dodd JM, Crowther CA, et al. The University of Adelaide, Australia. Acta Obstet Gynecol Scand. 2005 Jun;84(6):526-33.

Progesterone Cuts Premature Deliveries: hydroxyprogesterone caproate, or 17P, can reduce preterm births by up to one-third, according to a study in the June 12, 2003, edition of the New England Journal of Medicine. A University of Utah study of 463 women with first pregnancy preterm DB PC started in 16-20^th week. 36% vs 54% had 2^nd pre-term. Progesterone relaxes the smooth muscle wall of the uterus, blocks the action of oxytocin, a hormone that makes the uterus contract, and inhibits the formation of gap junctions. Gap junctions are connections that allow the muscle cells in the uterus to communicate with each other so they can contract at the same time.

Prostaglandin E Gel for Dystocia Increases C-Sections: In a DB PC study of 332 nulliparous women with spontaneous labor at term who had progressed <2 cm of cervical dilation in the 4 hours following the diagnosis of labor were randomly assigned to receive a single dose of either 1 mg or 2 mg  PgE(2) vaginal gel or placebo gel. Dystocia resolved slightly more often after PgE(2) 1 mg (49%), and PgE(2) 2 mg (49%), compared with placebo (32%). Hyperstimulation was markedly increased after PgE(2) 2 mg treatment (15%), RR 5.6, but less after PgE(2) 1 mg (5.4%), RR 1.9 when compared with placebo (2.8%). There was an increase in caesarean sections performed in the second stage of labour in the PgE(2) groups versus placebo. There were no differences in measures of maternal or neonatal morbidity. Prostaglandin E vaginal gel to treat dystocia in spontaneous labour: a multicentre randomised placebo-controlled trial. Oppenheimer LW, Labrecque M, et al. University of Ottawa, Canada. 

Rubella: Vaccine in Early Pregnancy Not Harmful: A new study of 94 women inadvertently vaccinated in 1^st trimester and an older review of 321 similar cases has found no evidence of harm except for a slightly higher rate of abortion in the current study. BMJ 2001;322:695 ( 24 March )

Saunas, Hot Tubs, and Electric Blankets: Moms and Dads-To-Be Should Avoid: Men exposed to excessive heat in the weeks before conceiving a child may place the child at an increased risk of brain cancer.  Female animals, exposed to elevated temperature during pregnancy have more fetuses die or develop abnormally. Human sperm take 10 weeks to develop and are acutely sensitive to temperature. In a case-control study of 318 children with brain cancer and 318 controls, sauna use in the 3 months before conception was 240% more common and other heat sources 110% more common for the fathers of cancer children. Bunin GR, et al. Amer J Epidem 8/1/06.

Tooth Treatment of Peridontitis Lowers Premee Rate: 12% all births before 35^th week. Journal of Periodontology 9/03. 366 pregnant women who had periodontitis (a serious gum infection that destroys attachment fibers and supporting bone that hold teeth in the mouth) and found as much as an 84 percent reduction of premature births in women who were less than 35 weeks pregnant and who received scaling and root planing. Metronidazole after scaling and root planing had more preterm births than patients receiving scaling and root planing and a placebo. Marjorie Jeffcoat, University of Alabama

Vitamins C and E Helped Delay Delivery in Premature Rupture: In a DB PC study of 60 women with singleton pregnancies of 26 to 34 weeks' duration and preterm premature rupture of membranes, vitamin C (500 mg/day) and vitamin E (400 IU/day) did not reduce the number of cases of chorioamnionitis, early neonatal sepsis, and respiratory distress syndrome. However, the number of days of delayed delivery (latency) was increased to 10.5 days vs. 3.5 days (P=0.03) for placebo. All women received 2 doses of betamethasone in the first 24 h after admission as well as broad-spectrum antibiotic prophylaxis.  Vitamins C and E in the latency period in women with preterm premature rupture of membranes. Borna S, Borna H, et al. Tehran University, Iran. Int J Gynaecol Obstet. 2005 May 19

Vitamins, Skinniness Decrease Heart Defect: Periconceptional multivitamin use was associated with a reduced OR for isolated heart defects among average-weight women (OR = 0.61, 95% CI = 0.36--0.99) and underweight women but not among overweight or obese women (OR = 1.69). Woman with BMI 16.5 or less RR 0.61 vs. BMI 19-22.7 and those over 26 RR 1.4. Epidemiology 2001 Jul;12(4):439-46. Atlanta.

Vitamin D Prevents Rickets: 6 cases rickets in England assoc with breast feeding without Vitamin D supplement during pregnancy or after delivery. BMJ 1/16/99.

Vitamin D: 6000 Units a Day Recommended for Lactating Women: 78% of Iowa breast-fed children who were not getting supplements were vitamin D deficient during the winter, but only 4% during the summer. None of 49 receiving vitamin supplements were deficient. Ziegler EE, Univ Iowa; Hollis BW, Med Unit S. Carolina, Pediatrics 8/06. Ed: It would seem better to give the children vitamin D, but many mothers simply don't do it.

Vitamin K: Give to Mothers Who Will Deliver Early: Infants less than 35 weeks' gestation age are susceptible to periventricular-intraventricular hemorrhage. In a randomized study of 90 pregnant women in preterm labor at less than 35 weeks, antenatal vitamin K1 10 mg per day injection intramuscularly or intravenously for 2-7 days resulted in less infant brain hemmorrhage: vitamin K 32% vs. controls 52% (P = 0.036), and a lower frequency of severe PIVH was 5% vs. 20% (P = 0.038). Liu J, et al. Beijing Obstetrics and Gynecology Hospital. . J Perinat Med 2006;34(2):173-6. Ed: Since vitamin K has a wide safety margin, it would seem sensible to give in to all pregnant women late in pregnancy.  However, I haven't seen this recommendation yet.

Vitamins Cuts Birth Defects: Ginecol Obstet Mex 2000 Dec;68:476-81 found less anencephaly with multivitamin. Cleft Palate Craniofac J 2001 Jan;38(1):76-83 found marginally lower cleft palate. Third study found fewer isolated major heart defects in an Atlanta study under multivitamins. Also cuts urinary tract defects. N Engl J Med 2000 Nov 30;343(22):1608-14 while anti-folate meds like carbamazepine, phenobarb, phenytoin increase all of these defects in pregnancy unless supplemental folate.

Vitamins Decrease Omphalocele Birth Defect: Periconceptional multivitamin use was associated with a 60% reduction in the risk for nonsyndromic omphalocele, an abnormality of the abdominal wall. Case-control in Atlanta of 72 cases and 3023 control infants. Botto, CDC, Pediatrics 2002 May;109(5):904-8

Alcoholism Risk May be Lowered by Vitamin K at Birth: Taking advantage of a serendipitous event in the history of treating newborns, two thirds of the original 330 subjects in this study were high-risk sons of alcoholic fathers. Of 238 completing the 30-year follow-up, 44 received vitamin K supplementation at birth; 161 were considered high risk, and 66 were categorized as having lower birth weight (<6 lbs). Vitamin K treatment, inherited risk and low birth weight each independently predicted alcohol dependence and problem drinking. Vitamin K treatment was associated with significantly lower rates of alcohol dependence and fewer symptoms of problem drinking. Vitamin K might reduce early postnatal hemorrhage and oxidative brain damage, and thus lower the risk of alcoholism. Neonatal vitamin K might reduce vulnerability to alcohol dependence in Danish men. Manzarda AM, et al. University of Kansas. . J Stud Alcohol 2005 Sep;66(5):586-92. Vitamins K and D are recommended at birth.

Increased uterine artery resistance assoc with maternal anxiety: BMJ 1/16/99. Babies of stressed or anxious mothers tend to be born early.

Thomas E. Radecki, M.D., J.D.

modern-psychiatry.com