Pregnant Women with COVID-19 Face High Mortality Rate

Women and their babies in the study were also at risk for preterm birth, preeclampsia and admission to the ICU.
In a worldwide study of 2,100 pregnant women, those who contracted COVID-19 during pregnancy were 20 times more likely to die than those who did not contract the virus.

UW Medicine and University of Oxford doctors led this first-of-its-kind study, published today in JAMA Pediatrics. The investigation involved more than 100 researchers and pregnant women from 43 maternity hospitals in 18 low-, middle- and high-income nations; 220 of the women received care in the United States, 40 at UW Medicine. The research was conducted between April and August of 2020.

The study is unique because each woman affected by COVID-19 was compared with two uninfected pregnant women who gave birth during the same span in the same hospital.

Aside from an increased risk of death, women and their newborns were also more likely to experience preterm birth, preeclampsia and admission to the ICU and/or intubation. Of the mothers who tested positive for the disease, 11.5% of their babies also tested positive, the study found.

Although other studies have looked at COVID-19’s effects on pregnant women, this is among the first study to have a concurrent control group with which to compare outcomes, said Dr. Michael Gravett, one of the study’s lead authors.

“The No. 1 takeaway from the research is that pregnant women are no more likely to get COVID-19, but if they get it, they are more likely to become very ill and more likely to require ICU care, ventilation, or experience preterm birth and preeclampsia,” he said. Gravett is a professor of obstetrics and gynecology at the University of Washington School of Medicine. Co-investigator Dr. Lavone Simmons is a UW acting assistant professor of OB-GYN.

One caveat, Gravett noted, was that women whose COVID-19 was asymptomatic or mild were not found to be at increased risk for ICU care, preterm birth or preeclampsia. About 40% of the women in this study were asymptomatic. Pregnant women who were obese or had hypertension or diabetes were at the greatest risk for severe disease, the findings showed.

Babies of the women infected with COVID-19 were more likely to be born preterm; but their infections were usually mild, the study found. Breastfeeding seemed not to be related to transmitting the disease. Delivery by Caesarean section, however, might be associated with an increased risk of having an infected newborn, the study found.

Gravett suggested that these and parallel research findings compelled U.S. states’ decisions to open vaccine eligibility to pregnant women – who were initially considered a population at low risk for severe COVID-19.

“I would highly recommend that all pregnant women receive the COVID-19 vaccines,” based on this research, he said.

Source: University of Washington

Pregnancy Raises the Risk for Kidney Stones

Kidney stones can happen to anyone, but now a new study confirms that being pregnant may increase your risk of developing them.

Previous research has suggested that a number of pregnancy-related changes in the body can contribute to kidney stone formation, but this study is the first to provide evidence of that link, according to the researchers.

For the study, the Mayo Clinic team reviewed the medical records of nearly 3,000 women from 1984 to 2012, including 945 who had a first-time symptomatic kidney stone and a control group of 1,890 age-matched women.

The researchers concluded that pregnancy increases the risk of a first-time symptomatic kidney stone, and that the risk is highest close to delivery and then declines by one year after delivery.

However, a slight risk persists beyond one year after delivery, according to the study published April 15 in the American Journal of Kidney Diseases.

Symptomatic kidney stones are the most common non-obstetric reason for hospital admission among pregnant women, the study authors noted. They occur in one of every 250 to 1,500 pregnancies, most often during the second and third trimesters.

“We suspected the risk of a kidney stone event would be high during pregnancy, but we were surprised that the risk remained high for up to a year after delivery,” said nephrologist and senior study author Dr. Andrew Rule.

“There also remains a slightly increased risk of a kidney stone event beyond a year after delivery. This finding implies that while most kidney stones that form during pregnancy are detected early by painful passage, some may remain stable in the kidney undetected for a longer period before dislodging and resulting in a painful passage,” Rule explained in a Mayo Clinic news release.

In pregnancy, kidney stones can cause significant complications, ranging from preeclampsia and urinary tract infections to preterm labor/delivery and pregnancy loss. And diagnosis and treatment of kidney stones during pregnancy can be challenging, Rule said.

According to nephrologist and study corresponding author Dr. Charat Thongprayoon, “During pregnancy, a kidney stone may contribute to serious complication, and the results of this study indicate that prenatal counseling regarding kidney stones may be warranted, especially for women with other risk factors for kidney stones, such as obesity.”

General recommendations for preventing kidney stones include high fluid intake and a low-salt diet. Mayo Clinic experts also recommend that pregnant women get at least 1,000 milligrams of calcium a day, preferably from food sources such as dairy products rather than calcium supplements.

Source: HealthDay

Study: Even a Little Coffee in Pregnancy Could Impact Newborn’s Weight

Dennis Thompson wrote . . . . . . . . .

As little as half a cup of coffee each day might be enough to stunt the growth and birth weight of a baby in the womb, a new study claims.

Women who consumed an average 50 milligrams of caffeine per day — equivalent to half a cup of coffee — had infants that were 2.3 ounces lighter than babies born to women who didn’t drink any caffeine, researchers report.

That amount is a fraction of the daily caffeine consumption limit currently recommended by the American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization (WHO), said lead researcher Jessica Gleason. She is a postdoctoral researcher with the U.S. National Institute of Child Health and Human Development.

ACOG recommends that pregnant women limit their caffeine consumption to less than 200 milligrams a day, and the WHO suggests less than 300 milligrams daily, Gleason said.

“Our results do stand out in light of those recommendations, because we’re finding that even at lower levels we are seeing these small reductions in size,” Gleason said.

“We always recommend that women discuss their caffeine consumption with their provider,” Gleason added. “Until we know more, our research does suggest that it may be prudent to limit caffeine consumption” during pregnancy.

Previous studies looking at caffeine’s effects on pregnancy relied on women to report how much they consumed daily, Gleason said.

This study took things a step further, using blood samples taken between 10 and 13 weeks of pregnancy from more than 2,000 women at 12 clinical sites in the United States, to determine their exact levels of both caffeine and its metabolite, paraxanthine.

Overall, pregnant women with the highest blood levels of caffeine gave birth to babies that were about 3 ounces lighter, 0.17 inches shorter, 0.11 inches smaller in head circumference, and about 0.13 inches smaller in thigh circumference than the infants of women with no or minimal caffeine in their bloodstream, the researchers found.

These effects on birth size and weight from caffeine are on par with those observed in pregnant smokers, Gleason noted.

“This reduction in birth weight is within the range we see in reductions of birth weight among women who smoke during pregnancy,” Gleason said, noting that smokers tend to deliver babies an average 1.8 to 7 ounces lighter than those of nonsmokers.

The findings were published online in JAMA Network Open.

But while these results are concerning, pregnant women shouldn’t rush to throw out all their coffee beans, tea bags and diet colas, said Dr. Jill Berkin, an assistant professor of maternal-fetal medicine with the Mount Sinai Health System in New York City.

The results of this study conflict with prior research, which found no significant link between caffeine and fetal growth, Berkin said.

Further, the effects of caffeine on birth size and weight observed here were not enormous, Berkin said, and so it’s hard to say whether these babies would suffer any of the long-term health effects typically associated with stunted fetal development.

These effects can include increased risk of obesity, heart disease and diabetes later in life, the researchers said in background notes.

“It was so very small, really only coming out to about 3 ounces of difference in body weight. Whether the 3 ounces has clinical impact on a baby long-term remains to be determined,” Berkin said. “We know there are poorer outcomes associated with babies that are in the less than tenth percentile for expected weight for gestational age, but not smaller reductions in potential fetal weight, so whether that’s clinically significant is really unknown.”

Berkin added that caffeine did not significantly affect one crucial measure of fetal development — abdominal circumference.

“Traditionally when looking at fetal growth, abdominal circumference is probably the most important feature of predicting which fetuses are larger and which fetuses are smaller,” Berkin said. “In the calculations that we use to determine fetal growth, abdominal circumference is weighed heavier than all the other parameters.”

There are several theoretical reasons to suspect that caffeine could inhibit fetal growth, Gleason said.

“We know that caffeine and its primary metabolite paraxanthine both cross the placenta, but the fetus lacks the enzymes to break down or clear caffeine from its system,” Gleason said. As caffeine builds up in fetal tissues, it could disrupt growth in the womb.

Prolonged exposure to caffeine could also cause blood vessels in the uterus and placenta to constrict, which could reduce blood supply to the fetus and inhibit growth, Gleason said.

Caffeine also might disrupt normal hormonal processes in fetal development, she added.

“The results of a single study are never going to allow us to make any sort of recommendations, but just this evidence alone should certainly spark additional research into low-level caffeine consumption and size at birth and growth restrictions,” Gleason said.

Birth size is not the only thing that can be affected by coffee consumption during pregnancy: Research published earlier this year in the journal Neuropharmacology found that too much coffee during pregnancy was linked to a higher risk for behavioral problems among children.

Source: HealthDay

High Blood Pressure in Pregnancy is Linked to Shorter Life Spans for Women

Steven Reinberg wrote . . . . . . . . .

High blood pressure during pregnancy may lead to early death from heart disease, a new study suggests.

There are several types of high blood pressure (also known as hypertension) during pregnancy. Chronic hypertension means high blood pressure was already present before a pregnancy, but in gestational hypertension readings rise during pregnancy. A third form, called preeclampsia, occurs when a woman with gestational hypertension also has elevated protein in her urine. Women can also have chronic high blood pressure with preeclampsia.

But developing high blood pressure from any cause during pregnancy appears linked to shortened life spans, the researchers found. This study can’t prove that high blood pressure is the cause of premature death, only that there appears to be a link. The factors behind that aren’t yet clear.

“It is important that additional research identifies these contributing factors, and that clinicians taking care of women are aware of the link between hypertension in pregnancy and later cardiovascular health,” said lead researcher Dr. Jorge Chavarro. He’s associate professor of nutrition and epidemiology at Harvard T.H. Chan School of Public Health, in Boston.

For the study, Chavarro’s team collected data on nearly 88,400 women who took part in a long-term study of nurses’ health.

The findings showed that 14% of the women had high blood pressure during pregnancy.

Those with high blood pressure or preeclampsia were more likely than other women to be heavier, have gestational diabetes and a parental history of diabetes and heart attack or stroke, the study found.

During 28 years of follow-up, nearly 2,400 women died prematurely, including 212 from heart or blood vessel disease, according to the report published online in the Journal of the American College of Cardiology.

A history of high blood pressure or preeclampsia was linked to a 42% higher risk for early death. The link remained after accounting for diet after pregnancy, lifestyle and reproductive characteristics.

Women with a history of high blood pressure during pregnancy had more than twice the risk of premature death from heart disease, the study authors found.

“It is really important for clinicians who should be aware not only of the link between hypertension during pregnancy and long-term adverse health outcomes, but also that this may happen even in the absence of chronic hypertension,” Chavarro said.

Dr. Suzanne Steinbaum, a spokeswoman for the American Heart Association, called the findings significant.

“This is an important study, really showing the profound impact of hypertension disorders in pregnancy … and the profound impact that plays on outcomes for her and her risk for cardiovascular disease is incredibly important to understand,” said Steinbaum, a cardiologist at the Juhi-Ash Integrative Health Center in New York City.

Pregnancy is the first stress test women undergo to determine their risk of heart disease, she said. Because heart disease develops over decades, this is most likely the start of small artery disease, which is also associated with weight, family history and chronic high blood pressure.

“Those risk factors are already in place, and what it means is this woman already has the predisposition to develop heart disease, whether it’s due to her genetics or her risk factors, but that’s what makes pregnancy and looking at it as a stress so interesting, because it’s the first time you get to say, ‘I can intervene now, and this woman doesn’t get to have heart disease,’ we can change her outcomes,” Steinbaum said.

Prevention starts early, she said. Women need to know their risks and get their blood pressure, cholesterol and blood sugar levels checked.

“The concept of lifestyle intervention from eating healthy and exercising is the best medication for reducing risk factors and preventing cardiovascular disease,” Steinbaum said.

“I would suggest that for these women, they go through a lifestyle intervention program prior to even getting pregnant,” she added.

Source: HealthDay

Is Any Amount of Coffee Safe for Baby During Pregnancy?

Denise Mann wrote . . . . . . . . .

Too much coffee during pregnancy could lead to kids with behavior problems later on.

That’s the key takeaway from new research that examined 9,000 brain scans from 9- and 10-year-olds as part of the largest long-term study of brain development and child health.

“The goalposts are moved by caffeine, and there are subtle, but real changes in behavioral outcomes in most kids who were exposed to caffeine in utero,” said study author John Foxe. He is director of the Del Monte Institute for Neuroscience at the University of Rochester in Rochester, N.Y.

“This may not make a meaningful difference in the behaviors of some kids, but for those who are vulnerable in other ways, it may flip them over the threshold,” Foxe added.

For years, pregnant women have been told to limit their caffeine intake to lower their risk for miscarriage or preterm birth, but this new study suggests that pregnant women who consume any coffee may be more likely to have kids with behavioral issues later in life.

Brain scans of kids whose mothers consumed caffeine during pregnancy showed changes in pathways that could lead to behavioral problems later on, including attention difficulties and hyperactivity. The changes tracked with higher scores on checklists for problem behaviors seen among kids whose moms reported drinking coffee while pregnant.

Most of the behavioral issues seen in the kids were minor, but noticeable, Foxe said. Other risks for developing behavioral issues include family history and some social and economic factors, he added.

While it’s known the fetus can’t break down caffeine when it crosses the placenta, Foxe said exactly how or at what point in pregnancy caffeine leads to these changes is not fully understood.

The study did not find any changes in the children’s intelligence or thinking ability.

The American College of Obstetricians and Gynecologists suggests pregnant women limit their caffeine intake to 200 milligrams per day. That’s about two 6-ounce cups, but even that may be too much, the study suggested.

“I would advise pregnant women to take in as little caffeine as possible and switch to decaf altogether if they can,” Foxe said.

But he urged women not to go cold turkey if they can help it, because caffeine withdrawal can cause a host of symptoms, including headaches, irritability, nausea and difficulty concentrating.

“We don’t know what withdrawal, irritability, stress and anxiety will do to a pregnancy,” Foxe said. “Try to whittle away at your caffeine consumption before you get pregnant.”

The study does have some limitations. Women were asked to recall how much caffeine they consumed while pregnant, and memory isn’t always 100% accurate.

The findings were recently published online in the journal Neuropharmacology.

Dr. Mark Klebanoff, principal investigator at the Center for Perinatal Research in Columbus, Ohio, said many studies have looked at the effects of caffeine on pregnancy outcomes, such as risk of miscarriage. But less is known about how caffeine affects kids as they age.

“The new study adds to the literature, but it’s not enough to really implicate caffeine in any strong way,” said Klebanoff, who was not involved with the study but reviewed the findings.

“Pregnant women can be reasonably reassured that consuming less than 200 milligrams per day of caffeine will not cause miscarriage or preterm birth,” he said. But more study is needed on how it affects child development, Klebanoff added.

“A typical cup at home has about 100 mg of caffeine, so women can limit themselves to two cups a day when pregnant,” he said.

But they should keep in mind that other sources of caffeine (such as energy drinks, power bars and chocolate) should be considered as part of the total, Klebanoff said.

Source: HealthDay