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Chocolate is the Caffeine of Choice for Moms to Be

Thursday, August 30th, 2012

When you get pregnant, you want to do everything you can to ensure the safety of your developing baby.  For this reason, most moms cut out foods, drinks, and chemicals that might have adverse effects on their baby.  Caffeine is just one thing they often give up, which means no more tall daily lattes or espressos.  Although high levels of caffeine can be dangerous, small amounts are fine, and one study found that the levels of caffeine found in chocolate are safe for moms and their unborn babies.

Many experts agree that moms should avoid taking in any more than 200 mg of caffeine per day.  This allows for a small cup of coffee, but most women still choose to avoid it altogether, which is probably a good idea, unless you need it as a stimulant for bowel regularity.  You never know how much caffeine a particular brew of coffee might hold, and it’s always better to be safe than sorry. When pregnancy has you craving something sweet though, you might forget that chocolate too contains caffeine.

Fetal heart rate reactivity is a medical term that describes how reactive the baby’s heart rate is when it is moving around in utero.  With fetal movement, the fetal heart rate accelerates about 15 beats per minute and is a sign of fetal well-being.  Fetal reactivity assessment is used as a surveillance tool when we are worried about the baby in a Mom who may have hypertension or diabetes (known as a nonstress test or NST).  The more “reactive” the fetal heart rate is, the better.   A study published in the Journal of Maternal-Fetal and Neonatal Medicine determined that eating chocolate can make the fetal heart rate more reactive .  This increased heart rate did not appear to be from the caffeine in chocolate, but rather from the theobromine, which dilates blood vessels and decreases blood pressure.  In order to make up for this physiologic change, your heart and also your baby’s heart have to pick up the pace in order to maintain adequate blood circulation, resulting in a more reactive fetal heart rate pattern, which is a good thing.

However, as with any chemical, food or supplement that alters your body function, it should be taken in moderation.  In other words, don’t go overboard, but don’t feel the need to pass up on a “chocolate moment” to satisfy those cravings once in a while either.


– Yvonne S. Thornton, M. D., M. P. H.

Don’t Rush Your Delivery

Monday, August 27th, 2012

While being pregnant is a blessing, how you feel while pregnant is hardly ever comfortable or convenient.  As your delivery date approaches, this will become even more true.  That doesn’t mean it’s a good idea to rush your delivery though.  In fact, rushing your delivery could lead to serious problems that would make life after your pregnancy even more inconvenient.  Let me clarify the definition of a full-term pregnancy.  A full-term pregnancy is between 38 weeks, 0 days and 42 weeks, 6 days.  Yes, four weeks!  Mother Nature gives the baby four weeks to make up its mind to exit the padded “condo”.  With that said, recent neonatal literature ( has concluded that babies who are delivered before the 39th week of gestation are significantly at risk for neurological deficits and respiratory problems.

Unfortunately, we have become a society of convenience.  Consequently, there has been an increase in the number of births by early induction of labor lately.  While it’s true that if there is medical reason to induce labor early, it can be a necessity, that does not mean it is safe or recommended for everyone.  In some cases, couples decide that they would like their baby to be born on a special date for future birthdays.  For others, it is because a father might be leaving for a while and would otherwise miss the birth of his child.  In still other cases, doctors actually recommend early induction simply because they are hoping to have the holiday off or don’t want to be called away from their vacation should delivery come later than the expected due date.  A study by the Agency for Healthcare Research and Quality concerning the results of elective induction once again confirm the dangers involved.  Inducing labor before your baby is ready, can cause serious problems that could harm his or her physical and mental development.  Those developmental issues could affect them for the rest of their life.  Also, babies born too early often have to stay in the hospital longer and sometimes must spend that time in intensive care.  The March of Dimes has supported this study and is now strongly opposing early elective delivery before 39 weeks.

Although you and your doctor might be itching to get that baby out and into the world, that is no reason to induce labor.  If it becomes medically necessary to do so, then it can be done safely, but the risks are still increased.  If your doctor urges you to induce labor without a medical reason, seek a second opinion.  If it’s just your impatience pulling you in that direction, be patient.  You’ll have plenty of time with your little one soon enough, and by waiting for your baby’s natural delivery date, the time you get with them will be of a much better quality.


– Yvonne S. Thornton, M. D., M. P. H.

No Breastfeeding; No Guilt

Thursday, April 19th, 2012

I was raised in an era when children were fed Karo Syrup and evaporated milk, and nobody gave my mother a guilt-trip for doing so.  As with many low-income families, she spent much of her time working to provide for our family and would not have been able to stay home to breastfeed.  Somehow though, we all grew up to be healthy, happy adults.  In fact, two of my sisters are doctors and the other is a lawyer and Ph. D., so I’d say we turned out pretty well.  The American Academy of Pediatrics (AAP) though, would like moms to believe otherwise.

When an organization like the AAP recommends breastfeeding, new moms are likely to trust in their expertise and follow suit, assuming the organization has conducted years of research and found conclusive results in favor of breastfeeding.  Unfortunately, that just isn’t the case.  That hasn’t stopped them from publishing an executive summary of their recommendations though.

In their most recent Executive Summary on Breastfeeding and the Use of Human Milk, the AAP cited, “a variety of government data sets, including the Centers for Disease Control and Prevention (CDC) National Immunization Survey, the NHANES, and Maternity Practices in Infant Nutrition and Care.”  These studies merely show how many people are breastfeeding in developed countries, not whether or not this has been beneficial for the children involved.

In fact, there has so far only been one scientific study performed and this is where all of their data is coming from.  Also, the study itself admits that, “Because almost all the data in this review were gathered from observational studies, one should not infer causality based on these findings.”  In other words, they gathered their information from other reports and performed a scientific analysis, but did not do any controlled experiments themselves, so they can’t be certain that the relationship between the health of children and the rate of breastfeeding are actually related.  Even more shocking is the AAP’s blatant disregard for some of the findings in the study.  The AAP Summary reports that, “Adjusted outcomes for intelligence scores and teacher’s ratings are significantly greater in breastfed infants.”  While the study they are citing actually says, “There was no relationship between breastfeeding in term infants and cognitive performance.”  Human breast milk is deficient in iron and Vitamin D; yet, those deficiencies are rarely mentioned when it comes to comparing breastfeeding and formula feeding.  Moreover, the touted immunity conferred to the newborn from breastfeeding has not resulted in better outcomes for breastfed infants.

So why are they so adamant about it?  It turns out; they have spent the past several years urging the Senate to carry out a $15 million campaign to promote breastfeeding at maternity care practices, community-based organizations, and hospitals.  In other words, wherever mothers might be giving birth or receiving pediatric care, their physicians are flooded with propaganda pushing the importance of breastfeeding.  This has led to a lot of pressure on moms who have chosen not to breastfeed, and consequently, a lot of unnecessary guilt.  Mothers have the right to choose the method they feel most comfortable with, and shouldn’t have to feel guilty for that choice.

— Yvonne S. Thornton, M. D., M. P. H.



Baby’s tastebuds mirror Mom’s food choices?

Wednesday, November 30th, 2011

You’ve probably heard the claim that exposing a baby in the womb to Mozart will increase his or her IQ. Despite the hype, the research doesn’t support major leaps in smarts (but, if nothing else, it might improve your child’s musical taste, later on).

Now, there’s some evidence showing that you may be able to shape a yet-to-be-born child’s taste in food.

“The flavor and odors of what mothers eat show up in the amniotic fluid, which is swallowed by the fetus, and in breast milk. There is evidence that fetal taste buds are mature in utero by 13 to 15 weeks, with taste receptor cells appearing at 16 weeks, according to researchers.

“’With flavor learning, you can train a baby’s palate with repetitive exposure,” said Kim Trout, director of the nurse midwifery/women’s health nurse practitioner program at Georgetown University.

“Trout recently co-authored a paper that reviews the evidence on prenatal flavor learning and its implications for controlling childhood obesity and diabetes, among the country’s most pressing health problems…”


Although I’m just as skeptical of this claim as I am about the one for baby-and-Mozart, I see real benefit in giving this a try, whether it makes your baby want broccoli or not. That’s because, in my practice, I see too many women gaining too much weight during pregnancy, which can not only cause complications for mother and baby, but can be almost impossible to shed once your baby is born.

So, bring on the Brussels sprouts, and eschew the Twinkies. Pass by the apple pie and bite into a nice juicy apple instead. Whether it does a thing to change your baby’s mind about what tastes good later in life, it will do a world of good for you both right now.

– Yvonne S. Thornton, MD, MPH

You are what you eat…and so is your baby

Thursday, October 20th, 2011

We’ve all been told how important it is to eat well in order to stay healthy. Now, new research shows that what you eat when you’re pregnant can be as important for your baby as it is for you.

A study published in the Archives of Pediatrics and Adolescent Medicine shows that when mothers-to-be ate healthful foods, such as those that make up the so-called Mediterranean diet, their babies had fewer birth defects such as cleft palates and neural tube defects.

The Mediterranean diet focuses on vegetables, beans, fruits, grains and fish, and is lower in meat, dairy and “empty” carbs.

Before you panic if you’re reading this while gorging on burgers and fries, no, your baby isn’t going to be born with birth defects just because you’re taking a vacation from your diet. The birth defects researchers looked at in the study are quite rare to begin with. It’s just that they are rarer still among women who eat well.

But the study does hint at something we know: your baby’s development depends, in part, on the nutrients you consume. So, give your little one a head-start on a good future. You’ll be doing a favor for both of you.

– Yvonne S. Thornton, MD, MPH

Drug Maker Attempted to Capitalize on the Lives of Infants

Tuesday, April 5th, 2011

There is a synthetic form of progestin called hydroxyprogesterone caproate, or 17P, that is used to prevent mothers-to-be from delivering prematurely. Treating a mother at risk of having a preemie with hydroxyprogesterone caproate was found, in tax-payer funded studies by the National Institute of Child Health and Human Development, to reduce the incidence of pre-term births, which naturally means that babies suffer fewer of the complications that plague preeemies. The studies also found that giving this drug to mothers-to-be at risk of premature delivery could save the health care system at least $2billion per year.

Until recently, the drug had been available only through “compounding pharmacies” (pharmacies that formulate drugs that aren’t commercially available), at a cost of about $10 to $20 per dose. But the FDA recently licensed one manufacturer, KV Pharmaceuticals, to manufacture the drug commercially, and exclusively, for the next seven years.

What usually happens at the point where a manufacturer is given exclusive rights to market a drug is that compounding pharmacies are told that they may no longer produce the drug.

And that would have happened this time – if KV Pharmaceuticals hadn’t done something that has caused a huge uproar in the maternal-fetal medicine and obstetrics community. It raised the price of the drug from the $10 to $20 per dose that compounding pharmacies had been charging to (are you sitting down?) $1,500 per dose.

No, that’s not a typo.

They raised the price by an average of 100 times what it had been.

Remember, it was tax-payer dollars that funded much of the research, so the raise in price could not be attributed simply to recouping research costs. And driving the price that high would put it out of reach of most women (and babies) who needed it. A full course of the drug, given between the 16th and 36th weeks of pregnancy, had previously cost about $400. The price increase would push that cost to $30,000!

This story, at least, has a happy ending. Although, according to this article in the Seattle Times, KV Pharmaceuticals agreed  to drop the price to $690 per dose (still outrageously high, in the opinion of most in the obstetrics community), the FDA decided to allow compounding pharmacies to continue to formulate the drug when presented with a prescription.

But just imagine all the mothers and babies who would have suffered had the FDA allowed KV to put profits ahead of all else, and ordered compounding pharmacies to cease formulating the prescription.

As a maternal-fetal specialist and a mother, it sends shivers up my spine.

– Yvonne S. Thornton, MD, MPH

Moms-to-be: A New Warning Against Smoking

Monday, March 7th, 2011

A study by the CDC, appearing in the journal Pediatrics shows, once again, that smoking cigarettes during pregnancy (with its nicotine and other toxic substances) is a health risk to your baby. Reuters Health reports:

…women who smoked early in pregnancy were 30 percent more likely to give birth to babies with obstructions in the flow of blood from the heart to the lungs, and nearly 40 percent more likely to have babies with openings in the upper chambers of their hearts.

We’ve known for many years of the dangers of smoking during pregnancy, and this study just adds to that knowledge. Mothers-to-be take note: what goes into your body affects your baby—possibly for a lifetime.

– Yvonne S. Thornton, MD, MPH

The Latest News From the CDC on Birth Defect Risks

Saturday, March 5th, 2011

In a report published in the American Journal of Obstetrics and Gynecology, the Centers for Disease Control (CDC) [] warned against using prescription opiate-based painkillers such as codeine, hydrocodone or oxycodone (brand names include Vicodin and Oxycontin) during pregnancy.

According to an article about the CDC report:

In the study of data from 10 states, the CDC researchers found that 2 percent to 3 percent of mothers interviewed received prescription opioid pain killers, or analgesics, just before they got pregnant or early in their pregnancy. Any illicit use of painkillers was not assessed.

For those women, the risk of having a baby with hypoplastic left heart syndrome — a critical heart defect — was about double that of women who took no opioid drugs.

Risks of other birth defects, including spina bifida (a type of neural tube defect), hydrocephaly (build up of fluid in the brain), congenital glaucoma (eye defect), and gastroschisis (a defect of the abdominal wall), also somewhat increased among babies whose mothers took these drugs either shortly before or during pregnancy.

I have concerns about the generalization of both articles, but the conclusions may be valid. Taking a drug before you’re pregnant, or up to 17 days after conception, is unlikely to cause birth defects. It will either cause a miscarriage or will have no effect. But because most women don’t know precisely when they conceived, it’s best to avoid taking drugs at any time during pregnancy.

The greatest risk to a developing baby from a pregnant mother taking potentially toxic drugs occurs between 17 days post-conception to 12 weeks (end of the first trimester).

You’ve probably heard of Thalidomide, a sedative given in the 1950s to pregnant women in their first trimester. It dramatically illustrated the risks to a fetus’s development from drug effects during the critical first weeks. Thalidomide given early in pregnancy stunted the development of babies’ arms, legs, hands and feet, and caused other limb deformities.

If you’re pregnant, or planning to be, you should also be aware that most drugs, whether prescription or over-the-counter can have unknown effects on a growing fetus. The bottom line is: Every drug is, in some sense, a poison. Don’t consider any drug safe in pregnancy unless prescribed by someone who knows its toxicity as well as the risks and benefits of the drug.

– Yvonne S. Thornton, MD, MPH

Time to Deliver? Mother Nature Knows Best

Thursday, December 30th, 2010

For years, I’ve been sounding the alarm about Cesarean delivery on-demand, and have persuaded my patients that childbirth isn’t something you can simply pencil into your schedule when convenient. It’s not just that a baby needs all the time nature gives her within the womb to develop, and that delivering just a few days early can mean that lung development and other functions may be potentially compromised. Cesareans are major surgery, which brings inherent danger to both mom and newborn. Necessary Cesareans are often life-savers. Unnecessary Cesareans can be just the opposite.

And now, at last, the word is spreading.

The San Jose Mercury News reports:

Babies born early through induction or C-section without a medical reason are nearly twice as likely to spend time in the neonatal intensive care unit, researchers say. They also are more likely to contract infections and need breathing machines, according to a 2009 study in the New England Journal of Medicine and a number of other reports.

“We are finding out that the last weeks of pregnancy really do count,” said Leslie Kowalewski, an associate state director for the March of Dimes.

“At 35 weeks, the brain is only two-thirds of what it will weigh at 40 weeks.” Many organizations are responding with programs designed to eliminate early elective deliveries. Most significantly, chapters of the American Congress of Obstetricians and Gynecologists have begun to notify doctors about the serious consequences of performing early elective births.

With luck, as information about potential consequences spreads, expectant mothers and their doctors will decide to let nature take her course, for the sake of the mom’s health and her baby’s.

– Yvonne S. Thornton, MD, MPH

Ready to Deliver and Morbidly Obese: One of My Most Challenging Cases

Wednesday, June 23rd, 2010

A recent article in The New York Times talked about how the obesity epidemic is affecting pregnant women and their babies:

About one in five women are obese when they become pregnant, meaning they have a body mass index of at least 30, as would a 5-foot-5 woman weighing 180 pounds, according to researchers with the federal Centers for Disease Control and Prevention. And medical evidence suggests that obesity might be contributing to record-high rates of Caesarean sections and leading to more birth defects and deaths for mothers and babies.

New York City’s health department reported last Friday that half of the 161 women who died because of a problem with their pregnancy between 2001 and 2005 were obese. Black women were hit hardest, with a mortality rate seven times that of white women. While deaths are extremely rare in pregnancy, the city’s rate of 23.1 per every 100,000 births is twice the national average.

My new book, SOMETHING TO PROVE, is a personal memoir first, but because I’m a maternal-fetal medicine specialist and a surgeon, it also details a number of gripping moments in the operating room.

One of my most challenging cases involved a pregnant patient transferred to my care. When I walked into my new patient’s hospital room, I discovered she weighed more than 500 pounds and her baby was showing signs of distress on the fetal monitor.  The patient needed to be delivered. Let me give you a sense of the challenge with a brief excerpt:

…Many surgeons would begin their cut above her navel in an attempt to avoid that enormous layer of fat, while trying to find the uterus to get the baby out. …The area above the pubis, even in a morbidly obese woman, is usually flat and firm. Instead of a vertical incision from the navel down, I’d lift up the apron of fat and do a horizontal incision just above the pubis. That would allow me to get into the uterus and get the baby out. …We taped her massive belly to her chest, swabbed her with an antiseptic solution, and I went in. I was able to perform the cesarean quickly, without incident or excessive bleeding, and delivered the baby in only a few minutes.

The surgeon who handled the case recounted in The New York Times decided to cut through all the mother’s layers of fat, rather than using my technique of retracting and taping the massive layers of fat, which a colleague dubbed the “Thornton suspenders.” While there might have been excellent reasons for the physician’s decision, I hope more obstetricians learn to use the “Thornton suspenders” for such difficult deliveries in obese moms. Because, as the Times article explains:

… where every minute counted, it took four or five minutes, rather than the usual one or two, to pull out a 1-pound 11-ounce baby boy.

– Yvonne S. Thornton, MD, MPH