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Understanding and Preventing Fetal Alcohol Spectrum Disorders

Thursday, May 1st, 2014

Do you know what the only preventable form of mental retardation is?  Fetal Alcohol Syndrome.

For some reason, there seems to be a lot of confusion among pregnant women about how much alcohol they can safely consume. The answer is extremely simple: NONE.  There is no amount of alcohol consumption known to be safe during pregnancy, and no specific minimum amount a pregnant woman must drink in order to put her baby at risk for being born with a fetal alcohol spectrum disorder (FASD).

Unlike an adult, the fetus does not have the liver enzyme alcohol dehydrogenase and consequently cannot metabolize alcohol; resulting in alcohol hanging around and causing damage. 

FASDs occur in babies whose mothers drank alcoholic beverages while pregnant, and can cause a range of symptoms including physical, behavioral, and learning problems. It is very common for a person with an FASD to have a combination of these problems. FASDs are entirely preventable – by simply not drinking while you’re pregnant. There is no known safe time during pregnancy to drink, and no known safe amount you can drink. And because women often don’t know they’re pregnant until several weeks in, any woman who might become pregnant should not drink, either.

Signs and Symptoms of FASDs

FASDs is a term that refers to the whole group of possible disorders babies whose mothers drank while pregnant are vulnerable to. The specific symptoms range from mild to severe and may include:

  • An abnormal facial appearance
  • A smaller-than-normal head
  • Short stature and low body weight
  • Problems with coordination
  • Hyperactivity, attention deficit, memory problems
  • Learning disabilities
  • Mental retardation
  • Speech delays
  • Poor reasoning skills
  • Sleep problems
  • Hearing or vision problems
  • Heart, kidney, or bone problems

Types of FASDs

There are several types of FASDs. The term used to describe an individual disorder depends on the specific symptoms present. For example, fetal alcohol syndrome refers to the more severe symptoms on the FASD spectrum. Fetal death is one such possible outcome of maternal drinking during pregnancy. Fetal alcohol syndrome sufferers may also have growth problems, problems involving the central nervous system, and abnormal facial features, among other problems.

Alcohol-related neurodevelopmental disorder can cause intellectual disabilities, and these individuals generally do poorly in school, especially when it comes to math, attention, memory, and impulse control. There are also alcohol-related birth defects which can range from hearing loss to heart problems and more.

Treatment for FASDs

There is no cure for FASDs. However, early treatments are imperative and can be effective at improving a child’s development and quality of life. Treatment options include medication for certain symptoms, certain types of therapy, parent education, and more. There is no one treatment that will be right for every child or every type of FASD. Early diagnosis and intervention, a stable and loving home environment, and involvement with special education services can all help people with FASDs overcome their disability and reach their full potential.

It’s never okay to drink alcohol while you are pregnant.  Read my book, Inside Information for Women, for more information on this. You’re only pregnant for a few months, and the choices you make now last two lifetimes: yours and your baby’s.

– Yvonne S. Thornton, M. D., M. P. H

Newly Discovered Dangers of Secondhand Smoke

Thursday, April 10th, 2014

Researchers already know that secondhand smoke, or passive smoking, is linked to myriad risks, including an increased risk of hearing loss, diabetes, and obesity. Now they have discovered new risks to add to the growing list: the increased risk of ectopic pregnancy, miscarriage, and stillbirth.

The new study points out that while smoking during pregnancy is known to be related to a higher risk of birth complications and miscarriage, more information was needed to determine whether passive smoking by pregnant women has similar effects. The study included over 80,000 women who had been pregnant at least once and gone through menopause.

Some of the women were current smokers (around six percent), some were former smokers, and some had never smoked. The women who had never smoked (or, more specifically, had smoked fewer than 100 cigarettes in their lifetimes), were divided into groups according to their secondhand smoke exposure as children, adults at home, and adults at work.

The study found that women who had been smokers during their reproductive years had a 44% higher risk of stillbirth, a 43% higher risk of ectopic pregnancy, and a 16% higher risk of miscarriage than the women who had never smoked and had not been exposed to secondhand smoke.

This was probably not a huge surprise to anyone, but the really interesting results were found in the group of never-smokers. The ones who had experienced secondhand smoke exposure also had a higher risk of miscarriage, stillbirth, and ectopic pregnancy compared with the ones who had never smoked and had not been exposed to secondhand smoke. In addition, the increase in risk was directly related to the level of secondhand smoke exposure the women had experienced.

The women with the highest levels of secondhand smoke exposure – over ten years either as a child, as an adult at home, or as an adult at work – had an extremely elevated risk of miscarriage, stillbirth, and ectopic pregnancy. The risk of having an ectopic pregnancy was a whopping 61% percent greater than that of women with no cigarette smoke exposure, and they were also 55% more likely to have experienced a stillbirth and 17% more likely to have had a miscarriage.

With many states enacting bans on smoking in public places and places of business in recent years, we are certainly headed in the right direction. However, the new research certainly highlights the need for more progress, especially in the states that still have no bans on smoking in public places whatsoever, in order to further protect women and their future babies from secondhand smoke, which appears to be even more harmful than previously thought.  

– Yvonne S. Thornton, M. D., M. P. H

VBAC vs Repeat Cesarean Delivery

Thursday, March 6th, 2014

Not so long ago, a vaginal birth after a cesarean delivery (VBAC) was unheard of. Because the uterus was cut in such a way that weakened it and made it vulnerable to rupture in subsequent pregnancies, women were often scheduled for cesareans before they could even go into labor if they had had a cesarean delivery in the past.

Now, with improved surgical techniques, VBAC is a choice that many women get to make, depending on the reason for the original cesarean. For example, if the first cesarean was performed because of a too-large baby and a too-small pelvis, that reason will in most cases still exist in subsequent pregnancies. On the other hand, if an isolated event such as breech presentation mandated the first cesarean, the event does not reoccur, and the correct surgical procedure was used the first time, then attempting a VBAC is usually safe.

Benefits of VBAC

This is important for a number of reasons. The most important reasons involve the safety of both mother and baby. A vaginal birth is safer than a cesarean delivery. Although the risk of infection or hemorrhage is relatively low with a cesarean, it is still several times greater than with a vaginal delivery. Therefore, a cesarean should be a last resort whenever possible.

Another reason VBAC safety matters is because many women prefer the natural experience of childbirth. This, of course, should not be a reason to put her life or the life of her fetus in jeopardy, but when it’s feasible, childbirth is a nicer experience when it fulfills the mother’s wishes.

Other benefits of VBAC include avoiding an additional scar on your uterus, which is important if a future pregnancy is desired. The more scars on the uterus, the more likely the uterus is to rupture.  Also, the placenta is more likely to be more adherent to the scarred uterus and not separate naturally, causing a life-threatening condition known as placenta accreta and resulting in massive hemorrhaging which may lead to maternal death.

Vaginal birth also comes with an easier recovery period, less pain afterward, a shorter hospital stay, and a more active role for you and your partner in the birth of your baby.

Risks of VBAC

The possibility (however remote) still exists for the uterus to rupture at the site of the previous cesarean scar, and this is one of the main fears when attempting VBAC. If the uterus ruptures, an emergency cesarean and possibly hysterectomy will be required to prevent severe injury to both baby and mother. That is why it is so important to be delivered in a hospital or medical center that has 24-hour anesthesia and in-house obstetrical coverage with a good blood bank.   With that the said, the risk of uterine rupture after a VBAC is 0.2% compared to 0.1% in those patients who had scheduled another cesarean.  Both figures mean that in 99.8% to 99.9% of the cases, a VBAC does not result in uterine rupture.

If you are hoping to have VBAC, you should clearly discuss this with your doctor to see if it is a good fit for your individual situation. In addition, you will need to deliver in a facility that has the equipment and staff capable of handling any emergency that might arise.

If you and your doctor decide that VBAC may be safe for you, you will be able to have a “trial of labor,” or TOLAC (trial of labor after cesarean). This means that you will go into labor naturally with the goal of delivering vaginally. However, there are no guarantees. Some women who attempt VBAC end up with necessary cesareans anyway. A trial of labor is a safe choice as long as the conditions that necessitated the first cesarean no longer exist and the baby is monitored closely for signs of distress. For more information on this and other women’s health issues, see my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

Options for Labor Pain Management

Thursday, November 14th, 2013

No two women experience labor pain exactly the same way, but one thing is certain: if you go through labor, you will experience pain. The size of your baby, his or her position, and the strength of your contractions all affect the severity and location of your pain; your stress level, including whether you are afraid and how prepared you are mentally and physically for labor, will also have an effect. For these reasons, knowing what to expect and what your options are before you ever have your first contraction is vital. Education and preparedness can allow you to make informed decisions unpressured by the immediacy of pain that you are unprepared to handle.

Lamaze Still the Best Overall Option

Your best bet, all things considered, is a labor and delivery free of drugs of any kind. Lamaze training doesn’t seem to be as en vogue as it once was, but it remains the safest option and, when learned properly, is highly effective. It does not block the sensation of pain entirely, but instead, teaches you techniques for coping with the pain calmly by focusing your attention on your breathing and on some focal point outside of your body. Many women have been pleasantly surprised to find out how effective Lamaze actually is. Perhaps its biggest benefit is its complete lack of potentially harmful side effects – something that cannot be said about drugs used in labor pain management (or any drug, for that matter).

Epidurals Effective But (Somewhat) Risky

Despite the fact that Lamaze costs nothing, is free of risk, and is effective, many women understandably prefer a pain relief method they perceive to be better: the epidural. Epidurals have become so common that these days, almost every pregnant woman plans on having one. Epidurals offer the distinct advantage of blocking pain sensations entirely (some pressure is still felt but it isn’t painful) while leaving Mom wide awake and ready to greet her new baby.

Which sounds great, except for one tiny detail: epidurals are not completely harmless. For starters, they are extremely expensive, although that isn’t much of a deterrent for most women when an insurance company is footing the bill. The much more important issue is that the drug used in epidurals crosses the placenta and can slow the fetal heart rate, sometimes necessitating Cesarean deliveries that would otherwise not have been necessary. There are also potential risks to the mother, including the possibility of needing to be put on a respirator if the epidural blocks more sensation than it is meant to, and other risks such as headache and low blood pressure.

My personal assessment, after delivering 5,542 babies and being an obstetrician for over 40 years, is that prolonged use of epidural anesthesia is associated with the development of autism in childhood.  This is just a theory, based on anecdotal observations; but, I have found that the babies born to mothers who are attended by midwives, who don’t use epidural anesthesia,  are less likely to be diagnosed with autism compared to children who have been exposed for many hours to the drugs used in administering epidural during labor.  It sounds preposterous, but remember where you read it first.

This is not to say that I am against any woman ever having an epidural. But women need to be informed of the risks and provided with the opportunity to learn completely safe alternative pain management techniques, such as Lamaze. If an epidural is chosen, it should not be administered too early in labor – not before the cervix is dilated to at least five centimeters. In addition, the epidural should be stopped once the cervix is dilated ten centimeters and the mother is ready to push; otherwise, she will not be able to push effectively. For more information on this topic, as well as my theory on epidurals and autism, see my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

What Prenatal Screening Tests Should You Expect?

Monday, October 14th, 2013

Prenatal tests are diagnostic procedures used to uncover potential chromosomal or structural fetal disorders. All expectant mothers, but particularly mothers over 35, should have thorough prenatal testing because of the increased risk of birth defects and other abnormalities. These are a few of the tests your doctor may want you to have; talk to him or her about others that may be necessary or helpful.

Maternal Alpha-Fetoprotein

Alpha fetoprotein (AFP) is a protein normally produced by the liver and yolk sac of a developing baby during pregnancy. AFP levels decrease soon after birth. AFP probably has no normal function in adults. The amount of AFP in the blood of a pregnant woman can detect abnormalities in the fetus, be they chromosomal or structural, such as Down syndrome or spina bifida, respectively.

This test is routinely administered to every pregnant woman, except those over 35 who will be having amniocentesis. If screening reveals worrisome levels (too high or too low) of AFP in the mother’s circulation, additional tests like amniocentesis are administered to further investigate the problem.

Cell free fetal DNA testing

Noninvasive prenatal testing that uses cell free fetal DNA from the plasma of pregnant women is now being offered as a screening tool for fetal aneuploidy (Down syndrome and  other trisomies). The only problem with cell free fetal DNA testing is that it requires informed patient consent after pretest counseling and should not be part of routine prenatal laboratory assessment. Cell free fetal DNA testing should not be offered to low-risk women or women with multiple gestations because it has not been sufficiently evaluated in these groups. A negative cell free fetal DNA test result does not ensure an unaffected pregnancy.  So why have this test?  Because many patients do not wish to be stuck with a needle or have any invasive testing done.  To me, it just delays the inevitable, but it is important that my readers know it exists.  A patient with a positive test result should be referred for genetic counseling and should be offered invasive prenatal diagnosis, i.e., chorionic villus sampling or amniocentesis, for confirmation of test results.


Ultrasound, or sonogram, is a test commonly administered during pregnancy that uses sound waves (not X-rays) to render an image of your baby inside your womb. Ultrasound is safe to use throughout pregnancy, and can be helpful in determining  an accurate gestational age  if the Mom is uncertain and can detect gross abnormalities, such as anencephaly or open neural tube defects.  Ultrasound has also been used to attempt to screen for Down syndrome by using specific markers, such as thickness of the fold behind the neck, or abnormal kidneys or absence of or abnormal development of the nasal bone.

Ultrasound is typically used at 16-20 weeks, when fetal structures have grown large enough to be seen somewhat clearly, and many abnormalities can be detected. The ultrasound technician checks to make sure the skull is present, the spinal column has closed, and various organs are present and developing normally, including the heart. Ultrasound does have its limitations; for example, it is not a perfect way to detect fetal heart malformations, as this study shows. That is because the fetal heart is so tiny and complex. Nonetheless, ultrasound remains a safe and effective tool for detecting many potential fetal problems.  However, there is a tendency to overuse and abuse ultrasound in an attempt to “have a picture of the baby in utero.”   Any imaging study needs to be performed because of a medical indication and not for entertainment.


Amniotic fluid contains the baby’s metabolic products and desquamated fetal skin cells, and therefore can be tested for genetic disorders that may be present. During amniocentesis, ultrasound is used to detect pockets of amniotic fluid, and a small amount of it is drawn out through a needle inserted into the amniotic sac. This fluid will then be used for chromosomal analysis as well as checked for AFP.

Amniocentesis can detect conditions characteristic of chromosomal and developmental disorders. It is used in conjunction with ultrasound.  Amniocentesis has the advantage of actually examining the chromosomes, not just the structure and appearance.

Chorionic Villus Sampling

Chorionic villus sampling (CVS) is the best-kept secret in obstetrics, which is a pity because it provides the earliest opportunity for prenatal diagnosis. In contrast to ultrasound and amniocentesis at 16 to 20 weeks, CVS is done in the tenth to the twelfth week of pregnancy, with the tenth week calculated as starting at nine weeks and one day.

Chorionic villi are the beginnings of the placenta. Rapidly growing, fingerlike projections in the sidewalls of the uterus, they look like sea kelp. By means of a soft catheter introduced vaginally and guided by ultrasound, a sample of these villi can be aspirated and sent to the laboratory for culturing. The cells are dividing very rapidly at this early stage and they grow quickly in the culture, giving results in seven days, in contrast to amniocentesis, which takes two weeks for results. As well as providing material for a chromosomal analysis, CVS allows us to rule out Tay-Sachs, sickle-cell anemia, and any inborn error of metabolism or enzymatic problem. The only thing this test does not do is establish the AFP level, but because every woman not having amniocentesis is screened with a blood test for AFP, this is not a problem.

Chorionic villus sampling yields the same information as an amniocentesis done five, six, or seven weeks later. The presence of anomalies can be confirmed at ten weeks—before the pregnancy is showing, before the woman is feeling fetal movement, and before there is the degree of bonding with the baby that is likely to have taken place by 20 weeks. Thus, if the findings give rise to a decision not to continue with the pregnancy, it can be interrupted with a D and C with far less morbidity and psychological stress than occasioned by a second trimester termination.

Even parents who know that they would never terminate a pregnancy regardless of the circumstance should undergo prenatal testing because education and preparedness can make such a difference in the quality of life for parents and children. You can find more detailed information on these and other common prenatal tests, as well as advice on deciding how to proceed in the event that a test reveals something troublesome, in my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

Thinking of Giving Birth at Home? Read This First

Thursday, October 3rd, 2013

More and more women are choosing a home birth experience when it comes time to start, or add to, their families. They say that childbirth is completely natural, that it is not a disease and there is no reason to be in a hospital bed. That their bodies know just what to do; that women have been giving birth at home for much longer than they have been going to hospitals. They say that they are perfectly healthy; maybe they have even given birth before with no complications. And they fear that “interference” from doctors and nurses and machines will mar their birth experience.

Most of this is perfectly true. But here’s something else that’s true. Did you know that the mortality rate is three times higher for babies born at home, compared with babies born in hospitals? The problem is that childbirth is notoriously unpredictable. Even if a woman is healthy and her entire pregnancy has been normal; even if she has already had an uneventful labor and delivery in the past, there is no way to predict some of the circumstances that may arise, or when medical intervention may become necessary.

The birth of your baby is indeed a very special time, and if you can have the experience you really want, that’s great. But remember that you also have a responsibility to keep your baby safe. So, with that in mind, how can you get the birth experience you desire without subjecting your baby to an increased risk of danger?

Choose a Midwife Who Practices in a Hospital Setting

Many women want a midwife to deliver their babies because they believe that midwives offer more personalized attention and try to interfere as little as possible with the natural course of events during labor and delivery. Many midwives practice in hospitals, and this is the ideal setting for birth in case of an emergency – which, again, you cannot predict. Yes, women have been giving birth at home for millennia. But the infant mortality rate is lower now than it ever has been. That’s because most women now give birth in hospitals.

Add a Doula to Your Support Team

A doula is a non-medical support person who can attend to your needs, help make you comfortable, help keep you focused, rub your back, bring you ice chips, and whatever else it is you might need, leaving your coach free to focus on you as well as his or her own experience.

Make the Hospital More Like Home

Get to know your hospital’s maternity floor ahead of time; being familiar with the setting will help you feel more comfortable. And feel free to bring things that are comfortable and homey, like a favorite blanket, pair of pajamas, or mug. After your delivery, you may necessarily be visited by medical personnel who will want to check your vital signs and make sure you and your baby are recovering well – but you can make the most of the times when you, your partner, and your baby are alone together by turning off the TV, dimming the lights, and getting to know each other. Celebrate with a glass of sparkling wine, play cards, decide on a name if you haven’t yet – do whatever you would do at home.

Making some compromises can keep you and your baby safer while still giving you a special birthing experience. Remember that the doctors are not there to get in the way, but to help you, especially if there is an emergency. You can read more about this topic in my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

Gut Flora of Babies Delivered by Cesarean Altered for At Least Six Months

Thursday, September 5th, 2013

One of the things I discuss in my book, Inside Information for Women, is the modern trend of cesarean on demand, or elective cesareans. For many women, cesarean delivery sounds like a simpler, easier alternative to labor and pushing, and to the many doctors who agree with them, it sounds like a good time management technique – preventing their sleep or other activities from being disrupted by inconvenient spontaneous labor. Women should remember that cesarean delivery is major surgery and carries the same significant risks of all major surgeries. Besides, the postoperative recovery period is more difficult following a cesarean than the recovery period following a vaginal delivery. And now, new studies show an additional reason to avoid cesarean whenever possible – the altered gut flora of babies born this way.

The early bacterial colonization of the intestine in newborns is an essential part of development, and now we have a new understanding of what factors can affect this colonization – and what effect altered colonization has on a child. A recent study shows that babies delivered by Cesarean have disturbed intestinal flora for up to, and sometimes longer than, six months after delivery. Two dozen babies were tested and then followed for up to two years. Fecal samples were tested one week after birth, and for up to 24 months in order to identify certain types of bacteria.

The results were striking. A particular type of bacteria known as Bacteroidetes was found less often in babies delivered by cesarean compared to those delivered vaginally, with a delayed colonization of this bacteria and significantly lower immune responses.

Those lower immune responses could mean a higher incidence of the development of allergies or asthma later. This could be because intestinal microbes influence and regulate certain parts of immune function all through the body. There was also less microbial diversity in the babies delivered by cesarean. That this off-balance mix is linked to allergies and other problems later is the conclusion of several recent studies.

There are factors that still need to be studied, but this is an interesting first step in understanding the link between gut flora and allergies and is a testament to the benefits of natural vaginal birth – Mother Nature knows what she is doing. So, as if there weren’t already enough reason to avoid unnecessary cesareans, the new information gleaned from the studies on intestinal flora confirm that women should avoid surgical birth any time it is safe to do so.

– Yvonne S. Thornton, M. D., M. P. H.

Autism Linked to Induced Labor

Monday, September 2nd, 2013

Researchers are constantly trying to find things that might be causing or linked to autism, and inducing labor (intentionally stimulating contractions before labor begins spontaneously) and augmenting labor (making contractions stronger, longer, or more frequent) are the latest suspects. Recent studies show that induction and augmentation of labor seem to be linked to the development of autism in children.

In epidemiological studies of over 600,000 live births, including 5,500 children with autism, researchers studied whether the births were induced, augmented, or both, and whether there was a correlation between that and whether the children had autism.

Children born without induction or augmentation were indeed less likely to develop autism than children whose mothers’ labors were induced, augmented, or both. The studies controlled for factors like socioeconomic status, the health of the mother, and the year of birth. Male children were found to be particularly susceptible to an increased risk of autism when their births involved induction or augmentation.

Further studies are needed, of course, to examine additional potential influences such as underlying conditions, other labor events, and the specific dosing used in induction. And women should not think that this makes Pitocin (the drug commonly used to stimulate contractions) the enemy or be afraid to use it if the situation so warrants. Pitocin (oxytocin) saves lives and prevents days-long labors that can cause serious harm to mother and baby. The increased risk of developing autism is slight, so mothers should realize that, should their doctors deem it necessary, Pitocin is still a safe choice.

Pitocin Not the Only Suspect

Keep in mind, too, that autism most likely has more than one cause. Other studies have shown other possible correlations, such as low levels of certain hormones, certain infectious agents, and some chemicals. Additionally, many parents have been concerned in recent years about a link between vaccines and autism – but studies show that no such link exists (see here and here).  This study, however, did not control for the type of anesthesia or the length of anesthesia.  My theory (for the past twenty years) has been that the prolonged infusion of epidural anesthesia for many hours during the induced or augmented labors (“Where’s my Epidural?”) is the culprit.  Not oxytocin.  Epidural anesthesia DOES cross the placenta.  Therefore, if the anesthetic can interfere with the neural transmission of pain in the mother, then surely it can interfere with the central nervous system (brain) of the fetus, neonate and infant.  The brain continues to develop until five years of age and if there had been an insult during the course of labor, it most likely will be manifested in the form of autism during childhood.  I say this, because my midwifery colleagues whose patients rarely use epidural and the lower socioeconomic moms, who either come in too late for an epidural or do not request it, rarely have children with autism.   However, I also predict that the incidence of autism will decrease in the years to come, secondary to the “new” maternal culture which demands elective cesarean deliveries and therefore, never experiences the many, many hours of labor; or having a gestational host (surrogate), who takes all the risks of pregnancy and labor only to have the biological parents come by and pick of their newborn, like a pizza.

The bottom line is that parents should not endanger their health or the health of their children by refusing treatments that are known to be reasonably safe, like Pitocin (oxytocin) and vaccines. More studies are needed and researchers are constantly trying to fill in the gaps in what we know, but for now, the benefits of Pitocin (and vaccines) are known to far outweigh any potential risks. Talk to your doctor about your concerns and to stay informed of the latest research so that you can make the best possible decisions for your family.

– Yvonne S. Thornton, M. D., M. P. H.

Use of Decongestants During Pregnancy May Be Linked to Birth Defects

Monday, July 22nd, 2013

Women have a long checklist list of products to avoid during pregnancy, from alcohol and caffeine to more serious chemicals that can seriously affect fetal development. However, the effects of certain medicines and other products have largely been unknown. One of the more common medications that women ask if they can use during pregnancy is the simple decongestant—something which most people take for granted. For a woman who is already suffering the discomfort of pregnancy, the idea of asking her to shoulder the burden of a stuffy nose and sinus pressure may seem a little harsh. However, new studies are suggesting that decongestants taken in the first-trimest of pregnancy may be a major item on the “to avoid” checklist, as they have been linked to birth defects.

The decongestants that researchers focused on in the study included both oral and nasal remedies. While the correlations between certain types of decongestants and potential birth defects still requires further investigation, this finding presents and opportunity to discuss one of the more important aspects of obstetric medicine. The simple fact of the matter is that there is no way to know all of the potential risks a woman faces during pregnancy.   Some women may not even know they are pregnant when taking these over-the-counter decongestants.  Therefore, any woman in the childbearing years who is not using effective contraception should think twice about relieving symptoms of an annoying stuffy nose as a trade-off  for increasing the risk of a child with birth defects.

While research has come a long way in identifying major risk factors, a number of other risk factors are still unknowns. This is even more so the case as new products are released into the market, new chemicals make their way onto store shelves, and ultimately pregnant women are exposed to an increasingly wider range of products during pregnancy. It is also a good reminder of the importance a woman should place on responsible behaviors during pregnancy, which include rethinking her normal habits and routines and consulting with a medical professional before taking any medication—even ones that seem fairly mild or harmless.

I hesitate to call women who take these products irresponsible or negligent—after all, not everyone is a doctor and not everybody has the access to medical information that can tell her at a glance what is and is not safe. That is why part of a responsible pregnancy is not only knowing to avoid certain products and materials, but is developing a good relationship with the medical professional in charge of one’s healthcare during pregnancy.

– Yvonne S. Thornton, M. D., M. P. H.

Preterm Delivery May Help Identify Risks for Cardiovascular Health

Monday, July 15th, 2013

Do you experience difficulty sleeping? If so, then you are not alone. More than a third of individuals report that they face some difficulty sleeping that leaves them tired throughout the day, whether that is insomnia, discomfort during sleep, or patterns of sleeping and waking in the middle of the night. An individual might have difficulty sleeping for any number of reasons, whether it is simply the fact that they are too busy to get the rest that they need or whether it is the result of some more severe issue related to emotional distress or anxiety. However, a new study suggests that sleep difficulties might be heightened in postmenopausal women.   A person should receive between 71/2 and 8 hours of uninterrupted sleep a day.

In this study, both premenopausal women and postmenopausal women were asked to keep a diary tracking their typical sleep patterns across a two-week period. The results showed that postmenopausal women did show a lessened ability to get the recommended amount of sleep throughout the night. When compared to these women’s workday and leisure day schedules, it also showed that postmenopausal women were more likely to lose sleep related to the stresses of their workday.  Consequently, postmenopausal women had less than 7 hours of sleep compared to their premenopausal counterparts who slept about seven and one half hours.

It can be easy to brush off studies like these, or to think that you’ll simply make up the sleep later if you are one of those that regularly experiences sleep problems. However, there is more than enough evidence available to suggest that losing sleep could lead toward much bigger problems down the line. Despite the potential risks of going without sleep, insomnia and related issues are still one of the most underreported medical problems that many people, and especially women, face. Be sure that if you are experiencing sleep difficulties, you speak to your doctor about them—especially if these sleep difficulties are concurrent with any other life changes, whether they are medical or emotional.

– Yvonne S. Thornton, M. D., M. P. H.