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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.

Sources:

http://www2.aap.org/breastfeeding/files/pdf/Breastfeeding2012ExecSum.pdf

http://www.usbreastfeeding.org/Portals/0/Letters-Comments/2011-03-07-Joint-Letter-BF-Approp.pdf

 

Posted in General health news, Pregnancy, Women's health issues, Your newborn baby | No Responses »
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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

Posted in General health news, Pregnancy, Women's health issues, Women's health news, Your newborn baby | No Responses »
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Should you be worried about the blot clot risk with newer birth control pills?

Monday, November 21st, 2011

You might have read the news that YAZ and Yasmin, two newer birth control pills, are riskier to take than older contraceptives due to higher potential for blood clot formation.

But it’s important to put this into perspective. No matter what birth control pill you use, blood clots are a possibility, if an uncommon one. What you might not know is that blood clots are even more common in pregnancy. Fortunately, the vast majority of the millions of women who get pregnant and give birth each year don’t suffer blood clots. Just as millions of women take birth control pills with no such side effects.

So, is there a unique problem with YAZ? Yes, but not the one identified in the headlines. The problem is in the marketing.

YAZ was promoted to women as a pill for bloating and acne in addition to its contraceptive effects. While that might be a good marketing strategy, it’s not a good medical one. Contraceptives are for birth control, and the best one for you, based on your medical history, might have nothing to do with acne. People shouldn’t pick their birth control the way they pick their toothpaste—on the basis of consumer advertising. You should consult your doctor who will look at your history and decide what form of contraception meets your needs. If your family has a history of strokes, blood clots, or thrombophlebitis (a blood clot that causes swelling in a vein), your doctor will almost certainly order advanced testing due to the possibility that any birth control pill—YAZ, Yasmin, or older medicines—might be inappropriate for your condition.

But if your doctor has already determined that YAZ or Yasmin is a safe bet, and you’re on one of these now? Keep taking it unless your doctor says otherwise. The alternative could be unintended pregnancy. And pregnancy, ironically enough, is more likely to cause a blood clot than your birth control pills.

– Yvonne S. Thornton, MD, MPH

Posted in Contraception (birth control), Fertility & Infertility, General health news, Pregnancy, Women's health issues, Women's health news | No Responses »
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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

Posted in Pregnancy, Women's health issues, Women's health news, Your newborn baby | No Responses »
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Learning Your Baby’s Gender at Seven Weeks –Test is Mixed Blessing

Tuesday, August 16th, 2011

For parents-to-be, impatient to know whether to paint the nursery blue or pink, a simple test can provide answers as early as seven weeks into the pregnancy.  These tests have been available for some time but weren’t widely used in the U.S., because their accuracy wasn’t known. Now, The New York Times reports, a new study in The Journal of the American Medical Association, has “found that carefully conducted tests could determine sex with accuracy of 95 percent at 7 weeks to 99 percent at 20 weeks.”

But is it really necessary to know your baby’s sex that early? For some parents, it can be.  The Times reports that European doctors routinely use such tests to:

… help expectant parents whose offspring are at risk for rare gender-linked disorders determine whether they need invasive and costly genetic testing. For example, Duchenne muscular dystrophy affects boys, but if the fetus is not the at-risk sex, such tests are unnecessary.

But the big downside, and one that concerns me greatly as a doctor and a mother, is that some cultures have such a bias against baby girls that the wide availability of such testing will result in ever more otherwise healthy female fetuses being aborted.

Several companies do not sell tests in China or India, where boys are prized over girls and fetuses found to be female have been aborted. While sex selection is not considered a widespread objective in the United States, companies say that occasionally customers expressed that interest, and have been denied the test. A recent study of third pregnancies in the journal Prenatal Diagnosis found that in some Asian-American groups, more boys than girls are born in ratios that are “strongly suggesting prenatal sex selection,” the authors said.
At least one company, Consumer Genetics, which sells the Pink or Blue test, requires customers to sign a waiver saying they are not using the test for that purpose. “We don’t want this technology to be used as a method of gender selection,” said the company’s executive vice president, Terry Carmichael.

Cultural preferences won’t be deterred by a signature on a form, but at least, it’s a start. At some point, all cultures will learn to value both genders equally. Until then, a test that holds promise for some, can be a terrible incentive for the ultimate act of bias against females in others.

– Yvonne S. Thornton, MD, MPH

Posted in Childbirth & delivery, Pregnancy, Women's health issues, Women's health news | No Responses »
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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

Posted in Childbirth & delivery, Health care policy, Pregnancy, Women's health issues, Women's health news, Your newborn baby | No Responses »
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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

Posted in Pregnancy, Women's health issues, Women's health news, Your newborn baby | No Responses »
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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

Posted in Health care policy, Pregnancy, Women's health issues, Women's health news, Your newborn baby | No Responses »
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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

Posted in Childbirth & delivery, General health news, Pregnancy, Women's health issues, Women's health news, Your newborn baby | No Responses »
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Overweight or Obese? Don’t Count On Your Birth Control Pills.

Wednesday, July 14th, 2010

Since the pill first appeared on the scene, about 50 years ago, women have felt secure knowing that they had an almost foolproof way to avoid unwanted pregnancies. And that’s been mostly true.

But maybe not for all women.

If you’re overweight or obese, recent studies suggest that birth control pills might not be as effective for you as they are for more slender women:

“In one study of oral contraceptive pills, women with a body mass index (BMI) in the overweight range (a BMI of 25 or more) had a higher risk of pregnancy that those in the normal weight range. In another study of contraceptive skin patches, higher body weight — not higher BMI — was associated with higher risks of pregnancy.”

In addition to the sobering news about the lessened effectiveness of hormonal birth control, these birth control methods are thought to slightly increase a woman’s risks of heart disease, high blood pressure and other conditions. When you consider that overweight and obese women are already at increased risk of heart disease, diabetes and other ills, and that pregnancy is a riskier venture, overall, for obese women and their babies, you have a new incentive for getting your weight down.

I know it isn’t easy. I’ve struggled with weight myself and can attest to the fact that it’s a constant battle. But it’s a battle we must fight – and win. And now, we have one more reason to do it.

– Yvonne S. Thornton, MD, MPH

Posted in Contraception (birth control), Fertility & Infertility, General health news, Pregnancy, Women's health issues, Women's health news | 1 Response »
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