Research and Education Help Babies Born Too Early

Newly Born Baby

Credit: iStock

A typical pregnancy lasts 40 weeks, but about 10 percent of babies in the U.S. are born preterm (before 37 weeks’ gestation) or premature. Less time in the womb means the infants’ organs are immature and not yet ready to function on their own. Generally, the earlier a preterm birth happens, the more likely it is that complications will occur. Most premature infants, or preemies, spend some time in the hospital in a special nursery called the neonatal intensive care unit, or NICU.

Preterm birth has occurred throughout history, but the issue did not catch the public’s attention until the death of President Kennedy’s son in 1963. Baby Kennedy was only 37 weeks’ gestation and died of respiratory distress. This increased focus on prematurity led to more funding to research ways to treat premature infants. Advances in medical treatment have dramatically increased the survival of preemies since the 1960s. By the 1980s, babies as young as 21 weeks’ gestation were surviving to adulthood.

Prematurity affects every organ system. Complications can be treated more successfully now than in the past. Some common issues include:

  • Digestive problems: When the cells lining the digestive tract are immature, babies may develop necrotizing enterocolitis (NEC). NEC is inflammation or infection of the intestine that can cause intestinal tissue to die. Doctors recommend breast milk for premature infants because babies who drink breast milk exclusively have a lower risk of NEC.
  • Breathing problems: Immature lungs do not produce a substance called surfactant, which helps the air sacs in the lungs stay open. Without surfactant, preemies may struggle to breathe and go into respiratory distress. Doctors first gave surfactant to premature infants in 1980. Death rates from respiratory distress in premature babies have dropped from over 90 percent in the 1950s to less than 5 percent today.
  • Vision problems: When a premature infant is born, their eyes are still developing. Blood vessels in the retina—the light-sensitive tissue in the back of the eye—can grow too much and pull it away from the rest of the eye. The detachment can lead to a type of vision impairment called retinopathy of prematurity (ROP). Doctors discovered that decreasing the concentration of supplemental oxygen given to preemies could actually help decrease the chances of developing ROP.

While treatment for premature infants continues to improve, the cause of preterm birth is still unknown. Doctors have identified some risk factors, including:

  • age—women over 35 have a higher risk;
  • alcohol or drug use;
  • intrauterine infection;
  • being pregnant with multiples;
  • spacing pregnancies very close together;
  • having a previous preterm birth; and
  • stress.

Both physicians and patients hope that more research and education will lead to fewer preterm births and improve health outcomes for preemies. November is Prematurity Awareness Month. Read more about ongoing research efforts on the March of Dimes website.

Rebekah Morrow 3Rebekah Morrow, PhD, is an assistant professor of immunology and microbiology at the Alabama College of Osteopathic Medicine.

Depression + Pregnancy = Diabetes?

Pregnant Frown

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Morning sickness, swollen ankles and a growing belly are just a few of the many physiological changes that women experience during pregnancy. The changes  we can see are just the tip of the iceberg. Blood volume, bones, heart rate, skin and many other parts of a woman’s body function differently during pregnancy.

Pregnancy-related changes can sometimes lead to more serious health consequences for mother and baby during pregnancy and beyond. For example, gestational diabetes—a temporary condition in which the body can’t process sugar during pregnancy the way it usually does—can lead to a higher risk of other pregnancy complications, including having a large baby and increased chances of developing diabetes mellitus down the road. Now researchers have found a link between gestational diabetes and depression during pregnancy, a condition which affects an estimated 13 percent of moms-to-be.

A recent study showed that women who had more symptoms of depression in the first and second trimesters were at the greatest risk of developing gestational diabetes. The study also found that women who had gestational diabetes were four times more likely to develop postpartum depression after giving birth. Researchers say the relationship between the two conditions needs more study, but they think that the chemical changes in the brain that occur with depression during pregnancy may affect how we break down sugar.

These links emphasize the need to tune in to emotional shifts that many pregnant women experience. When crying jags and lack of energy lasts for more than two weeks or if symptoms get increasingly worse, it may be more than just pregnancy hormones at work. Women should also look out for the physical symptoms of depression which may include:

  • headaches
  • general aches and pains
  • stomach problems
  • loss of appetite (which may sometimes be mistaken for a side effect of morning sickness)

Now that doctors are learning more about the link between depression and gestational diabetes, they can monitor their patients more closely for both conditions during pregnancy. For more information about depression during and after pregnancy, visit the federal Office on Women’s Health website.

Erica Roth



Dear Mom: Happy Mother’s Day … and Thanks for Sharing Your Bones

Black Family - mother nursing

Credit: Getty Images

Warning! Understatement of the year to follow: Many fascinating changes take place in a mother’s body during and after pregnancy. One of the most interesting changes for many new moms, myself included, is breastfeeding. Often called “nature’s perfect baby food,” breast milk seems to contain an almost magical mix of essential elements—proteins, fats, carbohydrates, water, vitamins, minerals and immune-boosting substances—that babies need to grow and thrive.

An extensive review article recently published in Physiological Reviews looks at calcium, which is an important nutrient for fetal and newborn development, and how mothers supply calcium to their babies during pregnancy and breastfeeding. The author, Christopher Kovacs of Memorial University of Newfoundland, sifted through more than 1,000 research articles on how humans and other animals transfer calcium to their offspring.

He found that during pregnancy, hormones signal a mother’s intestines to double the amount of calcium they absorb from food to provide the growing baby with enough to build and strengthen its bones. But the process changes during lactation. Studies showed that eating more or less calcium did not have an effect on the amount of calcium in a mother’s milk. According to Kovacs, the calcium in breast milk comes mainly from mom’s bones.

Our bones are constantly being built up and broken down. Normally, cells within the bone called osteoclasts break down old bone by secreting acid and enzymes, which makes minerals such as calcium available for the body to use. At the same time, cells called osteoblasts help develop new bone by secreting other enzymes and proteins that harden collagen into bone and help to store calcium. During breastfeeding, mothers secrete hormones that speed up bone breakdown to provide babies with roughly 200 milligrams of calcium—about the amount contained in a one-ounce serving of cheddar cheese—each day for about the first six months of life.

After weaning, mom’s body sends signals to ramp up the rebuilding of lost bone. “The maternal skeleton rapidly restores itself such that by six to 12 months after lactation (breastfeeding), the bone density has usually returned to baseline or better, even in women who suffered fragility fractures,” Kovacs wrote. Additionally, most of the studies showed that pregnancy and breastfeeding do not increase the chances of osteoporosis or broken bones and may even be protective for the bones.

There’s much more about breastfeeding that researchers are still trying to understand. But if you were breastfed, consider including a block of cheese as part of your Mother’s Day present. It’s not a full payback for all the calcium she’s given you, but it’s a start!

Stacy Brooks

Chemicals in Plastic May Be Bad News for Mothers and Babies

Emily Johnson Plastic Chemicals

Coral Hahn-Townsend presents “Metabolic dysfunction induced by prenatal exposure to Bisphenol-A and Diethylhexyl Phthalate: exacerbation by a high fat diet” at the Experimental Biology 2016 meeting in San Diego. Credit: Emily Johnson

If you’re a health-conscious shopper, you’ve probably noticed a new generation of “healthier” plastics popping up in grocery stores. These new plastics are “BPA-free,” which means a chemical called bisphenol-A (BPA) has been replaced with alternative chemicals. But are chemicals in plastic really something to be concerned about? Researchers from the University of Georgia and Michigan State University who study this question presented their findings at the Experimental Biology meeting in San Diego.

Coral Hahn-Townsend and other members of the research team studied how BPA and another chemical in plastic, diethylhexyl phthalate (DEHP), affected baby rats who were exposed to these chemicals during their mother’s pregnancy. “BPA is kind of like estrogen, and DEHP is an anti-androgen,” meaning they are endocrine disruptors, Hahn-Townsend explains. A lot of people are exposed to these chemicals in the environment, and it’s possible that they have an effect on our body weight and metabolism, she says.

After exposing the pregnant rats to the chemicals, the researchers studied their litters into adult life. Adult rats exposed to BPA and DEHP as fetuses had higher body weight than unexposed rats. They also showed early signs of diabetes, which worsened when the research team fed them high-fat diets.

Plasticizers—chemicals such as BPA and DEHP used to create plastic containers—are extremely common in both food products and the environment. However, scientists are only starting to understand how these chemicals may affect our bodies. Stay tuned for future research on their effects on present and future generations of humans and animals.

Emily Johnson

Emily Johnson, PhD, is an APS member and a former volunteer editor for the I Spy Physiology blog.

A New Discovery to Help Prevent Preterm Labor

Jessica Faulkner

Jessica Faulkner

In pregnancy, it’s best for women to carry babies to full term, considered to be between 39 and 40 weeks of pregnancy. Babies born before that time run the risk of having a small birth weight. Small birth weight is associated with incomplete development and increases the risk of cardiovascular disease in children, as well as other complications later in life.

Roughly 1 in 9 births in the U.S. are preterm. Preterm, or “premature,” labor and birth are more common in pregnant women with certain risk factors including obesity, gestational diabetes and high blood pressure in pregnancy. Unfortunately, due to rising rates of these risk factors among women, preterm labor remains a serious risk in many pregnancies. Current treatment strategies for women at risk for preterm birth or who are experiencing preterm labor revolve around delaying birth to allow the fetus to continue to develop as much as possible before delivery. This includes the use of steroids to help develop the infant’s lungs (one of the last organs to mature before the baby is born) and hormones such as progesterone to prevent uterine contractions. However, what causes preterm labor to start is not fully understood.

A recent study published in The Journal of Clinical Investigation found a new protein that plays a role in starting labor in mice. In previous research, scientists linked a deficiency in surfactant protein-A (SP-A)—a protein that helps the lungs develop and is increased right before birth—to a delay in birth. The research team wanted to determine if production of this protein, and ultimately the start of labor, could be delayed by targeting the building block steroid proteins involved in SP-A development. They found that reducing the steroid precursors led to reduced levels of SP-A and longer pregnancies and also led to reductions in inflammation and other factors linked to early labor. The authors concluded that fetal lungs may send signals that help labor to start and that steroids involved in SP-A production are an important part of this process.

While this research is still in its very young stages, this study lays the groundwork that this pathway may be a potential target for medicines that prevent premature birth in high-risk pregnant women and ultimately improve fetal outcomes.

Jessica Faulkner is a graduate student in the department of pharmacology and the Cardiovascular-Renal Research Center at the University of Mississippi Medical Center.

The Pregnancy Condition that Can Predict Future Heart Disease Risk

Jessica Faulkner

Jessica Faulkner

With rising rates of obesity and diabetes in the United States, high blood pressure in pregnant women is becoming increasingly prevalent. This can result in many pregnancy complications, the most severe of which include preeclampsia. Preeclampsia is a serious pregnancy-related condition that can affect the placenta, kidneys, liver and other organs. It can be life-threatening for mother and baby and is known to cause miscarriage and premature birth. Women who have had preeclampsia also have a greater risk of developing cardiovascular disease later in life.

A recent study published in the American Heart Association journal Hypertension showed that the time at which preeclampsia developed during a pregnancy may predict a woman’s future risk of cardiovascular disease.

Researchers measured several cardiovascular risk factors in 306 Dutch women who had experienced preeclampsia or high blood pressure in pregnancy two to five years after they gave birth. Then, they separated the women into two groups: those who developed preeclampsia early in pregnancy and those who developed it late in pregnancy. The study showed that women who developed early-pregnancy preeclampsia had significantly higher blood pressure, increased cholesterol, and higher blood sugar levels and insulin sensitivity (characteristics of diabetes) than those who developed preeclampsia in late pregnancy or who had high blood pressure without preeclampsia.

This study highlights the importance of prenatal care. The timing of a preeclampsia diagnosis (early vs. late in pregnancy) may be important information not only for mothers and babies during pregnancy, but also for physicians who treat women who had the condition later in life.

Cardiovascular disease is the #1 killer of women worldwide and prevention is the best medicine. This study indicates that women with preeclampsia, particularly those who develop it early in pregnancy, need to be continually conscious of their cardiovascular health as they age. It also highlights the importance of research in helping us uncover and understand unknown risk factors to fight cardiovascular-related deaths in women.

Jessica Faulkner is a graduate student in the Department of Pharmacology and the Cardiovascular-Renal Research Center at the University of Mississippi Medical Center.