Spotlight On: Preeclampsia

Pregnant woman holding hands over belly on black background

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Lady Sybil Crawley—the feisty youngest sister of a wealthy British family on the PBS television series “Downton Abbey”—made her way into viewers’ hearts. Devotees of the show were shocked when, in a surprise twist, she died soon after giving birth. Lady Sybil died from high blood pressure during pregnancy (preeclampsia) that developed into a more serious condition called eclampsia in which high blood pressure causes potentially fatal seizures.

Unfortunately, this type of tragedy is not a distant memory from the early 1900s when “Downton Abbey” was set. Preeclampsia still causes too many deaths—or near deaths—in the U.S. each year. However, when diagnosed properly, preeclampsia is manageable.

Preeclampsia develops in about 5–8 percent of all pregnancies. Symptoms include headaches, nausea, vomiting, and excessive swelling of the feet, hands and face.

There are also invisible symptoms, such as damage to internal organs like the liver and kidneys. Preeclampsia occurs when a woman’s blood pressure rises too high (140/90 mmHg or above) during mid- to late-pregnancy (more than 20 weeks of gestation). The increased blood pressure limits the amount of blood that the baby receives and can slow down fetal growth. Babies born to women with preeclampsia are frequently smaller and weigh less than those born to women with normal blood pressure. Preeclampsia is often connected with other health conditions such as obesity, diabetes, kidney disease and a history of high blood pressure.

A woman’s age, race and where she lives can also increase the likelihood of developing preeclampsia. Women over age 40, black women and women from the southern U.S. also have an increased risk of developing high blood pressure during pregnancy. The reasons why Southern women have greater risk are not clear, but it may be linked to the prevalence of obesity and diabetes, especially in the Deep South.

It is important for expectant women and their families to know the symptoms of preeclampsia, talk openly with their doctors about their potential risks and speak up when something doesn’t feel right. May is Preeclampsia Awareness Month. Talk to the pregnant women in your life and learn about preeclampsia together.

Jessica Taylor, PhDJessica C. Taylor, PhD, is the Senior Manager of Higher Education Programs at the American Physiological Society. She is a cardiovascular physiologist, the mother of one and hails from Mississippi.

How, What and When to Eat: Scientists Weigh In at Experimental Biology 2018

Each year, scientists who study physiology and other biomedical research fields—including anatomy, biochemistry, pathology and pharmacology—gather at the Experimental Biology (EB) meeting. Scientific meetings such as EB provide a platform to present and learn about new and cutting-edge research and form collaborations with colleagues that can lead to advances in science and medicine. This year’s EB meeting in San Diego featured studies ranging in topics from nutrition and exercise to mental well-being and women’s health. Read on for more about how the food we eat—and when we eat it—affects the body.

glasses of milk

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You may already know that probiotics—live bacteria found in yogurt and nutritional supplements—are good for digestive health. Now researchers from Auburn University in Alabama have found that drinking kefir, a fermented milk-based beverage, may help lower blood pressure. Their study suggests that probiotic-rich kefir restores balance to bacteria in the intestines and an enzyme in the brain that controls nervous system function. It seems the gut and brain are working together to regulate blood pressure.

Diner: Artificial Sweetener Caddy

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Have you replaced the sugar in your morning coffee with a no-calorie artificial sweetener? This approach may help you cut calories, but according to researchers from the Medical College of Wisconsin, it may not reduce your risk of obesity or diabetes. Their data suggest that zero-calorie sweeteners change how the body processes fat and gets energy. Moderation with any type of sweetener, artificial or natural, seems to be the key.

eating breakfast

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Breakfast skippers: New research from the Mayo Clinic suggests that passing on breakfast may be a cause of weight gain. Adult volunteers were found to gain less weight when they ate breakfast at least five days a week when compared to those who broke their fast later in the day. The results appear to confirm what your mother always told you: “Breakfast is the most important meal of the day.”

If you’re considering becoming pregnant, make sure your prenatal multivitamin includes zinc. Researchers at Pennsylvania State University found zinc is crucial for the health of a woman’s eggs. Zinc deficiency seemed to impair the development of eggs very early on, months before they are ready for release (ovulation) and fertilization. Zinc-deficient eggs were smaller and had problems with cell division, which can prevent fertilization from occurring.

Alternate-day fasting is a weight loss method that’s recently become more popular—but does it work? A research team from Kent State University in Ohio found that obesity-prone mice lost more weight when their calories were restricted every other day than lean mice did. This was the case even though the mice burned the same amount of calories on fasting and non-fasting days. The results suggest that alternate-day fasting may be effective in some people, but not as much in others.

Interested in learning about more research presented at the meeting? Read Meditation, Stress and Mental Fatigue: Research from Experimental Biology 2018.

Erica Roth 

Skip the Nightcap: Your Sperm or Eggs May Thank You

Alcoholic Beverages

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Alcohol may grease the wheels in the short-term and make trying to get pregnant a little more fun, but in the it long run it could throw a wrench in fertility. Roughly 10 percent of men and women in the U.S. report having difficulty getting pregnant. Worldwide, close to 49 million couples were considered to be infertile. Age, weight, smoking status, caffeine intake and fitness level can affect fertility. Moderate-to-heavy drinking can also lead to fertility problems in some people.

The Centers for Disease Control and Prevention defines moderate drinking as one drink per day for women and two for men. Heavy drinking is considered eight drinks or more per week for women and 15 for men. Drinking heavily may disrupt the endocrine system, which controls the hormones essential for healthy reproduction. This disruption may lead to decreased fertility in both women and men.

Long-term drinking may increase the amount of follicle stimulating hormone (FSH) circulating in the bloodstream in women. FSH naturally rises and falls throughout the menstrual cycle and is needed to maintain regular periods and ovarian function. Drinking may also reduce the number of follicles in the ovaries. Ovarian follicles contain the eggs that are released during ovulation. Fewer eggs being released and having irregular periods reduce the chances of getting pregnant each month.

Long-term alcohol use doesn’t just compromise fertility in women. Sperm health may also be affected. Alcohol may lower testosterone and progesterone—hormones that control sperm production and function—in men. Low levels of these hormones may lead to a lower sperm count and less mobile sperm.

Fortunately, not everyone who drinks will have trouble conceiving. Some studies have shown no association between alcohol and infertility, and research even suggests that a bit of wine may shorten the time it takes to get pregnant. So, if you’re trying to get pregnant, limiting yourself to an occasional glass or two of wine may be a good addition to your fertility checklist.

April is Alcohol Awareness Month. Visit the National Council on Alcoholism and Drug Dependence to learn more about boosting public awareness of alcohol-related problems.

Gilman_BigMamma2Casey A. Gilman, MS, is a PhD candidate in the Organismic and Evolutionary Biology graduate program at the University of Massachusetts Amherst. She was the 2016 American Physiological Society-sponsored AAAS Mass Media Science and Engineering Fellow at The Philadelphia Inquirer. Gilman’s research focuses on the postcopulatory sexual selection in lizards. She is also a freelance writer.

 

Research and Education Help Babies Born Too Early

Newly Born Baby

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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

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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.