Drinking alcohol when pregnant- what are the risks?

Women who drink alcohol and are pregnant at the time are seeking abortions under the misapprehension their babies will suffer foetal alcohol syndrome (FAS).
Drinking alcohol when pregnant- what are the risks?The British Pregnancy Advice Service (BPAS) says there is “no need” for an abortion in such cases, as there is “minimal” damage to babies from isolated episodes of binge drinking by their mothers.

FAS is a rare but serious condition that can cause:

  •     facial deformities
  •     restricted growth
  •     learning and behavioural disorders
  •     a poor memory or short attention span

Statistics for the incidence of the disorder in the UK are not available, but in America, experts say 0.2 to 1.5 cases occur for every 1,000 live births in certain areas of the country.

BPAS says this risk is incredibly small and women should not needlessly fear their behaviour has damaged their baby.

A Danish study in 2012 of more than 1,600 women suggested low-to-moderate drinking was not linked to adverse neurological effects in five-year-olds, but heavy, weekly drinking was associated with a lower attention span in the children.

What are the guidelines for drinking alcohol during pregnancy?

Up until the 1980s, pregnant women were advised to drink stout to boost their iron levels. Official advice today is somewhat different.

Pregnant women should avoid alcohol altogether, says the British government. And if alcohol really must be consumed, it should be limited to the equivalent of one small glass of wine, once or twice a week, it adds.

This advice is mirrored by the Royal College of Obstetricians & Gynaecologists, (RCOG), which says the safest option for women is not to drink at all for the first 12 weeks and then minimal amounts per week after that.

Meanwhile, national guidelines from the National Institute for Health and Care Excellence say women should not drink for the first three months of their pregnancy, to minimise the risk of miscarrying.

And after that, it says pregnant mothers should drink only one to two units a week.

Alcohol can disrupt the baby’s normal development in the womb, its health at birth, susceptibility to illness in infancy, childhood, teenage years and later life, warns the RCOG.
Woman and man drinking Binge drinking during pregnancy tends to have an “all or nothing” effect, says the RCOG

It says the effects of drinking are “most harmful” just before pregnancy, due to the way alcohol hampers fertility, in both men and women – the mechanism of which is largely unknown.

Later in pregnancy, the shared blood supply between the mother and her baby via the placenta means that any alcohol that is consumed could easily reach the baby.

Before this – soon after conception and often prior to the woman finding out she is pregnant – could be a different matter.

There is limited evidence about how alcohol affects the baby before there is a direct line between the mother and baby’s blood supply, which happens about week four of pregnancy, the point at which a woman might be aware of missing her period and suspecting she is pregnant.

Understandably, it is ethically difficult to study. This uncertainty means experts often err on the side of caution when providing advice

The jury is largely out about exactly how much alcohol can be drunk during pregnancy, and when.

New draft guidelines from the government are expected to be released in the middle of next year – until then, the Department of Health suggests anybody concerned they have drunk too much alcohol during pregnancy should contact their doctor.

Being born to young mothers is risk factor for early childhood death

Children born to mothers under 30 are more likely to die than those born to older mums according to a new report on child deaths in the UK.Being born to young mothers is risk factor for early childhood deathWhilst overall child mortality fell by 50% in the past 20 years having a young maternal age was found to be a risk factor for death in early childhood.

The research was led by the Institute of Child Health at UCL.  It looked at why children die in the UK using death registration data from January 1980 to December 2010. It focused on child injuries, birthweight and maternal age to assess the risk factors for child deaths.

The research found that in England, Scotland and Wales, the difference in mortality between children of mothers under 30 and those born to mothers aged 30 to 34 accounted for 11% of all deaths up to nine years old. This is equivalent to an average of 397 deaths in the UK each year, the report said.

Deaths in children born to mothers under 20 accounted for just 3.8% of all child deaths up to nine years old.

The study compared children with similar birthweight in each age category.  It reported that the biggest difference in deaths was in infants aged from one month to one year.

Among this age group, 22% of deaths in the UK were due to “unexplained causes”, the report said, “which are strongly associated with maternal alcohol use, smoking and deprivation”.

The report added that the current policy, which focuses support on teenage first-time mothers, was not wide-ranging enough because mothers aged under 30 account for 52% of all births in the UK.

Ruth Gilbert, lead researcher and professor of clinical epidemiology at UCL Institute of Child Health, said the findings were important.

“Young maternal age at birth is becoming a marker of social disadvantage as women who have been through higher education and those with career prospects are more likely to postpone pregnancy until their 30s. Universal policies are needed to address the disparities.”

The study, commissioned by the Healthcare Quality Improvement Partnership and published by the Royal College of Paediatrics and Child Health, had other key findings.

First, injuries continue to be the biggest cause of death in childhood, but they are declining,

Between 1980 and 2010, injuries accounted for 31% of deaths in one to four-year-olds and 48% of deaths in those aged 15 to 18.

England had consistently lower rates of deaths from injury than the other UK countries, particularly among older boys.

Maternity wards closure crisis

Maternity wards in England are shutting their doors a total of more than 1,000 times a year forcing expecting mothers to seek care elsewhere or give birth at home, according to new figures.
Maternity wards closure crisisUnits in some trusts are closing every other day as staff shortages and a lack of available beds prevent them from admitting new patients.

With wards closing for periods of up to three days at a time, data obtained by The Telegraph suggests more than 1,700 women have been turned away over the past two years.

Patients who went into labour faced the daunting decision of travelling up to 65 miles to the nearest ward with an available bed, or giving birth at home.

In most cases a lack of beds or “capacity” was cited as the reason for closures, which typically lasted several hours at a time and sometimes saw wards shut for several days.

Shortages of midwives, consultants, anaesthetists and other medical staff were the other major cause for turning women away as staff decided it would be unsafe to admit new patients.

Maternity wards are facing growing pressure because of a shortage of midwives and the increasing birth rate, which rose to 688,000 live births in England in 2011 — the highest total since 1971.

The Royal College of Midwives (RCM) warned in a report earlier this year that another 5,000 midwives are needed to deal with the rising number of births, which in some areas has increased by 50 per cent in recent years.

The report, presented to Parliament in January, warned that maternity wards are at a “tipping point” and that antenatal care too has become “threadbare” as midwife recruitment fails to match birth rates.

The new figures, obtained under the Freedom of Information Act, show that 66 NHS Trusts closed their doors at least 1,795 times in 2011 and 2012, with some returning figures for only part of that period. Some 40 trusts did not close at all.

When the 34 trusts with maternity units who did not answer the Telegraph’s request are taken into account, the figures suggest that at least 2,370 closures took place during the past two years.

Trusts reported a total of 1,309 women being directed to other units, equating to 1,728 across the country, but with many not keeping records of numbers being turned away the real figure is likely to be substantially higher.

The data are likely to embarrass the Conservative Party, which repeatedly attacked the previous Labour government for maternity unit closures while it was last in opposition.

Information published by the Tories in 2008 revealed that ten per cent of trusts had shut their doors on at least ten days during the previous year — but the new figures suggest that number rose to an average of 17 per cent over the past two years.

The Telegraph reported in October that there were recent or planned changes to close or downgrade consultant-led maternity wards at 18 hospitals, accounting for about one in nine departments in the country.

Risk of cot deaths rises five times if beds are shared

Sharing a bed with a newborn increases the risk of sudden infant death syndrome fivefold new research claims.
Risk of cot deaths rises five times if beds are sharedThe risk applies even if parents avoid tobacco, alcohol and drugs- other factors which are strongly linked to cot deaths.

The BMJ Open research Bed sharing with parents increases the risk of cot death fivefold even if the parents are non-smokers compared nearly 1,500 cot deaths with a control group of more than 4,500 parents.

Current guidance in the UK is that parents should decide where their baby sleeps, but says the safest option is in a crib or cot in the same room.

Many other countries, such as the US and the Netherlands, go further and say parents should not share a bed with their baby for the first three months of his or her life.

Prof Bob Carpenter, from the London School of Hygiene & Tropical Medicine, carried out the analysis and says the UK should now follow suit and “take a more definitive stance against bed-sharing for babies under three months”.

Prof Carpenter maintains avoiding bed-sharing would save lives – by his calculations, 120 of the 300 cot deaths that occur in the UK each year.

Current advice on Sudden Infant Death Syndrome (SIDS)

  • Place your baby on their back to sleep.
  • Cut smoking in pregnancy, including dads. Don’t let anyone smoke in the same room as your baby.
  • The safest place for your baby to sleep is in a crib or cot in a room with you for the first six months.
  • Never sleep with your baby on a sofa or armchair.
  • Do not let your baby get too hot, and keep their head uncovered.

Source: The Lullaby Trust

In his analysis, one or both parents had been sleeping with their child at the time of death in a fifth of cases.

Only one in every 10 parents in the control group said they had shared a bed with their baby.

Even in very low-risk breastfed babies, where there were no risk factors for sudden infant death syndrome (SIDS) other than that they had slept in their parents’ bed, 81% of cot deaths in infants under three months of age could have been prevented by not bed sharing.

Prof Carpenter says he is not suggesting that babies should be banned from being in the parents’ bed for comfort and feeding.

IVF success rates may be boosted by time lapse embryo imaging

Time lapse imaging- which takes thousands of pictures of developing embryos can boost the success rate of IVF, according to British research.IVF success rates may be boosted by time lapse embryo imagingThe article Retrospective analysis of outcomes after IVF using an aneuploidy risk model derived from time-lapse imaging without PGS was reported in Reproductive BioMedicine Online, can be used to select embryos at low risk of defects.

Scientists at the CARE fertility group say such informed selection can improve birth rates by 56%.

Other experts say the result is exciting, but the study of 69 couples is too small to be definitive.

The research followed the couples at the CARE fertility clinic in Manchester last year, when 88 embryos were imaged and implanted.

The process involves putting the embryos into an incubator and imaged them every 10 to 20 minutes.

Continual embryo monitoring through time-lapse imaging is aimed at selecting those with the lowest risk of aneuploidy – where the cells have chromosome abnormalities. Aneuploidy is the single biggest cause of IVF failure.

But this form of embryo screening is a predictive rather than diagnostic tool.

Couples at high risk of passing on a chromosomal abnormality may prefer to have Pre-implantation Genetic Screening. This invasive test removes cells from the early embryo for analysis. It costs around £2,500 on top of the £3,000 charged for conventional IVF.

The researchers classified the embryos as low, medium or high risk of chromosome abnormalities based on their development at certain key points.

Eleven babies were born from the low risk group (61% success rate) compared to five from the medium risk group (19% success rate) and none from those deemed high risk.

“In the 35 years I have been in this field this is probably the most exciting and significant development that can be of value to all patients seeking IVF,” said Prof Simon Fishel, managing director of CARE Fertility Group.

“This technology can tell us which embryo is the most viable and has the highest potential to deliver a live birth – it will have huge potential. This is almost like having the embryo in the womb with a camera on them.”

In standard IVF, embryos are removed from the incubator once a day to be checked under the microscope. This means they briefly leave their temperature-controlled environment and single daily snapshots of their development are possible.

Obese women restricted in NHS IVF treatments

New NHS IVF treatment rules have been drawn up in Scotland.
Obese women restricted in NHS IVF treatmentsCouples who need help conceiving will be guaranteed two free infertility treatments from 1 July, however the treatments will only be available to those under 40, and it will not be offered to women who are obese.

In addition, couples need to have been in a stable relationship for two years and neither partner can smoke for three months before treatment begins.

Both partners also need to be methadone-free for a year before IVF starts

If either partner smokes they will need to have stopped before treatment is commenced

Women aged between 40 and 42 will be eligible for one cycle of fertility treatment if they have never previously undergone the procedure.

The new IVF criteria has been approved by the Scottish government.

The guarantees came as the National Infertility Group published a report with recommendations on new criteria.

The eligibility criteria for free fertility treatment in Scotland currently includes a female age limit of 39; the patient must not already have a child living at home; and they must have had less than three previous funded embryo transfers.

Scotland’s Public Health Minister Michael Matheson said the government was committed to “providing fair, reliable and faster access to IVF treatment”.

He insisted that it was important to end the different approaches across the country and to offer “equity”.

“We are investing £12 million over three years to help drive down waiting times for IVF treatments, and waiting times are already reducing in a number of NHS board areas.

“We also have to be responsible about the effects of smoking and obesity on pregnancy and beyond. Smoking not only reduces the effectiveness of IVF, but also doubles the risk of pregnancy loss.

“NHS boards will offer patients the support needed to make the lifestyle changes demanded of the new criteria.

“The safety of mother and baby is of utmost importance and the recommendations will ensure healthier outcomes for both families and babies born as a result of IVF treatment.”

Local maternity wards top the list of pregnant womens’ priorities

Pregnant women list the proximity of their local hospital or birthing centre as their top priority in their birth experience, according to a survey.Local maternity wards top the list of pregnant womens' prioritiesA quarter of British mothers listed the location of the birthing unit as their top priority when asked to identify the most important thing about their experience of giving birth.

The importance of the proximity to the hospital increased as women prepared to give birth to second (26 per cent) and third (30 per cent) children.

But while women see local maternity care as their top priority, the NHS is considering closing maternity units across the country in order to cut costs. A report published last year by the Royal College of Obstetricians and Gynaecologists recommended merging services into super-units.

Also high on the list of priorities for first-time mothers were: having a private room (14 per cent); access to a birthing pool (10 per cent); and having space for a partner stay overnight (nine per cent). As women prepared to give birth to second or third children, pools and partners, in particular, dropped in popularity, with only five per cent of women listing pools as a priority, and only four per cent citing an over-night stay by their partner as a key consideration.

While issues of comfort and personal, home-from-home care scored highest in the priorities of the women polled, a third of women said their top concerns were around the act of giving birth.

Fourteen per cent said their top priority was to have midwife-led care, whereas just 5 per cent of women polled said it was most important to them to have doctor led care. Another 11 per cent of women said that giving birth in a hospital with a good neonatal ward was their top priority.

“The fact that women want greater choice when it comes to giving birth is of little surprise; through our More Midwives campaign, WI members have been telling us that being able to make a choice about where and how they give birth is one of their greatest hopes,” said Ruth Bond, Chair of the National Federation of Women’s Institutes.

“Despite welcome commitments from the Government to overhaul maternity services, the number of midwives is not keeping pace with the ongoing the baby boom; this translates into fewer choices for women, and ultimately, an unsustainable strain on the system,” said Ms Bond.

The desire for midwife-led care comes days after the Royal College of Midwives gave warning that an extra 5,000 midwives were needed in England alone to deal with the highest birth rate in 40 years.

The poll, conducted by Bounty in conjunction with Ipsos/MORI, surveyed nearly 900 new mothers across Britain, exclusively for Telegraph Wonder Women.

From: http://www.telegraph.co.uk/Local-maternity-wards-top-list-of-womens-priorities-when-giving-birth

Men need to become match fit if they want to be fathers

Men have been warned they need to become ‘match fit’ if they want to be fathers, as a fertility study claims too much attention has been focused on mothers’ weight.Men need to become match fit if they want to be fathersWhile the health risks surrounding obesity and pregnancy have largely been centred on overweight mothers, the focus is now on men to lose weight.

Less efficient sperm results in smaller foetuses, poor pregnancy success and reduced placental development.

The discovery was made by reproductive experts from the University of Melbourne, Australia.

World Health Organisation figures show that a staggering 48 per cent of adult males are overweight or obese – making the findings even more of a worry.

The research was conducted by Professor David Gardner, Dr Natalie Hannan and PhD student Natalie Binder.

Prof Gardner, Head of the Department of Zoology, said: “A lot of men don’t understand they need to be healthy before conceiving. Sperm needs to be ‘match fit’ for the games of life and creating life is the biggest thing that we can do.”

The study used IVF to determine the effects of paternal obesity on embryo implantation into the womb and foetal development.

PhD candidate Natalie Binder generated embryos from both normal weight and obese male mice.

She said: “We found development was delayed in the foetuses produced from obese fathers.  Furthermore, placental weight and development was significantly less for embryos derived from the sperm of obese males.

These findings indicate that paternal obesity not only negatively affects embryo development, but also impacts on the successful implantation into the womb.

“This then results in a small placenta which impairs fetal growth and development with long term consequences for the health of the offspring. Our study provides more information about the impact of obesity in men and their ability to start a family and the need to shed kilos in preparation to conceive.”

The findings were presented at the Annual Scientific Meeting of the Endocrine Society of Australia and the Society for Reproductive Biology 2012.

From: http://multi-vitamins.eu/men-need-to-become-match-fit-if-they-want-to-be-fathers

Maternity units must be closed to make childbirth safer

Maternity units must be shut and merged in to big new ‘super-units’ to help women give birth safely experts say.Maternity units must be closed to make childbirth saferThe NHS maternity system is “unsustainable” and its out of hours care, which is “propped up by junior doctors”, is often poor, according to a new report RCOG release: Education and training of specialists to radically change published by the Royal College of Obstetricians and Gynaecologists.

The college recommended that services be merged into super-units providing specialist, round-the-clock cover with consultants working nights and weekends.

A “flexible workforce” must be created by giving doctors new training, so that more patients can be treated in community hospitals, local clinics, and even mobile health units, the report said.

The college argues that wards can only continue to be staffed by fully trained doctors through a process of downgrading or the merger of many local units, so that women with more complex problems can be moved on to a larger centre.

The report said: “The college is adamant that the obstetric delivery suite needs fully qualified specialists available at all times, 24 hours a day, seven days a week – more than half of all births, after all, take place ‘out of hours’.

“That requires more specialists which raises the issue of affordability. This may mean fewer acute obstetric units so that for the more specialised obstetric care women may have to travel farther as the service applies the logic that care should be ‘localised where possible, centralised where necessary’.”

Patient deaths in London were halved when services from hospitals were streamlined into only eight specialised units.

According to one recent study, babies born “out of hours” are a third more likely to die than those born during the working week.

Dr Wendy Reid, vice-president of the Royal College, said: “When you have a baby you deserve the same quality of care at 3am as at 3pm. We cannot go on running the NHS in our specialty propped up by junior doctors.

She added: “My focus has to be on patient safety because if you don’t get that right, you don’t have much of a right to comment on anything else.

“That’s why we’re pushing for specialists available on the labour ward, because that’s the high risk time. But that isn’t to the exclusion of interaction with the team all along the pregnancy so that you pick up as many people as potentially high risk before it happens.”

Infections after caesarean birth higher than other operations

One in ten women who give birth by caesarean section develop an infection, a study has found- which is a much higher rate than for similar operations.Infections after caesarean birth higher than other operationsIt suggests that 15,000 women a year in England suffer an infection after their caesarean birth, the researchers said.

The study found that 9.6 per cent of women having caesarean section births developed an infection afterwards compared with just 6.6 per cent of women having a hysterectomy.

As one in four births are by caesarean, experts said the infections are a serious problem for both patients and add extra costs for the NHS.

Being overweight, aged under 20 and having the operation performed by a more junior doctor than a consultant increased the risk of infection even more.

The study investigated almost 400 infections in more than 4,000 caesarean births during 2009.

The findings Infection following a caesarean is more likely if you are obese, suggests new research were published in the British Journal of Obstetrics & Gynaecology surprised experts because the operation is considered relatively ‘clean’ unlikely surgery involving the large bowel which results in 13 per cent of patients suffering infections.

Of the 394 women who developed an infection, the majority had been given antibiotics as a precaution.

Most infections were not serious however seven per cent were more serious and would have required an additional stay in hospital and a further five per cent were deep infections which may have required further surgery.

Women who were overweight were 60 per cent more likely to develop an infection and those who were obese were almost 2.5 times more likely to have an infected wound.

Women aged under 20 were almost twice as likely to have an infection compared with those aged 25 to 30 and having an associate specialist or staff grade doctor perform the operation instead of a consultant increased the risk by 60 per cent.

Dr Elizabeth Sheridan, Head of Healthcare Associated Infections at the HPA, said: “Reducing rates of surgical site infections following a caesarean should be made a priority.

“Given that one in four women deliver their baby by caesarean section, these infections represent a substantial burden. They will impact not only directly on the mother and her family but also are a significant cost in terms of antibiotic use, GP time and midwife care and every effort should be made to avoid them.

“Women choosing to have caesarean section for non-medical reasons should be aware of the risk of infection, particularly if they are overweight.”

“As has been seen in both this study and several others, there is an established link between BMI and an increase in the risk of developing a surgical site infection. Monitoring infections in women having a caesarean section is important as a means to drive down infection rates.”

“As levels of obesity are rising, optimising surgical techniques and identifying the most appropriate dosing of antibiotics could provide a means for reducing wound infections in obese women.”

Lead author Dr Catherine Wloch, Department of Healthcare Associated Infection and Antimicrobial Resistance at the Health Protection Agency said: “This study has identified high rates of surgical infection following a caesarean with one in ten women developing an infection. Whilst our study didn’t measure this, these infections are likely to have an impact on a woman’s experience and quality of life.

“Although most caesarean section wound infections are not serious, they do represent a substantial burden to the health system, given the high number of women undergoing this type of surgery. Minor infections can still result in pain and discomfort for the woman and may spread to affect deeper tissues. The more serious infections will require extended hospital stays or readmission to hospital.

“Prevention of these infections should be a clinical and public health priority.”

John Thorp, BJOG Deputy-Editor-in-Chief said: “With the rise in numbers of women having a caesarean section and the rise in obesity rates, this issue is an important one.

“Post-surgical infection can seriously affect a woman’s quality of life at a critical time when she is recovering from an operation and has a new born baby to look after. More needs to be done to look into this and address ways of reducing infection.”