Reproductive health and pregnancy planning

A resource focusing on reproductive choice and ensuring that pregnancy, if desired, occurs at the right time and when health is optimised | Public Health England

reproductive
Image source: http://www.gov.uk

This resource for professionals working with women and men that may have children in the future focuses on reproductive choice and ensuring that pregnancy, if desired, occurs at the right time and when health is optimised. Effective contraception and planning for pregnancy mean that women and men stay healthy throughout life and take steps to improve the health of the baby.

Mother’s attitude towards baby during pregnancy may have implications for child’s development

University of Cambridge | June 2018 | Mother’s attitude towards baby during pregnancy may have implications for child’s development

A meta-analysis which used data from 14 studies to explore if there was a relationship between the way parents think about their child during pregnancy and their behaviour towards them after birth.

The  research team from the Centre for Family Research at the University of Cambridge considered parents’ attitudes and feelings about their unborn child analysing the qualitative data from previous studies which included interviews and questionnaires.

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Studies included in the meta-analysis examined parents’ thoughts and feelings about their child during pregnancy through interviews and questionnaires, and researchers also reviewed their attitudes and emotions in the postnatal period.

If the parents to be demonstrated positive anticipation of their relationship with the child and viewed them as an individual the researchers determined them to have a ‘balanced’ representation of their child. By contrast parents considered to have a ‘distorted’ view for instance would have an idealised description of their child much narrower in scope.  In the studies included in this research, researchers had observed interactions and child observing their ‘sensitivity’ towards their child responding appropriately to the baby, for example recognising  their distress

After combining the results from all 14 studies, the team identified a modest association between positive thoughts and feelings about the infant during pregnancy and later interaction with the infant, but only in mothers.

“Studies have shown that parent-child interaction is crucial for a child’s development and learning, so we wanted to understand if there were prenatal signs that might predict a parent’s behaviour,” says Dr Sarah Foley, the study’s first author.

“Although we found a relationship between a mother’s attitude towards her baby during pregnancy and her later interactions, this link was only modest. This suggests it is likely to be a part of the jigsaw, rather than the whole story” (via University of Cambridge).
The study has now been published in the Development Review

Abstract

Drawing on data gathered from 14 studies involving a total of 1862 mothers and fathers, this meta-analysis reviews the measures that are used to tap into thoughts and feelings about the unborn infant during pregnancy and examines links between these prenatal measures and parent-child interaction quality. Questionnaire scores for parental-fetal attachment and interview ratings of expectant parents’ representations of their infant showed modest but robust associations with observed parent-child interaction quality. Moderator analyses showed that these associations were significantly stronger for mothers than for fathers. Key lessons for future research include the need for greater consistency in study measures, sample diversity and the examination of associations with child outcomes.

Full reference:

Foley, S and Hughes, C. | Great expectations? Do mothers’ and fathers’ prenatal thoughts and feelings about the infant predict parent-infant interaction quality? |A meta-analytic review| Developmental Review| June 2018 | DOI: 10.1016/j.dr.2018.03.007

Rotherham NHS staff can request the article here 

 

Simple bacteria test could halve number of premature births

Tommy’s | June 2018 | New bacteria test could half premature birth rate

Scientists have developed a new test to identify harmful bacteria which they say might prevent up to half of premature births; the test identifies if  women carry a harmful bacteria in their reproductive tract. The researchers from Genesis Research Trust
have indicated that the test could be used to 
identify the risk at routine check-ups, helping ensure early intervention.  The team are now trialing the use of supplements to replace these dangerous microbes with “good bacteria” (via Tommy’s). 

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Further information is at Tommy’s 

In the media:

The Telegraph Half of premature births could be avoided with simple bacteria test

Noninvasive blood tests for fetal development predict gestational age and preterm delivery

Ngo,  Thuy, T. M. et al | Noninvasive blood tests for fetal development predict gestational age and preterm delivery | Science : 1133-1136 |Vol. 360,  6393| pp. 1133-1136 | DOI: 10.1126/science.aar3819

A non-invasive blood test has been developed that can predict the baby’s gestational age. The test, which comprises two blood tests is as accurate as ultrasound, according to the researchers who developed it.  The first blood test is able to estimate the baby’s age and delivery date. The second test was able to identify women at risk of delivering prematurely. Now the tests will be assessed through blinded, clinical trials.

The research has  been published in the journal Science 

Abstract

Noninvasive blood tests that provide information about fetal development and gestational age could potentially improve prenatal care. Ultrasound, the current gold standard, is not always affordable in low-resource settings and does not predict spontaneous preterm birth, a leading cause of infant death. In a pilot study of 31 healthy pregnant women, we found that measurement of nine cell-free RNA (cfRNA) transcripts in maternal blood predicted gestational age with comparable accuracy to ultrasound but at substantially lower cost. In a related study of 38 women (23 full-term and 15 preterm deliveries), all at elevated risk of delivering preterm, we identified seven cfRNA transcripts that accurately classified women who delivered preterm up to 2 months in advance of labor. These tests hold promise for prenatal care in both the developed and developing worlds, although they require validation in larger, blinded clinical trials

The full article can be downloaded from Science

In the media:

BBC News Premature birth test being trialled

The importance of parents’ diet and lifestyle prior to conception

The authors of three papers published in The Lancet argue that parents’ diet and health may impact on the health of the child long before conception.  
Academics at the University of Leeds are among the authors of the papers.
Janet Cade, Professor of Nutritional Epidemiology and Public Health at Leeds, said: “Our work shows that many non-pregnant women may not be best prepared nutritionally for pregnancy with low intakes of fruit and vegetables, some key vitamins and minerals and high rates of overweight/obesity.

“Improved support and practical tools are needed to help people understand how, even before a woman becomes pregnant that parental lifestyle including weight and diet can influence the health of their children.” (via University of Leeds)
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They recommend interventions which begin in adolescence to support young people prepare for potential parenthood. In young adults this could engage them to think about healthy lifestyles and the impact of this in later life, during pregnancy and for future generations. Equally, for those with no plans to become a parent, they call for improved public awareness of preconception health. For adults planning a pregnancy the authors emphasise a need for improved support and practical tools to aid preconception health.

Executive Summary

Health and nutrition of both men and women before conception is important not only for pregnancy outcomes but also for the lifelong health of their children and even the next generation. The preconception period can be seen in three different ways: from a biological standpoint as the days and weeks before embryo development; from the individual perspective as the time of wanting to conceive; and through a population lens as any time a women is of childbearing age. This Series of three papers highlights the importance and summarises the evidence of preconception health for future health and suggests context-specific interventions. It also calls for a social movement to achieve political engagement for health in this particular phase in life. (From The Lancet)

Click on the title of each article to read its summary

Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health

Intervention strategies to improve nutrition and health behaviours before conception

Origins of lifetime health around the time of conception: causes and consequence

The articles can be requested by Rotherham NHS staff here

 

Women in a quarter of the UK still can’t access vital maternal mental health services

New maps launched today by the Maternal Mental Health Alliance show that pregnant women and new mothers in a quarter of the UK still cannot access lifesaving specialist perinatal mental health services.

background-2410669_1920According to new data, pregnant women and new mothers in 24% of the UK still have no access to specialist perinatal mental health services. In its press release, the Maternal Health Alliance makes the point that in the most serious cases, perinatal mental illness can be life threatening: suicide is a leading cause of death for women during pregnancy and one year after giving birth.

With more than 1 in 10 women developing a mental illness during pregnancy or within the first year after having a baby, it is important women with the most severe perinatal illnesses have access to vital specialist services wherever they live. If left untreated these illnesses can have a devastating impact on women and their families.

Full press release: Women in a quarter of the UK still can’t access vital maternal mental health services

Full detail: UK Specialist Perinatal Mental Health Community Teams (2017 data)

Related: Women across UK denied mental healthcare around childbirth, say doctors | The Guardian

How common are fetal alcohol spectrum disorders?

May, P. , A.  et al. | Prevalence of Fetal Alcohol Spectrum Disorders in 4 US Communities | JAMA| 2018| 319| Vol. 5| DOI: 10.1001/jama. 2017.21896

Researchers from University Of California,  Sand Diego School of Medicine looked at 4 regions in the US between 2010 and 2016, examined the incidence of fetal alcohol spectrum disorders (FASD); found that a significant number had fetal alcohol spectrum disorders.  The findings of this study, may represent more accurate prevelance rates of  FASD  than previous studies indicate.

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Abstract

Importance  Fetal alcohol spectrum disorders are costly, life-long disabilities. Older data suggested the prevalence of the disorder in the United States was 10 per 1000 children; however, there are few current estimates based on larger, diverse US population samples.

Objective  To estimate the prevalence of fetal alcohol spectrum disorders, including fetal alcohol syndrome, partial fetal alcohol syndrome, and alcohol-related neurodevelopmental disorder, in 4 regions of the United States.

Design, Setting, and Participants  Active case ascertainment methods using a cross-sectional design were used to assess children for fetal alcohol spectrum disorders between 2010 and 2016. Children were systematically assessed in the 4 domains that contribute to the fetal alcohol spectrum disorder continuum: dysmorphic features, physical growth, neurobehavioral development, and prenatal alcohol exposure. The settings were 4 communities in the Rocky Mountain, Midwestern, Southeastern, and Pacific Southwestern regions of the United States. First-grade children and their parents or guardians were enrolled.

Exposures  Alcohol consumption during pregnancy.

Main Outcomes and Measures  Prevalence of fetal alcohol spectrum disorders in the 4 communities was the main outcome. Conservative estimates for the prevalence of the disorder and 95% CIs were calculated using the eligible first-grade population as the denominator. Weighted prevalences and 95% CIs were also estimated, accounting for the sampling schemes and using data restricted to children who received a full evaluation.

Results  A total of 6639 children were selected for participation from a population of 13 146 first-graders (boys, 51.9%; mean age, 6.7 years [SD, 0.41] and white maternal race, 79.3%). A total of 222 cases of fetal alcohol spectrum disorders were identified. The conservative prevalence estimates for fetal alcohol spectrum disorders ranged from 11.3 (95% CI, 7.8-15.8) to 50.0 (95% CI, 39.9-61.7) per 1000 children. The weighted prevalence estimates for fetal alcohol spectrum disorders ranged from 31.1 (95% CI, 16.1-54.0) to 98.5 (95% CI, 57.5-139.5) per 1000 children.

Conclusions and Relevance  Estimated prevalence of fetal alcohol spectrum disorders among first-graders in 4 US communities ranged from 1.1% to 5.0% using a conservative approach.

The full article is available for Rotherham NHS staff from the hospital library or can be requested here