Pregnancy: Blood Test Could Predict Risk Of Having Dangerously Small Babies

Dr. Enrique Jacome

Researchers from the Ottawa Hospital Research Institute (OHRI) and the University of Ottawa (uOttawa) have found a protein in the blood of pregnant women that can predict if they are likely to have a fetus that doesn't grow properly, and thus has a high risk of stillbirth and long-term health complications. The research, led by Dr. Andrée Gruslin, could lead to a widely available blood test and could help develop ways for improving the outcomes of women and their children who face this risk - estimated to be as many as one of every 20 pregnancies. 

Dr. Gruslin's study, published in the Journal of Clinical Endocrinology and Metabolism, focuses on a protein called Insulin Growth Factor Binding Protein 4 (IGFBP-4). While this protein has been linked to pregnancy before, this study is the first to demonstrate its important role in human pregnancy complications. A key part of the study involved examining IGFBP-4 levels in first trimester blood samples from women who participated in a large study of pregnancies and newborns called the Ottawa and Kingston (OaK) birth cohort. 

Dr. Gruslin found that women with high levels of IGFBP-4 were 22 times more likely to give birth to tiny babies (defined as the smallest five per cent by weight for their gestational age), than women with normal levels of IGFBP-4. This part of the study involved a total of 72 women - half with tiny babies and half with normal weight babies. 

"Usually, we don't find out until later in a pregnancy that a fetus isn't growing properly, but this test can tell us in the first trimester if there's likely to be a problem," said Dr. Gruslin, a Scientist at OHRI, High Risk Obstetrician at The Ottawa Hospital and Professor in the Faculty of Medicine at uOttawa. "By identifying these high-risk pregnancies early on, we will be able to monitor these women more closely and hopefully help them deliver a healthier baby." 

The IGFBP-4 blood test is still experimental, but Dr. Gruslin hopes to develop a refined version that could be made available to all pregnant women within the next couple of years. She also hopes that her studies on IGFBP-4 could lead to new approaches that would improve fetal growth in high-risk pregnancies. This condition, called Fetal Growth Restriction or Intrauterine Growth Restriction, is thought to affect three to five per cent of all pregnancies, and cause close to half of all stillbirths. Babies born with this condition also have a higher risk of developing serious health complications in infancy and childhood, as well as chronic diseases such as hypertension and diabetes in adulthood. Fetal Growth Restriction is thought to occur when the placenta, which provides nourishment and oxygen for the fetus, doesn't grow properly. Research by Dr. Gruslin and others suggests that IGFBP-4 blocks the activity of a key placental growth hormone called IGF-II, which results in poor growth of the placenta and fetus. Dr. Gruslin and her team are already testing a number of strategies for targeting IGFBP-4 to improve placental and fetal growth. 

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Brain Aneurysm Risk Is Raised By Early Menopause

Dr. Enrique Jacome

How old a women is when she experiences menopause can influence her risk of having a brain (cerebral) aneurysm, researchers say.

The study, published online first in the Journal of NeuroInterventional Surgery, found that the younger a women is duringmenopause, the more likely she is to have a cerebral aneurysm.

A cerebral aneurysm occurs when a blood vessel in the brain enlarges and is usually only discovered once it ruptures, causing a potentially lethal and/or disabling bleed. 

According to the researchers, men are less likely to experience cerebral aneurysms than women. The development of aneurysms have been associated with fluctuations in the female hormone oestrogen and after menopause the incidence of aneurysms, along with heart disease, increase significantly.

The researchers enrolled 76 postmenopausal women who had had a brain aneurysm to participate in the study. In the majority of cases the womens' aneurysms had not ruptured. The team then asked participants questions regarding their reproductive and medical histories.

The age at which periods start and stop, as well as the number of pregnancies a women experiences determine lifetime exposure to oestrogen, while diabetes, high cholesterol,hypothyroidism, and hypertension can all increase the risk of stroke. 

The researchers then compared the information from study participants to information taken from more than 4,500 women who took part in the 2002 National Institute of Child Health and Human Development Contraceptive and Reproductive Experiences Study. The team then matched all the information for educational attainment and age.

According to the researchers, the average age at which women experience menopause was comparable in both groups. They found that women who went through menopause at an older age were 21% less likely to have an cerebral aneurysm. In addition, those who used hormone replacement therapy (HRT) were 77% less likely to experience an aneurysm.

26% (1 in 4) of the women who had experienced an aneurysm started menopause before the age of 40 vs. 19% of women in the comparison group. 

Furthermore, the team found that each successive four year increase in the age at which a woman experienced menopause reduced the risk of having a brain aneurysm by approximately 21%. The researchers found that although smoking did not increase the risk, alcohol consumption was of borderline significance.

Around 1 in 2 people who have a ruptured cerebral aneurysm are likely to die, while 1 in 10 die before they arrive at hospital. Furthermore, of those who survive, 1 in 5 are left severely disabled. Therefore, finding a potential marker may help medical professional identify the condition sooner.

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New Method For Detecting Fetal Down Syndrome And Edwards Syndrome Shows Promise

Dr. Enrique Jacome

A new study, published online in the American Journal of Obstetrics and Gynecology states that false positive and false negative results have been produced by current Down syndrome and Edwards syndrome screening methods, but researchers have found a new genetic test which is close to 100% accurate. 


The research shows that Down syndrome, caused by fetal trisomy 21 (T21) and Edwards syndrome, caused by fetal trisomy 18 (T18) have false negative rates of 5% or higher, and false positive rates from 2-3%. 


When a screening result comes back as positive, it is necessary to confirm the positive result by using chorionic villus or amniocentesis sampling, which results in 1 fetal death per every 300 procedures.

To find the new method, researchers used Digital Analysis of Selected Regions (DANSR), which examines fetal cell-free DNA, the small DNA parts which in pregnant mothers, circulates in the bloodstream. 

The study states that this test is different than others because DANSR solely examines the chromosomes which need to be looked at. Therefore, the course of action is quicker and not as expensive as other methods. 

To determine the results, a breakthrough technique is used, called the Fetal-fraction Optimized Risk of Trisomy Evaluation (FORTE). The FORTE looks at percentages of fetal DNA present in the sample and risks related to age in order to find out whether there is a risk of trisomy in the baby. 

4,002 pregnant women with an average age of 34.3 years, with a range of different ethnicities and races, from Sweden, the Netherlands, and the U.S were part of the NICE (Non-Invasive Chromosomal Evaluation). 

Before undergoing any testing to determine if there was a risk of trisomy, the women had their blood taken, which resulted in 774 samples being taken out of the trial before continuing. Of the remaining 3,228 samples, 91 were discarded because they failed to meet testing standards. In addition, 57 were counted out because the fetal cfDNA was low.

The High Risk and Low Risk analyses, determined by using the DANSR and FORTE were compared with outcomes from CVS and amniocentesis. 

Of the 81 T21 cases that were determined as High Risk, the DANSR and FORTE method identified 100% of them, and only had one false positive when it came to the 2,888 normal results. This gave the DANSR and FORTE method a false-positive rate of only 0.03%.

In addition, out of 38 T18 cases, 37 which were determined as High Risk by the method and 2 false positives were detected. This means the method had a success rate of 97.4% and a false positive rate of only 0.07%

Mary E. Norton, MD, director of perinatal research at Lucile Packard Children's Hospital at Stanford University commented: 

"The improvement in sequencing efficiency achieved by the DANSR platform provides a more affordable, scalable approach to cfDNA analysis with high throughput and potential for widespread clinical utility. Cell-free DNA offers high accuracy with a single blood test. It is potentially suitable as a replacement for current, relatively inefficient aneuploidy screening."

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Foods That Will Keep You Hydrated In The Summer

Dr. Enrique Jacome

Now that summer is almost here, it is important to stay hydrated. The scorching heat of the sun usually leads us to profuse sweating; the body loses water hence we need to maintain the required level of water. Dehydration can lead to loss of energy, headaches and decreased metabolism. Every individual should drink at least 8 glasses of water each day in order to avoid dehydration. However, drinking water is not the only way to stay hydrated; there are some kinds of food which increase the level of hydration in our body. 


Hydrated foods like fruits and vegetables do not only increase the level of water in our body but also gives fiber, protein and other nutrients which are necessary for the body! We will be discussing some kinds of food items that can help you stay hydrated:

Cucumber
Cucumbers have high water content, like many other fruits and vegetables. However eating cucumber would not only help in the hydration process but it would also provide you with many nutrients like Vitamin C. Hence try to add cucumber in your diet plan; you could eat plain cucumber or use it to make a cool refreshing drink!

Coconut Water
One of the best and easiest ways to beat the heat and to stay hydrated is drinking coconut water! Coconut water replaces the water content that is lost when you sweat during hot climate. This is one item that is easily available in many stores. So when you feel hot chose to have coconut water.

Apple
There is a reason behind the saying “an Apple a day keeps the doctor away”! Apples can not only help you to hydrated, but is also rich in various nutrients and helps one to avoid many diseases including cardiac diseases and even cancer. There are many different ways in which you can enjoy this fruit; pies, drinks or even plain. Just try to include an apple in your daily diet.

Pineapple
Pineapple, most of you guys enjoy this fruit with your desserts, salads and drinks like Pina colada. This fruit has high water content which helps you to stay hydrated! It also has other benefits like it helps to lose weight and they also help with the digestion process.

Carrots
This particular vegetable has 90 percent water content! Carrots also help to reduce the chances of any heart diseases; they improve the eyesight and have antioxidants as well. You could use carrot to make your salad however in this hot weather a glass of carrot juice sure sounds appealing!

Berries
Strawberries, blackberries and blueberries most of us are in love with one or more of these fruits already. However these seasonal fruits do not only help in the detoxification of the body but they also have high water content that help to stay hydrated. So when they are in season make sure to stock them up for summer!

Lettuce
Lettuce is one of the vegetables that have the highest water content that is more than 90 percent. This particular vegetable could be used to make excellent salads, try to get used to eating green salads because the benefits derived are not only limited to hydration; there are many other health benefits.

We now know that water is not the only thing that helps to hydrate the body, however it is important to understand that even though we have food substitutes for water; water itself is very important and this is one drink that helps you to the hydrate the most! So keep on drinking water but also try to include these food items in your diet as well.

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Tips To Help You Minimize Morning Sickness

Dr. Enrique Jacome

According to US and UK data from public health authorities, morning sickness affects over half of all pregnant mothers. It is generally related to an increase in estrogen levels, low blood sugar counts, and a greater susceptibility to some smells. More often, morning sickness will be present in the early hours of the morning and will ease up somewhat as the day goes on.

Morning sickness is also known as nausea gravidarum, nausea, vomiting of pregnancy (emesis gravidarum), or pregnancy sickness. At times, morning sickness can be mild. However, the pregnant mother may at other times feel so nauseous that she will vomit. Even though morning sickness can be extremely unpleasant, it is hardly ever severe enough to cause metabolic derangement. In most cases, morning sickness settles down by the end of the first trimester. Morning sickness is more likely to occur during the first three months of a pregnancy.Here are a few tips you can put in to practice to minimize unpleasant morning sickness symptoms:

1. Get plenty of rest. 
   
   You must ensure you get a good night´s sleep - wear a sleep mask, or even dark glasses, to block out as much light as possible. You might also consider a maternity body pillow that will properly help you support your back and stomach.
   
2. Get up slowly
   
   Don't be in a hurry to get out of bed when you wake up. Take your time.


3. Avoid some types of foods
   
   Avoid fatty and/or spicy foods. Avoid caffeine as well.


4. Food portion sizes - have small ones.
   
   It is important to always have some kind of food in your stomach, as this will lower your chances of experiencing nausea - and if you do, most likely symptoms will be milder. If the stomach is empty, the acids have nothing to workon, except for the stomach lining, resulting in worsening nausea.
   
   Have some salty crackers, peanut butter snacks, or some other protein snack before you get out of bed in the morning.
   
   At breakfast, cold apple sauce, pears, bananas or any citrus fruit will help you feel satisfied early. Baked potatoes, although, less tasty for many, are highly nutritious. The fruit's potassium may help prevent morning sickness. At night, try eating something high in protein snack/meal before going to bed, as this will help regulate your blood-glucose levels.
   
5. Computer monitor flicker. 
   
   The rapid, almost unnoticeable flickering of the computer monitor could cause morning sickness. If you are susceptible to morning sickness due to monitor flicker, try to avoid using a computer completely. If you must, you should adjust the screen by making the fonts bold and larger and changing the background to a soft tan or pink color - this will help reduce eye strain.


6. Physical activity. 
   
   Some mothers may find it hard to move around if they feel lousy. However, being physically active has been found to improve symptoms in many people.


7. Fluid intake. 
   
   Being hydrated is crucial for good health, and very important during pregnancy. Some mothers with morning sickness may not feel like consuming their recommended eight glasses of water per day, especially if their stomachs seem not to let them. However, the more dehydrated you are, the more nauseated you will become.
   
   If drinking water is hard, try adding apple cider vinegar and honey. Some mothers say flat Sprite helps, or decaffeinated cola. Sucking ice cubes made from water or fruit juice is also an effective method. The colder the drink, the easier it is to consume.


8. Ginger. 
   
   For many years, ginger has long been publicized as a stomach soother, and studies have shown that it may help relieve nausea symptoms. Sipping cold ginger ale, or adding a slice of raw ginger to water or tea may help sooth your stomach.
   
   
9. Keep your mind occupied. 
   
   It is important to try to take your mind off the nauseous feelings. Finding things to do might not be easy. Reading a book, doing puzzles, watching television, playing cards, or going for short walks around the block will clear your mind and relax you. However, you must also listen to your body, and stop whenever necessary.


10. Wear loose and comfortable clothing. 
    
    Restrictive or tight clothing may exacerbate the symptoms of morning sickness. Studies have found that pregnant mothers with nausea who switched from tight to loose-fitting clothing reported either reduced symptoms or non at all.


11. Consider using children's vitamins instead of regular pre-natal vitamins. 
    
    Children's vitamins are usually easier to digest.


12. Sniff fresh scents. 
    
    Morning sickness is very much smell-associated - the pregnant mother becomes more sensitive to odors. Certain ugly smells, smells you cannot get away from, and potent smells such as perfumes can trigger an episode of unpleasant nausea. The most effective scents, according to self-reports, are lemon extract and/or rosemary.
    
13. Triggers
    
    There are several triggers that can bring on an episode of nausea and a general feeling of being unwell due to morning sickness. Most people will soon identify what they are. Avoid them as much as you can, and your frequency of nausea and/or vomiting will reduce, as will severity of symptoms.


14. Acid reflux
    
    Sometimes, the náusea and vomiting may be due to acid reflux. Taking antacid medication before going to bed may help reduce stomach acid levels, and the subsequent morning vomiting. Check with your doctor before buying any medication during pregnancy.


15. Iron pills or iron-containing multivitamins
    
    Some pregnant women may become nauseous because of the iron supplements they have been told to take. Talk to your doctor and ask him/her to recommend a slower-release form, or even possible a lower dosage.


16. Acupressure
    
    Applying pressure on specific points on the body to control symptoms has been shown to help some women with morning sickness. In this case, it involves wearing a special band on your forearm.

Hyperemesis gravidarum - excessive vomiting during pregnancy. This may lead todehydration and malnutrition. A woman with hyperemesis gravidarum may weigh over 5% less than she did before she was pregnant.

About 1 in every 300 pregnant women develop hyperemesis gravidarum. The condition does not usually persist beyond the 20th week of pregnancy. Our office may recommend dietary changes, plenty of rest and the use of antacids. In severe cases the patient may need to receive fluids and nutrition intravenously.

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