How A Mother Loses Weight May Impact The Long-Term Health Of Her Offspring

Dr. Enrique Jacome

New research from the University of Cincinnati (UC) suggests that the healthy weight and glucose control women achieve through weight-loss surgery don't necessarily translate into health benefits for their future children.

An animal study featured in the the journalScience Translational Medicine suggests that treatment with vertical sleeve gastrectomy (VSG) weight loss surgery of a female rat prior to conception has no positive impact on - and could even impact negatively - the metabolic health of her offspring.

The study was led by Bernadette Grayson, PhD, postdoctoral fellow in the laboratory of Randy Seeley, PhD, UC professor and Donald C. Harrison Endowed Chair in Medicine and director of the Cincinnati Diabetes and Obesity Center.

"Maternal obesity and diabetes have long-term negative health consequences for offspring in both rodents and humans," says Grayson. "Bariatric surgical procedures like vertical sleeve gastrectomy are still the most effective way to achieve sustained weight loss and improvements in glucose levels."

Knowing this, Grayson, Seeley and team set out to determine if improving maternal obesity by treating with VSG pre-pregnancy could improve the metabolic health of the offspring.

Female rats were given high-fat diets to induce obesity and then some were treated with the VSG procedure. (During VSG, a portion of the stomach is removed to leave a much smaller "sleeve"-like section.) The female rats that underwent VSG lost weight, had improved glucose control and even showed some improvements in reproductive health when compared with obese rats that did not have the same procedure. But metabolic health of the VSG rats' offspring did not improve.

"On some measures the health of these offspring, in fact, got worse," Seeley says. "Their birth weights were lower when compared to rats whose mothers didn't receive the surgery. And when they were given access to a high-fat diet following puberty, offspring of VSG rats showed a greater propensity to gain body fat and develop glucose intolerance."

There are many causes for small-for-gestational age births, Seeley says.

"In the case of VSG, the hormonal changes induced by the surgery, which aid in weight loss, may be the very same culprits for the reduced growth. This is something we will be looking at in future research," he says.

"It may not be sufficient enough just to get mom healthier before she conceives; how she gets healthier seems to matter," says Seeley, adding that the diet the mom consumed during pregnancy in these studies also played a huge role. "The interaction between diet and the maternal environments - the uterus and placenta, for example - may impact susceptibility to metabolic disease in offspring."

These findings, the authors say, could have implications for the clinical use of surgical weight loss procedures, but more work is needed before clear guidelines can be determined.

The next steps, say Grayson and Seeley, are to determine the direct cause of the effect on the offspring and find out if other types of surgical weight loss procedures have similar effects. This work, they say, also has the potential to help in our understanding of how the maternal environment can increase or decrease the risk for obesity and diabetes in future generations.

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Study Shows Large Breakfast Diet Could Boost Fertility For PCOS Women

Dr. Enrique Jacome

Researchers from the University of Tel Aviv say that women with polycystic ovarian syndrome who control insulin levels - by increasing calories at breakfast and decreasing them at dinner - can improve their fertility.

The research was led by Prof. Daniela Jakubowicz, who notes that most women with PCOS are typically "insulin resistant," meaning that their bodies produce too much insulin, which eventually goes to the ovaries and prompts the production of testosterone, decreasing fertility.

She explains that doctors oftentimes suggest weight loss for overweight women with PCOS in order to manage their insulin levels, but many women with the condition and fertility issues related to it are not overweight.

In the study, 60 women with polycystic ovarian syndrome and a normal body mass index (BMI) were assigned randomly to one of two groups:

• Big breakfast group - consumed a 980 calorie breakfast, 640 calorie lunch and a 190 calorie dinner
• Big dinner group - consumed a 190 calorie breakfast, 640 calorie lunch and a 980 calorie dinner.

Both groups consumed a total of 1,800 calories each day and were tested after 90 days for insulin, glucose and testosterone levels. Ovulation and menstruation information was also analyzed.

Results showed that though neither group experienced a change in BMI, the big dinner group still had high levels of insulin and testosterone.

By contrast, the big breakfast group showed 56% less insulin resistance, as well as a 50% fall in testosterone levels.

Additionally, the reduction of insulin and testosterone levels in the big breakfast group led to a 50% rise in ovulation rate.

Improvement in other PCOS symptoms

Prof. Jakubowicz says this meal plan - eating more in the morning and less in the evening - follows the body's 24-hour metabolic cycle. She says this diet is not about "weight loss but insulin management."

For women who have PCOS but are not trying to get pregnant, eating according to the big breakfast guidelines could help with "other symptoms associated with the disorder," such as unwanted body hair, oily hair, hair loss and acne.

In addition, the researchers say that following the big breakfast diet could prevent the development of type-2 diabetes.

They note that since polycystic ovarian syndrome also impacts in vitro fertilization treatments and increases risk of miscarriage, managing insulin levels could be a way to help with fertility across the board.

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Report Shows Duration Of Mother's Breastfeeding Leads To Reduced Risk For Alzheimer's

Dr. Enrique Jacome

The report, newly published in the Journal of Alzheimer's Disease, suggests that the link may be to do with certain biological effects of breastfeeding. For example, breastfeeding restores insulin tolerance which is significantly reduced during pregnancy, and Alzheimer's is characterised by insulin resistance in the brain.

Although they used data gathered from a very small group of just 81 British women, the researchers observed a highly significant and consistent correlation between breastfeeding and Alzheimer's risk. They argue that this was so strong that any potential sampling error was unlikely.

At the same time, however, the connection was much less pronounced in women who already had a history of dementia in their family. The research team hope that the study - which was intended merely as a pilot - will stimulate further research looking at the relationship between female reproductive history and disease risk.

The findings may point towards new directions for fighting the global Alzheimer's epidemic - especially in developing countries where cheap, preventative measures are desperately needed.

More broadly, the study opens up new lines of enquiry in understanding what makes someone susceptible to Alzheimer's in the first place. It may also act as an incentive for women to breastfeed, rather than bottle-feed - something which is already known to have wider health benefits for both mother and child.

Dr Molly Fox, from the Department of Biological Anthropology at the University of Cambridge, who led the study, said: "Alzheimer's is the world's most common cognitive disorder and it already affects 35.6 million people. In the future, we expect it to spread most in low and middle-income countries. So it is vital that we develop low-cost, large-scale strategies to protect people against this devastating disease."

Previous studies have already established that breastfeeding can reduce a mother's risk of certain other diseases, and research has also shown that there may be a link between breastfeeding and a woman's general cognitive decline later in life. Until now, however, little has been done to examine the impact of breastfeeding duration on Alzheimer's risk.

Fox and her colleagues - Professor Carlo Berzuini and Professor Leslie Knapp - interviewed 81 British women aged between 70 and 100. These included both women with, and without, Alzheimer's. In addition, the team also spoke to relatives, spouses and carers.

Through these interviews, the researchers collected information about the women's reproductive history, their breastfeeding history, and their dementia status. They also gathered information about other factors that might account for their dementia, for example, a paststroke, or brain tumor.

Dementia status itself was measured using a standard rating scale called the Clinical Dementia Rating (CDR). The researchers also developed a method for estimating the age of Alzheimer's sufferers at the onset of their disease, using the CDR as a basis and taking into account their age and existing, known patterns of Alzheimer's progression. All of this information was then compared with the participants' breastfeeding history.

Despite the small number of participants, the study revealed a number of clear links between breastfeeding and Alzheimer's. These were not affected when the researchers took into account other potential variables such as age, education history, the age when the woman first gave birth, her age at menopause, or her smoking and drinking history.

The researchers observed three main trends:

• Women who breastfed exhibited a reduced Alzheimer's Disease risk compared with women who did not.
• Longer breastfeeding history was significantly associated with a lower Alzheimer's Risk.
• Women who had a higher ratio of total months pregnant during their life to total months breastfeeding had a higher Alzheimer's risk.

The trends were, however, far less pronounced for women who had a parent or sibling with dementia. In these cases, the impact of breastfeeding on Alzheimer's risk appeared to be significantly lower, compared with women whose families had no history of dementia.

The study argues that there may be a number of biological reasons for the connection between Alzheimer's and breastfeeding, all of which require further investigation.

One theory is that breastfeeding deprives the body of the hormone progesterone, compensating for high levels of progesterone which are produced during pregnancy. Progesterone is known to desensitize the brain's oestrogen receptors, and oestrogen may play a role in protecting the brain against Alzheimer's.

Another possibility is that breastfeeding increases a woman's glucose tolerance by restoring her insulin sensitivity after pregnancy. Pregnancy itself induces a natural state of insulin resistance. This is significant because Alzheimer's is characterised by a resistance to insulin in the brain (and therefore glucose intolerance) to the extent that it is even sometimes referred to as "Type 3 diabetes".

"Women who spent more time pregnant without a compensatory phase of breastfeeding therefore may have more impaired glucose tolerance, which is consistent with our observation that those women have an increased risk of Alzheimer's disease," Fox added.

Alzheimer's Society comment:

'The debate as to whether breast is best is a complex one. Other studies have suggested breastfeeding has health benefits, but we don't yet have robust evidence to suggest that a woman who feeds her child using her own milk will be less likely to get Alzheimer's disease.

This study is novel, and it's interesting to note that it found a consistent link between this feeding technique and Alzheimer's disease. However, it was a small study which doesn't explore why the two are associated. It is too premature to make recommendations for mothers regarding breast feeding and their risk of dementia.

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Study Shows Higher BMI Increases Risk Of Gallstones, Especially In Women

Dr. Enrique Jacome

New research reveals a causal association between elevated body mass index (BMI) and increased risk of gallstone disease. Results published in Hepatology, a journal of the American Association for the Study of Liver Diseases, show women are at greater risk of developing gallstones.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) describe gallstones as pebble-like material, which can develop when there is excess cholesterol - accounting for 80% of all gallstones - bile salts or bilirubin in bile stored in the gallbladder. Gallstone disease is one of the most common and costly gastrointestinal diseases - accounting for $5.8 billion (Sandler et al., May 2002). Prior studies have shown that greater BMI is associated with increased risk of gallstone disease; however it is unclear if it is the cause of the disease.

To further understanding of the connection between BMI and gallstone risk, a team led by Dr. Anne Tybjærg-Hansen from Rigshospitalet, Copenhagen University Hospital in Denmark studied 77,679 participants from the general population, employing a Mendelian randomization approach - a method using genetic variation to study the impact of modifiable risk factors as the cause of a disease. There were 4,106 participants who developed symptomatic gallstone disease during the 34 years of follow-up.

Participants with gallstone disease were more likely to be older, female, and less physically active. Researchers found that those with gallstones often used hormone replacement therapyand drank less alcohol than those without the disease. Analyses show that increased BMI was associated with gallstone disease risk with an overall hazard ratio (HR) of 2.84. When looking at BMI and gender, the team found that women had a higher risk of developing gallstone disease than men (HR=3.36 and 1.51, respectively).

Findings indicate that gallstone disease risk increased 7% for every 1 kg/M2 increase in BMI. "Obesity is a known risk factor for gallstone disease and our study suggests that elevated BMI likely contributes to the development of this disease," concludes Dr. Tybjærg-Hansen. "These data confirm that obesity adversely affects health, and lifestyle interventions that promote weight loss in overweight and obese individuals are warranted."

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Review Finds Delayed Cord Clamping After Birth Better For Baby's Health

Dr. Enrique Jacome

At most hospitals it is common practice to clamp the baby's umbilical cord less than a minute after birth. But a recent review of published studies suggests delaying cord clamping results in healthier blood and iron levels in babies, and this benefit outweighs the slightly higher risk of developing jaundice.

The reviewers arrived at this conclusion after analyzing data on nearly 4,000 women and their babies. They report their findings online in a July 11th issue of the Cochrane Database of Systematic Reviews.

One of the authors, Philippa Middleton of the Australian Research Centre for Health of Women and Babies at the University of Adelaide, says in a statement: 

"In light of growing evidence that delayed cord clamping increases early haemoglobin concentrations and iron stores in infants, a more liberal approach to delaying clamping of the umbilical cord in healthy babies appears to be warranted."

At most hospitals, the standard practice is to clamp the umbilical cord within a minute of the baby being born.

If cord clamping is delayed, the risk that the baby will develop jaundice rises. Newborns with jaundice are treated with light therapy.

However, stopping the blood from the placenta reaching the baby before the final few pulses stop, means there is a chance the baby will not receive enough blood from the mother and will have lower iron levels.

Middleton says they did find that clamping the cord later was linked to higher numbers of babies needing treatment for jaundice, however, she urges that:

"The benefits of delayed cord clamping need to be weighed against the small additional risk of jaundice in newborns. Later cord clamping to increase iron stores might be particularly beneficial in settings where severe anaemia is common"

The researchers reviewed 15 trials comparing early and late cord clamping covering a total of 3,911 women and their infants.

They examined results for mothers and babies separately, using haemoglobin measures as indicators of healthy blood and iron levels.

Although another reason sometimes given for early cord clamping is that it reduces the mother's risk of bleeding after birth, the reviewers found no evidence of this.

Benefits of delayed cord clamping did not come with any increased risks

Delayed cord clamping did not change the mother's risk of haemorrhaging, losing blood or having reduced haemoglobin levels, they note.

But delaying cord clamping did make a difference to the health of the babies. Between one and two days after birth, their haemoglobin levels were higher; between three and six months after birth, they were less likely to be deficient in iron.

The reviewers also found that delayed cord clamping was linked to higher birth weight and made no difference to deaths in newborns.

They also found delayed cord clamping appears to have no effect on longer-term brain development, although only one of the trials examined this.

The reviewers conclude their findings suggest we need to adopt a "more liberal approach" to delaying cord clamping which is likely to benefit babies, "as long as access to treatment for jaundice requiring phototherapy is available".

The World Health Organization recommends cord clamping between one and three minutes after birth.

This review only included babies born full term. However, another review published in the same journal in 2012 found that delayed cord clamping also benefits preterm babies. 

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Breast Really Is Best: Unraveling The Scientific Basis Of This Infant Feeding Axiom

Dr. Enrique Jacome

Scientists are making strides toward unraveling the surprisingly complex chemistry underpinning that axiom of infant feeding "breast is best," according to an article in the current edition of Chemical & Engineering News. C&EN is the weekly newsmagazine of the American Chemical Society, the world's largest scientific society.

Jyllian Kemsley, C&EN senior editor, points out that their findings reveal many intriguing and sometimes counterintuitive ways in which sugars, proteins and fat in milk interact with microbes in infants' intestines to nourish babies and protect their health. For instance, scientists have discovered that breast milk contains oligosaccharides, complex sugars that babies can't even digest. It turns out these oligosaccharides, rather than providing nutritional value directly to infants, actually confers protection. They feed beneficial intestinal bacteria that seem to crowd out harmful E. coli strains that might otherwise thrive.

This multifaceted research includes an approach termed "diaper diagnostics," in which scientists glean information from infants' urine and feces. The breast milk projects are important for figuring out how best to nourish infants who aren't breastfed, especially premature babies, 10 percent of whom contract an intestinal disease that can be life-threatening. Based on findings so far, one research team is developing probiotics and testing them in neonatal units to see if they help guard against harmful infections.

The article makes clear that a more complete understanding of breast milk content and its effect on gut bacteria could help give more babies a healthier start.

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Study Shows Pelvic Organ Prolapse An Increased Risk With Vaginal Delivery

Dr. Enrique Jacome

Women who give birth vaginally are at increased risk of developing pelvic organ prolapse during the year after delivery, according to a study of Chinese women by researchers at Yale School of Medicine and Wenzhou Third People's Hospital. 

Published online in the British Journal of Obstetrics and Gynaecology, the results show that factors unique to labor and delivery made the pelvic floor relax and not recover its former support during the year after birth. These factors were not present in women who delivered via cesarean section. 

"The choice between vaginal birth and c-section is a complex one, and our results are not meant to promote one over the other," said Marsha K. Guess, M.D., assistant professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine. "Our data will be useful to women and their obstetric providers as they weigh childbirth options." 

Pelvic organ prolapse is a common condition among women who have given birth vaginally. Hormonal changes, increased pressure, and the baby's passage through the birth canal can damage connective tissue, muscles, nerves, and blood vessels. The vagina and the surrounding organs relax, lose their support, and fall from their normal positions, leading to a host of complications such as urinary incontinence and bowel control. It is thought that some women are genetically predisposed to having an abnormal repair process after delivery, which may also contribute to pelvic organ prolapse. 

In this prospective observational study, Guess, corresponding author Yi Chen, and colleagues, compared changes in pelvic organ prolapse during late pregnancy with changes at three different points in time within one year after delivery. Between April and May 2009, they evaluated 110 women at the obstetrics clinic in Wenzhou Third People's Hospital in Wenzhou, Zhejiang, China. These women were in their 36th-38th week of pregnancy and were planning to undergo an elective c-section or vaginal delivery. 

They found that many women develop moderate prolapse in late pregnancy; however, women who underwent vaginal delivery or c-section after laboring were less likely to recover from pelvic organ prolapse at six weeks, six months, and one year postpartum, compared to those who delivered after an elective c-section with no labor. 

"Our study is among the few that provide information about short- and long-term effects of labor and route of delivery on pelvic floor support to determine if and when recovery of pelvic floor support structures occurs over long durations of time," said Guess. "More research should be done to better identify women at greatest risk for, or predisposed to developing, long-term pelvic floor consequences." 

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