Category Archives: Maternal-child health

Midwives take a stand

The nation’s leading midwifery organizations–the American College of Nurse-Midwives (ACNM), the Midwives Alliance of North America (MANA),  and the National Association of Certified Professional Midwives (NACPM)– recently issued a statement titled: “Supporting Healthy and Normal Physiologic Childbirth: A Consensus Statement by ACNM, MANA, and NACPM” 

Despite that rather sedate-sounding title the statement is remarkable, both for what it says and because of the politics that went into its making.

The purpose of the statement is to define “normal physiologic childbirth,” and to identify the factors that  promote–and interfere with–such a birth. The intent is to serve as a guide for providers, decision-makers, and pregnant women who wish to “protect, promote, and support human childbearing physiology and to avoid overuse of interventions, thus achieving better care, better health, and lower costs.”

It’s hard to argue with that.

Some definitions from the statement:

Normal physiologic birth

•             is characterized by spontaneous onset and progression of labor;

•             includes biological and psychological conditions that promote effective labor;

•             results in the vaginal birth of the infant and placenta;

•             results in physiological blood loss;

•             facilitates optimal newborn transition through skin-to-skin contact and keeping the mother and infant together during the postpartum period; and

•             supports early initiation of breastfeeding.

Factors that disrupt normal physiologic childbirth

•             induction or augmentation of labor;

•             an unsupportive environment, i.e., bright lights, cold room, lack of privacy, multiple providers, lack of supportive companions, etc.;

•             time constraints, including those driven by institutional policy and/or staffing;

•             nutritional deprivation, e.g., food and drink;

•             opiates, regional analgesia, or general anesthesia;

•             episiotomy;

•             operative vaginal (vacuum, forceps) or abdominal (cesarean) birth;

•             immediate cord clamping;

•             separation of mother and infant and/or

•             any situation in which the mother feels threatened or unsupported.

The statement’s authors call for systemic changes in clinical practice, education, research, and health policy to support physiologic birth whenever and wherever possible. It’s a measure of how glacially slowly progress comes in the field of obstetrics that this statement isn’t much different from one issued by the World Health Organization in 1996.

Given that 16 year-old WHO report, a reader might well ask: So what’s new about this? Hasn’t vaginal birth always been the “norm”?

Yes, for the vast majority of human history vaginal birth was the only viable way for a baby to leave the womb. But things have changed dramatically in the last few decades, as technological intervention–particularly cesareans and labor induction–has become so pervasive as to blur the boundaries of what constitutes the healthiest way for a low-risk woman to give birth.

Don’t get me wrong–I love medical technology when there’s an emergency or a complicated patient at hand. It’s just that the use of technology tends to beget the use of more technology, often in less and less urgent situations. An example: if elective cesareans (i.e., those performed without medical need) are performed frequently, at some point it becomes “normal” for healthy, low-risk women to opt for elective cesareans.

The joint statement is an effort to put a stake in the ground, to define “normal physiologic birth” even as the slope toward technological birth becomes ever slipperier. The goal is the promotion of low-intervention vaginal birth and the appropriate use of technology, not its elimination. For healthy, low risk women that means ready access to the kind of care that promotes “normal physiologic birth.”

* * * * *

A word about politics…

I think that most casual observers would assume that the conflict over American maternity care practices exists mainly between midwives and doctors, facing off over a Great Childbirth Divide—a battle between the Forces of Nature and the Techno-People, if you will. Yet there have long been disagreements within the field of midwifery itself, as reflected by the fact that there are three professional midwifery organizations in the U.S.

Most of American midwifery’s internal disagreements have revolved around issues of training, certification, and governance–questions of what qualifications a midwife should have, for example, and how midwifery as a profession should interface with the larger medical-obstetrical  world. The lack of a unified midwifery voice has sometimes made it easier for professional obstetrics organizations to downplay, and sometimes ignore, the very legitimate concerns raised by midwives.

This joint statement is a major step toward the goal of unifying that voice, a process that will ultimately be of great benefit to mothers and babies.

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Filed under Cesareans, Maternal-child health, Natural childbirth

Oops…

The perils of the virtual world…

Ahem… I’ve just been told that Science & Sensibility is having some spam problems, so apparently my post went up and came down quickly. Should be up again soon. In the meantime here’s the post (below). Check in at Science & Sensibility later to follow any comments that surface, or to further sabotage the site, as you see fit.

And no, I’m not the spammer…

* * *

Unintended consequences: Cesarean section, the gut microbiota, and child health.

When I first learned some years ago that cesarean section was associated with an increased risk of childhood asthma and eczema, I eagerly awaited the rest of the story. What could the link possibly be? Epidurals? Anesthetics? Antibiotics? Something strange and exotic was afoot, I was certain.

Imagine my surprise, then, when a growing body of evidence pointed to an unexpected source: the newborn gastrointestinal tract and the microorganisms that live there.

How might intestinal bacteria play such a major role in the health and well-being of newborns and children? The answer lies in an ancient, mutually beneficial relationship, one that modern birth technology has dramatically altered.

 * * *

Some friendly faces…

“Microbiota” is the term used to describe the community of microorganisms—bacteria, viruses, and fungi—that normally live in or on a given organ in the body. There’s a unique microbiota that inhabits the mouth, for example, another that lives on the skin, and still another that populates the intestine, or gut. Given an intestinal surface area of about 2,700 square feet—more or less the size of a tennis court—the microbiota inhabiting the gut is the largest and most diverse in the body.

How large and diverse? The gut microbiota contains roughly one quadrillion cells—at least ten times as many cells as does the human body itself. More than 1,000 bacterial species having been identified to date, with unknown numbers yet to be discovered.

How do all those bacteria get there? The fetal intestine, in the absence of congenital infection, is sterile in utero. The bacteria that come to colonize the bowel are acquired during birth and shortly afterwards, a process that is very much influenced by how a baby is born.

The gut microbiota and mode of delivery

In vaginally-born babies the colonizing bacteria originate primarily in the maternal birth canal and rectum. Once swallowed by the newborn during birth, these bacteria pass through the stomach and upper intestine and colonize the lower intestine, a complicated initial process that takes about a week.

Infants born by cesarean section—particularly cesareans performed before labor begins—don’t encounter the bacteria of the birth canal and maternal rectum. (If a cesarean is performed during labor the infant may be exposed to these bacteria, but to a lesser degree than in vaginal birth.) Instead, bacteria from the skin and hospital environment quickly populate the bowel. As a result, the bacteria inhabiting the lower intestine following a cesarean—the gut microbiota—can differ significantly from those found in the vaginally-born baby.

Whatever the mode of delivery, a core gut microbiota is well established within a few weeks of life and persists largely intact into adulthood. A less stable peripheral microbiota—one that is more sensitive to changes in diet and environmental factors, like antibiotics—is created as well. Between one and two years of age, when weaning from breast milk typically leads to a diet lower in fat and higher in carbohydrates, the gut microbiota takes on its final, mature profile.

Development of the newborn immune system

The dramatic first steps in immune system development take place at the same time the core microbiota is being formed, and the gut bacteria play a key role in that process.

In the hours and days following birth, the newly-arrived bacteria of the gut microbiota stimulate the newborn’s production of white blood

A t-lymphocyte

cells and other immune system components, as well as antibodies directed at unwelcome, disease-causing microorganisms. The bacteria of the microbiota also “teach” the newborn’s immune system to tolerate their own advantageous presence—to differentiate bacterial friend from foe, in other words.

In a cesarean birth the fledgling immune system is confronted with unfamiliar, often hostile bacteria—including Clostridium difficile, a particularly troublesome hospital-acquired bug. In addition, the healthy probiotic bacteria associated with vaginal birth that the newborn’s immune system expects to see arrive later and in lower numbers. These changes in the composition of the normal gut microbiota occur during a critical time in immune system development.

The cesarean-asthma theory (in a nutshell)

Here’s how cesareans and asthma are likely connected:

Humans evolved right along with the gut microbiota normally acquired during vaginal birth. When the composition of that microbiota is imbalanced, or unusual germs like Clostridium difficile appear, the immune system doesn’t like it. A low-grade, long-lasting inflammatory response directed at these intruders begins at birth, leading to a kind of “leakiness” of the intestinal lining. Proteins and carbohydrates that normally would not be absorbed from the intestinal contents—including large food molecules—make their way into the infant’s bloodstream.

To make a very long story short, that inflammation and the abnormal digestion and absorption of food that results appears to increase the risk of asthma and eczema—and diabetes, obesity, and other chronic illnesses—later in life.

* * *

Normalizing the post-cesarean gut microbiota

Reducing the cesarean rate is an obvious best practice in promoting a healthy gut microbiota. But there will always be a need for cesarean section, and so researchers are now beginning to focus on “normalization” of the gut microbiota of cesarean-born babies. Although there are as yet no proven therapies, here are some possibilities:

  • Probiotics. Though administering healthful probiotic bacteria to correct an imbalanced microbiota makes intuitive sense, studies to date have been disappointing. However, research into “good” bacteria and how they become established in the intestine is active and ongoing.
  • Direct transfer of maternal secretions. Placing maternal vaginal and rectal material into the newborn’s mouth has been proposed—more or less mimicking natural colonization—but to date there are no published studies to support the practice.
  • Fecal transplantation. Direct transfer of fecal material from healthy adults into the gastrointestinal tract of people suffering from Clostridium difficile infections has shown promise. Using healthy parents as “donors” for their babies has been proposed, but applying such technology to otherwise healthy newborns is highly impractical at present, to say the least.

Conclusion

A cesarean section doesn’t automatically doom a child to a lifetime of asthma or eczema, just as a vaginal birth isn’t an absolute guarantee of perfect health. But cesarean birth, by altering normal gut microbiota development, does appear to moderately increase the risk of these and other chronic health conditions. A woman who has the option of choosing her mode of delivery should consider this along with the many other factors she must weigh in deciding how her baby will be born.

Mark Sloan M.D.

Selected references:

1)    Effects of mode of delivery on gut microbiota composition

Biasucci G, Rubini M, Riboni S, et al (2010). Mode of delivery affects the bacterial community in the newborn gut. Early Human Development 86:S13-S15

Penders J, Tjhijs C, Vink C, et al (2006). Factors influencing the composition of the intestinal microbiota in early infancy. Pediatrics 118(2):511-521.

Salimen S, Gibson GR, McCartney AL (2004). Influence of mode of delivery on gut microbiota in seven year old children. Gut 53:1388-1389.

2)    Development of the newborn immune system

Huurre A, et al (2008). Mode of delivery: Effects on gut microbiota and humoral immunity. Neonatology 93:236-240.

Johnson C, Versalovic J (2012). The human microbiome and its potential importance to pediatrics.  Pediatrics (published online April 2, 2012; DOI: 10.1542/peds2011-2736).

Vael C, Desager, K (2009). The importance of the development of the intestinal microbiota in infancy. Current Opinion in Pediatrics 21(6):794-800

3)    Cesarean birth, gut microbiota, and asthma/atopic disease

Azad M, Korzyrkyj A (2012). Perinatal programming of asthma: The role of the gut microbiota. Clinical and Developmental Immunology Volume 2012; Article ID 932072; doi:10.1155/2012/932072

Thanvagnanam S, Fleming J, Bromley A, et al (2008). A meta-analysis of the association between caesarean section and childhood asthma. Clinical & Experimental Allergy 38(4): 629-633.

van Nimwegen F, Penders J, Stobberingh E, et al (2011). Mode and place of delivery, gastrointestinal microbiota, and their influence on asthma and atopy. Journal of Allergy and Clinical Immunology 128(5):948-955.e3

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Filed under Asthma, Cesareans, Maternal-child health, Natural childbirth, Obesity, Science

Science & Sensibility, part 2

Science & Sensibility, Lamaze International’s “Research Blog About Healthy Pregnancy, Birth & Beyond,” just posted an essay of mine titled “Unintended Consequences: Cesarean Section, the Gut Microbiota, and Child Health.” It’s an explanation of the probable link between cesareans and childhood asthma, eczema, and other chronic health problems. Stop by and have a read!


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Filed under Asthma, Cesareans, Maternal-child health, Obesity, Science

A closer look at “term” birth

Of baby brains and reading scores…

When I was in my pediatric residency I was taught that a baby born between 38 and 41 weeks was “full term.” Babies born in that golden four weeks were thought to be one homogeneous group in terms of future development. A baby born at 38 weeks gestation was home free, at least as far as his neurological future went.

Not so fast. A study of more than 100,000 New York children just published in the journal Pediatrics reports that those born at 38 weeks–the low end of the term age bracket–in general don’t perform as well on standardized tests of math and reading in third grade as do children born later in pregnancy.

And not only that:

Each week of increased gestation from 37 to 41 weeks showed an added benefit in both reading and math scores. Further, children born at 37 or 38 weeks performed significantly worse than children born at 39, 40, or 41 weeks, and have a significantly increased relative risk of impaired reading and math skills on standardized school achievement tests.

The brain grows rapidly between 38 and 41 weeks gestation: gray matter increases nearly 50%,  and myelinated white matter triples as the brain increases in complexity. It’s not surprising that being born even two or three weeks early might negatively impact some babies.

The study isn’t perfect, and it’s best to keep in mind that increased risk doesn’t equal inevitablility–the large majority of babies born at 38 weeks will be just fine. Still, researchers in Denmark, Belarus, Switzerland, and Scotland have recently reported findings similar to those in the New York study–all of which supports the growing effort to reduce elective, early labor induction.

Best to leave babies in the womb until nature says it’s time to come out!

 

 

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Filed under Education, Maternal-child health, Natural childbirth

More on breastfeeding…

As if you needed more reasons to choose breastfeeding, this just in from the journal Genome Biology:

Babies who breastfeed have a wider variety of bowel bacteria than those who are formula-fed. Why is this important? Because the bacteria in the newborn bowel (also known as the gut microbiota) help direct the development of the newborn’s immune system, among the many other beneficial functions they perform. A more diverse gut microbiota is associated with a healthier immune system.

We already know that babies born by cesarean section have a less-diverse gut microbiota than vaginally-born babies, and that following a c-section the newborn gut microbiota is often dominated by bacteria picked up from the hospital environment. Some of those hospital bacteria–clostridium difficile in particular–are associated with a number of nasty diseases in humans. From the looks of this study (and others), formula feeding may exacerbate the problem.

Nature intended for us to have a diverse gut microbiota, dominated by the types of bacteria picked up in the course of a vaginal birth and breastfeeding. We’re only now learning of the long-term health consequences of tinkering with that plan…

PS: In no way am I criticizing women who, for whatever reason, formula feed their babies. Exclusive breastfeeding isn’t always an easy thing to do in this day and age. But however it happens that a baby isn’t breastfed, the potential health impacts are the same.

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Filed under Breastfeeding, Cesareans, Maternal-child health, Nutrition

Where some addicted moms get their start…

Tagging on to my last post

According to a study in the new Archives of Pediatrics & Adolescent Medicine, one in eight (13%) American high school seniors admit to having used prescription pain medications–like codeine, vicodin, or oxycontin–that were either left over from a previous medical condition or not prescribed for them at all. Sadly, some of these teens go on to become drug-dependent mothers, with all the dangers to themselves and their babies that come with addiction.

From the article, summarized in Reuters Health:

“Most of the kids who used the drugs recreationally had previously been prescribed them for a medical condition. Teens may be using their own leftover medication for pain or recreational purposes, or may get painkillers from family members or friends who were prescribed the drugs, researchers said.”

Started in high school?

A popular place for teens to find prescription painkillers is in the medicine chest of a grandparent or other elderly person. I often speak to grandparents in my practice, and the discussion about properly disposing of old prescription drugs raises quite a few eyebrows. Narcotic abuse isn’t something most grandparents think about when the think of “childproofing” their homes.

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Filed under Maternal-child health, Safety

Jailing addicted new moms: A slippery slope?

Two troubling articles about pregnant women, addiction, and the law came out this week.

1) The first, in the most recent New York Times Magazine, describes how Alabama is increasingly handing out long jail sentences to drug-addicted new mothers. The charge? “Chemical endangerment of a child,” a Class A felony in Alabama that carries a mandatory 10-year sentence.

Emma Ketteringham, the director of legal advocacy at the National Advocates for Pregnant Women (NAPW), is particularly rankled by the use of the “chemical endangerment” statute to prosecute addicted women. The law was originally drawn up to protect children from the dangers of parental meth labs and the like; it was never intended to be used against pregnant women struggling with the disease of addiction. From the Times article:

[Ketteringham] argues that applying Alabama’s chemical-endangerment law to pregnant women “violates constitutional guarantees of liberty, privacy, equality, due process and freedom from cruel and unusual punishment.” In effect, she says, under Alabama’s chemical-endangerment law, pregnant women have become “a special class of people that should be treated differently from every other citizen.” And, she says, the law violates pregnant women’s constitutional rights to equal protection under the law.

It also makes it much less likely that an addicted woman will seek help during her pregnancy, thus putting her child in even greater danger–a point which seems to have been lost on the state’s legislators.

The push to prosecute drug-addicted pregnant women is actually part of the larger effort to pass “fetal personhood” laws (which have been introduced as initiatives and measures in 22 states to date), which declare that a fully constitutional-rights-endowed person is created the moment sperm meets egg.  A major problem with this view, according to Lynn Paltrow, executive director of NAPW, is that:

“… there is no way to treat fertilized eggs, embryos and fetuses as separate constitutional persons without subtracting pregnant women from the community of constitutional persons.”

In other words, from the moment of conception a woman’s rights would be superseded by those of her fertilized egg.

2) Okay, so getting jailed on a PWA (pregnant-while-addicted) charge may seem like a distant concern for most Americans–the vast majority of pregnant women in the U.S. are not drug-addicted, after all.

But hold on a moment. As the second article (from the Washington Post) points out, the number of pregnant women addicted to prescription painkillers has tripled in the last decade, including many women who are being treated for very legitimate pain issues–not the “typical” drug addict so often reviled in the media.

The Alabama law makes no distinction between “medical” addiction to painkillers (prescribed after a car accident, say), and “recreational” addiction to heroin or crack, and in a way, they’ve got a point. From a baby’s standpoint it doesn’t matter why mom’s addicted, so why not prosecute them all? There hasn’t been a legal stampede to throw the book at moms on Vicodin as yet, but it shouldn’t take a politically ambitious Alabama attorney too long to figure that one out.

Spending a decade in jail for the “crime” of having a baby while addicted to a doctor-prescribed treatment may seem like a stretch today, but today’s stretch is often tomorrow’s norm. As Rush Limbaugh-esque politicians steadily chip away at women’s reproductive rights, it doesn’t sound so far-fetched to me.

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Filed under Maternal-child health, Newborns, Politics

OBOS at our house

We had the pleasure of hosting a house party for Judy Norsigian at our home this week. The party was to celebrate the  40th anniversary of the publication of Our Bodies, Ourselves and to learn more about the ongoing efforts of Our Bodies Ourselves (aka OBOS), the nonprofit health education and advocacy organization that  Judy co-founded as the Boston Women’s Health Book Collective in 1969.

How important is Our Bodies, Ourselves? How about this as an indicator: Time  magazine named it one of the 100 most influential nonfiction books written since 1923. And it remains a trusted resource—Library Journal selected it as one of the eight best consumer health books of 2011. What can I say? As a writer, I’m jealous!

My wife and I have different recollections of the early editions of Our Bodies, Ourselves. Elisabeth has a special place in her heart for the book – like many, many women she learned a great deal about her own body and the larger world of women’s health on those pages.

Me? I was one of the very few people at the party who hadn’t read a single page of Our Bodies, Ourselves in my twenties. That’s not to say it didn’t influence my life. Nearly every woman I knew back then had a copy on her bookshelf, but I kept a respectful distance. Our Bodies, Ourselves was a mysterious woman-thing, all about their bodies and themselves. (I kept waiting for somebody to publish an equivalent guy-book—maybe Hey, Man! It’s Your Body!—but they never did.)

I first met Judy Norsigian in 2009, when I was on the Portland stop of my Birth Day book tour. We were introduced by a mutual friend (the indomitable Judith Rooks) and Judy very kindly agreed to introduce me at my Powell’s Books reading. I still have the sneaking suspicion that the audience was there for Judy, not me…

Judy Norsigian

We reconnected at the Home Birth Consensus Summit in Virginia last October, where Judy was the Summit’s go-to person for her wisdom and her well-grounded-in-reality common sense. She mentioned to me that she would be coming to Berkeley in April, and since we live just an hour away, we decided to do the house party.

It was a remarkable evening. Twenty-five women (and three men) listened as Judy spoke eloquently and passionately of OBOS’s ongoing advocacy efforts, which included a few topics that would have been straight out of a science fiction novel in 1969:

  • Calling for policies that preserve or expand access to sexual and reproductive services—a white-hot topic in the current political climate.
  • Advocating for improved maternity care policies, especially expanded access to midwifery care, the promotion of VBACs, and a reduction in unnecessary labor inductions.
  • Urging better FDA oversight of siliocne breast implants.
  • Serving on the Steering Committee for this summer’s  third Tarrytown Meeting, where prominent health advocates and academics will work for more responsible governance of new human genetic technologies.
  • Establishing better informed consent for women seeking assisted reproductive technology.
  • Serving as co-plaintiff in an ACLU lawsuit regarding the patenting of human genes.

As soon as the party ended Judy was hard at work, answering emails and preparing for the rest of her northern California trip. We dropped her off in Berkeley the next morning, after an enjoyable ride that included a thorough hashing of the public health challenges facing California (that’s Elisabeth’s turf, as director of Maternal, Child and Adolescent Health for Sonoma County—I played the role of driver/active listener).

Rough economic times are particularly rough on nonprofit organizations. I hope you’ll be inspired to contribute to OBOS here (not to put too fine of a point on it, but DONATE HERE!!) We need OBOS more now than ever!

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Filed under Maternal-child health, Politics

“The Most Scientific Birth Is Often the Least Technological Birth”

Here’s an interesting article on the science and ethics of American childbirth, from Alice Dreger in The Atlantic. It rings very true.

My career as a pediatrician attending births has been one long tale of learning a lot of stuff and then unlearning quite a bit of it. When I started in the late 1970s we went after even mildly distressed newborns like a medical SWAT team, with laryngoscopes, oxygen masks and umbilical catheters flying, snatching our pint-sized patients from the jaws of…what, exactly? In retrospect, a lot of them would have been just fine without us. Maybe even better off. (And just to be clear, a lot of them really needed the help, too…)

Things have changed remarkably since then. More and more studies support the wisdom of a patient, mother-centered approach to childbirth, though you wouldn’t know it from current epidural, induction and cesarean rates. Some of the refusal to accept what the research clearly tells us has to do with the way new doctors are often still taught to view childbirth: as a dangerous process in need of strict control. From the article:

“Many medical students, like most American patients, confuse science and technology. They think that what it means to be a scientific doctor is to bring to bear the maximum amount of technology on any given patient. And this makes them dangerous. In fact, if you look at scientific studies of birth, you find over and over again that many technological interventions increase risk to the mother and child rather than decreasing it.”

Add in the fact that you’re frequently scared to death as a med student and find technology a comfortable/comforting suit of armor to wear, and it’s not surprising that young doctors often live in fear of normal childbirth. I know…I was there. It only takes one bad outcome to make an aggressive approach look attractive, particularly when that’s the medical culture in which you’re being educated.

Dreger’s article is all the more interesting because she’s a professor of clinical medical humanities and bioethics at Northwestern University’s Feinberg School of Medicine, and her husband is an academic internist–not exactly the stereotype (e.g., the “woman who wears long cotton skirts, braids her hair, eats only organic vegan food, does yoga, and maybe drives a VW microbus,” as Dreger puts it) associated with midwifery and low-intervention births. But when Dreger and her husband did an extensive review of the scientific childbirth literature in 2000 and found that it supported just that–a low-intervention approach–they put what they learned into practice with the birth of their own child.

There’s a place for technology in childbirth, certainly, but most pregnancies don’t need nearly as much of it as they get in the U.S. these days.

Have a read–it’s a great article.

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Filed under Cesareans, Maternal-child health, Natural childbirth, Science

Nicotine: A colic risk factor?

Headed for colic?

A study from Denmark shows a link between nicotine exposure during pregnancy, particularly nicotine replacement therapy, and colic. (Popular nicotine replacement therapies, or NRTs, include products like Nicorette gum, patches, etc.)

Babies born to smokers were 1.3 times more likely to be colicky; those born to women using NRT were 1.6 times as likely. Interestingly, women who both smoked and used NRT were no more likely to have colicky babies than women who only smoked.

The reasons for the higher rate of colic from nicotine exposure, and especially the even higher rates for mothers using NRTs, aren’t known. Possibilities (just me guessing here) include a neonatal withdrawal syndrome along the lines with what’s seen with other drugs, or negative effects on the fetal brain from maternal life stresses that may predispose a pregnant woman to smoke in the first place.

The researchers didn’t look at the total amount of nicotine the fetus was exposed to. It’s possible that women trying to quit smoking during pregnancy actually increased their nicotine intake when they switched to an NRT. Pregnancy can be stressful enough by itself–trying to kick an addiction can add to that stress, and perhaps lead to increased nicotine use via NRTs.

Given all the risks of maternal smoking–including SIDS–a few weeks of colic seems a small price to pay for kicking the nicotine habit. But maternity care and pediatric providers (and family members and friends) should be prepared to support a new mother through a rocky period with her fussy baby–a stressful time that may increase the risk of her taking up smoking again.

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Filed under Environment/Toxins, Maternal-child health, Smoking