The tabloid media has kept a close eye on the slow-motion train wreck of Octo-Mom Nadia Sulaiman, a California woman who recently gave birth to octuplets, bringing her grand total of children to 14. TV interviews, absurd calls to 911, and scuffles with paparazzi have shown that this woman may not be entirely stable. New research reveals that one more complication for the Octo-Mom could be a severe case of postpartum depression.
Researchers at the Johns Hopkins Bloomberg School of Public Health recently examined the relationship between multiple births and maternal depressive symptoms. They found that multiple births increased the odds of maternal depression. Mothers ofmultiples had a 43 percent increased risk of moderate to severe depression compared to mothers of single-born children.
Complicating the issue further is evidence that few mothers with depressive symptoms, regardless of the multiple births status, reported talking to a mental health specialist or a general medical provider.
"The low numbers of women receiving mental health counseling despite symptoms reinforces the need for facilitating better referral of patients with depressive symptoms," said Cynthia Minkovitz, MD, MPP, senior author of the study
From the article:Mothers of multiples have 43 percent increased odds of having moderate to severe depressive symptoms nine months after giving birth compared to mothers of single-born children, according to researchers at the Johns Hopkins Bloomberg School of Public Health. Researchers examined the relationship between multiple births and maternal depressive symptoms and found that multiple births increased the odds of maternal depression, and that few mothers with depressive symptoms, regardless of the multiple births status, reported talking to a mental health specialist or a general medical provider. The results are published in the April 1, 2009, issue of Pediatrics.
"Our findings suggest that 19 percent of mothers of multiples had moderate to severe depressive symptoms nine months after delivery, compared to 16 percent among mothers of singletons," said Yoonjoung Choi, DrPH, lead author of the study and a research associate with the Bloomberg School's Department of International Health. "Mothers with a history of hospitalization due to mental health problems or a history of alcohol or drug abuse also had significantly increased odds. Non-Hispanic black mothers had higher odds compared to non-Hispanic white mothers. Mothers who were currently married, Hispanic, or with a high household socioeconomic status were less likely to have depressive symptoms." Choi, along with colleagues, used data from the Early Childhood Longitudinal Study--Birth Cohort, a nationally representative sample of children born in 2001. They measured depressive symptoms in mothers using an abbreviated version of the Center for Epidemiologic Studies Depression (CES-D) scale. Researchers examined the association between multiple births and maternal mental health, given the rapidly increasing multiple births rate in the U.S. over the last two decades. They also found that, among the mothers of both singleton and multiples, only 27 percent reported talking to a mental health specialist or a general medical provider when experiencing depressive symptoms. Researchers believe greater attention is needed in pediatric settings to address maternal depression in families with multiple births.
"The low numbers of women receiving mental health counseling despite symptoms reinforces the need for facilitating better referral of patients with depressive symptoms," said Cynthia Minkovitz, MD, MPP, senior author of the study and an associate professor with the Bloomberg School's Department of Population, Family and Reproductive Health. "Pediatric practices should make an additional effort to educate new and expecting parents of multiples regarding their increased risk for maternal postpartum depression. Furthermore, well-child visits are potentially valuable opportunities to provide education, screening and referrals for postpartum depression among mothers of multiples; such efforts require linkages between pediatric and adult systems of care and adequate community mental health resources."
"Multiple Births Are a Risk Factor for Postpartum Maternal Depressive Symptoms" was written by Yoonjoung Choi, David Bishai and Cynthia Minkovitz.
Tuesday, March 31, 2009
Most Popular: Octo-Moms at Risk for Postpartum Depression
Friday, March 6, 2009
Repeat C-Section Before 39 Weeks Raises Risk of Neonatal Illness
Women choosing repeat cesarean deliveries and having them at term but before completing 39 weeks gestation are up to two times more likely to have a baby with serious complications including respiratory distress resulting in mechanical ventilation and NICU admission.
UAB researchers, led by Alan T.N. Tita, M.D., Ph.D., assistant professor in the UAB Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, and colleagues reported in a study published January 8 in the New England Journal of Medicine that women who choose to have their babies delivered via repeat cesarean at 37 or 38 weeks without a medical or obstetric indication, risk serious complications for their child.
"The cesarean rate in the United States has risen dramatically, from 20.7 percent in 1996 to 31.1 percent in 2006. A major reason is the decline in attempted vaginal births after cesarean. Because elective cesareans can be scheduled to accommodate patient and physician convenience, there is a risk that they may be performed earlier than is appropriate." Tita said. "We knew from previous small studies that infants born before 39 weeks' gestation are at increased risk for respiratory distress.
Because nearly 40 percent of the cesareans performed in the United States each year are repeat procedures, we undertook this large study to describe the timing of elective repeat cesareans and assess its relationship with the risk of various adverse neonatal outcomes."
Tita and colleagues studied 13,258 women who had elective repeat cesarean sections at the 19 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network from 1999 through 2002. They were selected from the Cesarean Section Registry of the network. The registry contains detailed, prospectively collected information on nearly 50,000 women with a prior cesarean who underwent either repeat cesarean delivery or a trial of labor at the 19 centers over the 4-year period. The 13,258 women studied were those who underwent an elective cesarean of a viable infant at 37 weeks gestation or later in the absence of labor or other obstetric or medical indications for early cesarean delivery (prior to 39 weeks).
The researchers looked at whether an infant who was delivered at 37 weeks later died or was diagnosed with a number of conditions, including respiratory distress syndrome and/or transient tachypnea of the newborn, newborn sepsis, seizures, necrotizing entercolitis, hypoxic ischemic encephalopathy, required ventilator support within 24 hours of birth, had umbilical cord arterial pH (a measure of oxygenation) below 7.0, an Apgar score at five minutes of three or below, was admitted to a neonatal intensive care unit or required prolonged hospitalization.
Of the 13,258 women who had elective repeat cesarean sections, as many as 35.8 percent were delivered before 39 weeks. Babies born at 37 weeks, were two times more likely to suffer with conditions common to babies born too soon, and at 38 weeks, they were one and a half times more likely.
Tita said these findings, along with other studies, underscore the importance of not delivering a baby before 39 weeks for the sake of convenience.
"Unfortunately, these early deliveries are associated with a preventable increase in neonatal morbidity and NICU admissions, which carry a high personal and economic cost. These findings support recommendations to delay elective delivery until 39 weeks gestation and should be helpful in counseling women on the necessity of waiting to deliver."
Tuesday, September 2, 2008
Most Vaccine-Allergic Children Can Still be Safely Vaccinated, Experts Say
Newswise — With close monitoring and a few standard precautions, nearly all children with known or suspected vaccine allergies can be safely immunized, according to a team of vaccine safety experts led by the Johns Hopkins Children’s Center. Writing in the September issue of Pediatrics, the multicenter research team offers pediatricians a step-by-step tool for quickly identifying children with allergic reactions to vaccines, and a much-needed guide, they say, to safely immunize those who are allergic.
Serious allergic reactions to vaccines are extremely rare — one or two per million vaccinations, according to some estimates — but when they happen, such episodes can be serious, even life-threatening, making it critical for pediatricians to instantly spot true allergic reactions and differentiate them from more benign nonallergic responses, investigators say. It is also crucial that pediatricians design a safe immunization plan for children with confirmed vaccine allergies. Children who have had one allergic reaction are believed to be at a higher risk for future reactions, typically more serious than the first.
“We cannot reiterate enough that the vaccines used today are extremely safe, but in a handful of children certain vaccine ingredients can trigger serious allergic reactions,” says Robert Wood, M.D., lead author on the paper and chief of pediatric Allergy and Immunology at Hopkins Children’s. “For the most part, even children with known allergies can be safely vaccinated.”
Given recent outbreaks of vaccine-preventable infections like measles, mumps and whooping cough in the United States, and measles and polio overseas, it is essential to safely vaccinate as many children as possible, investigators say.
Combing through available evidence on vaccine safety and allergies, the Hopkins-led team developed a sequence of instructions – an algorithm – that prompts physicians one step at a time on how to evaluate and immunize children with known or suspected vaccine allergies.
The guidelines are intended for doctors and parents who are uncertain about vaccine safety in children who have already had or are at high risk for having allergic reactions to vaccines.
In such cases, the Hopkins-led group advises a workup by an allergist, including skin prick testing—a prick on the skin or an injection under the skin with a small dose of vaccine or the suspected allergen from the vaccine—or blood tests that would detect the presence of characteristic antibodies that patients develop to allergens, such as antibodies to gelatin or egg proteins used in several common vaccines.
In many cases, allergic children can be vaccinated using alternative forms of a vaccine that are free of the allergen. Even if allergen-free formulations are unavailable, many children can still be vaccinated and remain under physician supervision for several hours after vaccination. Another option is testing the child to check for immunity. If blood tests show the child has already developed protective antibodies, it may be OK, at least temporarily, to withhold further doses of the vaccine, researchers write.
“Vaccines save lives, and parents should know that children who have had allergic reactions after a vaccine are likely to have developed protection against infection as a result of the vaccination,” says investigator Neal Halsey, M.D., an infectious disease specialist at Hopkins Children’s, and professor of International Health at the Johns Hopkins University Bloomberg School of Public Health.
“Most children who have had an allergic reaction after a vaccine can still be vaccinated against other diseases safely and some can receive additional doses of vaccines they might have reacted to,” Halsey adds.
Many children with known vaccine allergies who have low levels of protective antibodies and require more doses can be vaccinated safely under the guidelines. In some cases, children with known allergies can be given antiallergy medications, such as antihistamines and corticosteroids, before vaccination to help ward off or lessen the allergic reaction. For a step-by-step guide to vaccine administration in children with known or suspected vaccine allergy, see the full text of the article at http://pediatrics.aappublications.org/future/122.3.shtml.
Immunizations of children with known vaccine allergies should always be administered under medical supervision in a clinic equipped to treat life-threatening allergic reactions or in a hospital intensive-care unit. Patients can usually go home after an hour or two if they have no adverse reactions.
True allergies typically cause immediate reactions, involving the immune system as a whole that occur within a few minutes to a few hours of vaccination. By contrast, delayed reactions, which occur within days, even weeks after vaccination, are generally benign and are rarely, if ever, dangerous.
Symptoms of immediate allergic reactions include hives, swelling, wheezing, coughing, low blood pressure, vomiting, diarrhea, and can lead to full-blown anaphylaxis, a life-threatening allergic reaction.
The research was funded by the Centers for Disease Control and Prevention.
Co-investigators on the research: Melvin Berger, M.D. Ph.D., University Hospitals of Cleveland; Stephen Dreskin, M.D. Ph.D., University of Colorado; Rosanna Setse, M.D. M.P.H., Johns Hopkins University Bloomberg School of Public Health; Renata Engler, M.D., Walter Reed Army Medical Institute; Cornelia Dekker, M.D., Stanford University School of Medicine. The Clinical Immunization Safety Assessment Network, consisting of six medical research centers with expertise in immunization safety, was part of the study.
Conflict of interest disclosure for Hopkins investigators: Halsey has received research support from vaccine manufacturer Wyeth and is a consultant for vaccine manufacturers GlaxoSmithKline and Merck.
Children of Older Fathers More Likely to Have Bipolar Disorder
Newswise — Older age among fathers may be associated with an increased risk for bipolar disorder in their offspring, according to a report in the September issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Bipolar disorder is a common, severe mood disorder involving episodes of mania and depression, according to background information in the article. Other than a family history of psychotic disorders, few risk factors for the condition have been identified. Older paternal age has previously been associated with a higher risk of complex neurodevelopmental disorders, including schizophrenia and autism.
Emma M. Frans, M.Med.Sc., of the Karolinska Institutet, Stockholm, Sweden, and colleagues identified 13,428 patients in Swedish registers with a diagnosis of bipolar disorder. For each one, they randomly selected from the registers five controls who were the same sex and born the same year but did not have bipolar disorder.
When comparing the two groups, the older an individual’s father, the more likely he or she was to have bipolar disorder. After adjusting for the age of the mother, participants with fathers older than 29 years had an increased risk. “After controlling for parity [number of children], maternal age, socioeconomic status and family history of psychotic disorders, the offspring of men 55 years and older were 1.37 times more likely to be diagnosed as having bipolar disorder than the offspring of men aged 20 to 24 years,” the authors write.
The offspring of older mothers also had an increased risk, but it was less pronounced than the paternal effect, the authors note. For early-onset bipolar disorder (diagnosed before age 20), the effect of the father’s age was much stronger and there was no association with the mother’s age.
“Personality of older fathers has been suggested to explain the association between mental disorders and advancing paternal age,” the authors write. “However, the mental disorders associated with increasing paternal age are under considerable genetic influence.” Therefore, there may be a genetic link between advancing age of the father and bipolar and other disorders in offspring.
“As men age, successive germ cell replications occur, and de novo [new, not passed from parent to offspring] mutations accumulate monotonously as a result of DNA copy errors,” the authors continue. “Women are born with their full supply of eggs that have gone through only 23 replications, a number that does not change as they age. Therefore, DNA copy errors should not increase in number with maternal age. Consistent with this notion, we found smaller effects of increased maternal age on the risk of bipolar disorder in the offspring.”
(Arch Gen Psychiatry. 2008;65[9]:1034-1040. Available pre-embargo to the media at http://www.jamamedia.org.)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
