Trying to conceive soon after a pregnancy loss may increase chances of live birth

NIH study finds no reason for delaying pregnancy attempts after a loss without complications.

Couples who attempt to conceive within three months after losing an early pregnancy, defined as less than 20 weeks gestation, have the same chances, if not greater, of achieving a live birth than those who wait for three months or more, according to a National Institutes of Health study.

This finding, published today in Obstetrics & Gynecology, questions traditional advice that couples should wait at least three months after a loss before attempting a new pregnancy. The World Health Organization, for example, recommends waiting a minimum of six months between a pregnancy loss and a subsequent attempt.

“Couples often seek counseling on how long they should wait until attempting to conceive again,” said Enrique Schisterman, Ph.D., chief of the Epidemiology Branch at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and senior author of the study. “Our data suggest that women who try for a new pregnancy within three months can conceive as quickly, if not quicker, than women who wait for three months or more.”

Previous studies of pregnancy spacing have focused on when women should become pregnant after experiencing a loss, but few have addressed the question of when couples should start trying to conceive.

In the current study, researchers analyzed data from the Effects of Aspirin in Gestation and Reproduction (EAGeR) trial, a multi site block-randomized, double-blinded, placebo-controlled trial  that took place from 2007 to 2011. The trial, which evaluated the effect of daily low-dose aspirin on reproductive outcomes in women with a history of pregnancy loss, enrolled 1,228 women aged 18 to 40 years. NICHD investigators concentrated on 1,083 of these women, more than 99 percent of whom had lost a pregnancy at less than 20 weeks gestation. None of the women had either of two potential complications of pregnancy: a tubal (ectopic) pregnancy or a molar pregnancy (growth of abnormal fetal tissue in the uterus).  The participants were followed for up to six menstrual cycles and, if they became pregnant, until the outcome of their pregnancy was known.

The researchers found that more than 76 percent of the women attempted to conceive within 3 months after losing a pregnancy. Compared to those who waited longer, this group was more likely to become pregnant (69 percent vs. 51 percent) and to have a pregnancy leading to a live birth (53 percent vs. 36 percent). The investigators did not observe any increase in the risk of pregnancy complications in this group.

“While we found no physiological reason for delaying attempts at conception following a pregnancy loss, couples may need time to heal emotionally before they try again,” said Karen Schliep, Ph.D., primary author of the study. “For those who are ready, our findings suggest that conventional recommendations for waiting at least three months after a loss may be unwarranted.”

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Alcohol Use and Binge Drinking Among Women of Childbearing Age

One in 10 women aged 18-44 years consumes alcohol during pregnancy, putting her baby at risk of physical and behavioral problems known as fetal alcohol spectrum disorders (FASDs) and other pregnancy problems such as miscarriage, stillbirth, and prematurity. Women who are pregnant or who might be pregnant should avoid drinking alcohol because there is no known safe amount, no safe time, and no safe type of alcohol to drink during pregnancy.

One in 10 (10.2 percent ) pregnant women aged 18-44 years in the United States reports drinking alcohol in the past 30 days and 3.1 percent  (1 in 33) reports binge drinking – defined as 4 or more alcoholic beverages on one occasion. Using the 2011-2013 Behavioral Risk Factor Surveillance System data, the study also found that among binge drinkers, pregnant women reported a significantly higher frequency of binge drinking than non-pregnant women (4.6 and 3.1 episodes respectively).

Healthcare professionals can help reduce alcohol consumption among pregnant and nonpregnant women who misuse alcohol by implementing alcohol screening and brief intervention in their primary care practices, and informing women that there is no known safe level of alcohol consumption when they are pregnant or might be pregnant.

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Researchers design placenta-on-a-chip to better understand pregnancy

National Institutes of Health (NIH) researchers and their colleagues have developed a “placenta-on-a-chip” to study the inner workings of the human placenta and its role in pregnancy. The device was designed to imitate, on a micro-level, the structure and function of the placenta and model the transfer of nutrients from mother to fetus. This prototype is one of the latest in a series of organ-on-a-chip technologies developed to accelerate biomedical advances.

Figure: A placenta-on-a-chip micro device: A) The device’s upper (blue) and lower (red) chambers are separated by a semipermeable membrane. B) Researchers placed maternal cells in one chamber and fetal cells in the other. They then added glucose to the maternal-cell chamber and observed how it traveled through the membrane to the fetal-cell chamber

The study, published online in the Journal of Maternal-Fetal & Neonatal Medicine, was conducted by an interdisciplinary team of researchers from the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the University of Pennsylvania, Wayne State University/Detroit Medical Center, Seoul National University and Asan Medical Center in South Korea.

“We believe that this technology may be used to address questions that are difficult to answer with current placenta model systems and help enable research on pregnancy and its complications,” said Roberto Romero, M.D., chief of the NICHD’s Perinatology Research Branch and one of the study authors.

The placenta is a temporary organ that develops in pregnancy and is the major interface between mother and fetus. Among its many functions is to serve as a “crossing guard” for substances traveling between mother and fetus. The placenta helps nutrients and oxygen move to the fetus and helps waste products move away. At the same time, the placenta tries to stop harmful environmental exposures, like bacteria, viruses and certain medications, from reaching the fetus. When the placenta doesn’t function correctly, the health of both mom and baby suffers.

Researchers are trying to learn how the placenta manages all this traffic, transporting some substances and blocking others. This knowledge may one day help clinicians better assess placental health and ultimately improve pregnancy outcomes.

However, studying the placenta in humans is challenging: it is time-consuming, subject to a great deal of variability and potentially risky for the fetus. For those reasons, previous studies on placental transport have relied largely on animal models and on laboratory-grown human cells. These methods have yielded helpful information, but are limited as to how well they can mimic physiological processes in humans.

The researchers created the placenta-on-a-chip technology to address these challenges, using human cells in a structure that more closely resembles the placenta maternal-fetal barrier. The device consists of a semi-permeable membrane between two tiny chambers, one filled with maternal cells derived from a delivered placenta and the other filled with fetal cells derived from an umbilical cord.

After designing the structure of the model, the researchers tested its function by evaluating the transfer of glucose (a substance made by the body when converting carbohydrates to energy) from the maternal compartment to the fetal compartment. The successful transfer of glucose in the device mirrored what occurs in the body.

“The chip may allow us to do experiments more efficiently and at a lower cost than animal studies,” said Dr. Romero. “With further improvements, we hope this technology may lead to better understanding of normal placental processes and placental disorders.”

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Ireland has highest rate of poultry food poisoning bacteria in Europe  A report this week by Ella McSweeney,The Consumer Show has revealed a bacteria that can cause lethal food poisoning in humans is present on more than 98% of Irish chicken. The bacteria, campylobacter, is a potentially lethal food poisoning bacteria and 98% of Irish chickens tested positive for it when they were assessed Continue Reading

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Undisclosed superbug sickened dozens at Virginia Mason.

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BPA exposure during pregnancy causes oxidative stress in child, mother

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Sun screen ultraviolet filters linked to pregnancy delays

Researchers identify two chemicals that appear to reduce fertility in men

Certain sunscreen chemicals used to protect against ultraviolet rays may impair men’s ability to father children in a timely manner, according to a study by the National Institutes of Health and the New York state Department of Health’s Wadsworth Center. But the researchers caution that the results are preliminary and that additional studies are needed to confirm their findings.

Benzophenone (BP)-type ultraviolet (UV) filters comprise a class of about 29 chemicals commonly used, among other purposes, in sunscreens and other personal care products to protect skin and hair from sun damage. Some of these chemicals, upon being absorbed by the skin, can interfere with the body’s hormones and endocrine system processes. Researchers found that men with high exposure to UV filters BP-2 or 4OH-BP had a 30 percent reduction in fecundity, the biological ability to reproduce. Lower fecundity may result in a longer time to pregnancy.

“In our study, male fecundity seems to be more susceptible to these chemicals than female fecundity. The women participants actually had greater exposure to the UV filters overall, but their exposure wasn’t associated with any significant pregnancy delays,” said Germaine Louis, Ph.D., director of the Division of Intramural Population Health Research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development. “Our next step is to figure out how these particular chemicals may be affecting couple fecundity or time to pregnancy—whether it’s by diminishing sperm quality or inhibiting reproduction some other way.”

The researchers followed the couples until pregnancy or up to one year of trying, to record the time it took for the women to become pregnant. They also tested participants’ urine samples and measured concentrations of five selected UV filters associated with endocrine-disrupting activity. In their data analysis, the researchers controlled for age, body mass index, and smoking, among other factors.

Their findings suggest that some, but not all, UV filters may be associated with diminished fertility in men, independent of their partners’ exposure. The researchers observed effects among men with the highest exposure (the 75th percentile and above) to UV filters BP-2 or 4OH-BP.

“The skin is the body’s largest organ, and how we care for our skin matters in more ways than one,” said Dr. Louis. “Sunscreen is important for sun protection, and we definitely encourage people to continue using sunscreen to avoid skin cancer. But men who are concerned about fertility may be interested in other ways to reduce their exposure to benzophenone UV filters—whether by cutting back on other products that contain the UV filters or by washing after returning indoors.”

Among the study’s major limitations: the researchers tested single urine samples from participants to assess chemical exposure, but participants’ levels of exposure may have changed over the course of trying for pregnancy. The researchers also had no data on what specific products the participants used that contained the UV filters.

Earlier research findings from the LIFE Study have linked reduced fertility to high cholesterol levels in women and couples and to high concentrations of phthalates and Bisphenol A (BPA) in men.

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More Knowledge Reduces Prenatal Testing

More Knowledge Reduces Prenatal Testing

At a Glance

• Pregnant women given computer-based information about prenatal screening were more likely to skip testing, especially invasive tests—even when the tests were free.
• The findings suggest that multimedia education can help patients make more informed choices about their medical care.

During the first trimester of pregnancy, women are routinely offered a variety of screening tests to assess the risk for genetic disorders in the fetus. For many women, testing provides reassurance. For others, the tests can be inconclusive, leading to uncertainty and anxiety. Some follow-up diagnostic tests, such as amniocentesis and chorionic villus sampling, are invasive and carry risks, including miscarriage. While less invasive tests are now becoming available, studies suggest that women may not understand the risks and benefits of prenatal genetic tests, or even know they’re optional.

A “decision-support” tool helped pregnant women make informed decisions about prenatal screening.

To help women make informed choices, a research team led by Dr. Miriam Kuppermann of the University of California, San Francisco, developed an interactive computer program to educate and guide decisions about prenatal testing. This “decision-support” tool uses video, audio, and text to explain the risks and benefits of various tests. The program also includes questions to help clarify the woman’s values, and emphasizes the personal nature of deciding what to do. It takes about 45 to 60 minutes to complete.

To assess the impact of this tool, the researchers studied 710 pregnant women of diverse backgrounds who hadn’t yet undergone prenatal genetic testing. The women were recruited from 8 clinical sites in the San Francisco area. The study was funded in part by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

Participants were randomly divided into 2 groups. The intervention group had access to the decision-support program. To remove financial barriers, they were able to receive prenatal tests with no out-of-pocket expense. The control group received standard care with no reimbursement for out-of-pocket costs of prenatal genetic testing. Study results appeared in theJournal of the American Medical Association on September 24, 2014.

The researchers found that women in the intervention group scored significantly higher in their understanding of genetic testing compared to the control group. Women in the intervention group were also much more likely to correctly identify the chance that an amniocentesis will cause a miscarriage and the likelihood that their fetus had Down syndrome.

The number of women who chose prenatal screening alone was similar—68.5% in the intervention group vs. 67.3% in the control group. However, women in the intervention group were less likely to undergo invasive diagnostic testing than women in the control group (5.9% vs. 12.3%). The intervention group was also more likely to forgo prenatal testing entirely (25.6% compared to 20.4% in the control group). Overall, these results suggest that the decision-support program helped women make informed choices about prenatal testing that were more closely aligned with their values.

"This does not mean that women in general don't want testing,” Kuppermann says. “But it does suggest that at least some women have undergone testing without having clarity about the implications.”

The team is now working to develop a clinic-ready decision-support tool for wider distribution. “Decisions about prenatal testing are personal and should be reflective of the patient’s own values and preferences, not those of her health-care providers," Kuppermann says.

—by Vicki Contie