Pregnancy…A special time to focus on health

According to the Eunice Kennedy Shriver National Institute of Child Health and Human Development, a first prenatal visit with a health care provider should involve discussion about:
1.  Folic acid and other vitamins—Physicians recommend taking 400 micrograms of folic acid per day to prevent certain birth defects.
2.  Avoiding alcohol and tobacco—Research shows that there is no safe amount of alcohol to drink while pregnant. Drinking alcohol during pregnancy can lead to fetal alcohol spectrum disorders. Using tobacco and alcohol can lead to sudden infant death syndrome (SIDS), the sudden, unexplained death of an infant.
3.  Medications—“Knowing what medications women are taking prior to pregnancy is important because we can help them manage any health conditions while pregnant as safely as possible,” says Dr. Simhan. “Women shouldn’t decide to just quit taking any medications for a health condition without consultation; it could result in them getting much sicker.”
4. Avoiding exposure to toxic substances, such as lead, radiation and solvents (chemicals dissolved in another substance)
5. Following and maintaining a healthy and safe diet, including limiting caffeine intake
6. The right amount of physical activity and maintaining a healthy weight
7. Getting regular dental checkups—Healthy teeth and gums are always important to overall health, but pregnancy hormones can inflame gums.
The best outcomes for pregnancy are healthy mothers and healthy babies. Even with prenatal care, pregnancy complications can happen. One of the worst complications is infant mortality—the death of an infant before age 1. In fact, based on a Centers for Disease Control and Prevention (CDC) study, the U.S. infant mortality rate of 6.1 infant deaths per 1,000 live births is more than twice that for Japan and Finland, the countries with the lowest rates.
“Infant mortality (IM) is a powerful indicator of the health of a country,” says Dr. Simhan. “Although the U.S. is a country with a lot of resources and high-quality health care, we rank poorly in the world in terms of infant mortality.”
Researchers like Dr. Simhan are looking at reasons why infants die and at ways to prevent it. “Infant mortality isn’t just one thing with one cause,” he says. “IM is caused by a number of diseases, problems or processes. Birth defects, trauma and accidents can contribute to IM. But a big contributor to IM is premature birth (a birth that happens before the 37th week of a full-term, 40-week pregnancy). Preterm babies are more likely to have illness, injury, handicap or death.”
Women can do everything they possibly can to have a full-term baby and still have a preterm birth. So, why does preterm birth happen? That’s a question researchers are trying to answer fully. The CDC reports preterm birth risk factors as having had preterm birth before, carrying more than one baby, problems with the uterus or cervix, drug, or alcohol use, cigarette smoking, health problems in the mother or certain infections during pregnancy. Research shows that African American women have higher rates of preterm birth. They are 60 percent more likely to have preterm birth than White women, according to the CDC. Researchers don’t know why this disparity exists. Based on initial research, Dr. Simhan thinks that environmental contributors to preterm birth differ by race. He also notes that vitamin D deficiency is a risk for many pregnancy complications, including preterm birth. Vitamin D deficiency is more common among African American women than White women. More research needs to be done to see whether there is a connection.
As a part of their efforts to lower the risk of IM and preterm birth, Dr. Simhan and other researchers are starting a large study to define factors that might predict preterm birth. The majority of women who experience preterm birth have never had one before. Health care providers can help women at risk for preterm birth reduce the chances of it happening, but they have to know which women are at risk.
Dr. Simhan says it’s especially important for women who have had preterm births before to get the appropriate prenatal care because their risk of having another preterm birth is much higher. “Women at risk need to seek high-risk prepregnancy care,” he says. “We can talk to them about strategies before pregnancy, like appropriate pregnancy spacing and control of medical conditions before and during pregnancy. Research shows that there are a lot of ways to reduce the risk of preterm birth. But we need to use them early in pregnancy. Lots of women don’t get these preterm birth interventions because either they don’t realize they’re at risk or their health care provider doesn’t.”
“Research into premature birth and pregnancy hasn’t been as well funded as other health conditions like heart disease and cancer,” says Dr. Simhan. “We lag behind in understanding what contributes to adverse pregnancy outcomes. Pregnant women have been excluded from a lot of studies, and we need to change that.”

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