The Importance of Nutrition During Pregnancy for Brain Development

The Lifelong Importance of Nutrition in Pregnancy for Brain Development

Susanne D. Rooij

How drastic is the effect of nutrition during pregnancy on infant brain development? -JR

The importance of a healthy diet for proper functioning of the brain is increasingly being recognized. Week in, week out studies appear recommending a high intake of certain foods in order to achieve optimal brain function and prevent brain diseases. Although it is definitely no punishment for the most of us to increase our chocolate consumption to boost brain function, the most important period during which nutrition affects our brain may already be behind us.

Nutrition affects the brain throughout life, but it is potentially most important during the critical prenatal period, during which the lion’s share of our brain development takes place. During the time we spend in the womb, our brains undergo dramatic changes. The fetal nervous system from which the brain and spinal cord progress is one of the first systems to develop. Its foundations are laid down during the very first days of pregnancy. At the end of pregnancy, the brain has grown exponentially and is capable of learning and forming memories. It is actually not very hard to imagine that to lay a good foundation for the brain it is of utmost importance to receive the best building blocks through proper nutrition of the mother.

A very dramatic illustration of the consequences of not receiving adequate nutrition was shown in a study from the seventies in which Zena Stein and colleagues investigated the effects of prenatal exposure to the Dutch famine on the development of babies. The Dutch ‘Hungerwinter’ was a period of severe famine that struck the Western part of the Netherlands at the end of World War II. There was so little food available that even pregnant women suffered from severe undernutrition. Stein and her colleagues found that babies that had been exposed to the famine during the first trimester of pregnancy had increased rates of birth defects of the central nervous system.

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Cannabis use during pregnancy: potential effects on child's brain development

Interesting review of research done to determine the effects of cannabis use during pregnancy. -JR

Cannabis use in pregnancy may alter offspring's brain structure

Written by Honor Whiteman

"Children born to mothers who use cannabis during pregnancy are more likely to have abnormal brain structure, which may have long-term consequences for mental health."

This is the conclusion of a new study published in the journal Biological Psychiatry, led by Dr. Hanan El Marroun, of Erasmus University Medical Center in the Netherlands.

According to the researchers, around 2-13 percent of women worldwide use cannabis during pregnancy.

Previous research has suggested that expectant mothers who use the drug are more likely to have children with behavioral and mental health problems.

Exactly how cannabis use affects the brain structure of offspring, however, has been unclear, and this is what Dr. El Marroun and colleagues set out to investigate.

"This study is important because cannabis use during pregnancy is relatively common and we know very little about the potential consequences of cannabis exposure during pregnancy and brain development later in life," says Dr. El Marroun.

Thicker prefrontal cortex for children prenatally exposed to cannabis

The team analyzed the data of 263 children aged 6-8 years who were part of the Generation R Study - a population-based study in the Netherlands, in which they were followed from birth.

However, compared with children who were prenatally exposed to tobacco only, the researchers found those who were prenatally exposed to both cannabis and tobacco had a thicker prefrontal cortex.

The prefrontal cortex is a brain region that plays a role in complex cognitive behavior, planning, decision-making, working memory, and social behavior.

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Pregnancy intervals might affect autism in children

A study shows that the intervals at which mothers space their children may influence the child's risk of autism.

The amount of time between a woman's pregnancies may matter when it comes to the possible risk of her children developing autism, new research suggests.

"Children conceived in less than two years after the birth of their older sibling or greater than six years have [about] a two- to threefold increased risk of being diagnosed with autism," said study researcher Lisa Croen, director of the autism research program at Kaiser Permanente division of research, in Oakland, Calif.

Croen said that previous studies have shown an increased risk associated with very short pregnancy intervals, and a higher risk with longer than usual intervals. "We are finding the same thing. I think now there is a growing body of evidence that is pointing in the same direction," she said.

She cautioned, however, that "this is not causal. These kinds of studies can't prove cause, this is association."

And at least one neonatologist reiterated that the study only found an association between pregnancy intervals and possible autism, and much more research is needed into the topic.

Croen said the findings lend support to the current recommendation by the World Health Organization to wait at least two years after a child is born before attempting the next pregnancy.

The research was released online Sept. 14 and will be published in the October print issue of the journal Pediatrics.

One in 68 U.S. children has an autism spectrum disorder, according to the U.S. Centers for Disease Control and Prevention. Boys are more likely than girls to be diagnosed with autism, the CDC reports. Genetic and environmental factors may play a role in the condition, which involves problems with communication and socialization.

The new study included medical record reviews of about 45,000 second-born children, delivered between 2000 and 2009 in Kaiser Permanente Northern California hospitals.

The researchers looked at codes that encompass a diagnosis of any condition under the umbrella of autism spectrum disorder (ASD), which can range from mild to severe. The study team also looked at interpregnancy intervals, defined as the time from the first birth to conception of the second child.

Most older siblings of the 45,000 second-born children did not have a diagnosis of ASD, but 878 did. The researchers first analyzed the group without an older sibling with ASD.

For these children, the risk of autism was 1.5 to three times higher for intervals less than 24 months and 72 months or longer, when compared with an interval of 36 to 47 months. Intervals of less than six months appeared to carry the highest risk, the study found.

The researchers did a secondary analysis of those whose older siblings had ASD and found the same pattern -- that short or long intervals increased the risk of an ASD diagnosis.

The researchers don't know how to explain the association with certainty, according to Croen. One possible explanation is that mothers with short intervals between a pregnancy may have depleted levels of folic acid. "Folic acid is a critical nutrient in terms of healthy brain development," she said.

Dr. David Mendez, a neonatologist at Nicklaus Children's Hospital in Miami, said many researchers have looked at the pregnancy gap and investigated the effects of long ones versus shorter ones. Some have linked short intervals to psychiatric disorders, such as schizophrenia, he added.

However, Mendez said, "more specific studies need to be done before anyone can say anything definitive."

Pregnancy interval is one of many factors that may affect a child's health and upbringing. However, he suggested that avoiding short intervals between pregnancy may make it easier for parents to cope.

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Study: Mothers with chemical intolerance more likely to have child with autism or ADHD

A study indicates that mothers with chemical intolerances are more likely to have a child with autism or ADHD.

A new study from The University of Texas Health Science Center at San Antonio found that mothers with chemical intolerances are two to three times more likely than other women to have a child with autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD).

The medical study was published in the July-August 2015 issue of the Journal of the American Board of Family Medicine.

People who are chemically intolerant often have serious reactions to common chemicals and some become too sick to carry out routine functions. Chemical intolerance affects about 10 percent to 30 percent of the U.S. population. Developmental disorders such as autism and attention-deficit disorder affect one in six children in the United States.

The study included 282 mothers of children who had ASD and 258 mothers of children diagnosed with ADHD. The control group consisted of 154 mothers whose children had no developmental disorders.

The study was based on maternal responses to the Quick Environmental Exposure and Sensitivity Inventory, or QEESI, a 50-question survey used by physicians worldwide to diagnose chemical intolerance.

"We are most concerned about how vulnerable the children with ADHD and autism were to environmental exposures," said the primary author, Lynne P. Heilbrun, M.P.H., autism research coordinator for the Department of Family and Community Medicine at the UT Health Science Center San Antonio. "Mothers reported that their children were significantly more sensitive to everyday exposures such as engine exhaust, gasoline, smoke, fragrances and cleaners than their neurotypical peers." The children reportedly also were more sensitive to adverse effects from infections, medications, chemicals, foods and allergens, the authors said.

The authors said chemically intolerant mothers were three times more likely to report having a child with ASD and 2.3 times more likely to have a child with ADHD. The study did not assess fathers.

Mothers in the study who had a child with ASD or ADHD reported that their children had more illnesses or symptoms associated with chemical intolerance than control mothers.

• The children with ADHD were 1.7 times more likely than control children (ASD were 4.9 times more likely) to have had multiple infections requiring prolonged use of antibiotics.
• Children with ADHD were twice as likely as control children (ASD were 1.6 times more likely) to have allergies.
• Children with ADHD were twice as likely (ASD were 3.5 times more likely) to have had nausea, headaches, dizziness or trouble breathing when exposed to smoke, nail polish remover, engine exhaust, gasoline, air fresheners or cleaning agents than control children.
• Children with ADHD were twice as likely as controls (ASD were 4.8 times more likely) to have strong food preferences or cravings for cheese, chips, bread, pasta, rice, sugar, salt and chocolate.

"The American College of Obstetrics and Gynecology issued a consensus statement in 2013 saying that there is sufficient evidence linking toxic exposures to adverse birth and developmental outcomes, calling for physicians to inform women to avoid specific environmental exposures even before conception. Studies that linked tobacco and alcohol to neurological disorders were available for decades before recommendations to avoid these became a major public health initiative. Physicians have the opportunity right now to become proactive in helping mothers protect their children from neurological disorders plaguing U.S. families," Heilbrun said.

The authors recommend that all mothers and pregnant women adopt preventive measures to avoid potentially harmful chemicals. Preventive measures include avoiding exposure to pesticides, solvents, combustion products, and chemicals used during construction and remodeling.

The authors urged doctors to use the QEESI to assess patients for potential chemical intolerance. Senior author Claudia S. Miller, M.D., professor emeritus at the Health Science Center and a visiting senior scientist for the Harvard School of Public Health, said, "It's important for everyone to know that doctors can use a readily available tool to identify more susceptible mothers and to suggest environmental interventions to help protect themselves and their developing children."

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Can doctors diagnose autism before a child is born?

Researchers in Scotland are trying to find a way to diagnose autism before a child is born.

There’s a potential breakthrough regarding autism.

Doctors might now be able to tell if a child has autism before they’re born.

Making a diagnosis of autism depends on signs and symptoms as a child grows and develops.

“Right now, we consider an early diagnosis made anywhere between 18 months and 3 years of age. Making a diagnosis before 18 months of age is really, really difficult. I don’t think anyone is making the diagnosis of autism before 18 months of age. However, you can find red flags before 18 months,” CHP Developmental Pediatrician Dr. Diego Chaves-Gnecco said.

Even as a baby, not making eye contact, not turning when their name is called, not pointing to needs — these are red flags.

But, what if you could tell even before birth?

Researchers in Scotland are working on this.

In their studies, they found as early as 20 weeks gestation, head and abdomen sizes are larger in the fetuses that grew into children later diagnosed with autism.

“The earlier we make the diagnosis, the more intensive the services are being received. That makes a difference,” Dr. Chaves-Gnecco said.

Services like physical, occupational, speech and behavioral therapy.

The study included 40 children diagnosed with autism, compared to 120 who were not.

This type of study can only show associations, but not cause and effect.

Of course, just having a large head as a fetus does not mean you will definitely have autism as a child.

“I don’t think you can make the diagnosis of autism with just measures,” Dr. Chaves-Gnecco said. “You can have a large head for many reasons. Families might have large heads.”

Prenatal care and pediatric care are important, so that any hints of something wrong can be followed.

These preliminary findings were presented at a professional conference, but have not yet been published in a peer-reviewed journal.

The gist of these findings is that perhaps, someday, there will be a prenatal measure to guide testing for the earliest possible diagnosis and intervention.

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What is microchimerism? Scientists Discover Children’s Cells Living in Mothers’ Brains

What a cool topic.  JR

Scientists Discover Children’s Cells Living in Mothers’ Brains

The connection between mother and child is ever deeper than thought

December 4, 2012 |By Robert Martone 

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The link between a mother and child is profound, and new research suggests a physical connection even deeper than anyone thought. The profound psychological and physical bonds shared by the mother and her child begin during gestation when the mother is everything for the developing fetus, supplying warmth and sustenance, while her heartbeat provides a soothing constant rhythm.

The physical connection between mother and fetus is provided by the placenta, an organ, built of cells from both the mother and fetus, which serves as a conduit for the exchange of nutrients, gasses, and wastes. Cells may migrate through the placenta between the mother and the fetus, taking up residence in many organs of the body including the lung, thyroid, muscle, liver, heart, kidney and skin. These may have a broad range of impacts, from tissue repair and cancer prevention to sparking immune disorders.

It is remarkable that it is so common for cells from one individual to integrate into the tissues of another distinct person. We are accustomed to thinking of ourselves as singular autonomous individuals, and these foreign cells seem to belie that notion, and suggest that most people carry remnants of other individuals. As remarkable as this may be, stunning results from a new study show that cells from other individuals are also found in the brain. In this study, male cells were found in the brains of women and had been living there, in some cases, for several decades. What impact they may have had is now only a guess, but this study revealed that these cells were less common in the brains of women who had Alzheimer’s disease, suggesting they may be related to the health of the brain.....

 Microchimerism is the persistent presence of a few genetically distinct cells in an organism. This was first noticed in humans many years ago when cells containing the male “Y” chromosome were found circulating in the blood of women after pregnancy. Since these cells are genetically male, they could not have been the women’s own, but most likely came from their babies during gestation....

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Study: Pregnant women with PTSD more likely to give birth early

A study found that pregnant women with PTSD are more likely to give birth early.

Pregnant women with post-traumatic stress disorder are at increased risk of giving birth prematurely, a new study from the Stanford University School of Medicine and the U.S. Department of Veterans' Affairs has found.

The study, which examined more than 16,000 births to female veterans, is the largest ever to evaluate connections between PTSD and preterm birth.

Having PTSD in the year before delivery increased a woman's risk of spontaneous premature delivery by 35 percent, the research showed. The results will be published online Nov. 6 in Obstetrics & Gynecology.

"This study gives us a convincing epidemiological basis to say that, yes, PTSD is a risk factor for preterm delivery," said the study's senior author, Ciaran Phibbs, PhD, associate professor of pediatrics and an investigator at the March of Dimes Prematurity Research Center at Stanford University. "Mothers with PTSD should be treated as having high-risk pregnancies."

Spontaneous preterm births, in which the mother goes into labor and delivers more than three weeks early, account for about six deliveries per 100 in the general population. This means that the risk imposed by PTSD translates into a total of about two additional premature babies for every 100 births. In total, about 12 babies per 100 arrive prematurely; some are born early because of medical problems for the mother or baby, rather than because of spontaneous labor.

A piece of the prematurity puzzle

"Spontaneous preterm labor has been an intractable problem," said Phibbs, noting that rates of spontaneous early labor have barely budged in the last 50 years. "Before we can come up with ways to prevent it, we need to have a better understanding of what the causes are. This is one piece of the puzzle."

Doctors want to prevent prematurity because of its serious consequences. Premature babies often need long hospitalizations after birth. They are more likely than full-term babies to die in infancy. Many of those who survive face lasting developmental delays or long-term impairments to their eyesight, hearing, breathing or digestive function.

Phibbs' team analyzed all deliveries covered by the Veterans Health Administration from 2000 to 2012, a total of 16,344 births. They found that 3,049 infants were born to women with PTSD diagnoses. Of these, 1,921 births were to women with "active" PTSD, meaning the condition was diagnosed in the year prior to giving birth, a time frame that the researchers thought could plausibly affect pregnancy.

The researchers examined the effects of several possible confounding factors. Being older, being African-American or carrying twins all increased the risk of prematurity, as extensive prior research has shown.

The researchers also looked at the effects of maternal health problems (high blood pressure, diabetes and asthma); possible sources of trauma (deployment and military sexual trauma); mental health disorders other than PTSD; drug or alcohol abuse; and tobacco dependence. However, these factors had little influence on risk for premature birth.

The effect of stress

In other words, although pregnant women with PTSD may have other health problems or behave in risky ways, it's the PTSD that counts for triggering labor early.

"The mechanism is biologic," Phibbs said. "Stress is setting off biologic pathways that are inducing preterm labor. It's not the other psychiatric conditions or risky behaviors that are driving it."

However, if a woman had been diagnosed with PTSD in the past but had not experienced the disorder in the year before giving birth, her risk of delivering early was no higher than it was for women without PTSD. "This makes us hopeful that if you treat a mom who has active PTSD early in her pregnancy, her stress level could be reduced, and the risk of giving birth prematurely might go down," said Phibbs, adding that the idea needs to be tested.

Although PTSD is more common in military veterans than the general population, a fairly substantial number of civilian women also experience PTSD, Phibbs noted. "It's not unique to the VA or to combat," he said, noting that half of the women in the study who had PTSD had never been deployed to a combat zone. "This is relevant to all of obstetrics."

The VA has already incorporated the study's findings into care for pregnant women by instructing each VA medical center to treat pregnancies among women with recent PTSD as high-risk. And Phibbs' team is now investigating whether PTSD may also contribute to the risk of the mother or baby being diagnosed with a condition that causes doctors to recommend early delivery for health reasons.

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Difficulties of treating epilepsy while pregnant

This article explains the difficulties of pregnant mothers with epilepsy treating the condition while pregnant.

A new study published in The Cochrane Library, highlights the difficult decisions women with epilepsy have to face when they become pregnant. Taking certain drugs used to control epilepsy during pregnancy may be linked to developmental problems in children. The authors of the study say evidence on the safety of anti-epileptic drugs is limited and that more research is needed to ensure women and their doctors make the most informed choices.

Studies on children born to women with epilepsy increasingly suggest that some anti-epileptic medications affect development in the womb. However, most women with epilepsy rely on these medications to control seizures during pregnancy.

To assess the safety of taking anti-epileptics during pregnancy, the researchers drew together evidence from 28 studies. They measured children's global cognitive ability using either intelligence quotient (IQ), for school aged children, or developmental quotient (DQ), for younger children, to provide a summary of development across a range of cognitive skills. The researchers looked at DQ and IQ scores in the children of three groups of women: those with epilepsy who took anti-epilepsy medication, those with epilepsy who did not take epilepsy medication and those without epilepsy.

The children of women who took one drug, sodium valproate, had lower DQs and IQs than the children of women in the other groups. Higher doses of this drug were linked to larger effects on IQ or DQ. However another drug, carbamazepine, did not appear to have any significant effects on DQ or IQ. Younger children born to women who took carbamazepine did have lower DQs but the researchers concluded that this effect was due to random variation between the results of studies.

"This review highlights the need for preconception counselling in women with epilepsy," said Rebecca Bromley, lead researcher of the study based at the Institute of Human Development at the University of Manchester in Manchester, UK. "Counselling should take account of the fact that many pregnancies are unplanned and cover the risks of anti-epileptic drugs, whilst considering how well they control epileptic seizures."

"The review also highlights the need to counsel patients about risks and benefits of treatment alternatives at the time of epilepsy diagnosis and treatment initiation, so that informed decisions can be made. This is particularly important for women with idiopathic generalised epilepsy for whom valproate is the most effective treatment. Some women may choose to initiate valproate as they have no plans to conceive, while others may choose to avoid valproate and try a less effective drug accepting the associated risk of further seizures." Tony Marson, Coordinating Editor Cochrane Epilepsy Group, University of Liverpool.

Some studies made comparisons between different drugs. The children of women who took valproate had lower IQs than children exposed to carbamazepine or lamotrigine in the womb. They also had lower DQs and IQs than children born to women who took phenytoin. There were no differences between the IQs of children exposed to either carbamazepine, phenytoin or lamotrigine.

Only a few studies analysed the effects of newer anti-epileptic drugs like lamotrigine, levetiracetam and topiramate. "Data was not available for all anti-epileptic drugs that are in use today and data on newer anti-epileptic drugs was especially scarce," said Bromley. "This makes it difficult for women and their doctors to know which medications are safe to use during childbearing years. Future research needs to be carried out in a timelier manner to ensure that when prescribing decisions are being made the risks are already established. Women should however not stop or make alterations to their medication without first seeking medical advice."

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Air toxics and autism

A study found that children with autism are more likely to have been exposed to air toxics while in utero.

Children with autism spectrum disorder (ASD) were more likely to have been exposed to higher levels of certain air toxics during their mothers' pregnancies and the first two years of life compared to children without the condition, according to the preliminary findings of a University of Pittsburgh Graduate School of Public Health investigation of children in southwestern Pennsylvania.

This research, funded by The Heinz Endowments, will be presented today at the American Association for Aerosol Research annual meeting in Orlando, Fla.

"Autism spectrum disorders are a major public health problem, and their prevalence has increased dramatically," said Evelyn Talbott, Dr.P.H., principal investigator of the analysis and professor of epidemiology at Pitt Public Health. "Despite its serious social impact, the causes of autism are poorly understood. Very few studies of autism have included environmental exposures while taking into account other personal and behavioral risk factors. Our analysis is an addition to the small but growing body of research that considers air toxics as one of the risk factors for ASD."

Dr. Talbott and her colleagues performed a population-based study of families with and without ASD living in six southwestern Pennsylvania counties. The researchers found links between increased levels of chromium and styrene and childhood autism spectrum disorder, a condition that affects one in 68 children.

"This study brings us a step closer toward understanding why autism affects so many families in the Pittsburgh region and nationwide -- and reinforces in sobering detail that air quality matters," said Grant Oliphant, president of The Heinz Endowments. "Our aspirations for truly becoming the most livable city cannot be realized if our children's health is threatened by dangerous levels of air toxics. Addressing this issue must remain one of our region's top priorities."

Autism spectrum disorders are a range of conditions characterized by social deficits and communication difficulties that typically become apparent early in childhood. Reported cases of ASD have risen nearly eight-fold in the last two decades. While previous studies have shown the increase to be partially due to changes in diagnostic practices and greater public awareness of autism, this does not fully explain the increased prevalence. Both genetic and environmental factors are believed to be partially responsible.

Dr. Talbott and her team interviewed 217 families of children with ASD and compared these findings with information from two separate sets of comparison families of children without ASD born during the same time period within the six-county area. The families lived in Allegheny, Armstrong, Beaver, Butler, Washington and Westmoreland counties, and the children were born between 2005 and 2009.

One of the strengths of the study was the ability to have "two types of controls, which provided a comparison of representative air toxics in neighborhoods of those children with and without ASD," said Dr. Talbott.

For each family, the team used the National Air Toxics Assessment (NATA) to estimate the exposure to 30 pollutants known to cause endocrine disruption or neurodevelopmental issues. NATA is the Environmental Protection Agency's (EPA) ongoing comprehensive evaluation of air toxics in the U.S., most recently conducted in 2005.

Based on the child's exposure to concentrations of air toxics during the mother's pregnancy and the first two years of life, the researchers noted that children who fell into higher exposure groups to styrene and chromium were at a 1.4- to two-fold greater risk of ASD, after accounting for the age of the mother, maternal cigarette smoking, race and education. Other NATA compounds associated with increased risk included cyanide, methylene chloride, methanol and arsenic. As these compounds often are found in combination with each other, further study is needed.

Styrene is used in the production of plastics and paints, but also is one of the products of combustion when burning gasoline in vehicles. Chromium is a heavy metal, and air pollution containing it typically is the result of industrial processes and the hardening of steel, but it also can come from power plants. Cyanide, methylene chloride, methanol and arsenic are all used in a number of industries or can be found in vehicle exhaust.

"Our results add to the growing body of evidence linking environmental exposures, such as air pollution, to ASD," said Dr. Talbott. "The next step will be confirming our findings with studies that measure the specific exposure to air pollutants at an individual level to verify these EPA-modeled estimates."

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Study: Mothers of autistic children less likely to have taken iron supplements

A study shows that mothers of autistic children were less likely to have taken iron supplement pills around the time of their pregnancy.

Mothers of children with autism are significantly less likely to report taking iron supplements before and during their pregnancies than the mothers of children who are developing normally, a study by researchers with the UC Davis MIND Institute has found.

Low iron intake was associated with a five-fold greater risk of autism in the child if the mother was 35 or older at the time of the child's birth or if she suffered from metabolic conditions such as obesity hypertension or diabetes.

The research is the first to examine the relationship between maternal iron intake and having a child with autism spectrum disorder, the authors said. The study, "Maternal intake of supplemental iron and risk for autism spectrum disorders," is published online in the American Journal of Epidemiology.

"The association between lower maternal iron intake and increased ASD risk was strongest during breastfeeding, after adjustment for folic acid intake," said Rebecca J. Schmidt, assistant professor in the Department of Public Health Sciences and a researcher affiliated with the MIND Institute.

The authors of the current study in 2011 were the first to report associations between supplemental folic acid and reduced risk for autism spectrum disorder, a finding later replicated in larger scale investigations.

"Further, the risk associated with low maternal iron intake was much greater when the mother was also older and had metabolic conditions during her pregnancy."

The study was conducted in mother-child pairs enrolled in the Northern California-based Childhood Autism Risks from Genetics and the Environment (CHARGE) Study between 2002 and 2009. The participants included mothers of children with autism and 346 mothers of children with typical development.

The researchers examined maternal iron intake among the study's participants, including vitamins, other nutritional supplements, and breakfast cereals during the three months prior to through the end of the women's pregnancies and breastfeeding. The mothers' daily iron intake was examined, including the frequency, dosages and the brands of supplements that they consumed.

"Iron deficiency, and its resultant anemia, is the most common nutrient deficiency, especially during pregnancy, affecting 40 to 50 percent of women and their infants," Schmidt said. "Iron is crucial to early brain development, contributing to neurotransmitter production, myelination and immune function. All three of these pathways have been associated with autism."

"Iron deficiency is pretty common, and even more common among women with metabolic conditions," Schmidt said. "However we want to be cautious and wait until this study has been replicated.

"In the meantime the takeaway message for women is do what your doctor recommends. Take vitamins throughout pregnancy, and take the recommended daily dosage. If there are side effects, talk to your doctor about how to address them."

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Drinking before pregnancy may indicate behavior problems in children

A study found that women who drink before pregnancy are more likely to have children with behavioral problems.

Risk drinking before pregnancy can increase the risk of the development behavioral problems in toddlers. This comes from a new study using data from the Norwegian Mother and Child Cohort Study (MoBa). Early intervention to help and support mothers and their children could help to prevent these problems from developing into long term behavioral problems.

In the study, several screening questions were used to measure maternal drinking behavior; how many drinks were needed to feel high, had others irritated or hurt them by criticizing their alcohol consumption, had they felt they ought to drink less alcohol, and had they ever drunk alcohol in the morning to relieve a hangover.

The study shows that risk drinking before pregnancy increases the risk of early behavior problems among children. According to the researchers, risk drinking may be due to other associated risk factors in maternal behavior such as anxiety, depression or attention deficit hyperactivity disorder (ADHD), which also are known to have an impact on child behavioral problems.

Prenatal exposure to alcohol is known to affect the developing fetus, with adverse cognitive and behavioral effects. Most risk drinking women therefore limit or stop drinking alcohol while pregnant. Paternal risk drinking is also known to have a negative impact on toddler behavior. This is the first study to study the impact of risk drinking before pregnancy. The results could not be explained by alcohol consumption during pregnancy and after birth.

"This increased risk for behavioral problems in the child is probably not due to the risk drinking per se, but rather to the general mental health and lifestyle of some of the mothers. Risk drinking behavior before pregnancy may indicate that these families could need closer follow-up and support during the early years of the child's life" says Ann Kristin Knudsen, primary author of the article published in the European Child and Adolescent Psychiatry journal.

The study considered both internalizing and externalizing behavioral problems among the toddlers. Internalizing behavioral problems include anxiety, inhibition, withdrawal or depression. Restlessness, defiance, fighting and lack of remorse are examples of externalizing behavior. These are known risk factors for behavior problems in childhood and adolescence, which sometimes continue into adulthood.

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Study: Sleep disordered breathing can change pregnancy outcomes

According to a study, sleep disordered breathing during pregnancy can influence pregnancy outcomes, such as gestational diabetes.

Humans spend around 30 percent of their lives sleeping. Unfortunately, this time to re-energize and recharge our batteries may not always be so "restful" for everyone. Now, a recent study published in the American Journal of Obstetrics & Gynecology found that women dealing with this health issue may endure more problems throughout their pregnancy.

For the study, researchers examined 188 women and assessed the prevalence and trend of sleep-disorder breathing (SDB) and its effect on pregnancy outcomes.

Researchers discovered a dose-dependent relationship between the severity of SDB throughout early pregnancy and the risk of developing gestational diabetes. They also found that those with more moderate or severe SDB throughout early pregnancy were at an increased risk of developing gestational diabetes.

"This study suggests a dose-dependent relationship between SDB exposure in early pregnancy and the subsequent development of gestational diabetes," the authors noted in the study. 

However, researchers note that there was no association between SDB exposure in early or late pregnancy, as well as any of the other adverse pregnancy outcomes.

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High blood pressure, snoring, and sleep apnea during pregnancy

This article examines how high blood pressure and snoring during pregnancy can indicate sleep apnea in pregnant women.

Half of hypertensive pregnant women who snore and one quarter of those who do not snore have unrecognized obstructive sleep apnea (OSA), suggesting such women should be tested for this condition. Findings from this cohort study were published online May 29 in BJOG.

OSA is a sleep disorder associated with reduced nocturnal blood oxygen levels and other morbidity. The prevalence of OSA increases during pregnancy, affecting up to one third of women by the third trimester.

"We know that habitual snoring is linked with poor pregnancy outcomes for both mother and child, including increased risk of C-sections and smaller babies," lead author Louise O'Brien, PhD, associate professor, Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, said in a news release. "Our findings show that a substantial proportion of hypertensive pregnant women have [OSA] and that habitual snoring may be one of the most telling signs to identify this risk early in order to improve health outcomes."

The study goal was to examine the prevalence of OSA among women with and without hypertensive disorders of pregnancy followed-up at obstetric clinics at an academic medical center. Pregnant women who were normotensive and those with hypertensive disorders (chronic hypertension, gestational hypertension, or preeclampsia) completed a questionnaire regarding habitual snoring. They also underwent overnight ambulatory polysomnography to determine the presence and severity of OSA.

Snoring and Hypertension Linked to OSA

Of 51 women with hypertensive disorders, 31 (61%) had OSA compared with 3 (19%) of 16 normotensive women (P = .008 by chi-square). Although nonsnoring women with hypertensive disorders generally had mild OSA, more than 25% of snoring women with hypertensive disorders had moderate to severe OSA.

Among women with hypertensive disorders, those who snored had a substantially greater apnea/hypopnea index than did nonsnorers (19.9 ± 34.1 vs 3.4 ± 3.1; P = .013), as well as a significantly lower oxyhemoglobin saturation nadir (86.4 ± 6.6 vs 90.2 ± 3.5; P = .021).

After stratification by obesity, the pooled relative risk for OSA in snoring versus nonsnoring women with hypertension was 2.0 (95% confidence interval, 1.4 - 2.8), or double the risk.

Women with chronic snoring were most likely to have chronic hypertension, whereas women with gestational hypertension were more likely to have the onset of snoring during pregnancy.

Limitations of this study include an inability to determine causality. In addition, only about one third of women who were invited to take participate actually did so.

"Hypertensive pregnant women who report snoring should be evaluated for [OSA,] since sleep apnea can be treated during pregnancy," Dr. O'Brien said. "Prompt recognition, evaluation, and management will not only improve health benefits for both moms and babies but may also help cut the high healthcare expenses of operative deliveries, taking care of babies who are admitted to the [neonatal intensive care unit] and other associated health risks."

In an accompanying commentary, F. Facco, MD, from the Department of Obstetrics and Gynecology, University of Pittsburgh, Pennsylvania, reviews current knowledge of sleep-disordered breathing (SDB) in pregnancy.

"[W]ell-designed clinical trials of CPAP use in pregnancy are needed to determine whether treatment of SDB during pregnancy can improve pregnancy outcomes; however, in the meantime we have to recognise that as our obstetrical patient population is becoming more obese, we will encounter more women with symptomatic SDB in pregnancy," Dr. Facco writes. "It is well documented that patients with symptomatic SDB, typically those who snore and report persistent complaints of significant sleep disruption and excessive daytime sleepiness, can benefit from CPAP in terms of sleep quality and daytime function. Therefore, in addition to encouraging women already prescribed CPAP to continue their therapy during pregnancy, obstetricians who suspect a patient may suffer from symptomatic SDB should refer her to a sleep specialist for diagnosis and possible treatment."

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Elevated steroid hormones in the womb could lead to autism

A study found that mothers of children with autism had elevated levels of steroid hormones in the womb.

Scientists from the University of Cambridge and the Statens Serum Institute in Copenhagen, Denmark have discovered that children who later develop autism are exposed to elevated levels of steroid hormones (for example testosterone, progesterone and cortisol) in the womb. The finding may help explain why autism is more common in males than females, but should not be used to screen for the condition.

Funded by the Medical Research Council (MRC), the results are published today in the journalMolecular Psychiatry.

The team, led by Professor Simon Baron-Cohen and Dr Michael Lombardo in Cambridge and Professor Bent Nørgaard-Pedersen in Denmark, utilized approximately 19,500 amniotic fluid samples stored in a Danish biobank from individuals born between 1993-1999. Amniotic fluid surrounds the baby in the womb during pregnancy and is collected when some women choose to have an amniocentesis around 15-16 weeks of pregnancy. This coincides with a critical period for early brain development and sexual differentiation, and thus allows scientists access into this important window in fetal development. The researchers identified amniotic fluid samples from 128 males later diagnosed with an autism spectrum condition and matched these up with information from a central register of all psychiatric diagnoses in Denmark.

Within the amniotic fluid the researchers looked at 4 key 'sex steroid' hormones that are each synthesized, step-by-step from the preceding one, in the 'Δ4 sex steroid' pathway: progesterone, 17α-hydroxy-progesterone, androstenedione and testosterone. They also tested the steroid hormone cortisol that lies outside this pathway. The researchers found that levels of all steroid hormones were highly associated with each other and most importantly, that the autism group on average had higher levels of all steroid hormones, compared to a typically developing male comparison group.

Professor Baron-Cohen said: "This is one of the earliest non-genetic biomarkers that has been identified in children who go on to develop autism. We previously knew that elevated prenatal testosterone is associated with slower social and language development, better attention to detail, and more autistic traits. Now, for the first time, we have also shown that these steroid hormones are elevated in children clinically diagnosed with autism. Because some of these hormones are produced in much higher quantities in males than in females, this may help us explain why autism is more common in males."

He added: "These new results are particularly striking because they are found across all the subgroups on the autism spectrum, for the first time uniting those with Asperger Syndrome, classic autism, or Pervasive Developmental Disorder Not-Otherwise-Specified. We now want to test if the same finding is found in females with autism."

Dr Michael Lombardo said: "This result potentially has very important implications about the early biological mechanisms that alter brain development in autism and also pinpoints an important window in fetal development when such mechanisms exert their effects."

Steroid hormones are particularly important because they exert influence on the process of how instructions in the genetic code are translated into building proteins. The researchers believe that altering this process during periods when the building blocks for the brain are being laid down may be particularly important in explaining how genetic risk factors for autism get expressed.

Dr Lombardo adds: "Our discovery here meshes nicely with other recent findings that highlight the prenatal period around 15 weeks gestation as a key period when important genetic risk mechanisms for autism are working together to be expressed in the developing brain."

Professor Baron-Cohen said: "These results should not be taken as a reason to jump to steroid hormone blockers as a treatment as this could have unwanted side effects and may have little to no effect in changing the potentially permanent effects that fetal steroid hormones exert during the early foundational stages of brain development."

He cautioned further: "Nor should these results be taken as a promising prenatal screening test. There is considerable overlap between the groups and our findings showed differences found at an average group level, rather than at the level of accurately predicting diagnosis for individuals. The value of the new results lies in identifying key biological mechanisms during fetal development that could play important roles in atypical brain development in autism."

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