Challenging guidelines on pregnancy interval following miscarriage or abortion
Study reviews over 72,000 Norwegian births over eight years
Peer-Reviewed PublicationIMAGE: RESEARCHERS REVIEW GUIDELINES ON PREGNANCY INTERVAL FOLLOWING MISCARRIAGE OR ABORTION. view more
CREDIT: PIXABAY, PEXELS (CC0, HTTPS://CREATIVECOMMONS.ORG/PUBLICDOMAIN/ZERO/1.0/)
Conception within three months of a miscarriage or an abortion is not associated with increased risks of adverse pregnancy outcomes, according to new research publishing November 22nd in the open access journal PLOS Medicine. The study suggests that, contrary to current advice, women could attempt pregnancy after a previous miscarriage or induced abortion without elevated perinatal risks and reassures those who want to try again sooner than guidelines recommend.
The World Health Organization recommends waiting six months after miscarriage or abortion before becoming pregnant again to avoid complications in the next pregnancy, yet evidence for this is scarce. Gizachew Tessema of the Curtin School of Population Health, Australia, and colleagues conducted a cohort study with a total of 49,058 births following miscarriage and 23,707 births following abortion in Norway between 2008-2016. They looked at six adverse outcomes: preterm birth, spontaneous preterm birth, small for gestational age, large for gestational age, preeclampsia and gestational diabetes.
Compared with waiting 6-11 months after miscarriage, there were lower risks of small for gestational age for babies conceived in less than six months and a lower risk of gestational diabetes in women conceiving in under three months. Following abortion there was a slight but non-significant increased risk of small for gestational age for conception in less than three months compared with 6-11 months but the risk of large for gestational age was lower in the group with an interpregnancy interval of 3-5 months.
There was no evidence of higher risks of adverse pregnancy outcomes among women with an IPI of greater than 12 months after miscarriages or induced abortions, with the exception of a modest increased risk of gestational diabetes. The authors acknowledge that the study was limited in that it lacked information on potential confounders, including pregnancy intention and health seeking behavior. Additionally, the data only included miscarriages recorded through the healthcare system.
The findings do not support current guidelines to wait six months after miscarriage or abortion, and suggest a need to review these guidelines and provide up to date, evidence based, recommendations for women.
The authors add, “Based on this study and others, we called for a review of the existing World Health Organization recommendations for pregnancy spacing following pregnancy loss.”
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In your coverage, please use this URL to provide access to the freely available paper in PLOS Medicine:
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004129
Citation: Tessema GA, Håberg SE, Pereira G, Regan AK, Dunne J, Magnus MC (2022) Interpregnancy interval and adverse pregnancy outcomes among pregnancies following miscarriages or induced abortions in Norway (2008–2016): A cohort study. PLoS Med 19(11): e1004129. https://doi.org/10.1371/journal.pmed.1004129
Author Countries: Australia, Norway, United States
Funding: see manuscript
JOURNAL
PLoS Medicine
METHOD OF RESEARCH
Observational study
Acupuncture can relieve lower back/pelvic pain often experienced during pregnancy
And no observable major side effects for newborns of mums-to-be who opted for therapy
Peer-Reviewed PublicationAcupuncture can significantly relieve the lower back and/or pelvic pain frequently experienced by women during their pregnancy, suggests a pooled data analysis of the available evidence, published in the open access journal BMJ Open.
And there were no observable major side effects for newborns whose mums opted for the therapy, the findings indicate, although only a few of the published studies included in the analysis evaluated outcomes, such as premature birth, note the researchers.
Acupuncture is emerging as a potential therapy for various different types of pain, because it doesn’t involve the need for drugs and is considered safe, say the researchers.
Exactly how it might ease pain isn’t clear, but is thought to involve the release of the body’s innate ‘happy’ chemicals—endorphins—plus increases in blood flow to local skin and muscle.
But whether it can ease the debilitating low back and/or pelvic pain experienced by up to 90% of women during their pregnancy remains hotly contested.
To add to the evidence base, the researchers trawled research databases for relevant clinical trials that compared the pain relief afforded to pregnant women given acupuncture, alone or when combined with other therapies, with other/no/dummy treatments, as well as the potential impact on their newborns.
The final analysis included 10 randomised controlled trials, involving 1040 women. Every study was published between 2000 and 2020, and carried out variously in Sweden, the UK, the USA, Spain and Brazil.
The mums-to-be were all healthy, 17 to 30 weeks into their pregnancy on average, and had lower back and/or pelvic pain.
Acupuncture was delivered either by trained acupuncturists, physiotherapists, or midwives. Seven trials described body acupuncture; three described auricular (ear lobe) acupuncture.
All the studies reported the acupuncture points for treatment, needle retention time, and dose. In 7, points usually regarded as contraindicated in pregnancy—’forbidden points’—were used.
Pooled data analysis of the trial results for 9 studies suggested that acupuncture significantly relieved pain during pregnancy.
Of those studies (4) reporting on the potential of acupuncture to restore physical function, the results showed that this was significantly improved.
Quality of life was recorded in 5 studies. When the results of these were pooled, the findings suggested that acupuncture significantly improved this too.
Pooled data analysis of 4 studies indicated that there was a significant difference in overall effects when acupuncture was compared with other or no interventions.
But pooled data analysis of 2 studies reporting on pain relief medication indicated no difference in intake between those given acupuncture and those given nothing.
The adjusted pooled data analysis also suggested that acupuncture is safe, and for the 4 studies reporting on it, that there was no significant difference in health (Apgar) scores of newborns when acupuncture was compared with other intervention(s) or none.
Only one study reported on gestational age and that study wasn’t included in the pooled data analysis. Preterm contractions were reported in 2 studies, but these babies were in good health at birth.
Seven studies recorded other expected minor side effects for the mums-to-be, such as pain, soreness and bleeding at the needle site, and drowsiness. Nevertheless, participants rated acupuncture favourably and most were willing to repeat it, if needed.
The researchers sound a note of caution about their findings, however: the number of included studies was relatively small and their quality variable. What’s more, the design, methodology, outcomes, and participant characteristics differed substantially. And in 2 studies, the drop-out rate exceeded 20% among the comparison group.
Nevertheless, they conclude that acupuncture merits closer attention for its potential to ease pain at a time when it’s preferable to avoid drugs because of their potential side effects for mother and baby.
“Acupuncture significantly improved pain, functional status, and quality of life in women with [lower back/pelvic pain] during the pregnancy. Additionally, acupuncture had no observable severe adverse influences on the newborns,” they write.
“More large-scale and well-designed [randomised controlled trials] are still needed to further confirm these results,” they add.
JOURNAL
BMJ Open
METHOD OF RESEARCH
Systematic review
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Acupuncture for low back and/or pelvic pain during pregnancy: a systematic review and meta-analysis of randomised controlled trials
ARTICLE PUBLICATION DATE
21-Nov-2022
Drinking during pregnancy changes baby’s brain structure
Reports and ProceedingsIMAGE: LEFT: FETAL BRAIN POST-INTRAUTERINE ALCOHOL EXPOSURE IN FETUS BETWEEN 25 AND 29 GESTATIONAL WEEKS. NOTE THE SMOOTH CORTEX IN FRONTOPARIETAL AND TEMPORAL LOBES. RIGHT: BRAIN OF MATCHED HEALTHY CONTROL CASE IN FETUS BETWEEN 25 AND 28 GESTATIONAL WEEKS. THE SUPERIOR TEMPORAL SULCUS IS ALREADY BILATERALLY FORMED (RED ARROWS) AND APPEARS DEEPER ON THE RIGHT HEMISPHERE THAN ON THE LEFT. view more
CREDIT: RSNA AND PATRIC KIENAST, M.D.
CHICAGO – A new MRI study revealed that consumption of alcohol even in low to moderate amounts during pregnancy can change the baby’s brain structure and delay brain development. Results of the study will be presented next week at the annual meeting of the Radiological Society of North America (RSNA).
“Fetal MRI is a highly specialized and safe examination method that allows us to make accurate statements about brain maturation prenatally,” said study senior author Gregor Kasprian, M.D., associate professor of radiology from the Department of Biomedical Imaging and Image-guided Therapy of the Medical University of Vienna in Austria.
Alcohol consumption during pregnancy can expose the fetus to a group of conditions called fetal alcohol spectrum disorders. Babies born with fetal alcohol spectrum disorders could develop learning disabilities, behavioral problems or speech and language delays.
“Unfortunately, many pregnant women are unaware of the influence of alcohol on the fetus during pregnancy,” said lead author Patric Kienast, M.D., a Ph.D. student in the Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology at the Medical University of Vienna. “Therefore, it is our responsibility not only to do the research but also to actively educate the public about the effects of alcohol on the fetus.”
For the study, researchers analyzed MRI exams of 24 fetuses with prenatal alcohol exposure. The fetuses were between 22 and 36 weeks of gestation at the time of MRI. Alcohol exposure was determined via anonymous surveys of the mothers. The questionnaires used were the Pregnancy Risk Assessment Monitoring System (PRAMS), a surveillance project of the Centers for Disease Control and Prevention and health departments, and the T-ACE Screening Tool, a measurement tool of four questions that identify risk drinking.
In fetuses with alcohol exposure, the fetal total maturation score (fTMS) was significantly lower than in the age-matched controls, and the right superior temporal sulcus (STS) was shallower. The STS is involved in social cognition, audiovisual integration and language perception.
“We found the greatest changes in the temporal brain region and STS,” Dr. Kasprian said. “We know that this region, and specifically the formation of the STS, has a great influence on language development during childhood.”
Brain changes were seen in the fetuses even at low levels of alcohol exposure.
“Seventeen of 24 mothers drank alcohol relatively infrequently, with average alcohol consumption of less than one alcoholic drink per week,” Dr. Kienast said. “Nevertheless, we were able to detect significant changes in these fetuses based on prenatal MRI.”
Three mothers drank one to three drinks per week, and two mothers drank four to six drinks per week. One mother consumed an average of 14 or more drinks per week. Six mothers also reported at least one binge drinking event (exceeding four drinks on one occasion) during pregnancy.
According to the researchers, delayed fetal brain development could be specifically related to a delayed stage of myelination and less distinct gyrification in the frontal and occipital lobes.
The myelination process is critical to brain and nervous system function. Myelin protects nerve cells, allowing them to transmit information faster. Important developmental milestones in infants, as rolling over, crawling and language processing are directly linked to myelination.
Gyrification refers to the formation of the folds of the cerebral cortex. This folding enlarges the surface area of the cortex with limited space in the skull, enabling an increase in cognitive performance. When gyrification is diminished, functionality is reduced.
“Pregnant women should strictly avoid alcohol consumption,” Dr. Kienast said. “As we show in our study, even low levels of alcohol consumption can lead to structural changes in brain development and delayed brain maturation.”
It is unclear how these structural changes will affect brain development in these babies after birth.
“To assess this accurately, we need to wait for the children who were examined as fetuses at that time to get a little older, so that we can invite them back for further examinations,” Dr. Kienast said. “However, we can strongly assume that the changes we discovered contribute to the cognitive and behavioral difficulties that may occur during childhood.”
Co-authors are Marlene Stuempflen, M.D., Daniela Prayer, M.D., Benjamin Sigl, M.D., Mariana Schuette, M.D., Ph.D., and Sarah Glatter, M.D., M.M.Sc.
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Note: Copies of RSNA 2022 news releases and electronic images will be available online at RSNA.org/press22.
RSNA is an association of radiologists, radiation oncologists, medical physicists and related scientists promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Illinois. (RSNA.org)
For patient-friendly information on pediatric imaging and MRI, visit RadiologyInfo.org.
How you help a child go to sleep is
related to their behavioral development,
finds new study
A group of international researchers examined parental methods to help toddlers sleep across 14 cultures and found that these methods are related to the development of a child’s temperament. The researchers suggested focusing on better sleep-related parenting practices to support positive behavioral development across cultures.
The importance of good sleep during childhood development has been extensively researched. Bad sleep quality and behaviors are detrimental to neurobehavioral functioning, emotional reactivity and regulation, and can pose a risk for future psychopathology.
“Parental sleeping techniques are correlated with children’s sleep quality, and the importance of cultural context in child development has been long recognized,” said corresponding author Ms Christie Pham, of Washington State University.
“We wanted to examine whether cross-cultural differences in parental sleep-supporting strategies account for differences in toddler temperament.”
In a study published in Frontiers in Psychology, Pham and her colleagues studied the effect of different parental sleep-supporting techniques on child temperament across 14 cultures. They hypothesized that passive ways of helping a child fall asleep (eg, cuddling, singing, and reading), but not active methods (eg, walking, car rides, and playing), would be positively related to a child’s temperament.
Child temperament
Child temperament is defined as the way children regulate their behavior and handle their emotions. Different child temperaments can have effects on a child’s mental and physical well-being and can pose a risk for future disorders. Researchers previously defined temperament by three overarching factors:
- Surgency (SUR), which reflects positive affect such as smiling and laughter, approach tendencies, activity, and enthusiasm.
- Negative Emotionality (NE), which captures overall distress proneness, including in situations eliciting fear, anger, sadness, and discomfort.
- Effortful Control (EC), involving attention-based regulatory skills and enjoyment of calm activities.
Each of the factors independently contribute to predicting behavioral, achievement, and interpersonal outcomes, such as behavior problems, social competence, and academic performance.
The international group of researchers asked 841 caregivers across 14 cultures (Belgium, Brazil, Chile, China, Finland, Italy, Mexico, Netherlands, Romania, Russia, Spain, South Korea, Turkey, and the US) to fill in the early childhood behavior questionnaire and a daily activities questionnaire. They were asked to report on their toddler’s (between 17 and 40 months of age, 52% male) temperament and their sleep-supporting parenting techniques, respectively.
“Utilizing linear multilevel regression models and group-mean centering procedures, we assessed the role of between- and within-cultural variance in sleep-supporting practices in relation to temperament,” explained Pham.
Active vs passive sleep support
They found that differences in sleep-supporting methods between cultures and within the same culture were associated with different temperament characteristics. The difference was larger between cultures, meaning that sleeping methods independently contribute to differences in child temperament across cultures.
“Our study shows that a parent’s sleep-supporting techniques are substantially associated with their child’s temperament traits across cultures, potentially impacting their development,” said Pham.
“For example, countries with greater reliance on passive strategies had toddlers with higher sociability scores (higher SUR),” Pham continued.
On the other hand, fussy or difficult temperament (higher NE) was significantly correlated with active sleep techniques.
Overall, passive sleep-supporting techniques were associated with lower NE and higher SUR at the culture level and higher EC at the individual level. Active sleep-supporting techniques were associated with higher NE at an individual level only.
Rank-ordering the extent to which a culture’s sample endorsed using passive techniques, the results show that the US, Finland, and Netherlands top the list and South Korea, Turkey, and China are at the bottom of this distribution. In contrast, rank-ordering for active techniques, the researchers find that Romania, Spain, and Chile top the list while Turkey, Italy, and Belgium are at the bottom of the distribution.
“Our results demonstrate the importance of sleep promotion and suggest that parental sleep practices could be potential targets for interventions to mitigate risk posed by challenging temperament profiles across cultures,” concluded Pham.
JOURNAL
Frontiers in Psychology
DOI
About 2% of pregnant Canadian individuals self-report using cannabis in pregnancy, with usage associated with higher risk of preterm births, low birthweight newborns, and congenital anomalies, in a multi-region study of 1.28m births
IMAGE: ABOUT 2% OF PREGNANT CANADIANS SELF-REPORT USING CANNABIS IN PREGNANCY, IN A MULTI-REGION STUDY OF 1.28M BIRTHS. view more
CREDIT: DANIEL RECHE, PIXABAY, CC0 (HTTPS://CREATIVECOMMONS.ORG/PUBLICDOMAIN/ZERO/1.0/)
Article URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0276824
Article Title: Cannabis use in pregnancy and maternal and infant outcomes: A Canadian cross-jurisdictional population-based cohort study
Author Countries: Canada, USA
Funding: Perinatal Services BC (SL, AH, KD, AP) received funding from the Public Health Agency of Canada through a contract agreement (#4500384537). The funders were members of the National Maternal Cannabis Working group where consensus was achieved through majority vote of 50% plus 1 regarding study design, data collection and analysis, and decision to publish.”
JOURNAL
PLoS ONE
ARTICLE TITLE
Cannabis use in pregnancy and maternal and infant outcomes: A Canadian cross-jurisdictional population-based cohort study
ARTICLE PUBLICATION DATE
23-Nov-2022
