Pregnancy

All Articles in the Category ‘Pregnancy’

You Mamas Taking Iodine?

A new policy statement from The American Academy of Pediatrics finds that many women, including up to 1/3 of pregnant women, may have low levels of iodine putting them at risk for iodine deficiency. The reason for the deficiency is the changing food source. Over the last 20-30 years our major source of salt has shifted away from table salt (supplemented with iodine) to salt from processed foods, sea salt or gourmet salts that have no supplemental iodine. This is especially important for breastfeeding and pregnant women as iodine is essential for thyroid function that supports fetal and newborn brain development.

This policy statement was news to me. I had no idea that the salt used to make most processed foods lacked iodine, that the majority of prenatal vitamins didn’t provide iodine, and the number of women who may have a deficiency. I’m not alone; when I polled my Mama Doc Facebook community most moms & many doctors also commented this was a newsflash. Here’s more:

Iodine Deficiencies– Shifting Sources Salt

  • WHY ARE WE DEFICIENT? Most processed foods made are with salt that is not iodized.  Since we get most of our salt from those foods we’re taking in less iodine than we used to.
  • TABLE SALT INTAKE: Table salt is iodized, many gourmet salts are not. Consider ensuring that when cooking in your home (ie putting salt in the pasta water or salting the veggies) you use iodized table salt so your intake of iodine goes back up. REMEMBER: this doesn’t mean you should eat MORE salt, just swap in the table salt for the fancy salts when you can.
  • WHY DO WE NEED IODINE? We need iodine for thyroid hormone synthesis as thyroid is essential in brain development and metabolism. The policy reminds us that even mild iodine deficincy can affect fetal and early childhood neurocognitive development stating, “adequate thyroid hormone production is critical in pregnant women and neonates because thyroid hormone is required for brain development in children.” The recommendations from AAP spelled out:

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Peanut Brittle For Preggers

Photo from Edwart Visser Flickr Creative Commons

Photo from Edwart Visser, Flickr Creative Commons

“Children appear to be less at risk for developing peanut or tree nut allergies if their mothers are not allergic and ate more nuts during pregnancy,” according to a study published today in JAMA Pediatrics. And although this doesn’t mean that you need to run out for the peanut brittle the minute you’re pregnant, it may mean we can reassure pregnant women that if they have no allergies themselves, what they eat during pregnancy should contain nuts, among other things.

As you’ve likely heard, children with peanut allergies have more than tripled in the United States this last 15 years. Food allergies affect 1 in 13 children in the United States and up to 40% of children have had a life-threatening or severe reaction. Any family with a food-allergic child will tell you this is a BIG deal.

The rapid rise of food allergies is incompletely understood, but more and more research suggests that waiting to introduce “high allergy” foods (traditionally thought of as peanut, egg, or shellfish for example) may have actually caused more allergies than prevented them. As this was being discovered this last decade or so, flip-flopping recommendations on what to eat ourselves when pregnant and what to feed our babies have left many of us confused.

When Should I Start Baby Food?

New recommendations really encourage introduction of a variety of foods, including nuts, eggs, shellfish, wheat, and soy within the first year of life. The theory is that early introduction of the components of these foods allow a child’s developing body to create a tolerance to them, thus potentially avoiding any allergy or reaction to them later on. Read full post »

Arriving Early: World Prematurity Day

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I think about the essay Welcome to Holland by Emily Perl Kingsley a lot. Her explanation of what it’s like to raise a child with a disability helps approximate (for me) the unexpected realities that ensue for families who encounter significant pediatric health challenges. Although her essay is not about prematurity and it’s not new, when I sat down to write about World Prematurity Day I couldn’t help but think back to her words and her metaphor. What’s marvelous, of course, is that her essay is built of love so all of us have a chance to understand it.

Sunday, World Prematurity Day, is a day to think cautiously, bravely, and empathetically about the opportunity to improve the lives of children born prematurely, all around the world. When a child arrives early there are obviously significant health challenges not only to survival but to a long life thereafter, sometimes with significant disability. Parents all over world suffer and learn to thrive with and after prematurity every single day. In fact,

Prematurity is the leading cause of death in newborns. Although some risk factors are known for preterm birth, we don’t know very much about the cause.

None of us will really ever know what it’s like to survive and thrive in someone else’s experience. So we share stories, quotes, photos, and moments as best we can to help others understand. As I’ve met and been invited to help care for parents, families and children who are born prematurely, one thing is certain — it’s a journey. It starts often with surprise and evolves individually. The essay by Kingsley is clearly about the journey, not about the diagnosis of prematurity at the time of birth.

Here’s what a colleague and friend, Kim, shared with me about her experience with her twin daughters who were born over three months early: Read full post »

Buying Breast Milk Online

New research out today confirms that buying breast milk on the Internet via milk-sharing sites may not be safe. Although breast milk purchased from online sites may be free or as cheap as $1-$2 an ounce, it may carry significant risk for babies. Clearly the benefits of breast milk are vast; pediatricians and health experts recommend exclusive breast feeding until 6 months of age. However, simply put, breast milk obtained from unknown (or known) individuals online may carry contamination from medications/drugs excreted in the breast milk,  bacterial, or viral contamination. If a mother isn’t able to provide enough breast milk for her newborn or infant, parents must know that milk from online sellers can be contaminated at the time of collection and/or during transport, dangerous especially for babies born prematurely. If buying human breast milk parents should look for a certified milk bank.

Back in 2010 the FDA spoke out against the practice of buying breast milk online, warning parents of potential risks due to bacteria or viral contamination, exposure to chemicals, medications, and drugs. The research out today confirmed these hesitations: nearly 3/4 of the breast milk obtained by researchers online had bacterial contamination and 20% of the samples tested positive for a virus called CMV.

It should be noted that breast milk bacteria (or virus) counts aren’t deterministic for infection, meaning that just having bacteria in a breast milk sample doesn’t mean a baby will get sick from it. How old a baby is, the amount of bacteria in the sample, and the immune status of an infant all also play a part. However, there are reports of premature babies and babies with immune dysfunction becoming seriously ill from donated unpasteurized breast milk so caution is necessary.

To be very clear the breast milk obtained and studied in the new research was NOT from a milk bank. Human Milk Banking of North America (HMBANA)  breast milk banks screen donors for infections (like HIV) and pasteurize the breast milk to ensure improved safety protection. The trouble for many families unable to make enough breast milk with using these banks can be very costly secondary to the handling, screening, and pasteurization. Milk can be several dollars an ounce! Read full post »

Enter The Smart Diaper

Screen Shot 2013-07-09 at 10.09.35 PMToday I learned about “smart diapers,” disposable diapers that have QR code indicators with colored sensors ready to detect not only wetness but risk of infection, dehydration, or kidney disease. Only a matter of time, I suppose, that infants’ clothing educates us about their health since it’s been just weeks since TweetPee, the diaper unveiled in Brazil that tweets parents when wet, was unleashed. By report, the smart diapers unveiled today will ring up at the register only 30% higher than a typical diaper. These highly capable diapers may therefore become mainstream whether we like it or not. Worried about your baby’s weird smelling pee and/or worried your infant is getting dehydrated during a bad illness? Just throw on a smart diaper for some insight. Not such a bad idea for a worried parent with a punky baby at 2am.

Formal self-tracking is thunderously augmenting human life as our experience with our bodies and health adapts to available technology. Mobile health apps (think Baby Tracker or Map My Run), self-trackers (think Fit Bit or Up), and devices (think smartphone camera) are continually providing us with new ways to assess and improve our self-awareness. Many Americans (infants to adults) self-track, or are being tracked, without knowing it. Susannah Fox, a researcher studying the intersection of technology and health care, introduced me to informal self-tracking last year when she mentioned the utility of “skinny jeans.” Each pair of skinny jeans out there in closets around America showcases the perfect tracking device for weight balance. We know just where we are when we try them on…

I saw a friend last week who showed me her son’s daycare app–throughout her workday she has constant access to his “feed”–how many ounces of milk he drank, his last dirty diaper, and live, uploaded photos of him on the play mat. These 2013 babies will grow up with a distinct digital timeline. A wealth of data to evaluate and mine, indeed. Yet while the genius of great tracking devices is ease of use and insignificant work for data transfer, the beauty of a smart diaper is that it may potentially alleviate parental concern in minutes.

Some quantified-self devices are clearly amazing. But I have just one hesitation on this one.

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Value Of Well Baby Check-Ups


Some new data published in the American Journal of Managed Care finds increased value in preventative well baby and toddler check-ups. Not because it keeps pediatricians busy, but really because it potentially can save suffering and hospitalizations for young children that would otherwise hopefully not occur.

A study published this month evaluated over 20,000 babies and toddlers in the Group Health network. They reviewed medical charts to study both rates of hospitalizations and rates that families showed up for their well baby check-ups. They specifically evaluated rates of hospitalizations for what they call, “ambulatory-care sensitive hospitalizations,” in which access to routine care could potentially avoid an illness developing that would require a child to be admitted to the hospital for treatment. Here’s more and how you can find low cost medical or dental clinics for yourself or your child and get help applying for health insurance:

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Home Births: Polarizing Views

baby OLike so many controversial parenting topics, discussing home births brings out dynamic opinions. These controversial topics unfortunately often tear us apart from one another. This week, the American Academy of Pediatrics (AAP) issued a policy statement on home births that will hopefully help inform. In general, the policy statement identified data confirming it’s safer to have birth in a hospital, but outlined ways to decrease risks for moms and families, midwives, and doulas that want to partner with moms to have their babies at home, as safely as possible.

  • Home births only occur in about 1% of births here in the United States although interest in increasing. Distance from the hospital matters~ if it takes more than 20 minutes to get into a hospital from home, risk of complications including infant mortality are higher. Data shows that home births carry at 2-3 fold higher risk for infant death when compared to hospital births. 
  • The AAP states home births should only be considered if no maternal health problems, if it’s a term baby (after 37 weeks and before 41 weeks gestation), labor started at home spontaneously or as an outpatient, and it’s a single pregnancy that isn’t breech. Having had a previous C-section makes a home birth a no-no in their mind.
  • The AAP recommends having at least 2 people attending the birth with at least one person at the birth who’s sole job is to care for and tend to the baby after the birth. They outline that the baby’s caregiver needs to know how and why to resuscitate a newborn. The team caring for mom and baby need access to consultation with obstetricians and pediatricians and a well-planned way to access the hospital or medical team easily if needed.
  • The AAP says, “Every newborn infant deserves health care that adheres to the standards highlighted in this statement.” Care described includes warming the baby and initial transitions, glucose monitoring, infection monitoring, feeding assessment, jaundice checks, vitamin K shot, Hepatitis B shot, eye infection prevention, hearing screen, newborn blood screen, and follow-up care plans.

I believe we each have the right to make health care decisions that are best for our families. We also must have access to un-biased information on safety. Every single health decision we make is a process where we weigh risks against benefits. Home birth versus hospital birth is no exception.

My disclaimers: I had 2 hospital births which required all sorts of intervention and intensive care—2 C-sections, a bedside resuscitation for my newborn, and a short NICU stay for one of my sons. I would never have wanted to have a home birth after my training in pediatrics. That being said, there were aspects of the hospital care that really upset me. I didn’t have a birth plan, per se. I wanted this: a healthy baby and to survive the delivery without complication. I got both, thank goodness, but it wasn’t perfect. The beginning of motherhood was a challenge for me both times around and in part, I’ve always looked back feeling I should have been a stronger mom in the hospital… Read full post »

You Can Help Prevent Shaken Babies

Babies get shaken most after periods of inconsolable crying. Since April is Child Abuse Prevention month, here’s some information on abusive head trauma (previously know as “shaken baby syndrome”) and ways you can help support new parents with babies who cry.

All babies cry. But some babies cry more (see the graph in the video). Babies do follow predictable patterns in crying: most babies start crying around 2 weeks of age and their crying peaks by 2 months, then tends to resolve around 3 to 4 months of age. But there are some babies who simply cry more than others. Dr Ronald Barr has researched crying in infants for over 30 years and developed the PURPLE period of crying based off data on all types of infants. Learning about the PURPLE period so you can help reassure families that they aren’t doing ANYTHING WRONG when they have a fussy baby. It’s okay that a baby fusses and cries, particularly at peak times (around 2 months of age, in the evening), our job as parents and community members is to support parents dealing with this fussiness.

Crying is aggravating to all of us. When I spoke with Dr Ken Feldman, a pediatrician and expert in shaken baby syndrome (now called abusive head trauma), he reminded me of a startling finding. He mentioned a North Carolina study found that 20% of parents surveyed admitted to shaking a baby out of frustration at some point.

You’re not alone if you’ve felt overwhelmed while caring for a cranky baby.

Take turns soothing fussy babies. Put babies in their cribs on their backs if you get really frustrated. It’s always okay to walk away from a really cranky baby for a 10-15 minute break!

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Why Do Babies Wake Up At Night?

Most babies wake up at night. And although some superhero babies sleep 10-12 hours straight starting around 3-4 months of age, most infants wake up during the night and cry out for their parents. There are scientific reasons and some developmental and behavioral explanations for these awakenings. I spoke with my friend Dr Maida Chen, a pediatric pulmonologist, mother to three, and director of the Pediatric Sleep Disorders Center to put a list together regarding why babies do this. Leave questions and comments below if we can explain more. I’ll author a follow-up blog on ways you can help your baby when they wake up, too.

10 Reasons Babies Wake Up At Night:

  1. Sleep Cycle: Babies wake up during the night primarily because their brain waves shift and change cycles as they move from REM (rapid eye movement) sleep to other stages of non-REM sleep. The different wave patterns our brains make during certain periods define these sleep cycles or “stages” of sleep. As babies move from one stage of sleep to another during the night, they transition. In that transition, many babies will awaken. Sometimes they call out or cry. Sometimes they wake hungry. It’s normal for babies (and adults) to wake 4-5 times a night during these times of transition. However, most adults wake up and then fall back to sleep so rapidly that we rarely remember the awakening. At 4 months of age, many parents notice awakenings after a first chunk of deeper sleep. This is normal, and often due to development of delta wave sleep (deep sleep). The trick for parents is to do less and less as each month of infancy unfolds during these awakenings; we want to help our babies self-soothe more and more independently (without our help) during these awakenings so that sleeping through the night becomes a reality. Read full post »

When Should I Start Baby Food?

first foodsWhen to start baby food? The timing on starting baby food may seem confusing. If you survey your neighbors, your own moms, the doctors you see, and the child care or daycare providers who help you, I bet you’d get about 4 different answers backed with 4 different theories and rationales. The reason is, the pendulum on when and how to start baby food has changed. Bits and pieces of old data mixed with contrasting new research findings are getting tossed around. Most new parents I talk with are a bit puzzled on what is truly best.

It’s okay to start your baby on baby foods or “complementary foods” when they show signs of readiness if they are at least 4 months of age. Signs of readiness include watching you eat (following your spoon’s every movement at a meal), lip smacking and licking when they smell food, and opening their mouths when you present them with a spoonful of food. Most babies ready to eat have also doubled their birth weight and started cooing and laughing, sitting up with assistance, and rolling over.

I used to advise families to wait until 6 months to start baby foods but new research over the last couple of years has caused me to change my tune. Read full post »