Research - Pregnancy
Association of Prenatal Maternal Depression and Anxiety Symptoms With Infant White Matter Microstructure
Douglas C. Dean III, PhD; Elizabeth M. Planalp, PhD; William Wooten, MS; Steven R. Kecskemeti, PhD; Nagesh Adluru, PhD; Cory K. Schmidt, BA; Corrina Frye, BS; Rasmus M. Birn, PhD; Cory A. Burghy, PhD; Nicole L. Schmidt, MS; Martin A. Styner, PhD; Sarah J. Short, PhD; Ned H. Kalin, MD; H. Hill Goldsmith, PhD; Andrew L. Alexander, PhD; Richard J. Davidson, PhD
Maternal depression and anxiety can have deleterious and lifelong consequences on child development. However, many aspects of the association of early brain development with maternal symptoms remain unclear. Understanding the timing of potential neurobiological alterations holds inherent value for the development and evaluation of future therapies and interventions.
To examine the association between exposure to prenatal maternal depression and anxiety symptoms and offspring white matter microstructure at 1 month of age.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study of 101 mother-infant dyads used a composite of depression and anxiety symptoms measured in mothers during the third trimester of pregnancy and measures of white matter microstructure characterized in the mothers’ 1-month offspring using diffusion tensor imaging and neurite orientation dispersion and density imaging performed from October 1, 2014, to November 30, 2016. Magnetic resonance imaging was performed at an academic research facility during natural, nonsedated sleep.
MAIN OUTCOMES AND MEASURES
Brain mapping algorithms and statistical models were used to evaluate the association between maternal depression and anxiety and 1-month infant white matter microstructure as measured by diffusion tensor imaging and neurite orientation dispersion and density imaging findings.
In the 101 mother-infant dyads (mean [SD] age of mothers, 33.22 [3.99] years; mean age of infants at magnetic resonance imaging, 33.07 days [range, 18-50 days]; 92 white mothers [91.1%]; 53 male infants [52.5%]), lower 1-month white matter microstructure (decreased neurite density and increased mean, radial, and axial diffusivity) was associated in right frontal white matter microstructure with higher prenatal maternal symptoms of depression and anxiety. Significant sex × symptom interactions with measures of white matter microstructure were also observed, suggesting that white matter development may be differentially sensitive to maternal depression and anxiety symptoms in males and females during the prenatal period.
CONCLUSIONS AND RELEVANCE
These data highlight the importance of the prenatal period to early brain development and suggest that the underlying white matter microstructure is associated with the continuum of prenatal maternal depression and anxiety symptoms.
Source : JAMA Pediatrics
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Investigating the effect of Sesame Ointment on Wound healing of Episiotomy
Najmeh Amani Babadi, Masoomeh Kheirkhah, Faraz Mojab, Hamid Haghani
Episiotomy is one of the most common midwifery interventions method for preventing injuries to the pelvic floor during the delivery process. Traditional medicine has a special place in improving the quality of postpartum care. Sesame is one of the herbs with anti-inflammatory, anti-bacterial and antioxidant activity. This study was evaluate the effect of sesame ointment on episiotomy healing. Methods: This randomized control clinical trial was performed on 104 eligible women. The samples were block randomly assigned to one of the groups Intervention and control. Samples were used sesame and placebo ointment for epizootics from 4 hours after delivery for ten days every 8 hours. Clinical evaluation of episiotomy ulcer was performed 4 hours, 7 and 10 days after delivery with using REEDA tool. SPSS software version 16 was used for data analysis. P value less than 0.05 was considered significant. Results: The average of wound healing rate was 7 days after episiotomy in the intervention group 0.09 ± 0.29 and in the control group was 0.73 ± 0.44. Independent t-test showed that the two groups had a significant difference (p <0.001).Healing of the wound 10 days after episiotomy showed that the mean scores in the control group (0.4 ± 0.49) and in the intervention group (0.02 ± 0.13), healing in the intervention group significantly decreased from the control group (p <0.001).
Conclusion: Sesame ointment can be used as a pain relief and accelerator for episiotomy healing.
Source : Internatitional Journal of Ayurvedic Medicine
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Pre-pregnancy dietary carbohydrate quantity and quality, and risk of developing gestational diabetes: the Australian Longitudinal Study on Women’s Health
Moniek Looman1 *, Danielle A. J. M. Schoenaker2 , Sabita S. Soedamah-Muthu3,4, Anouk Geelen1 , Edith J. M. Feskens1 and Gita D. Mishra5
1 Division of Human Nutrition, Wageningen University & Research, PO Box 17, 6700 AA Wageningen, The Netherlands
2 Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC 3004, Australia
3 Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
4 Institute for Food, Nutrition and Health, University of Reading, Reading RG6 6AR, UK
5 School of Public Health, University of Queensland, 288 Herston Road, Herston, QLD 4006, Australia
Carbohydrate quantity and quality affect postprandial glucose response, glucose metabolism and risk of type 2 diabetes. The aim of this study was to examine the association of pre-pregnancy dietary carbohydrate quantity and quality with the risk of developing gestational diabetes mellitus (GDM). We used data from the Australian Longitudinal Study on Women’s Health that included 3607 women aged 25–30 years without diabetes who were followed up between 2003 and 2015. We examined carbohydrate quantity (total carbohydrate intake and a low-carbohydrate diet (LCD) score) and carbohydrate subtypes indicating quality (fibre, total sugar intake, glycaemic index, glycaemic load and intake of carbohydrate-rich food groups). Relative risks (RR) for development of GDM were estimated using multivariable regression models with generalised estimating equations. During 12 years of follow-up, 285 cases of GDM were documented in 6263 pregnancies (4·6 %). The LCD score, reflecting relatively high fat and protein intake and low carbohydrate intake, was positively associated with GDM risk (RR 1·54; 95 % CI 1·10, 2·15), highest quartile v. lowest quartile). Women in the quartile with highest fibre intake had a 33 % lower risk of GDM (RR 0·67; 95 % CI 0·45, 0·96)). Higher intakes of fruit (0·95 per 50 g/d; 95 % CI 0·90, 0·99) and fruit juice (0·89 per 100 g/d; 95 % CI 0·80, 1·00)) were inversely associated with GDM, whereas cereal intake was associated with a higher risk of GDM (RR 1·05 per 20 g/d; 95 % CI 1·01, 1·07)). Thus, a relatively low carbohydrate and high fat and protein intake may increase the risk of GDM, whereas higher fibre intake could decrease the risk of GDM. It is especially important to take the source of carbohydrates into account
Source : The British Journal of Nutrition via Sci-Hub
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Vitamin D status is associated with uteroplacental dysfunction indicated by pre-eclampsia and small-for-gestational-age birth in a large prospective pregnancy cohort in Ireland with low vitamin D status
1,2 Mairead E Kiely,3,4* Joy Y Zhang,3 Michael Kinsella,3 Ali S Khashan,4,5 and Louise C Kenny
Background: Associations between vitamin D and pregnancy outcomes have been inconsistent. Objectives: We described the distribution of 25-hydroxyvitamin D3 [25(OH)D3], 3-epi-25(OH)D3, and 25(OH)D2 in early pregnancy and investigated associations with pre-eclampsia and small-for-gestationalage (SGA) birth, which are indicative of uteroplacental dysfunction.
Design: The SCOPE (Screening for Pregnancy Endpoints) Ireland prospective pregnancy cohort study included 1768 well-characterized low-risk, nulliparous women resident at 528N. Serum 25(OH)D3, 3-epi-25(OH)D3, and 25(OH)D2 were quantified at 15 wk of gestation with the use of a CDC-accredited liquid chromatography– tandem mass spectrometry method.
Results: The mean 6 SD total 25(OH)D concentration was 56.7 6 25.9 nmol/L, and 17% and 44% of women had 25(OH)D concentrations , 30 and , 50 nmol/L, respectively. The prevalence of pre-eclampsia was 3.8%, and 10.7% of infants were SGA. There was a lower risk of pre-eclampsia plus SGA combined (13.6%) at 25(OH)D concentrations . 75 nmol/L (adjusted OR: 0.64; 95% CI: 0.43, 0.96). The main predictors of 25(OH)D were the use of vitamin D–containing supplements (adjusted mean difference: 20.1 nmol/L; 95% CI: 18.5, 22.7 nmol/L) and summer sampling (adjusted mean difference: 15.5 nmol/L; 95% CI: 13.4, 17.6 nmol/L). Non-Caucasian ethnicity (adjusted mean difference: 2 19.3 nmol/L; 95% CI: 2 25.4, 2 13.2 nmol/L) and smoking (adjusted mean difference: 2 7.0 nmol/L; 95% CI: 2 10.5, 2 3.6 nmol/L) were negative predictors of 25(OH)D. The mean 6 SD concentration of 3-epi-25(OH)D3, which was detectable in 99.9% of samples, was 2.6 6 1.6 nmol/L. Determinants of 3-epi-25(OH)D3 were 25(OH)D3 (adjusted mean difference: 0.052 nmol/L; 95% CI: 0.050, 0.053 nmol/L) and maternal age (adjusted mean difference: 2 0.018 nmol/L; 95% CI: 2 0.026, 2 0.009 nmol/L). The mean 6 SD concentration of 25(OH)D2 was 3.1 6 2.7 nmol/L, which was present in all samples. No adverse effects of 25(OH)D concentrations . 125 nmol/L were observed.
Conclusions:In the first report to our knowledge of CDC-accredited 25(OH)D data and pregnancy outcomes from a large, clinically validated, prospective cohort study, we observed a protective association of a 25(OH)D concentration . 75 nmol/L and a reduced risk of uteroplacental dysfunction as indicated by a composite outcome of SGA and pre-eclampsia. Well-designed, adequately powered randomized controlled trials are required to verify this observation.
Source : American Journal of Clinical Nutrition
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Effects of omega-3 supplementation during pregnancy and youth on neurodevelopment and cognition in childhood: a systematic review and meta-analysis
- Masha L Shulkin1,
- Laura Pimpin1,
- David Bellinger2,3,4,
- Sarah Kranz1,
- Christopher Duggan2,4,
- Wafaie Fawzi4 and
- Dariush Mozaffarian1
BACKGROUND Long-chain omega-3 fatty acids are thought to be crucial for optimal neurodevelopment in early life.
OBJECTIVES To investigate the effect of omega-3 supplementation during pregnancy and infancy on child cognitive and developmental outcomes.
METHODS We searched PubMed, Cochrane Library, EMBASE, and PsychInfo through May 2015 without language or publication year restrictions for randomized controlled trials (RCTs) of omega-3 supplementation (>3 months) i.e. docosahexanoic acid (DHA) and eicosapentaenoic acid (EPA), and quantitative measure of neurodevelopment or cognition. Full-text inclusion decisions and data extractions were performed independently and in duplicate. Our primary outcome was the standardized mean difference in Bayley Scales of Infant Development (BSID) score between intervention groups in RCTs. Other outcomes included the Weschler Intelligence Scale for Children, Weschler Preschool and Primary Scale of Intelligence, Kaufman Brief Intelligence Test, Kaufman Assessment Battery for Children, Peabody Picture Vocabulary Test, and other standardized measures.
RESULTS Among 571 abstracts, we identified 15 trials with 20 intervention arms involving 2,525 children. Trials used DHA + EPA (N=6 arms), DHA only (N=2), DHA + arachidonic acid (AA) (N=10), or DHA + EPA + AA (N=2); either prenatally (mean 20 weeks gestation; N=4 arms) or within the first few days of birth (N=16). Mean supplementation duration was 7.3 months; and age at outcome assessment, 16 months. In pooled analyses, both maternal and infant supplementation similarly improved neurodevelopment: standardized mean difference (SMD) in BSID= 0.21 (95% CI: 0.01, 0.41) and 0.24 (0.00, 0.48) respectively (Figure 1). Among BSID subscales, DHA and/or EPA raised the psychomotor developmental index (N=8 arms; SMD 0.40; 95% CI: 0.10, 0.70), while DHA + AA raised the mental developmental index (N=15 arms; SMD 0.17; 95% CI: 0.00, 0.35). Pooled findings for other outcomes will be presented.
CONCLUSION Omega-3 supplementation during either pregnancy or infancy improves child neurodevelopment. These findings indicate the importance of sufficient polyunsaturated fatty acid intake by pregnant women and young children.
Source : The FASEB Journal
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Effect of orange peel essential oil on postpartum sleep quality: A randomized controlled clinical trial
Mojgan Mirghafourvanda, Sakineh Mohammad-Alizadeh Charandabib, Sevil Hakimic, Laleh Khodaied, Mina Galeshie,
Pregnancy and postpartum are two critical and stressful periods. Despite the joy of motherhood, these periods are sometimes associated with important physiological and pathological changes such as sleep deprivation and poor sleep quality. This study aimed to determine the effect of orange peel essential oil on sleep quality after delivery.
This triple-blind randomized controlled clinical trial was conducted on 96 postpartum women. Verified samples were assigned to intervention and control groups using randomized blocking. The intervention group received 10 drops of orange peel essential oil and the control group received 10 drops of placebo in a glass of water, three times a day, after each meal for 8 weeks. All participants filled out the Pittsburgh Sleep Quality Index before and after the intervention.
There was no statistically significant difference between groups in terms of socio-demographic characteristics sleep quality score before intervention (p > 0.05). A significant improvement in sleep quality was observed in the group receiving orange peel essential oil compared with the control group at 8 weeks after delivery [adjusted mean difference: 5.0; 95% confidence interval: 3.9 to 6.1; p = 0.001]. Regarding the components of the sleep quality index, there were statistically significant differences between the two groups except for the daytime dysfunction component (p < 0.05).
Orange peel essential oil has a positive effect in improving mothers’ sleep quality in the postpartum period. However, further studies are needed on a more general population of women in order to decide on its use as an appropriate medication to use in clinical situations.
Source : The European Journal of Integrative Medicine
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Maternal/neonatal vitamin D deficiency: a risk factor for bronchopulmonary dysplasia in preterms?
M Çetinkaya1, F Çekmez2, T Erener-Ercan1, G Buyukkale1, A Demirhan3, G Aydemir4 and F N Aydin5
The objective of this study was to investigate the possible association between maternal/neonatal 25-hydroxy vitamin D (25-OHD) levels and development of bronchopulmonary dysplasia.
One hundred and thirty-two preterm infants 32 weeks of gestation who were diagnosed with respiratory distress syndrome were enrolled. 25-OHD levels were determined in maternal/neonatal blood samples that were obtained at the time of admission to the neonatal intensive care unit.
A total of 100 infants were included and 31 (31%) developed bronchopulmonary dysplasia (BPD). Both maternal and neonatal 25-OHD levels in the BPD group were significantly lower compared with those in the no-BPD group (P=0.0001). A positive correlation was detected between maternal and neonatal 25-OHD levels. All of the infants with BPD had a 25-OHD level <10 ng ml−1, which represented severe deficiency. Univariate logistic regression analysis revealed that maternal/neonatal vitamin D levels were a significant predictor of BPD (odds ratio (OR): 0.76 and 0.61, respectively, P<0.001).
We demonstrated for the first time that lower maternal and neonatal vitamin 25-OHD levels were associated with BPD development in preterm infants. However, further studies with larger sample sizes are needed to delineate the possible link between vitamin D deficiency and BPD.
Source : Journal Perinatology
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Maternal vitamin D3 supplementation at 50 μg/d protects against low serum 25-hydroxyvitamin D in infants at 8 wk of age: a randomized controlled trial of 3 doses of vitamin D beginning in gestation and continued in lactation1
- Kaitlin M March2,
- Nancy N Chen2,
- Crystal D Karakochuk2,
- Antonia W Shand5,
- Sheila M Innis3,
- Peter von Dadelszen4,
- Susan I Barr2,
- Michael R Lyon6,
- Susan J Whiting7,
- Hope A Weiler8, and
- Tim J Green2,*
Background: Vitamin D supplementation is recommended for breastfed infants. Maternal supplementation beginning in gestation is a potential alternative, but its efficacy in maintaining infant 25-hydroxyvitamin D [25(OH)D] concentration after birth is unknown.
Objectives: We determined the effect of 3 doses of maternal vitamin D supplementation beginning in gestation and continued in lactation on infant serum 25(OH)D and compared the prevalence of infant serum 25(OH)D cutoffs (>30, >40, >50, and >75 nmol/L) by dose at 8 wk of age.
Design: Pregnant women (n = 226) were randomly allocated to receive 10, 25, or 50 μg vitamin D3/d from 13 to 24 wk of gestation until 8 wk postpartum, with no infant supplementation. Mother and infant blood was collected at 8 wk postpartum.
Results: At 8 wk postpartum, mean [nmol/L (95% CI)] infant 25(OH)D at 8 wk was higher in the 50-μg/d [75 (67, 83)] than in the 25-μg/d [52 (45, 58)] or 10-μg/d [45 (38, 52)] vitamin D groups (P < 0.05). Fewer infants born to mothers in the 50-μg/d group had a 25(OH)D concentration <30 nmol/L (indicative of deficiency) than infants in the 25- and 10-μg/d groups, respectively (2% compared with 16% and 43%; P < 0.05). Fewer than 15% of infants in the 10- or 25-μg/d groups achieved a 25(OH)D concentration >75 nmol/L compared with 44% in the 50-μg/d group (P < 0.05). Almost all infants (∼98%, n = 44) born to mothers in the 50-μg/d group achieved a 25(OH)D concentration >30 nmol/L. At 8 wk postpartum, mean maternal 25(OH)D concentration was higher in the 50-μg/d [88 (84, 91)] than in the 25-μg/d [78 (74, 81)] or 10-μg/d [69 (66, 73)] groups (P < 0.05).
Conclusions: Maternal supplementation beginning in gestation with 50 μg vitamin D3/d protects 98% of unsupplemented breastfed infants against 25(OH)D deficiency (<30 nmol/L) to at least 8 wk, whereas 10 or 25 μg vitamin D/d protects only 57% and 84% of infants, respectively.
Source : American Journal of Nutrition
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Selenium status in UK pregnant women and its relationship with hypertensive conditions of pregnancy
Margaret P. Rayman, 1 ,* Sarah C. Bath, 1 Jacob Westaway, 2 Peter Williams, 3 Jinyuan Mao, 1 Jessica J. Vanderlelie, 2Anthony V. Perkins, 2 and Christopher W. G. Redman 4
Dietary intake/status of the trace mineral Se may affect the risk of developing hypertensive conditions of pregnancy, i.e. pre-eclampsia and pregnancy-induced hypertension (PE/PIH). In the present study, we evaluated Se status in UK pregnant women to establish whether pre-pregnant Se status or Se supplementation affected the risk of developing PE/PIH. The samples originated from the SPRINT (Selenium in PRegnancy INTervention) study that randomised 230 UK primiparous women to treatment with Se (60 μg/d) or placebo from 12 weeks of gestation. Whole-blood Se concentration was measured at 12 and 35 weeks, toenail Se concentration at 16 weeks, plasma selenoprotein P (SEPP1) concentration at 35 weeks and plasma glutathione peroxidase (GPx3) activity at 12, 20 and 35 weeks. Demographic data were collected at baseline. Participants completed a FFQ. UK pregnant women had whole-blood Se concentration lower than the mid-range of other populations, toenail Se concentration considerably lower than US women, GPx3 activity considerably lower than US and Australian pregnant women, and low baseline SEPP1 concentration (median 3·00, range 0·90–5·80 mg/l). Maternal age, education and social class were positively associated with Se status. After adjustment, whole-blood Se concentration was higher in women consuming Brazil nuts (P= 0·040) and in those consuming more than two seafood portions per week (P= 0·054). A stepwise logistic regression model revealed that among the Se-related risk factors, only toenail Se (OR 0·38, 95 % CI 0·17, 0·87, P= 0·021) significantly affected the OR for PE/PIH. On excluding non-compliers with Se treatment, Se supplementation also significantly reduced the OR for PE/PIH (OR 0·30, 95 % CI 0·09, 1·00, P= 0·049). In conclusion, UK women have low Se status that increases their risk of developing PE/PIH. Therefore, UK women of childbearing age need to improve their Se status.
Source : British Journal of Nutrition
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Researchers link endocrine disrupting chemical exposure to altered gene function in pregnant women’s placentas, which could hamper fetal growth
By Brian Bienkowski - Environmental Health News
Women exposed to widely used chemicals while pregnant are more likely to have altered gene function in their placentas, according to a new study.
It is the first study to show that exposure to phenols and phthalates may alter how genes are expressed in the placenta of pregnant women and suggests that such exposures may hamper fetuses’ proper development and growth.
“Altered expression of a gene is of concern because we will have more or less of a protein,” said senior author of the study, Karin Michels, a professor and epidemiologist at the Harvard University School of Public Health, in an emailed response. “Proteins have essential function, for example, as hormones in the body.”
"The placenta is vital for nutrient transport to the fetus, regulation of oxygen, transport of waste out of the fetal compartment ... preventing infection."-Jennifer Adibi, University of PittsburghThe researchers tested the urine of 179 women in their first trimester of pregnancy for eight phenols, including widely used bisphenol-A (BPA), and 11 phthalate metabolites, substances formed after the body processes phthalates. Then they tested how certain genes were expressed in the placenta. The women were enrolled in a study cohort at Harvard University.
They found that exposure was associated with altering certain molecules that regulate the expression of genes in the placenta. The study is concerning because the placenta is a lifeline for the fetus and properly functioning genes are crucial for the health of both the placenta and the growing fetus.
“In the early stages, the fetus doesn’t have a functional endocrine system, it does not produce the hormones it needs to develop, and the placenta actually provides those,” said Adibi, who was not involved in the study.
Phenols and phthalates are widely used. Phthalates are used in vinyl products, in cosmetic as fragrances and in other plastics to make them pliable.
Phenols have a wide variety of uses including plastic resins, pesticides, and cleaning and personal care products. One of the most common, BPA, is ubiquitous and used to make polycarbonate plastic and found in some food cans and paper receipts.
Both phthalates and phenols are found in most people and the compounds are endocrine disruptors, meaning they interfere with people’s hormones. Disrupted hormones can lead to numerous defects and diseases.
During pregnancy, various hormones rise to ensure that the fetus is carried to term. “Phthalates and phenols may interfere especially with these hormones by either mimicking their effect or blocking them,” Michels said.
The first trimester is a “critical window of exposure for implications in adverse health outcomes later in life,” Michels and colleagues wrote in the study published this month in the Environmental Health Perspectives journal.
Adibi said the study is more evidence that human placentas respond “very uniquely” to chemicals such as phthalates. “This kind of challenges that historical view of the placenta—that chemicals pass through it in a passive way and interact with the fetus directly,” she said.
The study had “numerous shortcomings,” according to a statement from the American Chemistry Council (ACC), which represents chemical manufacturers.
“This study does not provide enough information about the source of potential exposures and the study participants themselves to draw conclusions about the findings,” the statement said.
The ACC also pointed out that the study did not draw any conclusions about negative health effects associated with potential exposures, as the researchers did not find any associations between the expression of genes and birth weights or lengths.
However the altered gene expression may affect other aspects of long-term health such as metabolism or hormones, which may not directly impact birth weight or length but could manifest later in childhood or adult characteristics, Michels said.
Source : Truthout
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Evaluating the effects of Dill (Anethum graveolens) seed on the duration of active phase and intensity of labour pain
Seyedeh Tahereh Mirmolaee a, Seyedeh Fatemeh Hekmatzadehb, Anooshirvan Kazemnazhadc , Fariba Aidenloud, Mehri Shamsi
a,∗ a Nursing and Midwifery Faculty of Tehran University of Medical Sciences, Tehran, Iran
b Nursing and Midwifery Faculty of Yasuj University of Medical Sciences, Yasuj, Iran
c Trbiyat Modares University, Tehran, Iran
d Tehran Social Security Organization, Iran
Pregnant women in traditional cultures often use herbal medicines to facilitate childbirth and reduce labour pain. The aim of this study was to evaluate the effects of Dill seed on duration of the active phase and intensity of labour pain in parturient women.
Materials and methods
This retrospective cohort study evaluated the effects of Dill seed on duration of active phase and intensity of labour pain in 85 parturient women who consumed a tea made from Dill seed (case group) and 85 parturient women who consumed no medicines during labour (control group). Data collection instruments were a questionnaire, data recording sheet, Sonny Kidd and Visual Analogue Scale (VAS). All statistical analyses were performed by SPSS 16.
The results showed that in the first stage of labour pain the average duration of active phase in the case group was 4.21 ± 2.6 h compared with 6.01 ± 3.4 h in the control group (p = 0.001). The comparison of pain intensity in the two groups was not statistically significant (p > 0.05), but progress of labour in the case group was more than the control group (p = 0.001).
This study showed that a tea made from Dill seed can be used in the initial stages of labour without any side effects on mother and foetus to reduce labour pain.
Source : Journal Herbal Medicine
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Topical Lavender Cream Alleviates Anxiety, Stress, and Depression in Pregnant Women
Effati-Daryani F, Mohammad-Alizadeh-Charandabi S, Mirghafourvand M, Taghizadeh M, Mohammadi A. Effect of lavender cream with or without foot-bath on anxiety, stress and depression in pregnancy: a randomized placebo-controlled trial. J Caring Sci. 2015;4(1):63-73.
Maternal anxiety, stress, and/or depression during pregnancy have a negative effect on the health of both mother and child. Lavender (Lavandula angustifolia, Lamiaceae) flower essential oil has been shown to decrease anxiety, stress, and depression. Foot bathing has also been found to improve autonomic function, sleep quality, and relaxation. The purpose of this randomized, double-blind, placebo-controlled study was to compare the effect of lavender cream, foot bathing, and placebo treatment on anxiety, stress, and depression in pregnant women.
Healthy pregnant women (n=141, aged 18-40 years) at 25-28 weeks gestation participated in this study conducted at Tabriz University of Medical Sciences; Tabriz, Iran. Excluded patients had a history of any chronic disease; were taking any medication (e.g., sedatives) that might interfere with the interventions; smoked; had a history of infertility; had a recent unwanted pregnancy; had a history of allergy to herbal medicines; had inflammation at the site of cream application; had current severe depression, anxiety, or stress (score of ≥10 on the anxiety sub-scale, ≥17 on the stress sub-scale, or ≥14 on the depression sub-scale of the Depression Anxiety Stress Scales-21 [DASS-21]); were obese (body mass index ≥30); were illiterate; worked a night shift; or lived outside of Tabriz city. The sample size was calculated to detect a reduction of at least 43% in mean anxiety score and 40% in mean depression score on the DASS-21. P-values of <0.05 were considered significant.
Patients were randomly assigned into 3 groups as follows: placebo, lavender cream (Barij Essence Pharmaceutical Company; Kashan, Iran), and lavender cream + foot bath. The lavender cream contained 1.25% lavender essential oil; the placebo was the base cream consisting of stearic acid, acetyl alcohol, Vaseline®, and glycerin. Patients were instructed to rub 2 g of lavender or placebo cream on their legs for 10-20 minutes, 1.5 hours before bedtime for 8 weeks. The lavender + foot bath group was told to soak their feet in 40-42°C tap water, at a depth of 5 cm above the ankle, for 30 minutes after applying the cream. To facilitate blinding, patients only knew that the effect of an herbal cream was being investigated; the name of the plant was not mentioned.
The patients completed the DASS-21 questionnaire at baseline, 4 weeks, and 8 weeks. Based on their responses, anxiety, stress, and depression sub-scores were calculated. To assess compliance, patients were asked to keep a daily diary of treatment application and to return cream tubes at the week 4 and week 8 visits.
At baseline, the groups had similar characteristics. Compliance was similar among all 3 groups. No serious side effects were reported. One patient in the lavender + foot bath group and 3 patients in the placebo group were lost to follow-up.
At 4 weeks, a significant improvement in stress and anxiety scores (P<0.05 for both) was observed in the lavender group compared to placebo. The lavender + foot bath group had significantly improved stress scores compared to placebo (P<0.05).
At 8 weeks, there was a significant improvement in anxiety, stress, and depression in the lavender group compared with the placebo group (P<0.05 for all), and in the lavender + foot bath group compared with the placebo group (P<0.05 for all). There was no significant difference in DASS-21 scores between the lavender group and the lavender + foot bath group.
Acknowledged limitations of the study include the lack of a placebo + foot bath treatment arm, the lack of physiological measures of stress such as saliva cortisol levels, and that the results cannot be generalized to pregnant women with psychological disorders. In addition, this study only used one instrument (DASS-21) to measure anxiety, stress, and depression.
The authors conclude that lavender cream with or without foot bathing for 8 weeks significantly improved anxiety, stress, and depression in pregnant women. They recommend further studies to assess the effect of lavender on pregnant women with psychological disorders and women with postpartum depression. It is important to note that this study applies to the topical use of lavender essential oil. Future studies should consider the use of a natural carrier oil rather than a petroleum-based carrier.
—Heather S. Oliff, PhD
Source : American Botanical Council
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Prepregnancy low-carbohydrate dietary pattern and risk of gestational diabetes mellitus: a prospective cohort study1,2,3,4
- Wei Bao,
- Katherine Bowers,
- Deirdre K Tobias,
- Sjurdur F Olsen,
- Jorge Chavarro,
- Allan Vaag,
- Michele Kiely, and
- Cuilin Zhang
Background: Low-carbohydrate diets (LCDs) have been vastly popular for weight loss. The association between a low-carbohydrate dietary pattern and risk of gestational diabetes mellitus (GDM) remains unknown.
Objective: We aimed to prospectively examine the association of 3 prepregnancy low-carbohydrate dietary patterns with risk of GDM.
Design: We included 21,411 singleton pregnancies in the Nurses’ Health Study II. Prepregnancy LCD scores were calculated from validated food-frequency questionnaires, including an overall LCD score on the basis of intakes of carbohydrate, total protein, and total fat; an animal LCD score on the basis of intakes of carbohydrate, animal protein, and animal fat; and a vegetable LCD score on the basis of intakes of carbohydrate, vegetable protein, and vegetable fat. A higher score reflected a higher intake of fat and protein and a lower intake of carbohydrate, and it indicated closer adherence to a low-carbohydrate dietary pattern. RRs and 95% CIs were estimated by using generalized estimating equations with log-binomial models.
Results: We documented 867 incident GDM pregnancies during 10 y follow-up. Multivariable-adjusted RRs (95% CIs) of GDM for comparisons of highest with lowest quartiles were 1.27 (1.06, 1.51) for the overall LCD score (P-trend = 0.03), 1.36 (1.13, 1.64) for the animal LCD score (P-trend = 0.003), and 0.84 (0.69, 1.03) for the vegetable LCD score (P-trend = 0.08). Associations between LCD scores and GDM risk were not significantly modified by age, parity, family history of diabetes, physical activity, or overweight status.
Conclusions: A prepregnancy low-carbohydrate dietary pattern with high protein and fat from animal-food sources is positively associated with GDM risk, whereas a prepregnancy low-carbohydrate dietary pattern with high protein and fat from vegetable food sources is not associated with the risk. Women of reproductive age who follow a low-carbohydrate dietary pattern may consider consuming vegetable rather than animal sources of protein and fat to minimize their risk of GDM.
Source : The American Journal of Clinical Nutrition
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Antidepressant-like effects of omega-3 fatty acids in postpartum model of depression in rats.
Arbabi L1, Baharuldin MT2, Moklas MA1, Fakurazi S1, Muhammad SI3.Author information
Postpartum depression (PPD) is a psychiatric disorder that occurs in 10-15% of childbearing women. It is hypothesized that omega-3 fatty acids, which are components of fish oil, may attenuate depression symptoms. In order to examine this hypothesis, the animal model of postpartum depression was established in the present study. Ovariectomized female rats underwent hormone-simulated pregnancy (HSP) regimen and received progesterone and estradiol benzoate or vehicle for 23 days, mimicking the actual rat's pregnancy. The days after hormone termination were considered as the postpartum period. Forced feeding of menhaden fish oil, as a source of omega-3, with three doses of 1, 3, and 9g/kg/d, fluoxetine 15mg/kg/d, and distilled water 2ml/d per rat started in five postpartum-induced and one vehicle group on postpartum day 1 and continued for 15 consecutive days. On postpartum day 15, all groups were tested in the forced swimming test (FST) and open field test (OFT), followed by a biochemical assay. Results showed that the postpartum-induced rats not treated with menhaden fish oil, exhibited an increase in immobility time seen in FST, hippocampal concentration of corticosterone and plasmatic level of corticosterone, and pro-inflammatory cytokines. These depression-related effects were attenuated by supplementation of menhaden fish oil with doses of 3 and 9g/kg. Moreover, results of rats supplemented with menhaden fish oil were comparable to rats treated with the clinically effective antidepressant, fluoxetine. Taken together, these results suggest that menhaden fish oil, rich in omega-3, exerts beneficial effect on postpartum depression and decreases the biomarkers related to depression such as corticosterone and pro-inflammatory cytokines.
Source : Behav. Brain Res
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Exercise During Pregnancy Gives Newborn Brain Development a Head Start
As little as 20 minutes of moderate exercise three times per week during pregnancy enhances the newborn child’s brain development, according to researchers at the University of Montreal and its affiliated CHU Sainte-Justine children’s hospital. This head-start could have an impact on the child's entire life. “Our research indicates that exercise during pregnancy enhances the newborn child’s brain development,” explained Professor Dave Ellemberg, who led the study. “While animal studies have shown similar results, this is the first randomized controlled trial in humans to objectively measure the impact of exercise during pregnancy directly on the newborn’s brain. We hope these results will guide public health interventions and research on brain plasticity. Most of all, we are optimistic that this will encourage women to change their health habits, given that the simple act of exercising during pregnancy could make a difference for their child’s future.” Ellemberg and his colleagues Professor Daniel Curnier and PhD candidate Élise Labonté-LeMoyne presented their findings today at the Neuroscience 2013 congress in San Diego.
Not so long ago, obstetricians would tell women to take it easy and rest during their pregnancy. Recently, the tides have turned and it is now commonly accepted that inactivity is actually a health concern. “While being sedentary increases the risks of suffering complications during pregnancy, being active can ease post-partum recovery, make pregnancy more comfortable and reduce the risk of obesity in the children,” Curier explained. “Given that exercise has been demonstrated to be beneficial for the adult’s brain, we hypothesized that it could also be beneficial for the unborn child through the mother's actions.”
To verify this, starting at the beginning of their second trimester, women were randomly assigned to an exercise group or a sedentary group. Women in the exercise group had to perform at least 20 minutes of cardiovascular exercise three times per week at a moderate intensity, which should lead to at least a slight shortness of breath. Women in the sedentary group did not exercise. The brain activity of the newborns was assessed between the ages of 8 to 12 days, by means of electroencephalography, which enables the recording of the electrical activity of the brain. “We used 124 soft electrodes placed on the infant's head and waited for the child to fall asleep on his or her mother's lap. We then measured auditory memory by means of the brain’s unconscious response to repeated and novel sounds,” Labonté-LeMoyne said. “Our results show that the babies born from the mothers who were physically active have a more mature cerebral activation, suggesting that their brains developed more rapidly.”
The researchers are now in the process of evaluating the children’s cognitive, motor and language development at age 1 to verify if these differences are maintained.
Source : Newswise
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Acupuncture or acupressure for pain management in labour
- Caroline A Smith1,*,
- Carmel T Collins2,
- Caroline A Crowther3,
- Kate M Levett4
Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute towards the popularity of complementary methods of pain management. This review examined evidence supporting the use of acupuncture and acupressure for pain management in labour.
Objectives To examine the effects of acupuncture and acupressure for pain management in labour.
Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register and The Cochrane Complementary Medicine Field's Trials Register (October 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 4), MEDLINE (1966 to October 2010), and CINAHL (1980 to October 2010).
Selection criteria Published and unpublished randomised controlled trials comparing acupuncture and acupressure with placebo, no treatment or other non-pharmacological forms of pain management in labour. We included all women whether primiparous or multiparous, and in spontaneous or induced labour.
Data collection and analysis We performed meta-analysis using risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes. The outcome measures included pain intensity, satisfaction with pain relief, use of pharmacological pain relief, relaxation, caesarean section rate, augmentation with oxytocin, length of labour and anxiety.
Main results We included 13 trials with data reporting on 1986 women. Nine trials reported on acupuncture and four trials reported on acupressure. Less intense pain was found from acupuncture compared with no intervention (standardised mean difference (SMD) -1.00, 95% confidence interval (CI) -1.33 to -0.67, one trial, 163 women). One trial increased satisfaction with pain relief compared with placebo control (RR 2.38, 95% CI 1.78 to 3.19, 150 women). Reduced use of pharmacological analgesia was found in one trial of acupuncture compared with placebo (RR 0.72, 95% CI 0.58 to 0.88, 136 women), and compared with standard care, however, there was significant heterogeneity (RR 0.68, 95% CI 0.56 to 0.83, three trials, 704 women). Fewer instrumental deliveries from acupuncture were found compared with standard care (RR 0.67, 95% CI 0.46, 0.98, three trials, 704 women). Pain intensity was reduced in the acupressure group compared with a placebo control (SMD -0.55, 95% CI -0.92 to -0.19, one trial, 120 women), and a combined control (SMD -0.42, 95% CI -0.65 to -0.18, two trials, 322 women). No trial was assessed as being at a low risk of bias for all of the quality domains.
Authors' conclusions Acupuncture and acupressure may have a role with reducing pain, increasing satisfaction with pain management and reduced use of pharmacological management. However, there is a need for further research.
Plain language summary
Acupunture or acupressure for relieving pain in labour Acupuncture or acupressure may help relieve pain during labour, but more research is needed.
The pain of labour can be intense, and may be worsened because of a woman's tension, anxiety and fear affecting their labour and birth experience . Many women would like to labour without using drugs or invasive methods of pain management, and turn to alternatives to manage the pain. The review of 13 trials, with data reporting on 1986 women, found that acupuncture or acupressure may help relieve labour pain. Single or limited numbers of trials reported less intense pain, increased satisfaction with pain relief and reduced use of analgesic drugs with acupuncture compared with placebo or usual care. Acupressure also reduced pain intensity. Acupuncture involves the insertion of fine needles into different parts of the body to correct the imbalance of energy in the body. The intervention was administered at term as individualised treatment (six trials) or at standardised acupuncture points in the majority of trials but with wide variation in the mode of stimulation, duration of needling, number of points used, depth of needling and duration of the trial.
Source : The Cochrane Library
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Antenatal perineal massage helps reduce both perineal trauma during birth and pain afterwards.
Most women are keen to give birth without perineal tears, cuts and stitches, as these often cause pain and discomfort afterwards, and this can impact negatively on sexual functioning. Perineal massage during the last month of pregnancy has been suggested as a possible way of enabling the perineal tissue to expand more easily during birth. The review of four trials (2497 women) showed that perineal massage, undertaken by the woman or her partner (for as little as once or twice a week from 35 weeks), reduced the likelihood of perineal trauma (mainly episiotomies) and ongoing perineal pain. The impact was clear for women who had not given birth vaginally before, but was less clear for women who had. Women should be informed about the benefits of digital antenatal perineal massage.
Background: Perineal trauma following vaginal birth can be associated with significant short-term and long-term morbidity. Antenatal perineal massage has been proposed as one method of decreasing the incidence of perineal trauma.
Objectives: To assess the effect of antenatal digital perineal massage on the incidence of perineal trauma at birth and subsequent morbidity.
Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (22 October 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2012, Issue 10), PubMed (1966 to October 2012), EMBASE (1980 to October 2012) and reference lists of relevant articles.
Selection criteria: Randomised and quasi-randomised controlled trials evaluating any described method of antenatal digital perineal massage undertaken for at least the last four weeks of pregnancy.
Data collection and analysis: Both review authors independently applied the selection criteria, extracted data from the included studies and assessed study quality. We contacted study authors for additional information.
Main results: We included four trials (2497 women) comparing digital perineal massage with control. All were of good quality. Antenatal digital perineal massage was associated with an overall reduction in the incidence of trauma requiring suturing (four trials, 2480 women, risk ratio (RR) 0.91 (95% confidence interval (CI) 0.86 to 0.96), number needed to treat to benefit (NNTB) 15 (10 to 36)) and women practicing perineal massage were less likely to have an episiotomy (four trials, 2480 women, RR 0.84 (95% CI 0.74 to 0.95), NNTB 21 (12 to 75)). These findings were significant for women without previous vaginal birth only. No differences were seen in the incidence of first- or second-degree perineal tears or third-/fourth-degree perineal trauma. Only women who have previously birthed vaginally reported a statistically significant reduction in the incidence of pain at three months postpartum (one trial, 376 women, RR 0.45 (95% CI 0.24 to 0.87) NNTB 13 (7 to 60)). No significant differences were observed in the incidence of instrumental deliveries, sexual satisfaction, or incontinence of urine, faeces or flatus for any women who practised perineal massage compared with those who did not massage.
Authors' conclusions: Antenatal digital perineal massage reduces the likelihood of perineal trauma (mainly episiotomies) and the reporting of ongoing perineal pain, and is generally well accepted by women. As such, women should be made aware of the likely benefit of perineal massage and provided with information on how to massage.
This record should be cited as: Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD005123. DOI: 10.1002/14651858.CD005123.pub3
Source : Cochrane Collaboration
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Study shows prenatal DHA leads to healthier babies Omega-3 leads to increased birth weight and gestational age
A simple, inexpensive nutritional supplement could increase American infants’ birth weight and gestational age closer to those found in other developed countries.
University of Kansas researchers found that the infants of mothers who were given 600 milligrams of the omega-3 fatty acid DHA during pregnancy weighed more at birth and were less likely to be very low birth weight and born before 34 weeks gestation than infants of mothers who were given a placebo, according to a statement from the university. This result greatly strengthens the case for using the dietary supplement during pregnancy, leading to potentially improved neurodevelopment in infants as well as preventing hospitalizations for preterm birth and reducing the associated costs.
“A reduction in early preterm and very low birth weight delivery could have clear clinical and public health significance,” said Susan Carlson, A.J. Rice Professor of Dietetics and Nutrition at the KU Medical Center, who directed the study with John Colombo, KU professor of psychology and director of the Life Span Institute. The study will be published in the April issue of the American Journal of Clinical Nutrition and is available online.
DHA (docosahexaenoic acid) occurs naturally in cell membranes. Infants obtains DHA from their mother in utero and postnatally from human milk. The amount received depends upon the mother’s DHA status. American women typically consume less DHA than women in most of the developed world.
“We believe that supplementing U.S. women with DHA could safely increase mean birth weight and gestational age to numbers that are closer to other developed countries such as Norway and Australia,” said Carlson.
The results are from the first five years of a 10-year, double-blind, randomized controlled trial. Researchers will follow up with the same group of babies to see if DHA supplementation benefits their intelligence.
Source : NewHope360
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Acupuncture for tension-type headache in pregnancy: A prospective, randomized, controlled study
J.B. Guerreiro da Silva, M.U. Nakamura, J.A. Cordeiro, L. KulayAbstract
Acupuncture for tension-type headache in pregnancy: a prospective, randomized, controlled study.
This study was undertaken to test, under real-life conditions, the effects of acupuncture on headaches during pregnancy and compare this with a group of patients undergoing conventional treatment alone.
Forty-three conventionally treated (lifestyle modifications and stretching) pregnant women were randomly allocated into two groups to routine care or acupuncture. The severity and disability caused by this pain and its affect on mood, sleep and work were assessed using a Numerical Rating Scale (NRS). The main end-point was the mean difference between the first and the last interview after eight weeks of treatment. Secondary end points were the changes over time in the NRS assessments of pain intensity, disturbances in mood, sleep and working and the use of medications.
Differences between initial and final sessions were analyzed by a two-sample test. Changes over time in the NRS assessment were analyzed by the Fisher exact test. Mood's test for medians was used and a p-value<0.05 indicated a significant difference.
All women completed the treatment. No important adverse effects related to acupuncture treatment or to pregnancy's outcome were reported. Significant improvements were demonstrated for pain at the end of the trial in the study group, 3.9 vs 1.7 difference in favor to acupuncture group (p<0.05). This group also used less medication and had a greater improvement in mood and sleep when compared with the control group.
This study suggests acupuncture alleviates tension-type headaches during pregnancy.
Source : European Journal of Integrative Medicine
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High Vitamin D Levels in Pregnancy May Protect Mother More Than Baby Against Multiple Sclerosis
Pregnant women who have higher levels of vitamin D in their blood may have a lower risk of developing multiple sclerosis (MS) than women with lower levels, while their babies may not see the same protective effect, according to a study published in the November 20, 2012, online issue of Neurology®, the medical journal of the American Academy of Neurology. “In our study, pregnant women and women in general had a lower risk for MS with higher levels of the vitamin, as expected. However, a mother’s levels of vitamin D during early pregnancy did not have an effect on MS risk for her baby,” said study author Jonatan Salzer, MD, with Umeå University Hospital in Sweden.
For the study, scientists reviewed information about 291,500 blood samples from 164,000 people collected since 1975 in the northern half of Sweden. Of those, 192 people developed MS an average of nine years after their blood sample was drawn, and there were 37 blood samples drawn during pregnancy from mothers whose children went on to develop MS later in life.
The research found that women who had high levels of vitamin D in their blood had a 61 percent lower risk of developing MS, compared to those who had low levels of vitamin D in their blood. Overall, few people had high levels of vitamin D. Only seven of the 192 people who developed MS, or four percent, had high vitamin D levels, compared to 30 of 384 controls without the disease, or eight percent.
No association was found between the mother’s vitamin D level and whether her child would later develop MS.
“Since we found no protective effect on the baby for women with higher levels of vitamin D in early pregnancy, our study suggests the protective effect may start in later pregnancy and beyond,” said Salzer. “Another interesting finding in our study was that the vitamin D levels became gradually lower with time from 1975 and onward. It is possible that this decline in vitamin D status is linked to the increasing numbers of MS cases seen worldwide.”
Sources of vitamin D are diet, supplements and the sun.
Source : Newswise
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Yoga Reduces Depression in Pregnant Women, Boosts Maternal Bonding
University of Michigan study the first to show evidence that mindfulness yoga may offer effective treatment for depressed new mothers to be. Prenatal yoga may help women cope with depression.
It's no secret that pregnancy hormones can dampen moods, but for some expectant moms, it's much worse: 1 in 5 experience major depression.
Now, new research shows that an age-old recommended stress-buster may actually work for this group of women: yoga.
Pregnant women who were identified as psychiatrically high risk and who participated in a 10-week mindfulness yoga intervention saw significant reductions in depressive symptoms, according to a University of Michigan Health System pilot feasibility study. Mothers-to-be also reported stronger attachment to their babies in the womb.
The findings were published in Complementary Therapies in Clinical Practice.
"We hear about pregnant women trying yoga to reduce stress but there's no data on how effective this method is," says lead author Maria Muzik, M.D., M.S., assistant professor of psychiatry and assistant research scientist at the Center for Human Growth and Development. "Our work provides promising first evidence that mindfulness yoga may be an effective alternative to pharmaceutical treatment for pregnant women showing signs of depression.
"This promotes both mother and baby wellbeing."
Mental health disorders during pregnancy, including depression and anxiety, have become a serious health concern. Hormonal changes, genetic predisposition and social factors set the stage for some expectant moms to experience persistent irritability, feelings of being overwhelmed and inability to cope with stress.
Untreated, these symptoms bear major health risks for both the mom and baby, including poor weight gain, preeclampsia, premature labor and trouble bonding with the new baby.
While antidepressants have proven to effectively treat these mood disorders, Muzik says, previous studies show that many pregnant women are reluctant to take these drugs out of concern for their infant's safety.
"Unfortunately, few women suffering from perinatal health disorders receive treatment, exposing them and their child to the negative impact of psychiatric illness during one of the most vulnerable times," Muzik says. "That's why developing feasible alternatives for treatment is critical."
Evidence suggests women are more comfortable with nontraditional treatments, including herbal medicine, relaxation techniques and mind-body work.
Yoga continues to grow in popularity but in the United States, many classes concentrate on yoga as "exercise," omitting the practice of being fully present in the moment and aware, authors say.
Meanwhile, mindfulness yoga -- which combines meditative focus with physical poses -- has proven to be a powerful method to fight stress and boost energy.
For the U-M research study, women who showed signs of depression and who were between 12-26 weeks pregnant participated in 90-minute mindfulness yoga sessions that focused on poses for the pregnant body, as well as support in the awareness of how their bodies were changing to help their babies grow.
Funding for follow up work on this subject was recently provided by a grant from the Institute for Research on Women and Gender.
"Research on the impact of mindfulness yoga on pregnant women is limited but encouraging," Muzik says. "This study builds the foundation for further research on how yoga may lead to an empowered and positive feeling toward pregnancy."
Source : Science Daily
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Studies Assess Ginger for Treatment of Nausea During Pregnancy and Menstrual Pain
Reviewed: Ozgoli G, Goli M, Moattar F. Comparison of effects of ginger, mefenamic acid, and ibuprofen on pain in women with primary dysmenorrhea. J Altern Complement Med. 2009;15(2):129-132. Reviewed: Ozgoli G, Goli M, Simbar M. Effects of ginger capsules on pregnancy, nausea, and vomiting. J Altern Complement Med. 2009:15(3):243-246.
Researchers from Iran recently conducted 2 trials to evaluate the safety and effectiveness of ginger (Zingiber officinale, Zingiberaceae) for treating female reproductive complaints. The first study compared ginger preparations to non-steroidal anti-inflammatory drugs (NSAIDs) for relieving dysmenorrhea (painful or difficult menstruation). The second study evaluated ginger as a treatment for nausea and vomiting during pregnancy.
Dysmenorrhea is experienced by more than half of menstruating women. NSAIDs can be effective in relieving dysmenorrhea, but NSAIDs and other pain relievers commonly cause adverse side effects and are contraindicated in some people. Ancient medical texts refer to the use of ginger for relief of dysmenorrhea, but there are no published clinical trials to support its effectiveness. The researchers therefore conducted a study to compare the effects of ginger, mefenamic acid (a mild analgesic and fever-reducing NSAID used in some types of arthritis and for the relief of moderate short-term menstrual pain), and the NSAID ibuprofen on dysmenorrhea.
For the non-randomized, double-blind trial, the researchers recruited 150 female college students who were 18 years or older and had primary dysmenorrhea. The women completed a questionnaire that assessed menstrual characteristics and severity of pain. Those with moderate to severe dysmenorrhea were enrolled in the study and alternately allocated to 1 of 3 groups: the ginger group, the mefenamic acid group, or the ibuprofen group. Depending on their assigned group, the women were instructed to take either four 250-mg capsules of ginger rhizome powder (Zintoma; Goldaroo Company; Tehran, Iran), four 250-mg capsules of mefenamic acid (Ponstan; Razak Co.; Iran), or four 400-mg capsules of ibuprofen (Brufen; Roozdaru Co.; Iran) each day, beginning on the first day of their menstrual period and continuing for 3 days. After the 3 days, the women rated the severity of their dysmenorrhea, the degree of pain relief, and their satisfaction with the treatment. Only one menstrual cycle was studied.
All 150 women completed the study. There were no significant differences in baseline characteristics among the 3 groups. Dysmenorrhea severity decreased in all 3 groups (P values not reported) after 3 days. Severity of symptoms, improvement in pain relief, satisfaction with the treatment, and compliance with the capsules were not significantly different among the groups. None of the women reported any serious adverse side effects during the study.
The authors conclude that ginger is as effective as mefenamic acid and ibuprofen in decreasing menstrual pain. They also point out certain limitations of this study. The study subjects were alternately assigned to an experimental group rather than randomly assigned; however, baseline characteristics were similar among subjects in all 3 groups, and there is no indication of bias in group assignments. The study did not compare the effect of ginger on other menstrual symptoms, such as nausea, headaches, and fatigue. The scale used to rate dysmenorrhea severity was a verbal, 4-point scale, and the authors suggest that use of a 10-point visual analog scale or other standardized scale may detect more subtle differences in response among the experimental groups.
One issue the authors do not address is the dosage of comparator drugs used in this study. It is not clear if the doses selected for this study (1,600 mg ibuprofen and 1,000 mg mefenamic acid) are typical doses used for treatment of primary dysmenorrhea in the local population. In the United States, daily doses of 2,400-3,200 mg ibuprofen are commonly recommended for treatment of moderate or severe dysmenorrhea and may be more effective than the 1,600 mg dose of ibuprofen used in this study. The recommended dose for mefenamic acid is 1,500 mg per day. It is therefore unclear as to how much of a placebo-effect occurred in this study. It would have been better if a placebo group had been included for comparison. Another limitation is that the study was very brief; typically, dysmenorrhea studies are conducted over a 3 month period. In addition to correcting the limitations discussed by the authors, future trials should assess the safety and efficacy of ginger during several menstrual cycles, investigate a range of ginger doses, and include populations of women other than young college students.
The second study assessed the effects of 1,000 mg of ginger administered in capsule form on the severity of nausea and vomiting in pregnant women. Up to 90% of women experience nausea and vomiting during pregnancy. Little is known about the safety of antinausea drugs during pregnancy, so some pregnant women turn to herbs or other complementary therapies for relief. Ginger has long been used to relieve stomach upset in the traditional medicines of many cultures.
This single-blind, randomized, placebo-controlled trial was conducted at prenatal clinics and Isfahan Shahid Beheshti Hospital in Isfahan, Iran. Seventy healthy, pregnant women who were less than 20 weeks gestational age and who reported mild to moderate nausea with or without vomiting were enrolled in the trial. The women were randomly allocated to an experimental group or a matched control group. Women in the experimental group took four 250-mg capsules containing ginger root powder (Zintoma; Goldaroo Company; Tehran, Iran) daily for 4 days. Women in the control group took 4 placebo capsules containing lactose daily for 4 days. The women were instructed to take a capsule in the morning, at noon, in the afternoon, and at night.
Before starting the study, women rated the severity of their nausea and vomiting using a 10-point visual analog scale (VAS). The women were instructed to avoid fatty foods and to eat smaller, more frequent meals during the study. The women completed a questionnaire each day and recorded the severity of their nausea on the VAS twice a day (at noon and at bedtime). On the fifth day, the women were interviewed by a researcher to assess compliance with the dietary instructions and capsule use.
Of the 70 women who started the study, 67 completed the study (32 in the ginger group and 35 in the placebo group). There were no significant differences in nausea intensity between the 2 groups at baseline. Women in the ginger group reported significantly greater improvement in nausea than women in the placebo group (P < 0.05) during the 4-day trial. Nausea intensity declined in 84% of women in the ginger group and 56% of women in the placebo group (P < 0.05). The incidence of vomiting did not decrease significantly in the placebo group but decreased a significant 50% in the ginger group after 4 days (P < 0.05). None of the women reported any adverse side effects from the capsules. While compliance with the capsules was excellent in both groups, only about half of the women in each group reported complying with the dietary advice.
The authors conclude that daily treatment with 1,000 mg of ginger is a safe and effective way to decrease the intensity of nausea as well as the incidence of vomiting during pregnancy. However, the authors’ conclusions that 1,000 mg is the appropriate dose cannot be asserted given that this study was not a dose-ranging study. Also, the authors’ conclusion that this dose is safe cannot be asserted since there has been no long-term, follow-up studies of the infants, and, given the small sample size, only very large changes in pregnancy outcomes would have been seen.
The results of this study are consistent with 9 published randomized controlled trials, which have also evaluated the effectiveness of ginger for nausea and vomiting during pregnancy. In these trials, daily doses ranged from 1,000 mg to 1,500 mg and the ginger products included capsules containing ginger powder or ginger syrup, which is mixed with a beverage.
The authors point out that the short duration of this trial is a limitation. Another limitation that the authors did not discuss is whether the study was adequately blinded. Ginger capsules have a distinctive odor and flavor and it is possible that the people taking the placebo were aware that they had the placebo treatment. This could have contributed to the study outcome. Future trials should assess the safety and effectiveness of ginger over a longer period of time, should improve study blinding, and enroll pregnant women with severe nausea and vomiting to expand the understanding of this herb’s effectiveness during pregnancy.
—Heather S. Oliff, PhD
Source : American Botanical Council
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