Keeping up with medical news and changes in healthcare is undeniably a difficult task these days. Yet, the minute a woman learns she is pregnant, deciphering what is right and wrong for her or baby according to current guidelines seems like another full time job. Something may be deemed safe one minute, only to be reversed the next.
Having just given birth to my second child, it has been of utmost importance for me to keep abreast of the current information available regarding pregnancy and childcare. Even though my first pregnancy was only a short time ago, some new information on hot topics have surfaced during the previous year that made me realize I wasn’t as knowledgeable as I should be. The following is a brief compilation of recent updates that all new mothers should be aware of, but remember that nothing trumps intuition and personal preference when giving birth and raising children.
Delayed Clamping of Umbilical Cord
The American College of Obstetrics and Gynecologists (ACOG) recently released a statement that explains how delayed clamping of the umbilical cord appears to be beneficial for babies by increasing their blood supply and iron stores. The positive effect on babies’ circulation may possibly lead to better developmental outcomes. Delayed clamping by about 30 to 60 seconds is now recommended for both term and preterm infants, and some institutions recommend waiting even longer.
The rationale behind delayed cord clamping makes sense. Infant studies have shown that the placenta transfers blood to the baby even at 3 minutes after giving birth. The baby’s first breaths help to facilitate this transfer of blood. The additional blood supply that is given by waiting to clamp the cord leads to higher iron levels, especially in the first few months of life. Iron deficiency in children has been associated with some developmental delays, so establishing their supply at this early stage may be beneficial in the long run. Delayed clamping may also lead to the transfer of important cells that help with tissue injury and repair, but further studies are needed in this area.
No dangerous side effects appear to be associated with this practice, either for mom or baby. The only caveat appears to be a slight increase in jaundice among those babies whose clamping was delayed, and the ACOG recommends that mechanisms already be place to prepare for this. Studies have also yet to show any risk for maternal bleeding.
Room Sharing for Sleep
I have always been in favor of keeping my sleeping babies very close by for much longer than infancy, and to the point where I almost never relied on a baby monitor and never even set up a nursery for my second born. It was difficult to do this sometimes and probably does not appeal to all moms, but was something I felt comfortable with and helped me to sleep better at night knowing my baby was right there.
The American Academy of Pediatrics (AAP) now recommends this practice as well, advising parents to keep their babies in the same bedroom for at least the first 6 months and, optimally, for the first year of life. This practice has been found to reduce the risk of sudden sleep-related deaths.
While the AAP stresses that babies should sleep on a separate surface in the same bedroom, history tells us that moms have been judiciously sleeping with their babies by their side for almost all of time. It is important to take note of the safe sleeping guidelines — which can be found on the AAP’s website — but also to carefully adapt to what is personally best for both mom and baby.
Peanut Allergy
The food allergy world is riddled with much controversy. Continuously changing recommendations coupled with parents’ harboring feelings of guilt and fear oftentimes lead to a lack of faith in the medical community. Food allergies could mean either life or death for a child, but the seriousness of it only worsens the complexity.
Those living with peanut allergies are all too aware of the vigilance that must be undertaken to prevent a serious reaction. New recommendations specify that all infants should receive early introduction of peanut-containing foods to lower the risk of developing a peanut allergy. This umbrella recommendation is further broken down into 3 distinct guidelines.
Guideline 1 is for infants thought to be at high risk of developing a peanut allergy, because they already have an egg allergy or severe eczema. Peanuts should be introduced to these infants as early as 4 to 6 months, but not without a doctor evaluation first to see if specific allergy testing should be done.
Guideline 2 recommends that for babies with mild to moderate eczema, peanuts be introduced around 6 months of age. Guideline 3 is for infants not at risk and suggests peanuts be freely introduced at anytime. For all infants regardless of risk, other solids should be started before introducing peanuts.
While some healthcare professionals have had differing opinions over the years, early peanut introduction is in contrast to the previous recommendation to hold off giving peanut products until the age of 2. It was once thought that early exposure could actually increase the risk. Yet, several studies over the past few years have shown a drastic decrease in peanut allergies if they were given to high risk infants during the first year of life. Many professionals agree that the guidelines would not be changed if such drastic results weren’t seen.
In any case, it is always important to have a frank discussion with a pediatrician. Personally, I believe that early and repeated exposure of peanuts and other offenders are beneficial – it makes sense that exposure would allow the body to recognize the components and not see it as “foreign”. During both of my pregnancies, I also remembered a particular study that was published in the Journal of American Medicine. This particular study noted a decrease in peanut allergies among children whose mothers consumed peanuts during pregnancy, especially during the first trimester. While sometimes difficult, I think it is important that a mom eat as much variety of foods that she can handle while pregnant and/or breastfeeding to increase exposure to the child. While I believe perinatal consumption is helpful, food allergies be may imminent no matter what mom or baby does, so it is important to not feel guilty if one should develop.
Omega-3 Fatty Acids
Pregnant women may not be getting enough omega-3 fatty acids which are crucial to a baby’s central nervous system and visual development. The body is unable to make these fatty acids on its own and must rely on outside sources such as food or supplements. Seafood is a major source of omega-3 fatty acids, but pregnant women are often told to limit consumption due to mercury risks. This means a high quality fish oil supplement is often needed.
Two types of omega-3 fatty acids exist – EPA and DHA – and it is important for pregnant and breastfeeding mothers to consume both. Studies show multiple heath benefits in children when consumed during pregnancy including higher cognitive function, lower allergies and asthma, and longer gestations with higher birth weights. Omega-3s can also benefit the mother by helping with mood issues during and after pregnancy, inflammation, and heart health.
Pregnant women most likely need a higher dosage of omega-3s and would benefit from a quality fish oil supplement that contains at least 300mg of DHA. The supplement should also be continued if the mother is breastfeeding. Remember that supplements are not monitored by the FDA, so ask your doctor or pharmacist if you’re not sure about a reputable brand.
Unclear Association Between Heartburn Medicine During Pregnancy and Childhood Asthma
The Journal of Allergy and Clinical Immunology recently published a study that found a possible link between mothers who took heartburn medication during their pregnancy and childhood asthma – their child was about one-third more likely to develop asthma-like symptoms. Before many pregnant women panic, it is extremely important to note that the investigators of the study caution that many other factors could have influenced their findings and that further investigation is needed.
Heartburn is an incredibly common symptom in pregnancy. The stomach valve that keeps stomach acid down is often relaxed due to progesterone, a hormone that is produced from the placenta. Further in pregnancy, the growing uterus also pushes into the stomach which physically forces acid up. Those who suffer know it’s not just a discomfort; heartburn can cause a burning pain and disrupt an already disruptive sleep. Most heartburn medications have been deemed safe to use in pregnancy since they haven’t yet been found to affect the growing fetus.
At this point, healthcare professionals agree to continue to use heartburn medication on an as needed basis, but to also rely heavily on non-drug therapies, such as smaller meals, non-irritating foods, and not eating a few hours before bedtime. Many other factors contribute to childhood asthma, and not enough information exists to stop the use of medications that really do provide relief. The study itself is also not considered to be a “gold standard” design, so conclusions are very difficult to draw at this time. To make matters even more complex, the investigators are also not sure if the medication itself is contributing to asthma, or if there is possibly another factor that causes both heartburn in pregnant women and asthma in children.
Remember that non-drug therapy is always preferred first, especially in pregnant women. Non-drug therapy is especially helpful in controlling the symptoms of heartburn, so make sure you’ve exhausted those options first. If nothing else works, continue to take your heartburn medication under doctor supervision until a better association is found.
References:
American Pregnancy.org
American College of Obstetrics and Gynecologists
American Academy of Pediatrics
Frazier AL, Camargo CA, Malspeis C, et al. Prospective Study of Peripregnancy Consumption of Peanuts or Tree Nuts by Mothers and the Risk of Peanute or Tree Nut Allergy in Their Offspring. JAMA Pediatr. 2014;168(2); 156-162
Greenberg JA, Bell SJ, Van Ausdal W. Omega-3 Fatty Acid Supplementation During Pregnancy. Rev Obstet Gynecol. 2008 Fall; 1(4): 162–169
