As obesity rates are rising, more women are falling pregnant while already overweight and obese, putting themselves and their baby's health at risk. Advice from the Royal College of Obstetricians and Gynaecologists (RCOG), in a patient leaflet, says it is best if overweight women lose weight before they conceive as dieting when pregnant is not recommended. There are thought to be around 40,000 women  who are classed as severely obese with a body mass index of 35 or more who give birth each year. The guidance said being obese increases the risk of blood clots, gestational diabetes, high blood pressure and pre-eclampsia, a potentially life threatening condition. Risks to the baby include miscarriage, neural tube defects, larger birth weight, stillbirth and obesity and diabetes later in life.

Obese women also have more difficult labours and births and are more likely to need an emergency caesarean section. Philippa Marsden, Chairman of the RCOG’s Patient Information Committee, said: "This new advice gives women information about the risks of being overweight during pregnancy and giving birth but more importantly focuses on how women can work together with their health care team to reduce these risks. It also details the extra care a woman should have during her pregnancy if she has a raised body mass index.

“Trying to lose weight by dieting during pregnancy is not recommended – even if you are obese – as it may harm the health of your unborn baby. However, by making healthy changes to your diet you may not gain any weight during pregnancy and you may even lose a small amount. “Healthcare professionals can also help you with losing weight if you are planning for a future pregnancy or after you have had your baby.”The guidance said there is no need to eat for two, as pregnant women do not need extra calories until the third trimester and then only an extra 200 per day, the equivalent to two pieces of toast. The new advice also covers exercise in pregnancy, vitamin supplements, planning for labour and birth, after birth care and planning for a future pregnancy.

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A pregnant woman working at a nuclear arms factory has said that she was fired because she told her bosses of her pregnancy and morning sickness. Jennifer Cox alleged that she lost her job as a result of morning sickness after deciding 'honesty was the best policy' and telling her bosses she was expecting a child.

Cox, 33, had worked for the Ministry of Defence police at the Atomic Weapons Establishment in Aldermaston, Berkshire, as its website manager in charge of updating information on the base's intranet.

She had been hired on a part-time basis and within five weeks of the start of her job, she told bosses she was pregnant and began taking time off due to morning sickness and attending antenatal appointments.

This delayed progress on the website's development and as a result, she said her line manager Ray Cross had a 'threatening conversation' with her. "He just told me to stop going off sick... I didn't want to be sick, I couldn't help it," the Telegraph quoted her as saying. "The threatening and intimidating conversation left me leaving work feeling very miserable and low," she said.

She is charging her bosses with unfair dismissal due to sexual discrimination. Cox told the tribunal panel that when she informed her superiors of her condition it led to her newly formed job becoming 'at risk'.

"I had made the decision to notify my line manager, thinking that honesty was the best policy, which I now regret," she said. Martin Downs, representing the MoD, said Cross was not angry at her for missing work because of her sickness.

"This was not with focus on absence in mind... all Mr Cross was concerned about was the output on the intranet," Downs said. Her employment with the MoD ended on July 12, 2010. She had been employed on a six-month short-term casual contract for three days a week.

Cox said she was led to believe it would become permanent position. However, that appeared to have changed several months later, the tribunal was told.

"Mr Cross told me that if things didn't start to develop on the intranet soon he would have no option other than to end my contract and remind me that my contribution to the business was being evaluated while on a casual contract," she said. The case was adjourned with a reserved conclusion from Judge Robin Lewis expected in the New Year.

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There’s a growing body of research on how obesity can be ‘programmed’ in the womb—and a growing campaign to thwart America’s obesity ‘epidemic’ by targeting pregnant women. We’re all for public health agendas aimed at increasing maternal and fetal health. But the trend toward blaming obesity rates on women’s choices is worrying—don’t pregnant women have enough to think about without being responsible, literally, for the weight of the nation?

Melinda Sothern, a professor of clinical exercise at Louisiana State University, doesn’t quite blame pregnant women themselves for today’s high obesity rates—it was “the evil ’50s,” she told The Los Angeles Times, an era when doctors often advised pregnant women against gaining more than 10 pounds but said nothing about quitting smoking. The new moms and mothers-to-be of 1950s America smoked, dieted during pregnancy and spurned breast-feeding—what Sothern calls “the obesity trinity.” Inadequate fetal nutrition can program babies to ‘catch up’ on growth as infants, which studies suggest increases the risk of later obesity. Smoking during pregnancy is also thought to increase obesity risk in children, because nicotine interferes with the body’s control of appetite, metabolic rate and fat storage. And formula-fed babies have a higher risk for becoming obese than breast-fed babies.

I think this is all very interesting, and important in terms of figuring out what behaviors and habits doctors should recommend to pregnant women. I’m glad folks are conducting research on these topics, and I’m not saying we shouldn’t talk about it. But it’s framing pregnant women as “the root” of America’s obesity problems that I find troubling. Here’s how the LAT described Sothern’s theory:

Oh my. Obesity in our society (as Sothern acknowledges) has myriad causes—fast food, convenience food, decreased physical activity—many of which developed alongside changing maternal habits in the 1950s, 60s and 70s. Obesity rates may have began soaring in the 1980s due partly to mothers’ smoking, diet and lack-of-breast-feeding, but they had a lot of help from other areas.
 

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Last week’s NHS figures showing that one in four young women lost their virginity when they were below the legal age of consent, coupled with the recent Daily Telegraph revelation that the morning-after pill will soon be just a phone call away, reflect the difficult business of discouraging teenage girls from becoming pregnant.

The standard explanation for the much higher termination rates in girls up to the age of 18 (46 per 1,000), compared to other countries such as Holland, has always been that British parents are too uptight to give frank advice on these matters.

Hence, the state must intervene in the form of the Teenage Pregnancy Strategy, set up in 1998 with the modest ambition of cutting the number of teenage pregnancies by half. It has certainly blossomed, spending millions of pounds on outreach workers, sex education initiatives, and the ready availability of pills and condoms.

The upshot is that the teenage pregnancy rate has hardly shifted. It is difficult to see how the morning-after pill by phone will make much difference. Indeed, the advice that teenagers should stock up on supplies for Christmas does little but encourage opportunist sexual activity.

Private medicine – like flying club class – is wonderful if you can afford it, or if someone else is paying. But so expensive has it become that, as Dr Natalie Macdonald, Bupa’s managing director, pointed out recently, people can spend virtually their entire disposable income on insurance premiums.

To be sure, costs have risen. But the fault, Dr Macdonald says (reading between the lines), lies in the cupidity of specialists seeking to maximise their income by recommending unnecessary operations or treatment.

They would, of course, vigorously deny it, and their professional organisations have been queuing up to describe Dr Macdonald’s charges as “indefensible”. But Bupa has done its sums, and they are compelling: for every pound that those struggling to pay their premiums shell out, 20 pence goes on “inappropriate” health care.

It was, of course, ever thus: the likelihood of having a gall bladder operation or hysterectomy has always been two or three times higher in the private sector. But the process has accelerated as specialists seek to supplement their NHS earnings with private practice. It could, if left unchecked, undermine private medicine in Britain. In the meantime, Dr Macdonald’s observations are a reminder to all to be cautious before consenting to any proposed treatment.

Two suggestions for the gentleman plagued by a soreness of the legs “as if they were sunburnt”. A retired anaesthetist writes that this may be due to narrowing of the arteries, which usually causes the calf pain, known as intermittent claudication. Her symptoms improved with a combination of statins and regular exercise to improve the collateral circulation to the legs, the skin soreness “also vanished”.
The further possibility is that the sunburnt feeling is due to an abnormality of the sensory nerves in the leg, or from their compression as they exit the spinal cord at the base of the spine. Interestingly, a couple of readers comment on its seasonality, disappearing in the summer only to return with the cold weather.

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A mother's weight before and after pregnancy has been highlighted as a predictor of the baby's weight. Researchers at the Department of Pediatrics at Soerlandet Hospital and the University of Oslo, Norway, found that the birth weight of a new born child increased if the mother's body mass index (BMI) rose pre-pregnancy.

The results were also the same if the mother's weight increased whilst pregnant with their child. Stamnes Koepp, head of the research team, said: "Encouraging women to attain a healthy weight before conception and keep a moderate weight gain during pregnancy is important to avoid high or excessive birth weight in offspring."The study also found that women with the highest level of education had the highest offspring birth weight. Offspring weight in women with 17 years or more of education was 79.2g higher than those with less than or equal to nine years' of education.

Doctors have also warned mothers looking to lose their "baby weight" not to be induced by celebrity weight programmes which are "harmful to the health of mothers and their babies". Find a dietician job at Mediplacements, a genuine specialist providing recruitment opportunities in the NHS and private sector.

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Researchers at the University of Texas Medical Branch, Galveston, have participated in one of the largest studies on the causes of stillbirth to date. The results bring some good news and some not so good news.

According to the study, stillbirth affects 1 in 160 pregnancies in the United States, which is equal to the number of infant deaths each year. Rates of fetal deaths are higher here than in other developed countries. Researchers noted that there is a significant racial disparity in stillbirths that is currently unexplained.

For the study researchers analyzed data from 59 hospitals across the country between March 2006 to September 2008.  The study looked at 614 stillbirths, at 20 weeks of pregnancy or later, and 1,816 live births during that time period.  Researchers found that factors associated with stillbirth include:

Non-Hispanic black race/ethnicity;
Obesity;
Diabetes;
Pregnancy after age 40;
Maternal AB blood type;
Not living with a partner;
Smoking during three months prior to pregnancy; and
History of illicit drug use.
The bad news is the highest risk factor for having a stillbirth was race,and that’s one factor no one can control for.  What the researchers call a “significant racial disparity” is currently unexplained.

The researchers noted that other factors associated with a higher risk of stillbirth can be controlled such as obesity, smoking within three months prior to pregnancy and history of drug use. “Moms-to-be and clinicians have a window of opportunity to save babies’ lives by maintaining a healthy weight, managing conditions such as diabetes and stopping all unhealthy behaviors, such as smoking, prior to pregnancy,” Dr. George Saade, chief of maternal-fetal medicine at UTMB, said in a press release.

“We were surprised to learn that while these risk factors were significant on their own, they didn’t account for the largest risk of stillbirth. Even if effective, reducing modifiable risks across the board would be unlikely to prevent all stillbirths,” he continued.

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Stillbirth is often caused by pregnancy complications such as problems with the placenta or preterm labor, said US research published on Tuesday aiming to shed light on the causes and risks. Ten years ago, little was known about the causes of stillbirth, a term that describes when a baby dies at or after the 20th week of pregnancy. While rare in the United States, stillbirth happens in one of 160 pregnancies, at a higher rate than other developed countries.

A pair of studies published in the Journal of the American Medical Association show that about half the time, one or more pregnancy complications appear to be the cause. Those include problems with the placenta -- which provide nutrients and blood to the fetus and removes waste -- in 26 percent of cases, said the findings led by researchers at the US National Institutes of Health.

Infections caused 14-19 percent of stillbirths, and fetal abnormalities and problems with the umbilical cord were each linked to about 10 percent of stillbirths. Looking at data from 500 pregnant women across five states, researchers were able to identify a probable cause of stillbirth in 61 percent of cases. About a third of those were linked to one or more causes.

Often, the research was thwarted by the lack of a post-mortem analysis, which about half of families do not authorize due to the trauma of the moment or financial concerns. The study began with a potential set of over 900 women and ended with just 500, because it focused only on those who had ordered a complete post-mortem analysis. "Our study showed that a probable cause of death -- more than 60 percent -- could be found by a thorough medical evaluation," said Uma Reddy, one of the study authors. "Greater availability of medical evaluation of stillborn infants, particularly autopsy, placental exam and karyotype (chromosomal analysis), would provide information to better understand the causes of stillbirth."

Researchers also found African-American women face more than twice the risk of stillbirth than white or Hispanic women. "The consistent and persistent racial disparity in stillbirth (2.3-fold risk for non-Hispanic black compared with non-Hispanic white women in the United States remains largely unexplained," the study said. While the gap is often attributed to less frequent prenatal care among blacks, research shows that "racial disparity for stillbirth persists, even in women with prenatal care."Ninety-eight per cent of the 7,000 stillbirths that occur each day happen in developing countries, according to research published in the Lancet earlier this year. Finland, with two stillbirths per 1,000 births, has the lowest rate in the world, whereas Nigeria and Pakistan, with more than 40 per 1,000, are the highest.

The US rate is 6.2 stillbirths per 1,000, or just over a half percent of all births, a rate that has remained stagnant since 2003 but which the study authors called "unacceptably high."The second study was led by George Saade of the University of Texas Medical Branch at Galveston, and examined risk factors that could be glimpsed at the start of pregnancy. Some factors that were strongly associated with stillbirth included black ethnicity, diabetes, age 40 or older, AB blood type and a history of drug use with addiction. Others included cigarette smoking within three months of pregnancy, being overweight or obese and not living with a partner. "Further research is needed to identify pregnancies at highest risk overall and for specific causes," the study added.

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North London coroner Andrew Walker said action should be taken to reduce the risk to others after he held an inquest last week into the death of a three-month-old boy. In his letter to Andrew Lansley, Mr Walker said Milind Agarwal was taken to the doctor in July with symptoms of a probable viral infection. He was sent home with saline nasal drops. A later telephone consultation with another doctor led to his parents being advised to give him paracetamol.

But his mother and father still had concerns and called an ambulance. Their son was taken to Northwick Park Hospital in north London ''where it was recognised he was seriously unwell''. The baby died from septic inflammation of the heart against a background of an abnormal aortic heart valve. A consultant paediatric pathologist told the coroner's court that vitamin D deficiency played a role in progression of the infection and suggested all pregnant and breastfeeding women be prescribed vitamin D daily.

In his letter, Mr Walker told Mr Lansley that consideration should be given ''to increasing public awareness of vitamin D deficiency'', in particular that all pregnant and breastfeeding mothers should receive 10mcg of Vitamin D every day.

Research has previously found that pregnant women and those trying to conceive are lacking vitamin D.
In 2009, experts warned that a lack of vitamin D in pregnancy can lead to a youngster suffering rickets and longer-term problems such as schizophrenia and Type 1 diabetes. While many people can get vitamin D from sunshine, those living in cooler countries may not be getting enough.

As a result, the body often relies on its own stores of vitamin D in the winter months. Otherwise, dietary intake or multivitamins are needed. Vitamin D is found in small quantities in a few foods such as oily fish, eggs and liver, and in fortified foods such as margarine, breakfast cereals and powdered milk. But pregnant women are advised to avoid liver and liver products, raw or under-cooked eggs and to limit their intake of certain fish such as tuna.

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Elaine is the rarest of the rare Salina Christmas Fund applicants who not only has access to health insurance but can actually afford it for her family. "It's made a big difference," said the single mother. "It's huge." And she should know, because in a previous job, health coverage was not offered and private insurance was priced out of her reach.

That is, except when she was pregnant and qualified for coverage offered by the state. "If you're pregnant, they give you a medical card for up to two months post-partum," she said.

After her last child was born and her health coverage ceased, she developed infections in her teeth that sent her to the hospital emergency room, where doctors could prescribe only antibiotics. They told her she needed to see an oral surgeon because the problem would only worsen.

"(Dentists) can't help you unless you have the resources or you come up with the money," she said. Out of money, out of resources and out of solutions, she made a drastic decision. "I got pregnant on purpose. And I'm not the only one who's done that."

Elaine (case number 461), whose name has been changed for this story, is among individuals and families the Salina Christmas Fund hopes to help this holiday season. The fund, in its 27th year, provides gifts of food, clothing and other assistance to local needy families throughout the year.

Elaine admits to getting pregnant at other times just to gain access to medical care. Previously, she's undergone surgeries and bought much-needed glasses. She had known for about five years her vision was deteriorating, a nonmedical diagnosis she was forced to make on her own.

"I couldn't afford to go get my eyes checked," she said. Despite the relief that comes with health coverage, Elaine still is pinched financially every month. "I live paycheck to paycheck," she said.

Her income qualifies her for the federal Supplemental Nutrition Assistance Program (SNAP), which replaced the food stamp program. And until her youngest child reaches age 5, she also is eligible for the federal Women, Infants, Children program (WIC). According to its website, the program provides "federal grants to states for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding post-partum women, and to infants and children up to age five who are found to be at nutritional risk."

Elaine and other WIC recipients have access to milk, cheese, eggs, cereal, baby food, bread, and fresh fruit and vegetables. Elaine said some women who don't qualify for the SNAP program can qualify for WIC and, fearing the day their WIC eligibility ends, will get pregnant just to stay in the program. "I sure as heck wouldn't get pregnant for milk and cheese, but I know some who have," she said. "There's no way to get all the food and things they need."

Elaine says she loves her children dearly and wouldn't give any of them up, but admitted her family would be a lot smaller today had she been able to afford her own medical care. Elaine applied to the Christmas Fund in hopes of getting shoes for her youngest child and a coat for another.

"We're hoping for shoes," she said. Normally, she hands down clothes, but the smallest pair of shoes are too big for the littlest member of the family. "(The toddler) doesn't go outside, so it's not that big of an issue now," she said.

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State and territory ministers have signed off on the introduction of mandatory pregnancy warning labels on alcohol. Ministers responsible for food regulation met in Melbourne on Friday to consider their response to former federal health minister Neal Blewett's review of food labelling.

Dr Blewett's most controversial recommendation, that a "traffic light" system be introduced to help consumers make healthier food choices, has been rejected. The traffic light system of colour coding would tell a consumer, at a glance, if the food had high, medium or low amounts of fat, saturated fat, sugars and salt.

Instead, ministers have agreed that public health, consumer and industry groups be consulted in the development of an alternative front-of-pack labelling system, which is to be considered in June and hoped to be in place by the end of next year. They also want to give industry two years before making pregnancy warning labels on alcohol mandatory.

Food Standards Australia New Zealand is drafting a standard for nutrition and health-related claims and ministers also agreed to the development of a national nutrition policy. The federal government has come under fire from public health and consumer groups for opting not to pursue the traffic light system, but the food manufacturing industry has welcomed the move.

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