Tag Archives: pregnant

Lives of pregnant women and newborns at risk as funding cuts impact midwifery support

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But despite their critical role, UN support for midwifery is under serious threat due to severe funding cuts.

Each year, three-quarters of all maternal deaths occur in just 25 countries, the majority of them located in sub-Saharan Africa and South Asia, according to the UN reproductive health agency, UNFPA. 

Midwives are often the first and only responders delivering life-saving care to pregnant women and their newborns in crisis settings, where the risk of dying during pregnancy or childbirth doubles.

Funding cuts are now forcing UNFPA to scale back its support for midwifery. In eight of the affected countries the agency will only be able to fund 47 per cent of the 3,521 midwives it had intended to support in 2025.

On the frontline

In times of crisis, women often lose critical access to vital maternity services. Coming to the rescue in the direst of circumstances and serving as a lifeline to pregnant women, “midwives save lives,” said Natalia Kanem, Executive Director of UNFPA.

UN support for midwives in humanitarian settings includes training, providing supplies and equipment and in some cases transportation for mobile health clinics. All this is having to be cut back amid the funding cuts. 

“When crises strike and systems break down, midwives step up,” said UNFPA, marking International Day of the Midwife.

Funding cuts

Amid a global shortage of nearly one million midwives, rising death rates among women and newborns in conflict zones and fragile contexts are now being reported following budget cuts.

“We’re lacking everything, from blood bags to medicines. With the support of UNFPA and other partners, we can still provide services – but for how long?” said Fabrice Bishenge, Director of Kyeshero General Hospital in eastern DR Congo.

Deaths during childbirth in fragile and conflict-affected settings now account for 60 per cent of all maternal deaths globally. Worldwide, deep funding cuts only exacerbate this trend. In Yemen, for instance, over 590,000 women of childbearing age are expected to lose access to a midwife.

© UNICEF/Mukhtar Neikrawa

The waiting room of a maternity hospital in Herat Province, Afghanistan.

New initiative

In light of the current funding crisis, UNFPA and partners recently launched the Global Midwifery Accelerator — a coordinated initiative to scale up midwife-led care in countries with the highest maternal mortality rates.

The initiative sets out a cost-effective roadmap focused on saving lives and strengthening national health systems, even in the most fragile contexts.

Making an urgent call for greater funding, training, and advocacy for midwifery, UNFPA stressed that universal midwife-led health coverage could avert two-thirds of maternal and newborn deaths, reduce healthcare costs, and lead to more productive workforces. 

Women may experience different PCOS or PCOD symptoms depending on where they live

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Women with polycystic ovary syndrome (PCOS) in Alabama may be more likely to have excessive hair growth and insulin resistance, whereas women with PCOS in California may be more likely to have higher testosterone levels, according to new research published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

PCOS affects 7–10% of women of childbearing age and is the most common cause of infertility. In the United States, an estimated 5 to 6 million women have PCOS, but the disorder is still underdiagnosed. Women are diagnosed with PCOS if they have two of the following criteria: androgen excess (excess male sex hormones such as testosterone), ovulatory dysfunction and polycystic ovaries.

“Our study found geographical differences in PCOS in black and white women, suggesting there are both genetic and environmental influences on how this disease manifests,” said Margareta D. Pisarska, M.D., of Cedars-Sinai Medical Center in Los Angeles, Calif. “Ongoing research is needed to identify modifiable risk factors for PCOS that may be race and ethnicity-specific to bring precision medicine to the management of this disease.”

PCOS/en.wikipedia.org

The researchers compared data from 1,620 back and white women with PCOS in Alabama and California. They found regional differences in the way these women met criteria for the diagnosis of PCOS and in symptoms associated with PCOS, with some variations among black and white women.

Overall, there were many similarities among the races. Women with PCOS in Alabama were more likely to have excessive hair growth and insulin resistance, whereas women with PCOS in California were more likely to have higher levels of testosterone.

When comparing black women with PCOS in Alabama and California, the average body mass index (BMI) did not differ between the locations, whereas in white women with PCOS, the average BMI was higher in Alabama than California.

“Since we have now identified that there are geo-epidemiologic differences, we intend to do follow up studies comparing black and white women with PCOS, controlling for geo-epidemiologic differences,” Pisarska said. “Furthermore, we are trying to look at factors that are contributing to these differences in order to tailor treatments based on specific needs for improvements in care for all women with PCOS.”

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Mind your language when diagnosing women with polycystic ovary syndrome

Mother’s ultra-processed food intake linked to obesity risk in children; Unlikely during peripregnancy

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A mother’s consumption of ultra-processed foods appears to be linked to an increased risk of overweight or obesity in her offspring, irrespective of other lifestyle risk factors, suggests a US study.

Researchers suggest that mothers might benefit from limiting their intake of ultra-processed foods, and that dietary guidelines should be refined and financial and social barriers removed to improve nutrition for women of child bearing age and reduce childhood obesity.

According to the World Health Organization, 39 million children were overweight or obese in 2020, leading to increased risks of heart disease, diabetes, cancers, and early death.

Ultra-processed foods, such as packaged baked goods and snacks, fizzy drinks and sugary cereals, are commonly found in modern Western style diets and are associated with weight gain in adults. But it’s unclear whether there’s a link between a mother’s consumption of ultra-processed foods and her offspring’s body weight.

To explore this further, the researchers drew on data for 19,958 children born to 14,553 mothers (45% boys, aged 7-17 years at study enrollment) from the Nurses’ Health Study II (NHS II) and the Growing Up Today Study (GUTS I and II) in the United States.

pregnant lady/Commons.wikimedia.org

The NHS II is an ongoing study tracking the health and lifestyles of 116,429 US female registered nurses aged 25-42 in 1989. From 1991, participants reported what they ate and drank, using validated food frequency questionnaires every four years.

The GUTS I study began in 1996 when 16,882 children (aged 8-15 years) of NHS II participants completed an initial health and lifestyle questionnaire and were monitored every year between 1997 and 2001, and every two years thereafter.

In 2004, 10,918 children (aged 7-17 years) of NHS II participants joined the extended GUTS II study and were followed up in 2006, 2008, and 2011, and every two years thereafter.

A range of other potentially influential factors, known to be strongly correlated with childhood obesity, were also taken into account. These included mother’s weight (BMI), physical activity, smoking, living status (with partner or not), and partner’s education, as well as children’s ultra-processed food consumption, physical activity, and sedentary time.

Overall, 2471 (12%) children developed overweight or obesity during an average follow-up period of 4 years.

The results show that a mother’s ultra-processed food consumption was associated with an increased risk of overweight or obesity in her offspring. For example, a 26% higher risk was seen in the group with the highest maternal ultra-processed food consumption (12.1 servings/day) versus the lowest consumption group (3.4 servings/day).

In a separate analysis of 2790 mothers and 2925 children with information on diet from 3 months pre-conception to delivery (peripregnancy), the researchers found that peripregnancy ultra-processed food intake was not significantly associated with an increased risk of offspring overweight or obesity.

This is an observational study, so can’t establish cause and the researchers acknowledge that some of the observed risk may be due to other unmeasured factors, and that self-reported diet and weight measures might be subject to misreporting.

Other important limitations include the fact that some offspring participants were lost to follow-up, which resulted in a few of the analyses being underpowered, particularly those related to peripregnancy intake, and that mothers were predominantly white and from similar social and economic backgrounds, so the results may not apply to other groups.

Nevertheless, the study used data from several large ongoing studies with detailed dietary assessments over a relatively long period, and further analysis produced consistent associations, suggesting that the results are robust.

The researchers suggest no clear mechanism underlying these associations and say the area warrants further investigation.

Nevertheless, these data “support the importance of refining dietary recommendations and the development of programs to improve nutrition for women of reproductive age to promote offspring health,” they conclude.

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Neanderthal gene in modern women helps give birth to more children, says study

Frozen embryo transfers linked with high blood pressure risks in pregnancy; What is sibling comparison?

Frozen embryo transfers linked with high blood pressure risks in pregnancy; What is sibling comparison?

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In vitro fertilization (IVF) using frozen embryos may be associated with a 74% higher risk of hypertensive disorders in pregnancy, according to new research published today in Hypertension, an American Heart Association journal.

In comparison, the study found that pregnancies from fresh embryo transfers – transferring the fertilized egg immediately after in vitro fertilization (IVF) instead of a frozen, fertilized egg – and pregnancy from natural conception shared a similar risk of developing a hypertensive disorder.

High blood pressure during pregnancy often signals preeclampsia, a pregnancy complication including persistent high blood pressure that can endanger the health and life of the mother and fetus. Approximately 1 out of every 25 pregnancies in the United States results in preeclampsia, according to the American Heart Association.

One IVF treatment process available utilizes frozen embryos: after an egg is fertilized by sperm in the lab, it is frozen using a cryopreservation process before being thawed and transferred to the uterus at a later date. The procedure is becoming more common because of the significantly improved freezing technology or cryopreservation methods that started in the late 2000s and because more patients are choosing to freeze embryos, according to the study authors. Yet, frozen embryo transfer is known to be associated with a higher risk of hypertensive disorders in pregnancy than both natural conception and fresh embryo transfer. However, prior to this study, it was unknown whether this was due to the freezing process or a risk factor from the parents.

“Frozen embryo transfers are now increasingly common all over the world, and in the last few years, some doctors have begun skipping fresh embryo transfer to routinely freeze all embryos in their clinical practice, the so-called ‘freeze-all’ approach,” said Sindre H. Petersen, M.D., the study’s lead author and a Ph.D. fellow at the Norwegian University of Science and Technology in Trondheim, Norway.

Researchers examined national data from medical birth registries from Denmark, Norway and Sweden of nearly 2.4 million women who were ages 20 to 44 years old who had single deliveries and gave birth during the study period – from 1988 through 2015. These data were the basis of a population-based study that also included a comparison of women who had both an IVF pregnancy and a naturally conceived pregnancy, called sibling comparison. This approach was used to isolate if the potential reason for the hypertensive disorders was attributable to parental factors or to the IVF treatment.

pregnant lady/Commons.wikimedia.org

The study included more than 4.5 million pregnancies, of which 4.4 million were naturally conceived; more than 78,000 pregnancies were fresh embryo transfers; and more than 18,000 pregnancies were frozen embryo transfers. Among all of the pregnancies, more than 33,000 were grouped for sibling comparison – mothers who conceived via more than one of these methods. The study is the largest to-date using sibling comparison. The odds of developing hypertensive disorders in pregnancy after fresh vs. frozen embryo transfers compared to natural conception were adjusted for variables such as birth year and the mother’s age.

“In summary, although most IVF pregnancies are healthy and uncomplicated,” Petersen said. “This analysis found that the risk of high blood pressure in pregnancy was substantially higher after frozen embryo transfer compared to pregnancies from fresh embryo transfer or natural conception.”

Specifically, the study found:

  • In the population analysis, women whose pregnancy was the result of a frozen embryo transfer were 74% more likely to develop hypertensive disorders in pregnancy compared to those who conceived naturally.
  • Among women who had both a natural conception and an frozen embryo transfer IVF conception (the sibling comparison), the risk of hypertensive disorders in pregnancy after frozen embryo transfer was twice as high compared to pregnancies from natural conception.
  • Pregnancies from fresh embryo transfer did not have a higher risk of developing hypertensive disorders compared to natural conception, neither in population level analysis nor in sibling comparisons.

“Our sibling comparisons indicate that the higher risk is not caused by factors related to the parents, rather, however, that some IVF treatment factors may be involved,” Petersen said. “Future research should investigate which parts of the frozen embryo transfer process may impact risk of hypertension during pregnancy.”

Among other findings, women in the study who gave birth after IVF pregnancies were average age 34 years for frozen embryo transfer, 33 years for fresh embryo transfer and 29 years for those who conceived naturally. About 7% of babies conceived from frozen embryo transfer were born preterm (before 40 weeks gestation) and 8% of babies after fresh embryo transfer were born preterm, compared to 5% of babies after natural conception.

In addition to preeclampsia, the researchers defined hypertensive disorders in pregnancy as a combined outcome, including gestational hypertension, eclampsia (the onset of seizures in those with preeclampsia) and chronic hypertension with superimposed preeclampsia.

One limitation of the study was the lack of data on the kind of frozen embryo cycle, so they were not able to pinpoint what part of the frozen cycle or frozen transfer may contribute to the higher risk of hypertensive disorders. Another limitation is that data from Scandinavian countries may limit generalizing the findings to people in other countries.

“Our results highlight that careful consideration of all benefits and potential risks is needed before freezing all embryos as a routine in clinical practice.  A comprehensive, individualized conversation between physicians and patients about the benefits and risks of a fresh vs. frozen embryo transfer is key,” said Petersen.

 

 

Mind your language when diagnosing women with polycystic ovary syndrome

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The language used by doctors when diagnosing female patients with polycystic ovary syndrome (PCOS) can negatively impact their wellbeing and how they view their condition later on in life, new research finds.

PCOS is a condition that affects the working of ovaries and can result in a range of physical symptoms (irregular periods or none at all) and metabolic issues (weight gain). Researchers from the University of Surrey found that the use of the word ‘raised’ by practitioners when discussing test results can lead to higher levels of body dissatisfaction and dieting behaviour amongst women, whilst the use of the word ‘irregular’ can result in concerns about fertility.

Jane Ogden, Professor of Health Psychology at the University of Surrey, said: “Diagnostic consultations may take a few minutes, yet how these minutes are managed, what words are used and how this makes a patient feel may change how they make sense of their condition and influence their wellbeing in the longer term. It is important that doctors have an awareness of the words they use and think about how they could be perceived by patients.”

pregnant lady/Commons.wikimedia.org

In one of the first studies of its kind, researchers from Surrey investigated the impact of PCOS diagnostic consultations and if the language used affected the subsequent wellbeing of patients.

To assess the impact, researchers surveyed 147 females with PCOS and asked about their satisfaction with their consultation, the language used during it and their overall wellbeing.

Researchers found that those who had felt uncomfortable with the consultation process were more likely to report poorer body esteem, reduced quality of life and greater concerns about health in later life. Over a quarter of those surveyed were dissatisfied with how doctors managed their distress and were unhappy with the lack of rapport they had with their practitioners.

“Words matter, as patients often replay conversations that they have had with doctors in a bid to make sense of situations. Although words such as ‘raised’ and ‘irregular’ are simple words they are vague which can cause women to worry, as they automatically think the worst, as they have not been provided with all the facts. Such anxiety at the time of diagnosis, can negatively impact how they feel about themselves as their life progresses,” Professor Ogden added.