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Vaginal birth after caesarean, here’s what you need to know

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A peaceful vaginal birth with no screaming and tears is how most mothers-to-be envision their perfect birthing story. However, those who’ve given birth even once know this is far from true. Just like every newborn, every birth is different.

For mothers who’ve had a c-section, the most common question is whether they will be able to attempt a vaginal delivery after a caesarean during their previous pregnancy. Throughout evolution and culture, a vaginal birth has been given a righteous status. However, mothers should understand that every birth is unique, every situation is unique and you need to choose what’s right for you and your baby growing inside you.

Is VBAC (vaginal birth after caesarean) risky?

Recently, scientists from the University of Alberta, along with researchers from various other institutions, decided to explore the question and its probable answers. It was found that attempted vaginal birth after caesarean (VBAC) is associated with higher rates of adverse effects or death for mothers and infants.

Although absolute rates were low in mothers who attempted this type of birth. “The absolute rates of adverse maternal and neonatal outcomes are low with both attempted VBAC and elective repeat caesarean delivery,” said researcher Carmen Young. “Both are reasonable options for women in general; however, attempted VBAC continues to be associated with higher relative rates of severe adverse maternal and neonatal outcomes compared with an elective repeat caesarean delivery.”

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High BP before pregnancy may raise miscarriage risk

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High blood pressure before conception and early in pregnancy may increase the risk of pregnancy loss, even if the woman does not have a hypertension diagnosis, new research has found.

“Elevated blood pressure among young adults is associated with a higher risk of heart disease later in life, and this study suggests it may also have an effect on reproductive health,” said lead author of the study Carrie Nobles from Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD) in Maryland, US.

Millimeter of mercury, or mm Hg, is the unit of measure used for blood pressure.

The findings, published in the journal Hypertension, showed that for every 10 mm Hg increase in diastolic blood pressure (pressure when the heart is resting between beats), there was 18 per cent higher risk for pregnancy loss among the study population.

The researchers also found a 17 per cent increase in pregnancy loss for every 10 mm Hg increase in mean arterial pressure, a measure of the average pressure in the arteries during full heart beat cycles.

The researcher studied more than 1,200 women who had already experienced one or two pregnancy losses and were trying to become pregnant.

The findings were similar for preconception and early-pregnancy blood pressure.

“The impact of cardiovascular risk factors starts really early in life. Physicians treating women of reproductive age should pay attention to slightly elevated blood pressure because it may have other not-well-recognised effects, such as adverse pregnancy outcome,” said senior author of the study Enrique Schisterman from NICHD.

“Preconception is a previously unrecognized critical window for intervention such as lifestyle changes that can help prevent later heart disease and may also improve reproductive health,” Schisterman said.

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Exercise before pregnancy key for healthy motherhood

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Expectant mothers who are more fit before pregnancy are at lower risk of developing gestational diabetes, a study suggests. Gestational diabetes is a condition in which women develop diabetes during the last half of pregnancy. Women with gestational diabetes are more likely to develop Type 2 diabetes after giving birth. “Women are very careful during pregnancy with what they eat and the exercise they get. But the study shows women should engage in these healthy behaviours before they get pregnant as well,” said co-author Kara Whitaker, Assistant Professor from University of Iowa.

For the study, published in the journal Medicine and Science in Sports and Exercise, the team analysed data from 1,333 women over a 25-year period (1985 to 2011) who enrolled in a National Heart, Lung, and Blood Institute study called Coronary Artery Risk Development in Young Adults (CARDIA). The women completed seven study visits after first being enrolled, reporting whether they had become pregnant or gave birth and whether they developed gestational diabetes.

The researchers also performed a fitness exam during the first study visit by testing whether the women could walk for two-minute intervals on a treadmill at increasing speeds and on steepening inclines. Over the study period, 164 women developed gestational diabetes.
Using that information, the research team determined that pre-pregnant women with high levels of fitness had a 21 per cent lower risk of developing gestational diabetes than did those with lower fitness levels.

“People interested in becoming more fit can do so by engaging in at least 150 minutes of moderate to vigorous physical activity per week — 30 minutes per day, five days per week,” Whitaker said. “Brisk walking would constitute moderate physical activity — jogging would be considered vigorous physical activity,” she added.

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Taking painkillers in pregnancy may harm baby’s fertility

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Taking painkillers during pregnancy may lower the fertility of the unborn child in later life, scientists have warned. The study identifies that these drugs may also affect the fertility of future generations, by leaving marks on DNA.

The findings add to a growing body of evidence that certain medicines, including paracetamol, should be used with caution during pregnancy.

Researchers stress that advice for pregnant women remains unchanged. Current guidelines say that, if necessary, paracetamol – also known as acetaminophen – should be used at the lowest possible dose for the shortest possible time. Ibuprofen should be avoided during pregnancy.

Scientists at the University of Edinburgh in the UK looked at the effects of paracetamol and ibuprofen on samples of human foetal testes and ovaries. They found similar effects using several different experimental approaches, including lab tests on human tissue samples and animal studies.

Human tissues exposed to either drug for one week in a dish had reduced numbers of cells that give rise to sperm and eggs, called germ cells, the study found. Ovaries exposed to paracetamol for one week had more than 40 per cent fewer egg-producing cells. After ibuprofen exposure, the number of cells was almost halved.

This is important because girls produce all of their eggs in the womb, so if they are born with a reduced number it could lead to an early menopause. Painkiller exposure during development could have effects on unborn boys too, the study found.

Testicular tissue exposed to painkillers in a culture dish had around a quarter fewer sperm-producing cells after exposure to paracetamol or ibuprofen. The team also tested the effects of painkiller treatment on mice that carried grafts of human foetal testicular tissue.

These grafts have been shown to mimic how the testes grow and function during development in the womb. After just one day of treatment with a human-equivalent dose of paracetamol, the number of sperm-producing cells in the graft tissue had dropped by 17 per cent. After a week of drug treatment, there were almost one third fewer cells.

Previous studies with rats have shown that painkillers administered in pregnancy led to a reduction in germ cells in female offspring. This affected their fertility and the fertility of females in subsequent generations. The study, published in the journal Environmental Health Perspectives, found that exposure to paracetamol or ibuprofen triggers mechanisms in the cell that make changes in the structure of DNA, called epigenetic marks.

These marks can be inherited, helping to explain how the effects of painkillers on fertility may be passed on to future generations.

Painkillers’ effects on germ cells are likely caused by their actions on molecules called prostaglandins, which have key functions in the ovaries and testes, the researchers found.

“We would encourage women to think carefully before taking painkillers in pregnancy and to follow existing guidelines – taking the lowest possible dose for the shortest time possible,” said Rod Mitchell, from University of Edinburgh, who led the research.

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Exercising in Heat or Taking Hot Baths May Be Safe During Pregnancy

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If you're pregnant and want to exercise in warm weather or take hot baths or short saunas, that's safe, according to new research.

Australian researchers said that doing so—within limits—should not raise your body temperature to a point that would put your baby at risk.

The findings come from an analysis of 12 studies that included 347 women at different stages of pregnancy. The women's body temperatures were recorded while they exercised, used a sauna or took a hot bath.

None of the women exceeded the recommended core body temperature limit of 102.2 degrees Fahrenheit during these activities.

Based on those results, the researchers concluded that pregnant women can safely do up to 35 minutes of high-intensity aerobic exercise (at 80 percent to 90 percent of their maximum heart rate) at air temperatures of up to 77 degrees Fahrenheit and a relative humidity of 45 percent.

No matter their pregnancy stage, women can also safely do aqua-aerobic exercise in water temperatures ranging from 83.8 degrees to 92.1 degrees Fahrenheit for up to 45 minutes, the study found. They also can sit in hot baths (104 degrees Fahrenheit) or hot/dry saunas (158 degrees Fahrenheit, and 15 percent relative humidity) for up to 20 minutes, the researchers said.

The study, by Ollie Jay, an associate professor of exercise and sports science at the University of Sydney, and colleagues was published online March 1 in the British Journal of Sports Medicine.

Current guidelines advise pregnant women to avoid heat stress because of concerns about possible risks if their body temperature rises too high, the study authors noted in a journal news release.

However, the researchers said the guidelines do not clearly define heat limits and thus may discourage exercise that could benefit both mother and child.

Jay and colleagues added that there's some evidence that the body's ability to regulate its core temperature is enhanced during pregnancy.

Still, the study authors said that further study on the issue is needed.

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