Women who experience severe gestational hypertension may give birth to boys at lower risk for testicular cancer, although the exact reasons why are still unclear, according to a paper published in the November 1, 2008, issue of Cancer Research, a journal of the American Association for Cancer Research.

Andreas Pettersson, M.D., a doctoral student at Karolinska Institute in Sweden, said the protective effect of gestational hypertension may be due to the hormones that are released when a placenta malfunctions.

“Ironically, a malfunctioning placenta may lower the risk,” said Pettersson.  “One possible reason is that estrogens are lower in pregnancies that develop severe gestational hypertension or preeclampsia, and this lack of estrogens may lower the risk of testicular cancer.”

Pettersson and colleagues observed 293 cases of germ-cell testicular cancer in the Swedish Cancer Register and 861 controls in the Swedish Medical Birth Register.  They extracted data on maternal and pregnancy characteristics such as gestational hypertension, proteinuria, anemia and glucoseuria.

If women experienced severe gestational hypertension, their male offspring were 71 percent less likely to develop testicular cancer than those women who experienced no hypertension.  If the gestational hypertension was mild, there was a 62 percent increased risk of testicular cancer.

Beyond decreased estrogen, severe gestational hypertension and preeclampsia increases the level of human Chorionic Gonadotropin, another pregnancy-related hormone, which may also have a protective effect against testicular cancer.

Pettersson said that these findings add knowledge to the mechanisms behind testicular cancer, but he cautioned against reverse thinking.

“This study does not suggest that a woman who does not have gestational hypertension is going to give birth to a boy who is at increased risk for testicular cancer,” said Pettersson.

Depressed pregnant women have twice the risk of preterm delivery than pregnant women with no symptoms of depression, according to a new study by the Kaiser Permanente Division of Research.  The study is published online in the Oxford University Press’s journal Human Reproduction on behalf of the European Society of Human Reproduction and Embryology.

The study found that pregnant women with symptoms of depression have an increased risk of preterm delivery, and that the risk grows with the severity of the depressive symptoms.  These findings also provide preliminary evidence that social and reproductive risk factors, obesity, and stressful events may exacerbate the depression-preterm delivery link, according to the researchers.

Because the majority of the women in the study did not use anti-depressants, the study provides a clear look at the link between depression and preterm delivery.

The study -which is among the first to examine depression and pre-term delivery in a representative and diverse population in the United States -looked at 791 pregnant Kaiser Permanente members in San Francisco city and county from October 1996 through October 1998.

Researchers interviewed the women around their 10th week of pregnancy and found that 41 percent of the women reported significant or severe depressive symptoms.  The women with less severe depressive symptoms had a 60 percent higher risk of preterm delivery -defined as delivery at less than 37 completed weeks of gestation -compared with women without significant depressive symptoms, and the women with severe depressive symptoms had more than twice the risk.

“Preterm delivery is the leading cause of infant mortality, and yet we don’t know what causes it.  What we do know is that a healthy pregnancy requires a healthy placenta, and that placental function is influenced by hormones, which are in turn influenced by the brain,” said lead author Dr. De-Kun Li, a reproductive and perinatal epidemiologist at Kaiser Permanente’s Division of Research in Oakland.

“This study adds to emerging evidence that depression during early pregnancy may interfere with the neuroendocrine pathways and subsequently placental function.  The placenta and neuroendocrine functions play an important role in maintaining the health of a pregnancy and determining the onset of labor,” Li explained.

“Post-partum depression has been extensively studied and discussed by the public, but depression during pregnancy is significantly under-recognized and under-diagnosed.  Clinicians should pay close attention to depression during pregnancy to catch it early,” Li said.  “If prenatal depression is indeed as prevalent as reported in this and other studies and doubles the risk of preterm delivery, then bringing depression to the forefront of prenatal care could lead to a significant reduction of preterm deliveries.”

In addition to being the leading cause of infant mortality and morbidity, preterm delivery is also the leading medical expenditure for infants, with estimated annual cost of about $26 billion in the United States alone.  Presently, other than a prior history of preterm delivery and some pregnancy complications, very little is known for its risk factors and origins.

“The key strengths of this study are that it ascertained the depressive symptoms early in pregnancy, long before the preterm delivery occurred, therefore avoiding recall bias.  In addition, the study was not clouded by antidepressant use because only 1.5 percent of the study population was prescribed antidepressants and we could exclude them in the analyses,” Li said.  “Considering the increased use of antidepressants among pregnant women, this study’s findings may provide a rare opportunity to evaluate the effect of depression on risk of preterm delivery without the entanglements of antidepressants.”

University of New South Wales (UNSW) research has highlighted a link between childhood obesity and a mother’s diet before and during pregnancy. The work in animals proves that overweight expectant mothers are more likely to have babies with more body fat, who are at greater risk of diabetes and lipid metabolic disorders later in life.

Previous research shows that around 30 percent of women who become pregnant are overweight.

The research, published in the journal Endocrinology, shows pups from obese mother rats who were fed more milk are almost twice as heavy as those born to lean mothers with a regular milk consumption at weaning age.

The cafeteria diet used to feed the mother rats is designed to approximate a western diet which people eat everyday at home. It is of high fat content, and palatable with a lot of variety.

The research found that the mother rats ate more than double the calories of the control group.

“Maternal obesity and overfeeding early on in life caused significant changes in the chemicals that regulate appetite, which may suggest that the babies were programmed to eat differently from those born from lean mothers,” says Professor Morris.

“Appetite is controlled by particular centres within the brain. Other research in this field* suggests that maternal food preferences during pregnancy can affect the food preferences of offspring.

“As brain control of appetite is likely set early in life, nutrient availability in the fetal or early post-natal period may contribute to adult obesity,” says Professor Morris.

The work also highlighted for the first time, different impacts of pre- and postnatal overfeeding on fat accumulation, circulating lipid levels, glucose metabolism, and brain appetite regulators.

In a separate paper, the same UNSW research group found that animals that were slightly undernourished in their early life had a head start on health.

“The less milk the babies had – and the lighter they were – the higher were levels of a hormone which is known to be protective of cardiovascular disease,” says Professor Morris.

The research, which is to be published in the International Journal of Obesity, also shows that pups that were undernourished remained lighter as adults, while those that were over-fed as babies continued to be fatter as adults.

“We know that undernutrition has an effect on longevity and this research seems to support this,” says Professor Morris.

Following an extensive evidence review, the U.S. Preventive Services Task Force (USPSTF) concluded that doctors, nurses, hospitals and health systems have a role to play in encouraging and supporting breastfeeding.  In an update to its 2003 recommendation on counseling to promote breastfeeding, the USPSTF recommends primary care interventions before, around, and after child birth to encourage and support breastfeeding.  The recommendation appears in the October 21, 2008, issue of Annals of Internal Medicine, the American College of Physicians’ flagship journal.

For the study, the Task Force evaluated more than 25 randomized trials of breastfeeding interventions conducted in the United States and in developed countries around the world.  The Task Force concluded that coordinated interventions throughout pregnancy, birth, and infancy can increase breastfeeding initiation, duration, and exclusivity.  For example, a cluster-randomized trial of more than 17,000 mother-infant pairs in the Republic of Belarus found that breastfeeding interventions increased the duration and degree (exclusivity) of breastfeeding.  Infants in the intervention group were significantly more likely than those in the control group to be exclusively breastfed (exclusive breastfeeding is when an infant receives no other food or drink besides breast milk).  The intervention emphasized health care worker assistance with initiating and maintaining breastfeeding and lactation and postnatal breastfeeding support.

“Our review produced adequate evidence that multifaceted breastfeeding interventions work,” said Task Force Chair Ned Calonge, MD, MPH, who is also Chief Medical Officer for the Colorado Department of Public Health and Environment, Denver.  “We found that interventions that include both prenatal and postnatal components may be the most effective at increasing breastfeeding duration.  Many successful programs include peer support, prenatal breastfeeding education, or both.”

In 2005, 73 percent of new mothers initiated breastfeeding, nearly reaching the U.S. Healthy People 2010 goal of 75 percent.  However, only 14 percent of infants were exclusively breastfed for their first six months, as recommended by the American Academy of Pediatrics, the American Academy of Family Physicians, and the U.S. Surgeon General.

Breastfeeding has substantial health benefits to babies and their mothers.  Babies who are breastfed have fewer infections and allergic skin rashes than formula-fed babies and also are less likely to have sudden infant death syndrome (SIDS).  After breastfeeding ends, children who were breastfed are less likely to develop asthma, diabetes, obesity, and childhood leukemia.  Women who breastfeed have a lower risk for type 2 diabetes, breast cancer, and ovarian cancer than women who have never breastfed.

“We hope that these recommendations will help women and their physicians understand what they need to do to start and continue breastfeeding their babies,” said Dr. Calonge.  “Simply telling mothers they should breastfeed or giving them pamphlets is not enough.”

Women who receive one to one instruction on how to contract the pelvic floor muscles and practice pelvic floor muscle exercises with health professional supervision are less likely to suffer urine leakage during or after pregnancy. A systematic review from The Cochrane Library suggests that these exercises are effective for preventing and treating incontinence.

A third of women are known to leak urine following childbirth, while 1 in 10 leak faeces, although due the obvious embarrassment and distress associated with incontinence, it is possible that rates are underestimated. To avoid giving medication during pregnancy and breastfeeding, pelvic floor muscle exercises are widely recommended for strengthening the muscles supporting the pelvic organs and helping women to gain greater urine control. This systematic review shows these exercises can markedly decrease rates of incontinence.

“With good one to one teaching and supervision, these exercises are safe and will benefit many women,” says lead author, Jean Hay-Smith, who works at the Wellington School of Medicine and Health Sciences at the University of Otago in Wellington, New Zealand.

The review team found 15 relevant studies involving a total of 6,181 women. They discovered that those with no prior history of leakage who are taught the exercises on a one to one basis and practice pelvic floor muscle exercises with supervision from a health professional are half as likely to report urinary incontinence in late pregnancy, and a third less likely up to six months after birth, than those who receive usual antenatal and postnatal care. Exercises are also an effective treatment for women with persistent urinary incontinence after childbirth.

The authors also say that exercises might be particularly beneficial for certain groups of women. “Those who give birth to large babies or who have forceps deliveries run a higher risk of incontinence and may benefit more from intensive pelvic floor muscle exercises,” says Hay-Smith.