Worth the weight?

Increasing numbers of British women are dieting during pregnancy, putting their children at risk of serious illness in later life, according to this article by Anita Chaudhuri. According to a study by Barker et al. for the Medical Research Council (MRC), pregnant women in Britain are dieting like never before, and the health implications are alarming. The findings indicated that four out of ten women eat a diet that is likely to deprive a child of essential nutrients.

Improving perinatal mental health care

Nursing Standard carries a freely-available article by Thomas Currid, lecturer at London South Bank University. (2004 19:3 40-43)

Abstract:
Pregnancy and the puerperium can bring many emotional, physical and social changes to the mother, her partner and the rest of the family. While many mothers find these changes – such as the experience of pregnancy or the addition of a new member to the family – joyous, some do not share these positive feelings and often undergo emotional upheaval resulting in severe biopsychosocial distress. This period of distress does not only subject the mother and her family to increased risk of psychological crisis, mental illness and developmental disturbances, but may also, if untreated, result in the fatalistic outcomes of infanticide or suicide. In this article, the author calls for a more robust, co-ordinated and interdisciplinary approach to perinatal mental health services.

National Service Framework for Children

On 15/09/04 the Department of Health published the National Service
Framework (NSF) for Children, Young People and Maternity Services. The
Children’s NSF is a 10-year programme intended to stimulate long-term and
sustained improvement in children’s health. Setting national standards for
health and social services for children, young people and pregnant women,
the NSF aims to ensure fair, high quality and integrated health and social
care from pregnancy, right through to adulthood.

The Children's NSF receives coverage in the Guardian, Times, and BBC News.

Recent days have seen extensive coverage of alcohol misuse issues:

A Guardian article, Binge drinkers 'risk babies with birth defects' (13/09/04) highlights the risks of FAS (fetal alcohol syndrome) incurred by young female binge drinkers, who may not realise that they are pregnant.

The BBC News site of 06/09/04 featured a Tommy's/NOP survey which shows that a large proportion of pregnant women are ignoring advice from health professionals, as 1 in 5 women smoked and 2 out of 5 drank alcohol during their pregnancy: Pregnancy not curbing bad habits. The survey also revealed extensive ignorance about diet and other lifestyle issues. Tommy's is publishing a book, 'Tommy’s guide to pre-pregnancy care’ , which is available free during September at larger Boots' branches.

Another BBC News feature on 13/09/04, Any alcohol a risk during pregnancy, highlights a presentation by Raja Mukherjee at the Foetal Alcohol Syndrome Aware UK conference. According to Dr Mukherjee, many children who develop behavioural problems as a result of exposure to alcohol in the womb are incorrectly diagnosed as having conditions such as attention deficit hyperactivity disorder. The real culprit, alcohol consumption, goes unnoticed in these milder forms, collectively called Foetal Alcohol Spectrum Disorder. He is of the view that there is no safe limit for alcohol consumption during pregnancy.

Common antiepileptic drugs in pregnancy in women with epilepsy (Cochrane Review): Adab et al.

A substantive amendment to this review was published on May 26th 2004.

The reviewers conclude: based on the best current available evidence, it would seem advisable for women to continue medication during pregnancy using monotherapy at the lowest dose required to achieve seizure control. Polytherapy would seem best avoided where possible. More population based studies adequately powered to examine the effects of in utero exposure to specific monotherapies which are used in everyday practice are required.

Pregnancy and autoimmune diseases

In an article in Best Practice and Research Clinical Rheumatology (18:3 2004 359-379) Caroline Gordon, a rheumatologist, outlines the pregnancy risk issues. Until about 15 years ago, the general advice to women with autoimmune rheumatic diseases, especially systemic lupus erythematosus, systemic sclerosis and vasculitic syndromes, was to avoid pregnancy as there was a high risk of maternal and fetal morbidity and mortality. However, it is now clear that these risks can be reduced in general by avoiding pregnancy when the diseases are active and continuing appropriate medication to reduce the chances of disease flare during pregnancy. The article reviews the evidence for this advice and also considers other issues that should be discussed with women before they attempt to become pregnant. This includes the influence of pregnancy on the individual autoimmune diseases.

Pregnancy and childbirth are leading causes of death in teenage girls in developing countries

Complications from pregnancy and childbirth are the leading cause of death in young women aged 15 to 19 in developing countries, according to a report published last week, the fifth annual State of the World's Mothers report, published by the international charity Save the Children. An estimated 70 000 adolescent mothers die each year because they have children before they are physically ready for parenthood, the report says.