Tag Archive for: pregnancy

Should I Use Folate or Folic Acid?

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In the past few years, there has been a trend toward using folate, the natural form of vitamin B9, versus using folic acid, the synthetic form. Many times I’ve answered the question “Which form is better? I’ve heard…” I said on Tuesday that the study on folic acid, blood lead levels, and autism had a lesson. That lesson is this:

Folic acid from enriched foods or supplements is equivalent to folate from foods or supplements.

The body efficiently converts folic acid to folate, and from that point, there’s no difference in the benefits to the mothers or their babies. Even in women who have the MTHFR mutations, folic acid is still beneficial.

This won’t close the door on people who insist that folate is the better choice, but we know their assertions aren’t based on research. Every study on the impact of folate/folic acid on pregnant women and their offspring used folic acid. That’s the form that was put into grain-based foods beginning in 1998 with the objective of reducing birth defects; the reduction in birth defects has been estimated at 70%. Further research has demonstrated benefits to the children of mothers who supplemented with folic acid, such as reductions in allergies, asthma, and ADHD.

The Bottom Line

The results from the study on the benefits to the offspring of women who may have been unintentionally exposed to lead is that folic acid intake is directly related to prevention of harms to their babies. It also illustrated that megadosing is not required. The lesson is that folic acid, whether added to grain products or in supplements, is an effective form of B9 to accomplish that goal.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1289/EHP14479

Folic Acid, Lead, and Autism

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Every once in a while, a research study provides an important lesson as well as some interesting findings. Let’s begin with the study.

During 2008 through 2011, researchers selected almost 1,900 pregnant women as subjects from 10 cities across Canada for the study. The overall goal was to identify environmental impacts on the mothers and children; this is an ongoing study. In this case, researchers looked at children who were diagnosed with autism, based on standard diagnostic criteria. Understand that autism is on a spectrum, and they used behaviors associated with autism when the children were three or four years old. They also tested maternal lead levels, folate levels, and folic acid intake in early pregnancy.

Researchers found there was an inverse relationship between blood lead levels and folic acid intake—as folic acid intake increased, the blood levels of lead decreased. The autism scores were also lower in the children of mothers who had sufficient folic acid intake, verified by their blood folate levels; 400 mcg intake was sufficient, and taking more folic acid didn’t provide additional benefit.

What does it mean? No one has to megadose folic acid to benefit their unborn children in response to environmental toxins. And even if pregnancy isn’t part of your future, the folic acid had a protective effect; if you suspect you have lead pipes, additional folic acid is a good idea.

What was the lesson? I’ll let you know on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1289/EHP14479

Obesity and Prenatal Omega-3s: Premature Conclusions

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Women frequently ask about prenatal supplementation, and omega-3 fatty acids are always part of prenatal recommendations; that’s why this study attracted my attention. Did they come to the right conclusions? I think the best place to begin is by reading the conclusion statement of the abstract, and then examine the data from the paper to see if it supports those conclusions.

Here we go:

“In this randomized clinical trial, children of mothers receiving omega-3 fatty acid supplementation had increased BMI at age 10 years, increased risk of being overweight, and a tendency of increased fat percentage and higher metabolic syndrome score. These findings suggest potential adverse health effects from n-3 long-chain polyunsaturated fatty acid supplementation during pregnancy and need to be replicated in future independent studies.”

Problems with the Conclusions

The difference in body weight was two pounds, with the fish oil group weighing more than the placebo group; neither group was classified as being overweight by international standards. With height being equal, that automatically meant that the BMI would be higher in the fish oil group. However, both groups would be classified as underweight based on standards for children five to ten years old. The implication was the omega-3 group might be overweight. They were not; in fact they were closer to normal weight than the lighter kids. The increased risk of being overweight isn’t supported by the data presented.

Related to the higher metabolic syndrome score, the researchers calculated the score using an algorithm that considered waist circumference, systolic BP, negative HDL cholesterol, the log of triglycerides, and the Homeostatic Model Assessment for Insulin Resistance or HOMA-IR for short. There was a difference of 3/10 of an inch in waist circumference, with the omega-3 group being slightly larger. There was no difference in triglyceride levels, and the omega-3 group had a higher HDL cholesterol level than the control group. There was no difference in systolic blood pressure between the groups. That leaves us with the HOMA-IR calculation.

Typically, serum insulin would be used in the calculation to determine the HOMA-IR number. They didn’t collect insulin data, so they used another indicator of insulin levels in calculating the HOMA-IR. The problem is that that algorithm was based on 21 adult subjects; it was never validated with a larger group or for use in children. I question its use, but for argument’s sake, let’s say it doesn’t matter.

The Real Problem

The real problem that I have is with the remark about a tendency towards increased percent body fat. When they assessed body composition at 10 years of age, they used bioelectrical impedance analysis (BIA). I worked on comparing methods of body composition analysis when I was a graduate student, so I can tell you from experience that underwater weighing is the gold standard for any group (and, yes, I’ve underwater weighed 10-year-olds). Specifically, there are two factors that are always concerning with BIA:

  • The algorithm is 95% dependent on height and weight. A two-pound difference in body weight in children could impact the calculation, even if the actual body composition was the same.
  • BIA is sensitive to fluid levels of the body. It assesses total body water and calculates fat mass by making an assumption about the water content of the remaining tissues. It’s not the best way to assess body fat in a major study such as this.

The Bottom Line

How?!!!

We hear that a lot when our grandson plays a videogame. When something happens that he doesn’t anticipate or understand, he yells “How?!!!” and that’s what I’m thinking right now. The most frustrating part of this research paper is their conclusion that omega-3 supplementation in the last trimester of pregnancy may result in adverse effects to the children.

How? How would supplementing with omega-3 fatty acids cause the offspring to have an increased risk of being overweight or obese? They did not provide any comment on how that could occur.

As it stands now, we really don’t know much more about omega-3 supplementation in the third trimester of pregnancy other than the kids whose mothers took omega-3 fatty acid had fewer serious asthma and allergy symptoms; because the incidence of asthma and allergies are rising steadily, that may be the most important observation from this study so far.

As for body composition? Not so much. This study will continue until the subjects are adults, so maybe further testing will yield more conclusive results.

What are you prepared to do today?

        Dr. Chet

Reference: AJCN. 2024. doi.org/10.1016/j.ajcnut.2023.12.015

Obesity and Prenatal Omega-3s

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Scientists continue to research the causes of obesity. For many, as we’ll see, it’s not as simple as eating less and moving more; in the study I’m going to review this week, the researchers are going prenatal.

The Copenhagen Prospective Studies on Asthma in Childhood 2010 (COPSAC) is an ongoing longitudinal study to examine the effects of omega-3 supplementation in the third trimester of pregnancy on a number of factors. The primary objective was to see if allergies and asthma were reduced in the offspring of women who took the omega-3s versus those who took a placebo. Asthma or persistent wheeze showed a 31% reduction in risk in the group receiving fish oil compared to 23% the placebo group.

The researchers also collected a variety of anthropometric data, plus blood samples for metabolic and blood lipid analysis, and assessed body composition. In a prior paper when the children were age six, the omega group were about one pound heavier but with a proportional increase in lean and fat mass.

In the current analysis at age ten, the omega group were determined to have an increased BMI, increased risk of being overweight, a tendency for increased fat percentage, and higher metabolic syndrome score when compared to the placebo group. That doesn’t sound good. Does this mean women should avoid omega-3 fish oil during pregnancy, especially the third trimester? I’ll let you know on Saturday.

Tomorrow is the monthly Insider Conference Call. I’m going to cover starvation but not the Minnesota Starvation Study—you’ll come away stunned. I’ll also answer your questions. If you’re not an Insider, become one by 8 p.m. tomorrow and you can join in.

What are you prepared to do today?

        Dr. Chet

References:
1. BMJ 2018. doi: https://doi.org/10.1136/bmj.k3312
2. AJCN. 2024. doi.org/10.1016/j.ajcnut.2023.12.015

Are Prenatal Vaccinations Safe?

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Vaccinations for infants and children always inspire debate. Sometimes, fierce debate. Today I’m going to look at a study that examined whether it’s safe for pregnant women to get the tetanus, diphtheria, and acellular pertussis (Tdap) vaccination or if it increases the risk of autism spectrum disorder (ASD) in their babies.

Researchers examined the records of over 81,000 mothers and offspring who were continuously in the care of the Kaiser Permanente Southern California Hospitals. They determined which pregnant women were vaccinated with Tdap. Those women and their children along with the women who were not vaccinated with Tdap and their children were monitored for four to seven years.

The rate of ASD diagnosis was 1.4% of the total subjects. The rate for the children was 3.78 out 1,000 per year for those who were exposed to the vaccination and 4.05 per 1,000 per year for those who were not. In other words, there was no impact on the children of the Tdap vaccination during pregnancy. The researchers concluded that the use of Tdap vaccinations was supported during pregnancy.

But my focus isn’t really on the use of vaccinations; you can look at the data and decide for yourself. It’s on the controversy around vaccinations.

Debate is good, especially as it relates to health, and nothing inspires more debate than vaccinations. But are all debates a real discussion of the issues or are they an attempt to create discord? A recent study may give us some insight. More on that Thursday.

What are you prepared to do today?

Dr. Chet

 

Reference: PEDIATRICS 14(3) September 2018:e20180120

 

How New and Expectant Mothers Can Be Healthier

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Complicated issues require complex solutions and the rise in maternal mortality rate (MMR) is complicated. Public healthcare policy and access to quality pre- and post-natal care is not directly in our hands; legislative public heath policies take time and not everyone agrees on what should be done. But a mother’s health is in her hands to some degree. What can she do to put the odds in her favor to have a healthy baby and protect her body for the long term?

Lose weight if necessary. Obesity carries with it an increased risk of high blood pressure and prediabetes. Even a 10% loss in weight may help her body withstand the stresses that pregnancy and childbirth bring. Obviously losing weight while pregnant is a delicate dance; it’s crucial to emphasize complete nutrition while minimizing calories.

Improve her fitness level. When you look at the physiological causes of MMR, close to 50% could be attributed to cardiovascular or metabolic issues such as prediabetes and hypertension. The more fit a woman is before she becomes pregnant, the lower the risk of those conditions.

Address issues during pregnancy such as gestational diabetes and preeclampsia seriously. They can impact a woman after she gives birth and contribute to increased bleeding, dangerously high blood pressure, and other cardiovascular issues. She should follow her physician’s recommendations for lifestyle and medications to address the issues.

Finally, a woman should know as much as she can about what to expect after childbirth. Not just taking care of the baby, but how to take care of her body, and the warning signs that something may not be right. When in doubt, check it out; better an unnecessary phone call than an unnecessary health crisis.

Let’s be practical. The MMR is rising but the risk is still very low at about 21 out 100,000 births in the U.S. If a woman does all she can to take care of herself before and after she gives birth, not only will it reduce the risk of MMR, it will result in healthier babies and mothers as well. That alone is worth the effort.

What are you prepared to do today?

Dr. Chet

 

References:
1. Obstetrics & Gynecology: August 2017;130(2):366–373.
2. http://bit.ly/2BZ1pOx

 

Why Is the MMR Rising?

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Based on the trends of the past 15 years, the maternal mortality rate (MMR) is increasing. There doesn’t seem to be any single cause that can be identified as “the” reason. Having looked at the research, I think there are three categories that contribute to the increase in MMR.

  • Access to prenatal and postnatal healthcare is inconsistent. In short, we don’t seem to spend enough time teaching mothers how to have a healthy baby, and then we don’t follow the mom’s health as well as we should to make sure she stays healthy. No single reason stood out, but the factors that stood out are the closing of rural hospitals, race and ethnicity, and limited access to healthcare coverage.
  • Women are waiting to have children later in life. While that’s a personal decision and can be related to the economy of the 21st century, every year older raises the risk of complications.
  • Women who wait to have children have a higher rate of obesity; along with that come a higher rate of prediabetes, hypertension, and an increased risk of cardiovascular disease.

Those seem to be the contributing factors to the increase in MMR. The question is what can be done about it? I’ll cover that on Saturday.

What are you prepared to do today?

Dr. Chet

 

References:
1. Beckers Hospital Review. December 2016.
2. America’s Health Rankings. 2016.
3. Obstetrics & Gynecology: August 2017;130(2):366–373.

 

The Rising Maternal Mortality Rate in the U.S.

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Paula recommended I read an article on maternal mortality rate (MMR). I had heard of the infant mortality rate but the MMR was new to me, so I dug into the details. This week, we’re going to take a look at the MMR, why it’s a cause for concern in the U.S., and what can be done about it.

The MMR is the number of women who die in the first year after childbirth. The problem is that there has been a rise in the U.S. MMR over the past 30 years from 7.2 women per 100,000 births to just over 26 per 100,000 births in 2015 (1). The MMR in the U.S. is moving in the wrong direction; other modern societies, such as Japan, the U.K., Finland, and Italy, have lowered their rates to fewer than five per 100,000 women. In Canada, deaths rose from six per 100,000 births in 1990 to 11 in 2013.

To use one of my favorite Vince Lombardi quotes, “What the hell is going on around here?” Why is this happening in the U.S.? The reasons are complicated, and that’s what I’ll talk about on Thursday. If you’d like to read the article that began this search for answers, check out the second reference.

What are you prepared to do today?

Dr. Chet

 

References:
1. Lancet 2016; 388: 1775–812.
2. http://n.pr/2EjqtvV

 

The Bottom Line on Chlorpyrifos

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Today’s health news is full of controversy, some based on reality but most not. Typically, I would have concluded that the op-ed piece was just that: an opinion that exaggerated the facts to put forth a specific point of view. But before I go further, let me be clear: I’m not in favor of any pesticides if they can possibly be avoided. But we also live with the necessity of feeding billions of people and can’t afford to lose crops; we judge fruits and vegetables by appearance because we no longer know the grower personally. There may be some chemicals that are necessary to get that done. The issue comes down to the question of safety. That’s where all the research I read comes into play.

PON1

When I attempted to find the statistics on chlorpyrifos, I came across a large body of research that examined how organophosphates such as chlorpyrifos were eliminated by the body. The paraoxonase 1 gene (PON1) makes enzymes that help the liver and kidney detoxify chemicals such as chlorpyrifos (1). Research on several groups of subjects show that if exposure doesn’t exceed the detoxification capacity of the body, the current tolerance limits are safe for most people.

The problem is similar to what we find in other genes: there are mutations of the PON1 gene that affect the ability of the gene to produce enough enzymes to detoxify the body effectively (2). If the body isn’t able to detoxify itself, the amounts of chlorpyrifos in the body can exceed safe levels. That means that those with the PON1 mutation may be most at risk for chlorpyrifos exposure.

Or maybe not. Again it comes down to exposure. In a study of farm workers chronically exposed to chlorpyrifos, there was no difference in the gene mutations with the ability to detoxify (3). In another study, blood samples with normal and mutated PON1 genes were exposed to high and low levels of chlorpyrifos; the high levels negatively affected the mutated version of the PON1. The low levels, reflective of typical environmental exposure, showed no negative effect (4).

The issue is one of exposure, whether someone has the PON1 mutation or not. Research shows that mothers and children who live in agricultural areas are more at risk to having higher levels of organophosphates in their systems. What isn’t clear is the impact of genetic mutations that result in health issues.

In a recently published paper, researchers found that infants born to mothers with the PON1 mutation and exposed to environmental organophosphates had smaller head circumferences relative to size (5). Whether that translates to reduced IQ or other neurological conditions remains to be seen.

The Impact of Nutrients on Chlorpyrifos Exposure

Several studies demonstrated potential benefits of nutrients on chlorpyrifos exposure. PON1 is also related to cardiovascular health. In a study of over 400 subjects, those subjects with a mutated version of the PON1 gene and with higher amounts of polyphenols from fruit and vegetable intake did better in measures of cardiovascular risk such as high cholesterol (6).

In another study, subjects who consumed organic honey as a supplement experienced less damage and better DNA repair after chronic exposure to organophosphates (7). The polyphenols in the honey were identified as the primary factor related to the repair process.

Finally, in a study of pregnant women and their offspring, researchers examined the affect of folic acid intake in those women who were and were not exposed to organophosphates (8). Those who had a greater than 800 mcg intake during their first month of pregnancy when exposed to pesticides had fewer children with autism spectrum disorder.

While all of this research is recent, it seems clear that nutrients can have a positive impact on people who are exposed to organophosphates such as chlorpyrifos and other pesticides.

The Bottom Line

When I began the research on one statement in an op-ed piece, I never imagined it would end up here, but you go where the research takes you. While this research trip took us to the USDA, the PON1 gene, and some nutrients that can be protective against exposure to chlorpyrifos, one fact I was unable to find was that we are exposed to excess amounts from the fruits and vegetables we eat. That statement in the op-ed was false. But in that journey, we learned a lot. It’s not where you begin; it’s where you finish.

Four final points:

  • I think the ban on chlorpyrifos should be reinstated. Tolerance limits doesn’t mean it’s safe for everyone, and not every harmful impact has been examined.
  • Whether the discontinuance is reinstated or not, eat your fruits and vegetables after you wash them carefully. The value of the nutrients for your health exceeds any risk from chemicals that may be present.
  • Add some extra insurance by taking your supplements.
  • If you’re a golfer, you may want to learn the course’s pesticide schedule and avoid those days.

What are you prepared to do today?

Dr. Chet

 

References:
1. www.ncbi.nlm.nih.gov/gene/5444.
2. Toxicology. 2013 May 10;307:115-22. doi: 10.1016/j.tox.2012.07.011.
3. Toxicol Appl Pharmacol. 2012;265(3):308-15. doi:10.1016/j.taap.2012.08.031.
4. Toxicol Lett. 2014 Oct 1;230(1):57-61. doi: 10.1016/j.toxlet.2014.07.029.
5. Ann Glob Health. 2016; 82(1): 100–110. doi:10.1016/j.aogh.2016.01.009.
6. J Transl Med. 2016 Jun 23;14(1):186. doi: 10.1186/s12967-016-0941-6.
7. Mol Nutr Food Res. 2016 Oct;60(10):2243-2255.
8. Environ Health Perspect. 2017 Sep 8;125(9):097007. doi: 10.1289/EHP604.

 

Men, Their Microbiome, and Infertility

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What role does a man’s microbiome play in infertility? Maybe a lot more than we thought. There are many more factors that affect fertility, with more studies published every day, but this week’s posts have focused on the microbiome. We’ll finish with a study on men.

Researchers examined the sperm of men who contributed semen to an in-vitro fertilization clinic before IVF with their partners. They wanted to determine whether there was a relationship between periodontal disease and sperm quantity and motility—how many sperm and how well those sperm moved. They found that men with periodontal disease had low sperm counts and the sperm were not as active. Those two problems can contribute to infertility.

Just as with women who have periodontal disease, the pathogenic bacteria appear to have an affect on fertility. The same type of treatment for periodontal disease may help fertility issues for both partners. But let me be clear: the microbiome is only one aspect of fertility; there are other issues that contribute to infertility that may also need to be addressed.

What are you prepared to do today?

Dr. Chet

 

Reference: J Clin Periodontol. 2011 Jun;38(6):542-6.