Pregnancy
Hospitals enhance care for babies exposed to substances in womb
Providers at a US hospital have created a process for caring for women giving birth to babies exposed to substances like opioids in the womb.
The new approach, developed by a team at US hospital Oklahoma Children’s Hospital OU Health, will see providers surround mother and baby with the care they need in the hospital, at home and in their communities for the years to come.
The American Academy of Pediatrics granted funding to the University of Oklahoma for hospital providers to refine and improve the discharge process for mothers and babies with neonatal abstinence syndrome, also known as neonatal opioid withdrawal syndrome.
The project, called the Perinatal Health and Substance Use Quality Improvement Virtual Learning Collaborative, is helping establish best practices for this transition. Oklahoma Children’s Hospital is one of eight hospitals nationwide chosen for the programme.
Neonatal hospitalist Benazir Drabu, M.D. is associate professor of paediatrics at the OU College of Medicine and team leader for the project.
Drabu said: “We want to provide continuity of care for mom and baby.
“Care starts prenatally and goes through labour and delivery, and for this project, we are focusing on our discharge planning.
“This is work we are already doing, but participating in the collaborative will allow us to learn how to do it better.”
Babies born with neonatal abstinence syndrome may experience withdrawal from the drugs that crossed the placenta while in utero.
Symptoms include jitteriness, trouble sleeping, diarrhea, vomiting, poor appetite and, in severe cases, seizures. I
f symptoms can be managed in the Mother-Baby Unit, the health care team focuses on soothing techniques, feeding and sleep support.
If a higher level of care is required, including medications, the baby is transferred to the Neonatal Intensive Care Unit.
Once discharge is possible, it is essential to have a well-structured plan to ensure caregivers receive adequate guidance and support.
Mothers and babies affected by substance use usually stay in the hospital longer than the general population of birthing mothers.
When discharge approaches, an interdisciplinary team of physicians, nurses, social services providers, physical therapists and occupational therapists shifts its focus to keeping the family well-supported at home.
Soothing strategies used in the hospital are reinforced, including providing the family with a “sleep sack” that swaddles the baby and teaching them how to console a fussy baby.
Safe sleep at home is also emphasised. The team encourages caregivers to have a crib or “pack and play” instead of letting babies sleep with parents.
Neonatologist Patricia Williams, M.D. is associate professor of paediatrics at the OU College of Medicine and a co-leader of the project.
Williams said: “In many cases, families don’t have a separate place for the baby to sleep, so they put them in their own bed, which puts the baby at risk for an adverse event.”
Mothers are screened for depression and coached on successful breastfeeding.
The hospital team also aims to strengthen communication with primary care providers to ensure continuity of care.
Social service providers connect the family to community organisations, such as Sooner Start and Oklahoma Family Network, that provide everything from diapers to respite care to support groups.
In addition, families are referred to the Little STAR clinic for an appointment 30 to 90 days after hospital discharge.
Little STAR is a follow-up programme to the Substance Use Treatment and Recovery (STAR) prenatal clinic at OU Health.
Susan Redwine, M.D. is an assistant professor of paediatrics in the OU College of Medicine and co-leader of the project.
She said: “Studies have shown that babies who have prenatal substance exposure can have poor developmental outcomes, both cognitively and behaviorally.
“We want to prepare caregivers for that but also give them hope because there are clinics and programmes that can help.
Early intervention is so important, as is being non-judgmental. Our goal is to provide as much support as possible.”
When babies reach 1 year old, they qualify for services at OU’s Child Study Center, which continues developmental and behavioural support up to age 7.
Redwine said: “We want to be the bridge between the baby leaving the hospital and getting families into programmes at the Child Study Center.”
OU was previously part of a national effort to improve the care of babies exposed to substances in the womb with its participation in the “Eat, Sleep, Console” clinical trial funded by the National Institutes of Health.
The trial evaluated the “ESC” approach to caring for babies with neonatal abstinence syndrome.
ESC includes feeding babies every three hours around the clock to address the weight loss that often comes with substance exposure.
ESC also prioritises consoling and ensuring babies get adequate sleep. If a baby cannot be consoled within 10 minutes, medication may be considered.
The trial had good outcomes, including a shorter hospital stay and decreasing the likelihood the baby would need medication. ESC has now become the standard of practice.
Drabu said: “It gives us a sense of fulfillment to help these babies and their caregivers and to keep them together as much as possible.
“Sending them home happy and prepared is priceless.”
Women who develop pre-eclampsia face a higher risk of chronic kidney disease and high blood pressure later in life, new research suggests.
The amount of protein found in the urine during pregnancy may help identify those at greatest risk of developing long-term health problems.
Pre-eclampsia usually involves high blood pressure and increased protein in the urine. Some women also experience severe headaches and changes to their vision.
The condition cannot be treated during pregnancy and, in some cases, labour must be induced early to protect both the woman and baby.
The study found that the condition may be linked to longer-term health problems.
Anne Høy Seemann Vestergaard, a medical doctor and PhD at the department of clinical medicine at Aarhus University, said: “What we can see is a clear association between pre-eclampsia and the development of high blood pressure, chronic kidney disease and cardiovascular disease later in life.”
The researchers found that the amount of protein passed in the urine during pregnancy was linked to the risk of developing chronic conditions after giving birth.
Protein in the urine can indicate that the kidneys are not filtering blood normally.
Vestergaard said: “The most surprising finding was how clearly the amount of protein in the urine during pre-eclampsia was linked to the risk of later high blood pressure and chronic kidney disease. Women with moderate to severe protein excretion had a higher risk of both conditions compared with women with low or no protein excretion.”
Among women with pre-eclampsia and moderate to severe levels of protein in the urine, around one in 20 developed chronic kidney disease within 10 years and around one in six developed high blood pressure.
Most women in the study did not develop long-term complications, but the researchers said the increased risk should still be taken seriously because the potential effects can be severe.
Vestergaard said: “At first glance, this may sound like a low number, but it represents a markedly increased risk when the groups are compared. In the group with pre-eclampsia and high levels of protein in the urine, around 1 in 20 women developed chronic kidney disease within ten years, including early stages of the disease, compared with around 1 in 100 in the group with lower or no protein excretion.”
She added: “That is a considerable number in light of the fact that chronic kidney disease is a potentially serious condition that can progress to kidney failure if isn’t diagnosed early.”
The findings suggest women who experience pre-eclampsia may benefit from more systematic monitoring after pregnancy.
Vestergaard said: “Our study suggests that these women may benefit from monitoring of blood pressure and kidney function after pregnancy.”
Light exercise and less sitting may reduce pregnant women’s risk of serious blood pressure complications, according to a new study.
Researchers have proposed a daily activity and sleep guide that they say was linked to a nearly 30 per cent lower risk of hypertensive disorders of pregnancy.
The suggested pattern includes fewer than eight hours of sedentary time, at least seven hours of light physical activity, around 22 minutes of more intense activity and nearly nine hours of sleep.
The University of Iowa-led study examined the daily behaviours of 470 pregnant women across all stages of pregnancy.
Participants wore monitors that measured physical activity over 24-hour periods and recorded how long they spent asleep.
Hypertensive disorders of pregnancy include chronic high blood pressure, gestational hypertension and pre-eclampsia.
Gestational hypertension is high blood pressure that develops during pregnancy, while pre-eclampsia is a potentially serious condition involving high blood pressure and signs that organs may be affected.
Sedentary behaviour means being mostly inactive, such as sitting or lying down.
Light physical activity can include casual walking, moving around the home or standing.
Moderate to vigorous activity includes movement such as brisk walking, where breathing and heart rate increase.
Kara Whitaker, associate professor in the department of health, sport, and human physiology at Iowa and corresponding author of the study, said: “We are identifying the optimal composition of movement behaviours across the day associated with the lowest risk of developing HDP and the most improved health outcomes.
“This blueprint holds for each and every trimester of pregnancy.”
Study participants were enrolled at sites in Iowa City, Pittsburgh and Morgantown, West Virginia.
The women wore activity and sleep monitors for at least one week during each trimester of pregnancy.
Four in five participants were non-Hispanic white and nearly a quarter lived in rural areas.
The data showed a steep rise in risk among pregnant women who were sedentary for more than 10 hours a day.
Women who increased light physical activity to at least four hours a day reduced their risk of hypertensive disorders of pregnancy to 15 per cent from 30 per cent.
Whitaker said: “Just moving around more seems to have significant health benefits.
“And I think it also may be a more feasible target for women who are pregnant who are not exercising regularly.”
The researchers said they were surprised that longer durations of moderate to vigorous physical activity did not appear to provide additional benefit.
Sleep beyond a certain duration also did not appear to bring major further benefits.
Whitaker said: “Through this study, we are providing evidence that reducing sedentary behaviour and engaging in light physical activity are important, and maybe more important, when it comes to pregnancy and health.”
The findings may be relevant beyond pregnancy because clinical research has shown that women who develop hypertensive disorders of pregnancy are more than twice as likely to develop heart disease later in life.
Cardiovascular disease includes conditions affecting the heart and blood vessels, such as heart disease and stroke.
Whitaker said: “We know that cardiovascular disease is the number one killer of women, and if we can intervene in pregnancy and prevent women from developing a hypertensive disorder of pregnancy, we are putting them on a better trajectory, away from cardiovascular disease and toward more optimal cardiovascular health.”
The study was published online on June 10.
A second study, published online on May 27, looked more closely at the ratio and type of sedentary behaviour and light physical activity linked to a lower risk of hypertensive disorders of pregnancy.
Whitaker is a lead co-author on that study.
Co-authors in the June 10 study include Alex Crisp, Jaemyung Kim, Karina Smith, Donna Santillan, Mark Santillan and Bridget Zimmerman, from Iowa; Jacob Gallagher, from Iowa State University; Melissa Jones, from Oakland University in Michigan; Bethany Barone Gibbs, Katrina Wilhite, Alexis Thrower and Iqra Sheikh, from West Virginia University; and Sabera Rahman, Janet Catov, Christopher Kline and Maisa Feghali, from the University of Pittsburgh.
The National Institutes of Health, the University of Iowa Institute for Clinical and Translational Science, the University of Pittsburgh Clinical and Translational Science Institute and the West Virginia Clinical and Translational Science Institute funded the research.
A £50m maternity consortium will bring together UK clinicians, researchers and communities to tackle the most critical gaps in maternal care.
Funding from the National Institute for Health and Care Research has established the NIHR Inequalities Challenge: Maternity Disparities Consortium under the leadership of the University of Birmingham and Newcastle University.
Higher education bodies, NHS organisations, community groups and voluntary organisations from across the UK will work together through the programme.
The NIHR has committed £50m over five years to support research led by clinicians, researchers and communities across the consortium.
Professor Joht Singh Chandan, consortium co-lead for research at the University of Birmingham, said: “National attention on maternity safety and equity has never been greater, but ambition must now be matched by evidence and implementation.
“Through this consortium, we will work across the UK to understand what works, for whom and in what contexts, and to ensure that research leads to practical changes in care for the women, babies and families who need them most.”
The launch comes at a pivotal moment for UK maternity care, with growing national attention on improving safety, equity and women’s experiences of care.
The government’s renewed Women’s Health Strategy highlights the need to improve care before and between pregnancies for underserved communities.
Against that backdrop, the consortium will generate the evidence, interventions and research capacity needed to help turn national ambition into practical improvements for women, babies and families.
University of Birmingham is leading work to improve maternity care pathways across the antenatal, intrapartum and postnatal periods.
Antenatal care covers pregnancy before labour, while intrapartum care refers to care during labour and birth.
The consortium will examine how women and families can be better supported before pregnancy and between pregnancies.
This includes improving access to advice and care that can help people prepare for pregnancy, manage existing health conditions and reduce risks before they build up.
Other research will focus on improving care during pregnancy, birth and the early weeks after birth.
This will include work on major causes of poor maternal health, such as high blood pressure, diabetes in pregnancy, obesity, perinatal mental health and complications during recovery after birth.
Professor Judith Rankin OBE, consortium co-lead for research and capacity development at Newcastle University, said: “This funding represents a critical opportunity to make the step change we need to improve outcomes for women and their babies.
“Alongside the research, the Consortium will be investing in tomorrow’s research leaders today to ensure we have the capacity to deliver on improving pregnancy outcomes, access to, and experience of, care.”
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