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Hospitals enhance care for babies exposed to substances in womb

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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.”

Fertility

France urges 29-year-olds to start families now

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France is urging 29-year-olds to have children as part of a 16-point plan to boost fertility and raise birth rates.

Health officials say the aim is to prevent men and women facing fertility problems later in life and thinking “if only I had known”.

The strategy comes as the country, like many western nations including the UK, faces tumbling birth rates.

The trend is creating concerns about how governments can fund pensions and healthcare for ageing populations with fewer younger working people paying taxes.

But policies to raise fertility rates globally have produced limited results, and critics of the scheme suggest better housing and maternity provision could be more effective.

The government will send out “targeted, balanced, and scientifically sound information” to young people on issues including sexual health and contraception.

The material “will also reiterate that fertility is a shared responsibility between women and men,” the country’s health ministry said.

The plan includes efforts to increase the number of egg-freezing centres from 40 to 70. The process involves extracting and storing a woman’s eggs for potential future use.

The country’s health system already provides free egg-freezing for people aged 29 to 37, a service that costs about £5,000 per round in the UK.

The country’s fertility rate of 1.56 children per woman is below the 2.1 needed to maintain a stable population.

However, it is higher than rates in China, Japan and South Korea, and the UK, where the latest figures show it dropped to a record low of 1.41 in England and Wales by 2024.

Professor François Gemenne, who specialises in sustainability and migration at HEC Paris Business School, told Sky News: “This is something that demographers had known for a long time, but the fact that there were more deaths than births in France last year created a shock effect.”

He said the country’s “demographic worry” is exacerbated by the design of its pensions system and its “obsession with immigration and the fear of being ‘replaced'”.

The plan also includes a new national communication campaign, a “My Fertility” website advising on the effects of smoking, weight and lifestyle, and school lessons for children about reproductive health.

The health ministry has acknowledged its maternal and infant mortality rates are higher than neighbouring countries and is beginning a review of perinatal care to address the “concerning” situation.

Channa Jayasena, professor in reproductive endocrinology at Imperial College London, told Sky News: “On the female side, societal changes leading to older age of motherhood are certainly important.

He said obesity was also a problem as it increased women’s risk of polycystic ovary syndrome and endometriosis.

Allan Pacey, professor of andrology (male reproductive health) at Manchester University, said for most people globally, deciding to have children was “down to [non-medical] factors such as better access to education, career opportunities, taxation, housing, mortgages, finance, etc.”

“Medicine can’t help with those things,” Pacey added.

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Pregnancy and breastfeeding linked to higher cognitive ability in postmenopausal women

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Pregnancy and breastfeeding are linked to stronger cognition in postmenopausal women, a long-term study suggests.

Greater cumulative time spent pregnant and time spent breastfeeding correlated with higher overall scores in the study, including verbal and visual memory, in later life.

Researchers analysed annual assessments of more than 7,000 women aged about 70 for up to 13 years using data from the Women’s Health Initiative Memory Study and the Women’s Health Initiative Study of Cognitive Aging.

On average, those who were pregnant for around 30.5 months were expected to have a 0.31 per cent higher global cognition score than those who had never been pregnant.

A lifetime average of 11.6 months of breastfeeding was linked to a 0.12 per cent higher global score.

Each additional month spent pregnant was associated with a 0.01-point rise in overall ability.

Each extra month of breastfeeding showed the same increase, and a 0.02-point gain in verbal and visual memory. Although small, these effects are similar to known protective factors such as not smoking and high physical activity.

The work was led by Molly Fox, an anthropology professor at the University of California, Los Angeles.

Fox said: “Any ways in which we can focus public health outreach or clinical interventions towards higher-risk populations leads to more effective and efficient efforts.”

Participants who had ever been pregnant scored, on average, 0.60 points higher than those who had never been pregnant.

Those who had breastfed scored 0.19 points higher overall and 0.27 points higher for verbal memory than those who had never breastfed.

Women are disproportionately affected by Alzheimer’s disease, a progressive condition that impairs memory and thinking skills, and this is not fully explained by life expectancy differences.

The authors say biology and social factors may both play roles.

They noted that more adult children could contribute to cognitive health by buffering stress, supporting wellbeing or encouraging healthy behaviour.

“If we can figure out, as a next step, why those reproductive patterns lead to better cognitive outcomes in old age, then we can work towards figuring out how to craft therapies, for example, new drugs, repurposed drugs or social programmes, that mimic the naturally occurring effect we observed,” said Fox.

The study team is now working to identify the mechanisms that link reproductive histories to cognitive resilience.

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Pregnancy

Stroke prevention and treatment during and after pregnancy key to women’s health – AHA

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Stroke prevention requires aggressive blood pressure control and rapid recognition of symptoms in pregnancy and postpartum, a new scientific statement urges.

The guidance details risk factors for pregnancy-related stroke and offers suggestions for prevention, rapid diagnosis, timely treatment and recovery during pregnancy and postpartum.

A stroke occurs in approximately 20 to 40 of every 100,000 pregnancies and is estimated to account for around four to six per cent of pregnancy-related deaths annually in the US.

The statement was published by the American Heart Association and endorsed by the American College of Obstetricians and Gynecologists.

Eliza Miller is chair of the writing group and associate professor of neurology at the University of Pittsburgh.

She said: “When a stroke occurs during pregnancy or the postpartum period, it can lead to serious complications for both the mother and baby, including neurological deficits, long-term disability, increased risk of future strokes and death.

“Controlling blood pressure and other stroke risks before and after delivery, responding immediately to stroke warning signs and providing timely treatment can help save lives and improve outcomes for mothers and their babies.”

There are two types of stroke: an ischaemic stroke occurs when a blood vessel supplying blood to the brain is blocked by a clot, while a haemorrhagic stroke occurs when a blood vessel ruptures and bleeds into the brain.

Risk factors for pregnancy-associated stroke include chronic hypertension (high blood pressure before pregnancy or diagnosed before 20 weeks), preeclampsia (a dangerous condition causing high blood pressure in pregnancy), advanced maternal age (35 years or older), diabetes, obesity, migraine with aura, infections, heart disease and clotting disorders.

Stroke disproportionately affects people of racial and ethnic minorities. A 2020 meta-analysis found that pregnant Black women are twice as likely to have a stroke compared with pregnant white women, even after adjusting for socioeconomic factors.

The statement authors emphasise that the majority of maternal strokes are preventable with earlier and more aggressive blood pressure control.

“Preeclampsia and eclampsia can occur before, during or after delivery, and the early postpartum period is actually the highest risk time for stroke.

“Very close monitoring of blood pressure is essential,” said Miller.

The statement urges all healthcare professionals who care for pregnant patients, including obstetricians, family medicine practitioners and nurses, to be trained to recognise stroke symptoms so they can promptly start treatment.

“It is crucial for women who are pregnant or have recently given birth and have symptoms of new neurological deficits or severe headache, especially if they also have elevated blood pressure, to be immediately evaluated for possible stroke,” said Miller.

The authors emphasise that pregnancy is not a reason to delay or interfere with recommended treatment for acute stroke.

Various anti-clotting medications are available that are safe for pregnant and lactating women, and mechanical thrombectomy (surgical removal of a blood clot) may be needed for patients with large-vessel blockages.

Survivors of pregnancy-associated stroke face unique challenges such as caring for an infant and require support from a multidisciplinary rehabilitation team.

Mood and sleep disorders are common after stroke and may be intensified by postpartum factors such as hormonal shifts, breastfeeding and disrupted sleep.

Miller said: “Babies depend on their mothers’ well-being, and supporting recovery after stroke, both emotionally and practically, is essential so mothers can heal and families can thrive.”

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