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For low-risk pregnancies, planned home births just as safe as birth centre births – study

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In low-risk pregnancies, mothers and children are just as safe with a planned home birth as they are with a planned birth center birth, a national study led by Oregon State University researchers has shown.

The findings, published in Medical Care, contradict doctors’ long-held concerns about home birth, including a recent opinion by the American College of Gynecologists and Obstetricians that describes hospitals and accredited birth centres as the safest places to have a baby.

A birth centres is a health care facility designed to provide a more natural and home-like environment than a hospital.

OSU scientists analysed two national registries for community births – planned birth either at home or in a birth centre for low-risk pregnancies – in the largest study to examine how the settings compared to each other in terms of health outcomes.

A low-risk pregnancy is defined as a single baby being carried to full term (at least 37 weeks) and positioned with its head down, with no major maternal complications such as diabetes or pre-eclampsia.

At least 70 per cent of pregnancies are low risk, said Marit Bovbjerg, an associate professor in the Oregon State College of Health.

Combined, the two registries documented more than 110,000 births from 2012 to 2019, representing all 50 U.S. states, and the data showed no safety difference between home birth and birth centre birth.

Bovbjerg said: “Historically, physicians in the U.S. have objected to planned home births but not planned birth centre births, even though from both settings you would need to transfer the birthing person to a hospital for any major complications.

“Until now, we’ve had no evidence about home versus birth centre outcomes.

“Our study is the first to provide evidence that these two birth settings are equally safe.”

Bovbjerg and Melissa Cheyney, a professor in the OSU College of Liberal Arts and a licensed midwife, did not directly compare the safety of community settings to hospitals but they note that the bulk of evidence globally, including a U.S. National Academies of Science, Engineering and Medicine report published in 2020, supports the idea that planned community birth is a safe alternative to hospital birth.

Bovbjerg, who with Cheyney co-directs Oregon State’s Uplift Lab, said: “That means that within the U.S., we already had evidence that birth centres were comparable to hospitals for low-risk births.

“Our study compared home to birth centre and suggests that both community settings are a reasonable choice for low-risk birthing people.”

The scientists note that the rate of home birth in the United States has been increasing over the last two decades, and that 2 per cent of births in the U.S. happen in one of the two types of community settings, which have similar attendants and interventions available but different practice standards, regulatory guidelines and levels of health systems integration.

They added that planned home birth resulted in a lower rate of transfer to hospital than planned birth centre birth for reasons that could relate to concern over negative hospital experiences.

“They might fear a loss of continuity of care provider, as well as possible mistreatment and judgment upon arrival at the hospital,” Cheyney said, citing a national care-experience study in which many participants reported mistreatment, including being ignored, scolded, shouted at or subject to an invasive procedure without consent.

“That was especially true for Black and Indigenous people who transferred to a hospital from a planned home birth,” she said.

“If previous hostile transfer experiences contribute to a reluctance to transfer, we obviously need to work together to improve the transfer experience.

“Transfer from community settings is often necessary, and anything that discourages a necessary transfer likely causes harm.”

Motherhood

New psychedelic treatment shows early promise against postpartum depression

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A single day of inhaled psychedelic treatment may relieve postpartum depression symptoms, with effects lasting for a week, early research suggests.

Postpartum depression is a severe mood disorder that affects women after giving birth. Symptoms can include extreme sadness, anxiety, changes in sleep and eating habits and difficulty bonding with a baby.

The condition affects up to one in five mothers globally. If untreated, it can have lasting effects on a mother’s psychological wellbeing and a child’s cognitive development.

Standard antidepressants, including selective serotonin reuptake inhibitors, a common type of antidepressant, often take four to six weeks to start working.

They can also cause side effects including weight gain, nausea and sexual dysfunction.

The only medication specifically approved by the US Food and Drug Administration for postpartum depression is zuranolone. It works faster than standard antidepressants but requires a 14-day daily course and carries warnings about drowsiness.

Researchers are exploring psychoactive compounds as possible alternatives for faster relief.

Mebufotenin, also known as 5-MeO-DMT, is a psychedelic compound that acts on serotonin receptors in the brain. Serotonin is a chemical messenger involved in functions including mood, sleep and digestion.

Previous early-stage trials found that an inhaled synthetic formulation called GH001 produced very rapid antidepressant effects in people with treatment-resistant depression.

Lead authors Martin Johnson of St Pancras Clinical Research and Kristina M. Deligiannidis of the Feinstein Institutes for Medical Research investigated whether the treatment could safely help women with severe postpartum depression.

The trial assessed its safety, side effects and impact on maternal functioning. It was funded by GH Research, the company developing the drug.

Researchers enrolled 10 women aged 18 to 45. All had major depressive disorder that began shortly before or after giving birth and were at least four weeks postpartum.

Participants also had to score at least 28 on a standard depression questionnaire, indicating moderate to severe depression.

Treatment was given on a single day using a specialised vaporisation system, with patients inhaling the medication from a collection balloon.

Doses were adjusted according to each woman’s response.

Participants first received 6mg. Those who tolerated the drug but did not experience a sufficiently intense psychoactive effect could receive 12mg one hour later, followed by 18mg after another hour if needed.

Researchers used a specialised scale to assess the intensity of the psychedelic experience, including feelings of losing control and how profound the experience felt.

Further doses were stopped once participants reached a predefined score.

Patients were monitored for changes in vital signs, psychiatric symptoms and overall comfort.

The psychedelic effects lasted for an average of around 20 to 25 minutes after each dose.

Participants also had to arrange for a trusted adult to care for their baby while they received treatment.

The main measure was the change in depression scores between the start of the study and day eight. Researchers also measured symptoms two hours after the final dose and on day two.

Four participants were lactating, allowing researchers to test their breast milk and assess how quickly the drug was eliminated from their bodies.

All 10 women experienced at least a 50 per cent reduction in depression symptoms two hours after their final dose.

By day eight, average depression scores had fallen by around 96 per cent and every participant met the study criteria for remission, meaning they no longer met the clinical threshold for depression.

Participants also reported improvements in maternal functioning.

Scores on a questionnaire assessing psychological wellbeing, self-care and mother-child interaction improved by around 56 per cent by day eight, with gains seen across almost all areas measured.

No serious adverse events were reported.

The most common side effect was mild to moderate headache, experienced by five of the 10 women.

The treatment did not cause lingering sedation and all participants were able to return home on the day they received it.

Among the four lactating women, levels of the drug and its byproducts in breast milk peaked around one hour after the final dose and fell below detectable levels after about 10 hours.

Researchers said this suggests mothers may only need to pause breastfeeding for a relatively short period on the day of treatment, although further research is needed before firm clinical recommendations can be made.

The trial was open-label, meaning both participants and researchers knew the active drug was being given.

There was no placebo comparison group, making it impossible to rule out the possibility that expectations about the treatment influenced the reported improvements.

The sample was also small and lacked demographic diversity, with nine of the 10 participants identified as white.

Almost none of the women were taking other psychiatric medications during the trial, meaning the findings may not reflect how a broader and more diverse group of mothers with postpartum depression would respond.

Researchers followed the women for only one week after treatment, leaving questions about how long the antidepressant effects may last.

Future studies will need to follow patients for several months to assess whether depression returns or additional doses are needed.

Larger trials will also need to randomly assign participants to receive either the active treatment or a placebo.

These studies will be needed to confirm the treatment’s safety and determine whether the drug itself is responsible for the rapid reduction in symptoms.

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One in eight mothers diagnosed with gestational diabetes, research finds

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One in eight mothers in England is now diagnosed with gestational diabetes, after diagnoses of the condition rose by 60 per cent in just five years, according to a major study.

The research found that rates of gestational diabetes increased from around 8 per cent of pregnancies in 2018 to more than 12 per cent in 2022.

Gestational diabetes mellitus (GDM) develops when the body cannot produce enough insulin to regulate blood sugar levels during pregnancy.

It is the most common complication to occur during pregnancy and is associated with a heightened risk of preterm birth, emergency caesarean section, and babies being born either larger or smaller than expected for their gestational age.

The condition is also linked to longer-term health risks for both mothers and their children.

Laura Magee is professor of women’s health at King’s College London and co-investigator on the study.

She said: “Pregnancy outcomes for women with gestational diabetes are still worse than those for women without gestational diabetes.

“Further work is required to address how control of blood sugar and timed birth can address the excess of adverse pregnancy outcomes, compared with the general maternity population.

“Follow-up after birth is also essential, as women with prior gestational diabetes are at increased risk of cardiometabolic disease, including type 2 diabetes mellitus, but also high blood pressure and elevated blood cholesterol, starting within the first year after birth.”

For the study, researchers analysed routinely collected NHS maternity data covering more than 2.3 million mothers and around 2.8 million births across 184 hospitals in England between 2018 and 2022, making it one of the largest investigations of its kind.

The study uncovered marked inequalities in both the prevalence of gestational diabetes and pregnancy outcomes more broadly.

The sharpest rises in diagnoses were recorded among Asian women, among whom rates reached around 23 per cent, and among women living in the most deprived areas, where rates climbed to about 14 per cent.

The disparities extended beyond gestational diabetes.

Black mothers were found to be more likely to experience an emergency caesarean birth, women in deprived areas were more likely to give birth prematurely, and Asian mothers were more likely to have babies born small for their gestational age.

Among these higher-risk groups, researchers found that a diagnosis of gestational diabetes further compounded the risk of preterm birth.

Rising maternal age, increasing rates of obesity and improvements in how data is captured by the NHS are all likely to be contributing to the growing prevalence of the condition, the researchers said.

Notably, they found that changes to gestational diabetes screening introduced during the Covid-19 pandemic did not meaningfully affect the overall upward trend in diagnoses, suggesting the rise reflects genuine underlying changes in the population rather than shifts in testing practice.

The researchers said the findings pointed to an urgent need to strengthen maternity services and improve support for the women at greatest risk.

Experts said the findings also carried implications that extend well beyond pregnancy itself.

Dr Sonya Babu-Narayan, clinical director at the British Heart Foundation, said the study was part of a wider pattern of research using large-scale health data to uncover hidden risks.

“Big data research studies like this, which can now analyse millions of healthcare records, are uncovering a concerning rise in conditions which raise people’s chances of having a future heart attack or stroke,” she said.

“Gestational diabetes often goes away after pregnancy, but it can increase women’s risk of future cardiovascular disease.”

Dr Babu-Narayan called on healthcare professionals to routinely ask women about pregnancy-related risk factors, regardless of how long ago the pregnancy took place.

“Healthcare professionals who want to fully understand people’s risk of heart attack and stroke should routinely ask women about risk factors unique to them, such as diabetes or high blood pressure in pregnancy – even if that pregnancy was decades earlier,” she said.

“If you are a woman who has had diabetes or high blood pressure during pregnancy, it is especially important to attend health checks when invited.”

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Parenthood impacts women’s health more than men’s, research finds

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Parenthood is associated with changes in women’s health that are not seen in men, including reduced exercise and differences in wellbeing, new research has revealed.

Men’s health indicators varied only slightly depending on whether they were fathers, while the number and age of children were linked to changes in women’s health.

Anna Barbuscia, of the OPIK research group at the EHU-University of the Basque Country, said sharing parental responsibilities more equally could help reduce these differences.

Having children can bring significant biological, psychological and social changes, but the study found that the effects varied considerably between women and men.

Barbuscia said: “Having children has greater consequences for the health of the mother, both in the short and long term.

“This is not only because of the biological changes as a result of the pregnancy and birth, but also the psychological consequences. Our findings show a significant gender gap.”

The study, carried out by the OPIK research group, examined the relationship between motherhood and fatherhood and several health indicators.

These included psychological wellbeing, perceived health, physical exercise, alcohol consumption and smoking.

The researchers also considered whether the number and age of participants’ children influenced these indicators.

“It was observed that, in men, neither the fact of being a father, nor family characteristics, affected the health indicators. All parameters remained practically the same,” said Barbuscia.

The findings showed a different pattern among women, with the number and age of their children associated with changes in health and wellbeing.

Mothers with only one child and those with adolescent children reported more depressive symptoms.

Women living with two or more young children reported a better perception of their overall health.

“Caring for younger children usually demands greater physical effort, which may result in increased tiredness and poorer quality sleep.

“Adolescence, on the other hand, has traditionally been considered the most stressful phase for both mothers and fathers,” Barbuscia said.

The study also found a significant gender difference in physical activity.

Women generally did less regular physical exercise than men, and the gap widened when they had children.

“Only 16 per cent of mothers with young children do regular exercise, compared to 30 per cent of women who do not have children.

“In men, however, again, there was scarcely any difference between those who are fathers and those who are not,” Barbuscia said.

“This all indicates that maternity reduces the time available for personal care, which has an impact on a habit as important for health as physical activity.”

Barbuscia said the findings should be considered when designing family policies and planning healthcare services.

“Facilitating work-family balance is not enough. It is also necessary to ensure that mothers have time to look after their own health and wellbeing. Investing in this time is investing in health.”

She added that sharing parental responsibilities more equally between mothers and fathers could help reduce the inequalities observed.

“If we want to build healthy families and encourage people to have children, we need to start by ensuring that raising children does not have such an unequal impact on men and women.”

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