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Obesity During Pregnancy
In the journal Nucleic Acids Research, scientists from the National Institute on Alcohol Abuse and Alcoholism and the National Institute of Standards and Technology report that polyamines—natural compounds essential for cell growth—react with acetaldehyde to trigger a series of reactions that damage DNA, an event that can lead to the formation of cancer. The work provides an important framework for understanding the underlying chemical pathway that could explain the association between drinking and certain types of cancer. The research team examined acetaldehyde’s reaction with polyamines, small molecules found in all cells. Polyamines are usually considered “good guys” because they have been shown to protect DNA from oxidative damage, yet the researchers
found the polyamines facilitated the conversion of acetaldehyde into crotonaldehyde (CrA), an environmental pollutant that has been shown to cause cancer in animals. This chemical in turn altered DNA, generating an abnormal, mutagenic DNA base called a Cr-PdG adduct. “We concluded that polyamines stimulated the formation of Cr-PdG adducts from acetaldehyde, and this may provide a mechanism to explain how alcohol consumption increases the risk of some types of cancer,” the authors said.
Obesity During Pregnancy
M
ore than one-third of American women are obese, the epidemic of which is presenting challenges for health care providers caring for obese
Bacteria in Household Dust May Trigger Asthma Symptoms
N
ew research shows that bacteria lurking in household dust produce chemicals that may trigger asthma and asthma-related symptoms such as wheezing. These bacterial chemicals, called endotoxins, particularly those found on bedroom floors, were linked with increased respiratory problems in adults. This study, supported by the National Institute of Environmental Health Sciences (NIEHS), part of the NIH, is the first nationwide study of endotoxins in the household environment, and it involved analysis of more than 2,500 dust samples from 831 homes across the U.S. Researchers at NIEHS and the University of Iowa found a strong association between endotoxin levels and the prevalence of diagnosed asthma, asthma symptoms, asthma medication use and wheezing. These relationships were strongest for bedroom floor and
October | November 2005
women in pregnancy, according to a new committee opinion from the American College of Obstetricians and Gynecologists (ACOG). The rates of obesity among American women are staggering: • 49 percent of non-Hispanic Black women are obese • 38 percent of Mexican American women are obese • 31 percent of non-Hispanic White women are obese Care during pregnancy and labor is exacerbated by obesity, including using external monitors to perform surgery, the committee wrote. Some studies show that obesity is an independent risk factor for miscarriage among women who undergo fertility treatment. Data also link obesity to miscarriage in women who conbedding dust. Households with higher endotoxin concentrations experienced higher prevalence of respiratory symptoms. The study was published online in the American Journal of Respiratory and Critical Care Medicine. Endotoxins are found in the cell wall of bacteria and are only released when bacteria rupture or disintegrate. Because bacteria can be found everywhere in the home, the likelihood of their release is high. Once released, endotoxins can cause inflammation of the airways and lead to asthma symptoms. Researchers know that endotoxins worsen asthma symptoms in adults, whether the person has allergies or not. Since the mid-1960s, researchers knew that house dust contains endotoxins, but it’s only within the past five years that they began to understand the impact of household endotoxins on human health. Knowing what triggers asthma, whether it’s endotoxins or something else, may help better prevent or treat symptoms.
AWHONN Lifelines
369
ceived naturally. Obesity has been linked to an increased risk of gestational hypertension, pre-eclampsia and gestational diabetes. And the higher the body mass index (BMI) a woman has, the higher the chance she will need a cesarean. Other studies show that obese women have more complications during and after cesarean surgery, including excessive blood loss, operating time greater than two hours, and wound infection. Surgery in obese women also poses anesthetic challenges, among them difficult epidural placement and respiratory problems from difficult intubation. Elevated risks to the babies of obese women include stillbirth, prematurity, macrosomia (large for gestational age), neural tube defects and higher rates of childhood obesity. In the opinion, ACOG makes the following recommendations for health care providers when working with obese patients who are pregnant or who are considering pregnancy:
370
AWHONN Lifelines
• Explain the Institute of Medicine recommendations for prenatal weight gain: 25 to 35 lb for women of normal weight, 15 to 25 lb for overweight women and 15 lb for obese women • Record height and weight for all women at the initial prenatal visit to allow BMI calculation • Offer nutrition consultation to all obese women and encourage them to follow an exercise program. This should be continued after the baby is born and prior to attempting another pregnancy • Consider screening obese pregnant women for gestational diabetes during the first trimester and repeating it later in pregnancy if initial screening result is negative • Discuss potential pregnancy complications such as difficulty estimating fetal weight and obtaining fetal heart rate • Suggest that patients consult with an anesthesiologist prior to delivery— or at the very latest, early in labor—
because they are at high risk for emergency cesareans To battle obesity, more people are turning to bariatric surgery. But as a result of the surgery, many patients who later become pregnant may see a host of complications such as gastrointestinal bleeding, anemia, intrauterine growth restriction, prematurity and neural tube defects. The surgery can also lead to deficiencies in iron, vitamin B12, folate and calcium. On the other hand, pregnancies following bariatric surgery are often less likely to be complicated by gestational diabetes, hypertension, macrosomia and cesarean delivery. ACOG’s recommendations for obese patients who are pregnant or planning to conceive include having a preconception consultation and weight-loss counseling, seeking information on the risks of obesity and pregnancy, and continuing nutritional counseling and exercise programs after delivery.
Volume 9
Issue 5
found the polyamines facilitated the conversion of acetaldehyde into crotonaldehyde (CrA), an environmental pollutant that has been shown to cause cancer in animals. This chemical in turn altered DNA, generating an abnormal, mutagenic DNA base called a Cr-PdG adduct. “We concluded that polyamines stimulated the formation of Cr-PdG adducts from acetaldehyde, and this may provide a mechanism to explain how alcohol consumption increases the risk of some types of cancer,” the authors said.
Obesity During Pregnancy
M
ore than one-third of American women are obese, the epidemic of which is presenting challenges for health care providers caring for obese
Bacteria in Household Dust May Trigger Asthma Symptoms
N
ew research shows that bacteria lurking in household dust produce chemicals that may trigger asthma and asthma-related symptoms such as wheezing. These bacterial chemicals, called endotoxins, particularly those found on bedroom floors, were linked with increased respiratory problems in adults. This study, supported by the National Institute of Environmental Health Sciences (NIEHS), part of the NIH, is the first nationwide study of endotoxins in the household environment, and it involved analysis of more than 2,500 dust samples from 831 homes across the U.S. Researchers at NIEHS and the University of Iowa found a strong association between endotoxin levels and the prevalence of diagnosed asthma, asthma symptoms, asthma medication use and wheezing. These relationships were strongest for bedroom floor and
October | November 2005
women in pregnancy, according to a new committee opinion from the American College of Obstetricians and Gynecologists (ACOG). The rates of obesity among American women are staggering: • 49 percent of non-Hispanic Black women are obese • 38 percent of Mexican American women are obese • 31 percent of non-Hispanic White women are obese Care during pregnancy and labor is exacerbated by obesity, including using external monitors to perform surgery, the committee wrote. Some studies show that obesity is an independent risk factor for miscarriage among women who undergo fertility treatment. Data also link obesity to miscarriage in women who conbedding dust. Households with higher endotoxin concentrations experienced higher prevalence of respiratory symptoms. The study was published online in the American Journal of Respiratory and Critical Care Medicine. Endotoxins are found in the cell wall of bacteria and are only released when bacteria rupture or disintegrate. Because bacteria can be found everywhere in the home, the likelihood of their release is high. Once released, endotoxins can cause inflammation of the airways and lead to asthma symptoms. Researchers know that endotoxins worsen asthma symptoms in adults, whether the person has allergies or not. Since the mid-1960s, researchers knew that house dust contains endotoxins, but it’s only within the past five years that they began to understand the impact of household endotoxins on human health. Knowing what triggers asthma, whether it’s endotoxins or something else, may help better prevent or treat symptoms.
AWHONN Lifelines
369
ceived naturally. Obesity has been linked to an increased risk of gestational hypertension, pre-eclampsia and gestational diabetes. And the higher the body mass index (BMI) a woman has, the higher the chance she will need a cesarean. Other studies show that obese women have more complications during and after cesarean surgery, including excessive blood loss, operating time greater than two hours, and wound infection. Surgery in obese women also poses anesthetic challenges, among them difficult epidural placement and respiratory problems from difficult intubation. Elevated risks to the babies of obese women include stillbirth, prematurity, macrosomia (large for gestational age), neural tube defects and higher rates of childhood obesity. In the opinion, ACOG makes the following recommendations for health care providers when working with obese patients who are pregnant or who are considering pregnancy:
370
AWHONN Lifelines
• Explain the Institute of Medicine recommendations for prenatal weight gain: 25 to 35 lb for women of normal weight, 15 to 25 lb for overweight women and 15 lb for obese women • Record height and weight for all women at the initial prenatal visit to allow BMI calculation • Offer nutrition consultation to all obese women and encourage them to follow an exercise program. This should be continued after the baby is born and prior to attempting another pregnancy • Consider screening obese pregnant women for gestational diabetes during the first trimester and repeating it later in pregnancy if initial screening result is negative • Discuss potential pregnancy complications such as difficulty estimating fetal weight and obtaining fetal heart rate • Suggest that patients consult with an anesthesiologist prior to delivery— or at the very latest, early in labor—
because they are at high risk for emergency cesareans To battle obesity, more people are turning to bariatric surgery. But as a result of the surgery, many patients who later become pregnant may see a host of complications such as gastrointestinal bleeding, anemia, intrauterine growth restriction, prematurity and neural tube defects. The surgery can also lead to deficiencies in iron, vitamin B12, folate and calcium. On the other hand, pregnancies following bariatric surgery are often less likely to be complicated by gestational diabetes, hypertension, macrosomia and cesarean delivery. ACOG’s recommendations for obese patients who are pregnant or planning to conceive include having a preconception consultation and weight-loss counseling, seeking information on the risks of obesity and pregnancy, and continuing nutritional counseling and exercise programs after delivery.
Volume 9
Issue 5