tag:theconversation.com,2011:/us/topics/pregnancy-624/articlesPregnancy – The Conversation2024-03-11T12:24:14Ztag:theconversation.com,2011:article/2251262024-03-11T12:24:14Z2024-03-11T12:24:14ZI’m a political scientist, and the Alabama Supreme Court’s IVF ruling turned me into a reproductive-rights refugee<figure><img src="https://images.theconversation.com/files/580509/original/file-20240307-26-mc43ro.jpg?ixlib=rb-1.1.0&rect=1095%2C1199%2C1403%2C1892&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Spencer and Gabby Goidel hadn't planned to become activists.</span> <span class="attribution"><span class="source">Spencer and Gabby Goidel</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>The day before the Alabama Supreme Court ruled that <a href="https://apnews.com/article/alabama-supreme-court-from-embryos-161390f0758b04a7638e2ddea20df7ca">frozen embryos created and used for in vitro fertilization</a> are children, my wife, Gabby, and I were greenlighted by our doctors to begin the IVF process. We live in Alabama.</p>
<p>That Friday evening, Feb. 16, 2024, unaware of the ruling, Gabby started taking her stimulation medications, worth roughly US$4,000 in total. We didn’t hear about the decision until Sunday morning, Feb. 18. By then, she had taken four injections – or two doses – of each of the stimulation medications.</p>
<p>For those who don’t know, the <a href="https://theconversation.com/what-is-ivf-a-nurse-explains-the-evolving-science-and-legality-of-in-vitro-fertilization-224476">IVF process is a winding journey</a> full of tests, bloodwork and bills. An IVF patient takes hormones for eight to 14 days to stimulate their ovaries to produce many mature eggs. The mature eggs are then retrieved via a minor surgical procedure and fertilized with sperm in a lab. The newly created embryos are monitored, sometimes biopsied and frozen for genetic testing, and then implanted, usually one at a time, in the uterus. From injection to implantation, one round of IVF takes four to eight weeks. </p>
<p>IVF can be as stressful as it is exciting. However, the potential of having a successful pregnancy and our own child at the end of the process, we hoped, would make it all worth it. The decision by the Alabama Supreme Court threw our dreams up in the air.</p>
<p>I <a href="https://scholar.google.com/citations?user=ow6DhIQAAAAJ&hl=en&oi=ao">study politics</a> – I don’t practice it. I’m not involved in state or local government. I’m a scholar, not an activist or an advocate. But now one of the most intimate, personal events of our lives had been turned into a political event by the state’s highest court. As a result, I became something else, too, which I had not been before: an activist.</p>
<h2>Making sense of the ruling</h2>
<p>Throughout the process of creating, growing and testing embryos in a lab, as many as <a href="https://www.illumefertility.com/fertility-blog/ivf-attrition-rate">50% to 70%</a> of embryos <a href="https://theconversation.com/most-human-embryos-naturally-die-after-conception-restrictive-abortion-laws-fail-to-take-this-embryo-loss-into-account-187904">can be lost</a>. Similarly, in the preimplantation stage of natural pregnancies, <a href="https://doi.org/10.12688%2Ff1000research.22655.1">many embryos don’t survive</a>.</p>
<p>If embryos are children, as the court ruled, then fertility clinics and patients would be exposed to an immense amount of potential legal liability. Under this new framework, patients would be able to bring wrongful death suits against doctors for the normal failures of embryos in the testing or implantation phase. Doctors would either have to charge more for an already expensive procedure to cover massive legal-insurance costs or avoid IVF altogether.</p>
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<a href="https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A screen shows a microscope's view of a needle and cells." src="https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580233/original/file-20240306-30-vi57hp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Lab staff at an in vitro fertilization lab extract cells from embryos that are then checked for viability.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/FrozenEmbryos/ebbb52ebd68b4ab691798f90b3319f05/photo">AP Photo/Michael Wyke</a></span>
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<p>The decision and its implication – that IVF could not continue in the state of Alabama – felt like a personal affront to us. We were infuriated to have this uncertainty injected into the process three days into injecting IVF medication. </p>
<p>While the decision clearly imperiled the future of IVF in Alabama, it was not clear to us whether we would be allowed to continue the process we had begun. We were left completely in the dark for the next four days. Gabby and I had no choice but to continue daily life and IVF as though nothing was happening. </p>
<p>For me, that meant teaching my <a href="https://bulletin.auburn.edu/coursesofinstruction/poli/">political participation course at Auburn University</a>.</p>
<h2>Teaching politics when it gets personal</h2>
<p>I’ll never forget walking into class on Monday, Feb. 19, and telling the students about the court’s ruling and how it – maybe? – was going to jeopardize Gabby’s and my IVF process. </p>
<p>Before starting IVF, Gabby and I had gone through three miscarriages together.</p>
<p>IVF doesn’t always work. Approximately <a href="https://nccd.cdc.gov/drh_art/rdPage.aspx?rdReport=DRH_ART.ClinicInfo&rdRequestForward=True&ClinicId=9999&ShowNational=1">55% of IVF patients</a> under the age of 35 – Gabby is 26 – have a successful pregnancy after one egg retrieval. We couldn’t imagine the pain of telling friends and family that our attempt at having a child had once again failed. So we had agreed we were going to tell as few people as possible about starting IVF. </p>
<p>Yet, here I was now, telling my entire class what we were going through and how the Alabama Supreme Court ruling could affect us. </p>
<p>I wasn’t alone in sharing our story. The night before my Monday morning class, Gabby published an <a href="https://www.al.com/opinion/2024/02/guest-opinion-alabama-supreme-court-embryo-ruling-may-make-it-difficult-for-us-to-have-children.html">opinion column</a> on our local news site about the ruling and our resulting fears and anxieties, which really resonated with people.</p>
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<a href="https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Clear batches of containers of eggs and embryos in a large, frozen circular container" src="https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=360&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=360&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=360&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578418/original/file-20240227-26-7ak5sq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Cryopreservation gives prospective parents more time to pursue pregnancy.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/frozen-embryos-and-eggs-in-nitrogen-cooled-royalty-free-image/520157312">Ted Horowitz Photography/The Image Bank via Getty Images</a></span>
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<p>I was, that day and throughout the next few weeks, fixated on the conceptual gulf between the court’s ruling and public opinion. I wondered aloud, “Who’s against IVF? Surely, only 5% to 10% of the public agrees with this ruling.”</p>
<p>The actual numbers aren’t far off my in-class guess. <a href="https://d3nkl3psvxxpe9.cloudfront.net/documents/econTabReport_XLG2Z6p.pdf">Only 8% of Americans</a> say that IVF is immoral or should be illegal. But the story is more nuanced than that. Approximately <a href="https://www.ipsos.com/sites/default/files/ct/news/documents/2024-02/Axios%20Ipsos%20Alabama%20IVF%20Topline%20PDF%202.28.24.pdf">31% of Americans and 49% of Republicans</a> support “considering frozen embryos as people and holding those who destroy them legally responsible.” </p>
<p>In an attempt to tie our personal political experience into the class topic, I remarked that this court decision was a surefire way to get people involved in politics. I had no clue at the time how prophetic my comment would be.</p>
<h2>Fleeing to Texas for reproductive rights?</h2>
<p>On Wednesday, Feb. 21, the <a href="https://www.al.com/news/2024/02/uab-pauses-in-vitro-fertilization-due-to-fear-of-prosecution-officials-say.html">University of Alabama Birmingham’s fertility clinic</a> paused IVF treatments. That wasn’t our clinic, but the move sent us into a total panic. Our clinic’s closure seemed inevitable – and within 24 hours <a href="https://www.nbcnews.com/health/health-news/university-alabama-pauses-ivf-services-court-rules-embryos-are-childre-rcna139846">it had paused IVF treatments as well</a>. </p>
<p>We didn’t know what we were going to do, but we knew we were likely leaving the state to continue IVF. I needed to tell my department chair what was going on.</p>
<p>I was walking out of my department chair’s office when my phone rang. Gabby told me, “We got in, we’re going to Temple.” I ran back into my department chair’s office, told her we were going to Temple, Texas, and then rushed home. </p>
<p><a href="https://www.cnn.com/2024/02/22/us/alabama-embryos-ruling-ivf-treatment-leaving-state/index.html">A reporter from CNN</a> beat me there. It was one of <a href="https://www.washingtonpost.com/nation/2024/02/24/alabama-ivf-treatment-ruling-abortion/">several</a> <a href="https://www.nbcnews.com/health/health-news/ivf-doctors-patients-fearful-alabama-court-rules-embryos-are-children-rcna139636">interviews</a> with <a href="https://apnews.com/video/alabama-assisted-reproductive-technology-courts-legislation-gabby-goidel-8990ee5efaab450b940da1e6a39bf8d1">major</a> <a href="https://www.msnbc.com/katy-tur/watch/-thoughtless-ivf-patients-speak-out-on-alabama-embryo-decision-204655173631">media</a> <a href="https://www.theguardian.com/us-news/2024/feb/22/alabama-fertility-pause-ivf-embryo-ruling">outlets</a> Gabby did in the wake of her opinion column. After the interview, we threw clothes in a suitcase, dropped our dogs off at the vet and drove to the Atlanta airport. We flew to Texas that night.</p>
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<figcaption><span class="caption">One of the Goidels’ many media interviews in the wake of the Alabama ruling.</span></figcaption>
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<p>The thought of not completing the egg retrieval never seriously entered our minds. We were confident that we could get in with another IVF clinic somewhere, anywhere. But we’re affluent. We’re privileged. What if we weren’t so well off? We wouldn’t have wanted to give up, but we wouldn’t have been able to afford the fight.</p>
<p>We spent exactly one week at my parents’ house in Texas. Thankfully, my parents live an hour and a half away from the Temple clinic. We met our new doctor, <a href="https://www.bswhealth.com/physician/gordon-bates">Dr. Gordon Wright Bates</a>, and were immediately reassured. His cool expertise and confidence were calming to a stressed-out couple. The Alabama Supreme Court may have upended our lives, but we felt weirdly lucky to be in such a comfortable place.</p>
<p>The egg retrieval was Wednesday morning, Feb. 28. By all indications, it went well. IVF, however, is full of uncertainties. Now we are waiting on the results from preimplantation genetic testing. After that, there’s implantation and hoping the embryo continues to grow. We’re not in the clear: IVF is a stressful process even without a state court getting in the way. But today we are in a situation more like an average couple going through IVF than we have been in the past few weeks.</p>
<p>Late Wednesday night, March 6, <a href="https://www.nytimes.com/2024/03/06/us/politics/alabama-ivf-law.html">Alabama Gov. Kay Ivey signed into law a bill</a> providing legal protection to IVF clinics in the state. Gabby and I rejoiced at the news. Hopefully, we’re the last Alabamian couple to flee the state for IVF.</p>
<h2>A mobilizing moment</h2>
<p>When state politics directly interferes with your life, it feels like a gut punch, as if the community that you love is saying you’re not loved back. It’s easy to see how such an experience could either discourage or motivate you. Research shows that traumatic events, for the most part, <a href="https://doi.org/10.1017/S0003055422001010">depress voter turnout</a> in the following presidential election. By contrast, families and friends of 9/11 victims <a href="https://doi.org/10.1073/pnas.1315043110">became and remained more politically engaged</a> than their peers. </p>
<p>In this case, the Alabama Supreme Court ruling mobilized Gabby and <a href="https://www.democracynow.org/2024/3/4/alabama_ivf_patients_warning_to_others">other</a> <a href="https://www.today.com/health/news/alabama-ivf-ruling-embryo-transfer-canceled-rcna140029">women</a> going through the IVF process. For better or worse, the women, couples and families mobilized by this decision will likely always be more engaged because of it.</p>
<p>“Oh, God,” I remarked to my dad, “we’re going to be activists now, aren’t we?”</p>
<p>“So?” he asked.</p>
<p>“No one likes activists,” I responded in jest. But if we’re going to have and raise the family we want, this is just the first of many decisions we’re going to make that someone’s not going to like.</p><img src="https://counter.theconversation.com/content/225126/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Spencer Goidel does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>I’m a scholar, not an activist or an advocate. But now one of the most intimate, personal events of our lives had been turned into a political event by the state’s highest court.Spencer Goidel, Assistant Professor of Political Science, Auburn UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2173602024-02-27T12:33:24Z2024-02-27T12:33:24ZHundreds of thousands of US infants every year pay the consequences of prenatal exposure to drugs, a growing crisis particularly in rural America<figure><img src="https://images.theconversation.com/files/567417/original/file-20231228-29-57e4ok.jpg?ixlib=rb-1.1.0&rect=50%2C10%2C6659%2C4456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Substance use during pregnancy can lead to a broad array of harmful effects.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/adorable-newborn-baby-with-pacifier-and-toy-in-royalty-free-image/1407722363?phrase=baby">Liudmila Chernetska/iStock via Getty Images Plus</a></span></figcaption></figure><p>Nearly 1 in 12 newborns in the United States in 2020 – <a href="https://www.samhsa.gov/data/sites/default/files/reports/slides-2020-nsduh/2020NSDUHWomenSlides072522.pdf">or about 300,000 infants</a> – were exposed to alcohol, opioids, marijuana or cocaine before they were born. Exposure to these substances <a href="https://www.cdc.gov/reproductivehealth/maternalinfanthealth/substance-abuse/substance-abuse-during-pregnancy.htm">puts these newborns at a higher risk</a> for premature birth, low birth weight and a variety of physical and mental disabilities. </p>
<p>These substances can have <a href="https://doi.org/10.1038/npp.2014.147">direct and indirect consequences on fetal development</a>. By crossing the placental barrier directly, they can cause abnormal development. And by affecting the mother’s organs, they can reduce blood flow to the placenta and damage the health of the growing fetus.</p>
<p>Considerable <a href="https://doi.org/10.1111/j.1521-0391.2010.00079.x">sociodemographic and geographic disparities</a> exist in the U.S. regarding the rates of prenatal substance exposure. This includes in West Virginia, where I live, a rural Appalachian state struggling with extraordinary rates of substance use and an opioid crisis. </p>
<p><a href="https://directory.hsc.wvu.edu/Profile/47295">As an epidemiologist</a>, I study the relationship between substance use during pregnancy and infant health outcomes. I am a member of the <a href="https://www.wvdhhr.org/birthscore/">Project WATCH</a> team, which is a long-standing, state-mandated surveillance and referral system in West Virginia funded by the <a href="https://dhhr.wv.gov/Pages/default.aspx">West Virginia Department of Health</a>. The surveillance system expanded in 2020 to include substance exposure data from all births in the state. </p>
<h2>Staggering numbers</h2>
<p>Our research work showed that between 2020 and 2022, prenatal substance exposure in West Virginia was <a href="https://doi.org/10.1111/jrh.12752">nearly 50% higher, at 124 per 1,000 births</a>, than the national rate of 80 per 1,000 births. This means that nearly 1 in 8 infants born in the state had exposure to substances during pregnancy. </p>
<p>We found that the <a href="https://doi.org/10.1016/j.jpeds.2022.11.040">rate of prenatal cannabis exposure</a> in West Virginia was 80 per 1,000 births, similar to the national rate. However, the rates of opioid exposure, 44 per 1,000 births, and stimulant exposure, 21 per 1,000 births, during pregnancy were nearly 10 times higher than national rates. Additionally, 1 in 5 women in the study smoked, and 64% of the infants exposed to substances were also exposed to smoking during pregnancy. </p>
<p>There are many reasons why the numbers in West Virginia are staggering. <a href="https://doi.org/10.3390/healthcare11081182">Economic challenges</a>, including poverty, low education and limited job opportunities, contribute to chronic stress, a known risk factor for substance use. Moreover, nearly half the population lives in rural areas with a <a href="https://www.marchofdimes.org/maternity-care-deserts-report">limited number of hospitals and clinics</a>. The geographic isolation <a href="https://doi.org/10.1186/s12954-023-00795-w">limits access</a> to health care and substance use treatment services. Finally, <a href="https://doi.org/10.1016/j.mhp.2019.01.010">stigma and judgment</a> within close-knit rural communities may discourage these mothers from seeking help.</p>
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<figcaption><span class="caption">Substances that can affect a developing embryo include alcohol, tobacco, cannabis and prescribed drugs such as methadone.</span></figcaption>
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<h2>Substance exposure and infant outcomes</h2>
<p>Our earlier work demonstrated that <a href="https://doi.org/10.1038%2Fs41390-019-0731-y">alcohol consumption during pregnancy</a> was associated with preterm birth, which is when a baby is born before the 37th week of pregnancy, and low birth weight, defined as babies born weighing less than 5 pounds, 8 ounces (2,500 grams).</p>
<p>Our more recent study has shown that <a href="https://doi.org/10.1016/j.jpeds.2022.11.040">prenatal opioid exposure</a> is also associated with low birth weight, while stimulant exposure was associated with preterm birth. </p>
<p>Stimulants include cocaine, methamphetamines, ecstasy and prescription stimulants such as those used for the treatment of attention-deficit/hyperactivity disorder. Illicit or misuse of prescription stimulants have <a href="https://www.cdc.gov/pregnancy/meds/treatingfortwo/features/keyfinding-ADHD-med-increase.html">increased among pregnant women</a> over the past decade. </p>
<p>While many national and statewide efforts have focused their attention on addressing the opioid crisis, the prevalence of prenatal stimulant use remains a growing and <a href="https://doi.org/10.1097%2FGRF.0000000000000418">underrecognized epidemic in the U.S</a>.</p>
<p>After alcohol, cannabis is the <a href="https://doi.org/10.1186/s12978-020-0880-9">most common psychoactive substance</a> used during pregnancy and its rate is increasing. This trend in cannabis use may be due to the increasing legality for medicinal or recreational purposes and the social acceptability that comes with it. </p>
<p>In addition, <a href="https://theconversation.com/mounting-research-points-to-health-harms-from-cannabis-thc-and-cbd-use-during-pregnancy-adolescence-and-other-periods-of-rapid-development-198206">many people wrongly assume</a> that cannabis is relatively safe and helps manage pregnancy-related conditions such as morning sickness, nausea, vomiting, weight gain and sleep difficulty. </p>
<p>However, a <a href="https://doi.org/10.1001/jama.2023.21146">growing body of research</a>, including our own, has shown that <a href="https://www.marchofdimes.org/find-support/topics/pregnancy/marijuana-and-pregnancy">prenatal cannabis exposure</a> is associated with <a href="https://doi.org/10.1016/j.jpeds.2022.11.040">adverse pregnancy outcomes</a>, including low birth weight, preterm birth, stillbirth or hypertensive disorders of pregnancy. </p>
<p>In addition, using multiple substances during pregnancy poses a higher risk to infants than using a single substance. We found that compared to no substance exposure during pregnancy, the risk of low birth weight was twice with opioids alone, four times with concurrent exposure to opioids and stimulants, and <a href="https://doi.org/10.1016/j.jpeds.2022.11.040">almost six times with concurrent exposure</a> to opioids, stimulants and cannabis.</p>
<p>Another adverse outcome that is associated with prenatal substance exposure, primarily to opioids, is a <a href="https://www.marchofdimes.org/find-support/topics/planning-baby/neonatal-abstinence-syndrome-nas#">set of withdrawal symptoms</a> experienced by the newborn known as <a href="https://www.ncbi.nlm.nih.gov/books/NBK551498/">neonatal abstinence syndrome</a>. Symptoms include irritability, feeding difficulties, tremors and respiratory issues. The syndrome requires specialized care and attention in neonatal units and a prolonged stay in the hospital.</p>
<p>Alongside the rising prevalence of opioid use in pregnancy, a <a href="https://doi.org/10.3390%2Fchildren10061030">fivefold increase</a> in incidence of infants with this condition has been documented over the past two decades. The highest rate <a href="https://doi.org/10.1111/ppe.12728">has been observed in West Virginia</a>, at 53 per 1,000 births. Other states with high rates include Maine, Vermont, Delaware and Kentucky, which are between <a href="https://doi.org/10.1001%2Fjama.2020.24991">three and four times the national average</a> of 7.3 per 1,000 births. </p>
<h2>Substance exposure in the womb and long-term outcomes</h2>
<p>Research on long-term outcomes of infants exposed to substances in the womb is still evolving. Limited studies have shown an association between neonatal abstinence syndrome and long-term neurodevelopmental consequences that may develop as early as <a href="https://doi.org/10.1001/jamanetworkopen.2019.7025">6 months old and persist into adolescence</a>. These include delays in learning and language skills, physical growth and motor skills, as well as difficulty in regulating <a href="https://doi.org/10.1007%2Fs10802-020-00766-w">behavior and emotions</a>.</p>
<p>However, research on the long-term effects of prenatal alcohol exposure is well established. A broad range of deficits are referred to as <a href="https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-fetal-alcohol-spectrum-disorders">fetal alcohol spectrum disorders</a>. These include growth deficiency, developmental delay, craniofacial malformations, intellectual disabilities, behavior issues and emotional well-being. A recent study of first graders in the U.S. estimated that the prevalence of <a href="https://doi.org/10.1001/jama.2017.21896">fetal alcohol spectrum disorders range from 1% to 5%</a>, which means up to 1 in 20 school-age children may have this disorder. </p>
<p>With the <a href="https://doi.org/10.1016/S2215-0366(23)00235-3">changing landscape of substance use</a> in the U.S., more research is needed to understand and establish the association between the various emerging types and forms of substance exposures and their lasting effects. But the findings are difficult to discern because of the influence of other environmental factors, preexisting medical conditions and <a href="https://www.cdc.gov/publichealthgateway/sdoh/index.html#">social determinants of health</a>.</p>
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<figcaption><span class="caption">Natalie is 6 years old. She has fetal alcohol syndrome.</span></figcaption>
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<h2>Efforts to reduce harms</h2>
<p>As a maternal and child health epidemiologist, I am fortunate to be part of the <a href="https://www.wvdhhr.org/birthscore/index.html">Project WATCH</a> team that works closely with health care providers and policymakers. </p>
<p>As high-risk infants are identified through this program, its referral system notifies pediatricians of substance exposure and connects these families to early intervention services and home visitation programs. </p>
<p>These services include developmental testing, interventions appropriate to the child’s needs and case management during the first few years of life. The data also informs state-level strategies and initiatives to address the substance use crisis for this vulnerable population.</p><img src="https://counter.theconversation.com/content/217360/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Project WATCH is a grant funded by the West Virginia Department of Health. </span></em></p>Many people wrongly assume that cannabis use during pregnancy is safe. Research is increasingly documenting a host of serious health harms from prenatal exposure to cannabis and other substances.Amna Umer, Associate Professor of Pediatric Epidemiology, West Virginia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2186822024-02-21T13:19:25Z2024-02-21T13:19:25ZMarriage is not as effective an anti-poverty strategy as you’ve been led to believe<figure><img src="https://images.theconversation.com/files/575664/original/file-20240214-26-6cr98q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Despite the popular guidance, marriage can be an economic risk for single parents with unstable partners.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/divorce-process-royalty-free-image/1329914655">simarik/iStock/Getty Images Plus</a></span></figcaption></figure><p>Brides.com predicts that 2024 will be the “<a href="https://www.brides.com/marriage-proposal-boom-2024-8358024">year of the proposal</a>” as engagements tick back up after a pandemic-driven slowdown.</p>
<p>Meanwhile, support for marriage has found new grist in recent books, including <a href="https://sociology.as.virginia.edu/people/w-bradford-wilcox">sociologist</a> Brad Wilcox’s “<a href="https://www.amazon.com/Get-Married-Americans-Families-Civilization/dp/0063210851">Get Married: Why Americans Must Defy the Elites, Forge Strong Families and Save Civilization</a>” and economist Melissa Kearney’s “<a href="https://press.uchicago.edu/ucp/books/book/chicago/T/bo205550079.html">The Two-Parent Privilege</a>.”</p>
<p>Kearney’s book was <a href="https://www.city-journal.org/article/review-of-the-two-parent-privilege-by-melissa-kearney">hailed by economist Tyler Cowen</a> as possibly “the most important economics and policy book of this year.” This is not because it treads new ground but because, as author <a href="https://www.city-journal.org/article/review-of-the-two-parent-privilege-by-melissa-kearney">Kay Hymowitz writes</a>, it breaks the supposed “taboo about an honest accounting of family decline.” </p>
<p>These developments are good news for the marriage promotion movement, which <a href="https://www.dol.gov/general/aboutdol/history/webid-moynihan">for decades</a> has claimed that marriage supports children’s well-being and combats poverty. The movement dates back at least to the U.S. Department of Labor’s <a href="https://www.dol.gov/general/aboutdol/history/webid-moynihan">Moynihan Report of 1965</a>, which argued that <a href="https://www.theatlantic.com/politics/archive/2015/09/the-moynihan-report-an-annotated-edition/404632/">family structure aggravated Black poverty</a>.</p>
<p>Forty years after the Moynihan Report, George W. Bush-era programs such as the <a href="https://www.acf.hhs.gov/ocs/policy-guidance/csbg-im-no-89-healthy-marriage-initiative">Healthy Marriage Initiative</a> sought to <a href="https://www.jstor.org/stable/4624797">enlist churches</a> and other community groups in an effort to channel childbearing back into marriage. These initiatives continue today, with the federally subsidized <a href="https://www.acf.hhs.gov/ofa/programs/healthy-marriage-responsible-fatherhood">Healthy Marriage and Responsible Fatherhood programs</a>.</p>
<p>Still, nearly <a href="https://www.census.gov/newsroom/stories/single-parent-day.html">30% of U.S. children</a> live in single-parent homes today, compared with 10% in 1965.</p>
<p>We are <a href="https://scholar.google.com/citations?user=gCJEShUAAAAJ&hl=en&oi=ao">law professors</a> who have written extensively about <a href="https://scholar.google.com/citations?user=0BBCYNAAAAAJ&hl=en&oi=ao">family structure</a> and <a href="https://www.fordham.edu/school-of-law/faculty/directory/full-time/eleanor-brown/">poverty</a>. We, and others, have found that there is almost no evidence that federal programs that promote marriage <a href="https://www.bgsu.edu/content/dam/BGSU/college-of-arts-and-sciences/NCFMR/documents/FP/FP-14-02_HMIInitiative.pdf">have made a difference</a> in encouraging two-parent households. That’s in large part because they forgo effective solutions that directly address poverty for measures that embrace the culture wars. </p>
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<a href="https://images.theconversation.com/files/575989/original/file-20240215-28-q3xgpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Child hangs upside down on playground equipment" src="https://images.theconversation.com/files/575989/original/file-20240215-28-q3xgpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575989/original/file-20240215-28-q3xgpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575989/original/file-20240215-28-q3xgpp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575989/original/file-20240215-28-q3xgpp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575989/original/file-20240215-28-q3xgpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575989/original/file-20240215-28-q3xgpp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575989/original/file-20240215-28-q3xgpp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Having a parent who has a college degree makes kids less likely to live in poverty than having parents who are married.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/girl-upside-down-on-the-jungle-gym-royalty-free-image/1127705002">Mayur Kakade/Moment Collection via Getty Images</a></span>
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<h2>Marriage and social class</h2>
<p>Today’s marriage promoters claim that <a href="https://ifstudies.org/blog/the-benefits-of-marriage-shouldnt-only-be-for-elites">marriage should not be just for elites</a>. The emergence of marriage as a marker of class, they believe, is a sign of societal dysfunction.</p>
<p>According to census data released in 2021, 9.5% of children living with two parents – and 7.5% with married parents – <a href="https://ojjdp.ojp.gov/statistical-briefing-book/population/faqs/qa01203#:%7E:text=In%202021%2C%209.5%25%20of%20children,17.4%25">lived below the poverty level</a>, compared with 31.7% of children living with a single parent.</p>
<p>Kearney’s argument comes down to: 1 + 1 = 2. Two parents have more resources, including money and time to spend with children, than one. She marshals extensive research designed to show that children from married couple families are <a href="https://doi.org/10.1146/annurev-economics-063016-103749">more likely to graduate</a> from high school, complete college and earn <a href="https://doi.org/10.1146/annurev-economics-063016-103749">higher incomes as adults</a> than the children of single parents.</p>
<p>It is undoubtedly true that two parents – that is, two nonviolent parents with reliable incomes and cooperative behavior – have <a href="https://www.brookings.edu/articles/cohabiting-parents-differ-from-married-ones-in-three-big-ways/">more resources for their children</a> than one parent who has to work two jobs to pay the rent. However, this equation <a href="https://doi.org/10.31235/osf.io/pmyhj">does not address causation</a>. In other words, parents who have stable incomes and behaviors are more likely to stay together than parents who don’t.</p>
<p>Ethnographic studies indicate, for example, that the most common reasons unmarried women are no longer with the fathers of their children are the men’s <a href="https://ssrn.com/abstract=3841832">violent behavior, infidelity</a> and <a href="https://www.ucpress.edu/book/9780520335233/essential-dads">substance abuse</a>.</p>
<p>Moreover, income volatility disproportionately affects parents who don’t go to college. So while they may have more money to invest in children together than apart, when one of these parents experiences a substantial drop in income, the other parent may have to decide whether to <a href="https://elibrary.law.psu.edu/cgi/viewcontent.cgi?article=1455&context=fac_works">support the partner or the children</a> on what is often a meager income.</p>
<p>The <a href="https://theconversation.com/having-a-single-parent-doesnt-determine-your-life-chances-the-data-shows-poverty-is-far-more-important-217841">impact of having single parents</a> also plays out differently by race and class. As sociologist and researcher <a href="https://www.nytimes.com/2019/12/09/opinion/two-parent-family.html">Christina Cross explains</a>, “Living apart from a biological parent does not carry the same cost for Black youths as for their white peers, and being raised in a two-parent family is not equally beneficial.” </p>
<p>For example, Cross found that living in a single-mother family is less likely to affect high school completion rates for Black children than for white children. Also, Black families tend to be more embedded in extended family than white families, and this additional support system may help protect children from negative outcomes associated with single-parent households.</p>
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<h2>Making men more ‘marriageable’</h2>
<p>Kearney, to her credit, does note that economic insecurity largely explains what is happening to working-class families, and that no parent should have to tolerate violence or substance abuse. But she doubles down on the need to restore a norm of two-parent families.</p>
<p>Many of her policy prescriptions are sensible. She advocates for better opportunities for low-income men – to make them, in the words of <a href="https://press.uchicago.edu/ucp/books/book/chicago/T/bo13375722.html">sociologist William Julius Wilson</a>, “marriageable.” Such policies would include wage subsidies to improve their job opportunities, investment in community colleges that provide skills training, and the <a href="https://theconversation.com/banning-the-box-would-help-people-released-from-prison-rebuild-their-lives-45539">removal of questions about criminal histories</a> from job applications, so that candidates who have previously been incarcerated are not immediately disqualified.</p>
<h2>A new marriage model</h2>
<p>What marriage promotion efforts overlook, however, are the underlying changes in what marriage has become – both legally and practically. </p>
<p>The new marriage model rests on three premises.</p>
<p>The first is a moral command: Have sex if you want to, but don’t have children until you are ready. While the shotgun marriage once served as the primary response to unplanned pregnancy, such marriages today often derail education and careers and are <a href="https://today.duke.edu/2016/11/shotgun-marriage-dead#:%7E:text=After%20a%20decade%2C%2030%20percent,prior%20to%20a%20child's%20conception.">more likely to result in divorce</a> than other marriages. Research shows that lower-income women’s pregnancies are much <a href="https://www.guttmacher.org/sites/default/files/factsheet/fb-unintended-pregnancy-us_0_4.pdf">more likely to be unplanned</a>. </p>
<p>The second is the ability to pick a partner who will support you and assume joint responsibility for parenting. As women have attained more economic independence, they are less in need of men to raise children, particularly if their partners are insensitive or abusive. With healthy relationships, couples pick partners based on trust, commitment and equal respect. This is more difficult to do in communities with high rates of incarceration and few opportunities for stable employment. </p>
<p>And the third is economic and behavioral stability. Instability undermines even committed unions. Parents who wait until they find the right partner and have stable lives bring a lot more to parenting, whether they marry or not.</p>
<p>We believe that creating opportunities for low-income parents to reach this middle-class model is likely to be the most effective marriage promotion policy.</p>
<h2>Economic support is key</h2>
<p>In relationships that fall outside of these premises, 1 + 1 often becomes 1 + -1, which equals 0.</p>
<p>Being committed to a partner who can’t pay speeding tickets, runs up credit card bills, comes home drunk or can’t be relied on to pick up the children after school is not a recipe for success. </p>
<p>Economic principles suggest that businesses with more volatile income streams need a stronger capital base to withstand the downturns. Working-class couples who face economic insecurity see commitment as similarly misguided; without a capital base, a downturn for one partner can wipe out the other.</p>
<p>The Biden administration’s child tax credit expansion included in the <a href="https://www.bloomberg.com/news/newsletters/2024-02-08/the-child-tax-credit-bill-seems-destined-for-defeat-in-the-senate?embedded-checkout=true">American Rescue Plan Act of 2021</a> helped cut the child poverty rate – after accounting for government assistance – <a href="https://www.cbpp.org/research/poverty-and-inequality/governments-pandemic-response-turned-a-would-be-poverty-surge-into">to a record low</a> that year. It did more to address child poverty than <a href="https://www.sciencedaily.com/releases/2014/01/140106094155.htm">marriage promotion efforts have ever done</a>.</p>
<p>Researchers have described such income-support policies as the “<a href="https://doi.org/10.1007/s12187-020-09782-0">ultimate multipurpose policy instrument</a>.” They improve the economic circumstances of single-parent families and, in doing so, may also provide greater support for two-parent relationships. </p>
<p>Policymakers know how to solve child poverty – and these measures are far more effective than efforts to put two married parents in every household.</p><img src="https://counter.theconversation.com/content/218682/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Marriage on its own won’t do away with child poverty, and in fact it can create even more instability for low-income families.Eleanor Brown, Professor of Law, Fordham UniversityJune Carbone, Professor of Law, University of MinnesotaNaomi Cahn, Professor of Law, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2213512024-02-14T12:21:06Z2024-02-14T12:21:06ZMaternal death rates in the UK have increased to levels not seen for almost 20 years – experts explain why<figure><img src="https://images.theconversation.com/files/573790/original/file-20240206-20-yeglh4.jpeg?ixlib=rb-1.1.0&rect=0%2C6%2C2305%2C1518&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> </figcaption></figure><p>Maternal death rates are widely considered to reflect a country’s overall wellbeing and the quality of the healthcare system. </p>
<p>In most high-income countries, giving birth is a <a href="https://www.who.int/publications/i/item/9789240068759">relatively safe experience</a>. Nevertheless, maternal deaths still happen and are <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00247-4/fulltext">increasing in many countries</a> around the world. </p>
<p><a href="https://www.npeu.ox.ac.uk/mbrrace-uk/data-brief/maternal-mortality-2020-2022">Recent data from the UK</a> show that death rates during pregnancy and the period shortly after are reaching levels not seen in the country for almost 20 years. It is important to understand why this is happening and what needs to be done to stop this worrying trend. </p>
<h2>COVID-19 not the only factor</h2>
<p>As the world continues to recover from the effects of a pandemic, it would be easy to blame the increase in maternal deaths directly on COVID-19 infection. Coronavirus may be part of the reason, but it is not the full picture. When the women who died directly from COVID-19 are not included in statistics, the UK maternal mortality rates are <a href="https://www.npeu.ox.ac.uk/mbrrace-uk/data-brief/maternal-mortality-2020-2022">still higher</a> than they were before the pandemic. This suggests there are larger issues with maternity care and the wider health system. </p>
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<p>During pregnancy the immune system changes to protect the growing baby. This means that pregnant women are at higher risk from some infections than those who are not pregnant. Large <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2779182">multi-country studies</a> have shown that women who get COVID-19 are more likely to need intensive care if they are pregnant or recently pregnant. </p>
<p><a href="https://www.npeu.ox.ac.uk/mbrrace-uk/data-brief/maternal-mortality-2020-2022">In the UK from 2020 to 2022</a>, COVID-19 was responsible for 14% of maternal deaths. This did not have to be the case. Studies clearly show that the <a href="https://jamanetwork.com/journals/jama/fullarticle/2790608">COVID-19 vaccine is safe in pregnancy</a> – but many pregnant women are still hesitant to get vaccinated. </p>
<h2>Pregnancy and inequality</h2>
<p>Being pregnant or recently pregnant <a href="https://www.npeu.ox.ac.uk/news/2188-new-report-highlights-persistent-inequalities-and-continued-inequitable-care-for-pregnant-women">leads to inequitable care</a>. Pregnant women are often <a href="https://www.bmj.com/content/380/bmj-2022-071278">excluded from medical research</a>. This means that they do not have the evidence necessary to make informed choices about their health and the health of their baby. It also means that the people caring for pregnant women do not feel prepared to offer advice or treatment. <a href="https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2023/MBRRACE-UK_Maternal_Compiled_Report_2023.pdf">Enquires into the care of pregnant women with COVID-19</a> showed that many were denied treatments known to be effective just because they were pregnant.</p>
<p>Inequalities are even greater when a pregnant woman belongs to an ethnic minority or socio-economically disadvantaged group. Black women and women living in the 20% most deprived areas of the UK have <a href="https://www.npeu.ox.ac.uk/mbrrace-uk/data-brief/maternal-mortality-2020-2022">unjustly high maternal mortality rates</a>. This is <a href="https://www.bmj.com/content/379/bmj-2022-070621">not a problem unique to the UK</a>. Nor is this a new problem. The problems faced by minority groups when accessing healthcare are <a href="https://www.birthrights.org.uk/campaigns-research/racial-injustice/">well known</a> and widespread. They were also made worse by the COVID-19 pandemic. </p>
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<p>The pandemic placed unprecedented stress on health care systems all over the world. It created new strains due to increased demand for services, staff shortages and <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00088-2/fulltext">burnout</a>. It also revealed cracks in established services and changed the way that care was provided.</p>
<p>Maternity care was not immune to pressures of the pandemic. Most women who die in high-income countries are <a href="https://www.bmj.com/content/379/bmj-2022-070621">not dying from pregnancy complications</a> such as bleeding. However, rates for these direct deaths are <a href="https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2023/MBRRACE-UK_Maternal_Compiled_Report_2023.pdf">rising in the UK</a>. Pregnancy complications can be managed if women have timely access to quality care and skilled health professionals. It is becoming increasingly clear that this may not always be the case in current under-pressure health systems. </p>
<h2>Overstretched health system</h2>
<p>In the era of COVID-19, services that should be easily available to women are becoming increasingly difficult to access. The current maternity population is more complex than it once was. Women giving birth are often older and many are overweight or obese. Many women also have other medical or mental health conditions that require additional care in pregnancy. From <a href="https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2023/MBRRACE-UK_Maternal_Compiled_Report_2023.pdf">2019 to 2021</a> 12% of the women who died in the UK had severe and multiple disadvantages including a mental health diagnoses, substance use or domestic abuse. </p>
<p>The changing maternal population needs enhanced services that can adjust to fit their individual needs. But access to specialised care was irregular or lost during the pandemic. This is especially true for care before or after pregnancy. Many women do not get the care they need before conceiving and many more are falling through the cracks after they have their baby. Mental health conditions are an important example of this. Almost half of maternal deaths in the year after pregnancy are due to <a href="https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2023/MBRRACE-UK_Maternal_Compiled_Report_2023.pdf">suicide or substance use</a>. Access to maternal mental health services is improving but more capacity is still needed. </p>
<p>The pandemic exposed and accelerated the cracks in health systems, and, as these latest figures show, this has set back progress towards safer pregnancy in the UK by decades. As a barometer of a nation’s health, this is a statistic we cannot ignore. Novel approaches and investment are needed to ensure every woman gets the individualised and equitable care they need before, during and after pregnancy.</p><img src="https://counter.theconversation.com/content/221351/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marian Knight receives funding from the Healthcare Quality Improvement Partnership and the National Institute for Health and Care Research. </span></em></p><p class="fine-print"><em><span>Allison Felker does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Maternal mortality in the UK is the highest for decades - as a barometer for a nation’s health, this is a statistic we cannot ignoreAllison Felker, Senior Researcher - MBRRACE-UK, University of OxfordMarian Knight, Professor of Maternal and Child Population Health, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2183872024-01-29T13:07:49Z2024-01-29T13:07:49ZKenya’s healthcare workers abuse a third of teen mums from informal settlements – study<p>Adolescent pregnancy is a global public health concern: in <a href="https://data.unicef.org/topic/child-health/adolescent-health/">2022</a>, about 13% of girls and young women gave birth before the age of 18. </p>
<p>Compared with women in their early 20s, adolescents are more <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70179-7/fulltext?__scoop_post=9ef44560-18a4-11e5-90a9-001018304b75&__scoop_topic=1749219">susceptible</a> to maternal deaths. Pregnancy-related complications are among the leading causes of <a href="https://esaro.unfpa.org/en/topics/adolescent-pregnancy#:%7E:text=Early%20childbearing%2C%20high%20fertility%20rates,women%2020%20years%20and%20above.">death</a> among Africa’s adolescent girls. </p>
<p>Babies born to adolescent mothers in low- to middle-income countries also face an increased risk of <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0195731">neonatal deaths</a>, and pre-term and underweight birth. </p>
<p>These risks make it vital that pregnant girls feel comfortable seeking healthcare.</p>
<p>Adolescent pregnancy is an issue in Kenya, too, where <a href="https://data.unicef.org/topic/child-health/adolescent-health/">15%</a> of adolescent girls become mothers before the age of 18. Girls from the <a href="https://link.springer.com/content/pdf/10.1186/s12905-022-01986-6.pdf">poorest households</a> are more likely to become mothers than girls from the richest households. </p>
<p>As specialists in medical sociology and public health, we conducted a <a href="https://gh.bmj.com/content/bmjgh/8/11/e013268.full.pdf">survey</a> in 2022 of adolescent mothers in an informal settlement in Kenya. About a third reported that they had been abused by health providers during childbirth. The study found that abusive treatment <a href="https://gh.bmj.com/content/bmjgh/8/11/e013268.full.pdf">discouraged</a> these girls from seeking future maternity care at healthcare facilities. </p>
<p>This matters for several reasons. One is that <a href="https://bmcpregnancychildbirth.biomedcentral.com/counter/pdf/10.1186/1471-2393-13-18.pdf">facility-based childbirths</a> have a lower neonatal mortality rate than home childbirths. Maternal deaths are also lower when births occur in health facilities than at home. </p>
<h2>Young mothers in Kenya</h2>
<p>Our study site, Korogocho, is an informal settlement on the outskirts of Nairobi. About 200,000 people live there. It is overcrowded, with poor infrastructure and limited access to water and sanitation. Crime rates are high and residents are often exposed to violence and social unrest.</p>
<p>The study focused on 491 adolescent girls ranging in age from 14 to 19 years, who had a biological child at the time of the interviews.</p>
<p>Data were analysed to estimate the scale of abuse of girls during childbirth in health facilities. In total 32.2% of adolescent mothers suffered abuse from health providers during childbirth. </p>
<p>1.) Physical abuse was reported by 7.5% of participants. </p>
<p>To assess physical abuse, we asked girls if health workers punched, kicked, slapped, gagged, or hit them with an instrument, physically tied them to a bed, forcefully held them down to the bed, or had forceful downward pressure placed on their abdomen before the baby came out.</p>
<p>2.) Among those interviewed, 26.7% reported verbal abuse. </p>
<p>We assessed verbal abuse by asking girls if they were shouted at or screamed at, insulted, scolded, mocked, or had negative comments made about their physical appearance (such as cleanliness, private parts or weight), the baby’s physical appearance, and their sexual activity. </p>
<p>3.) Of the participants 15.1% claimed they had been the victims of stigma and discrimination.</p>
<p>Experience of stigma and discrimination was assessed by asking participants if health workers made negative comments to them regarding their ethnicity, race, tribe or culture, religion, age, marital status, education and literacy level, economic circumstances, and HIV status. </p>
<p>4.) One in 10 girls reported neglect and abandonment during childbirth. Neglect and abandonment were assessed by asking girls if staff members were present or not during admission and when the baby came out. </p>
<p>5.) Detainment was assessed by asking girls if they or their babies were held at the facility against their will because of their inability to pay fees. About 17% of the girls reported detainment. </p>
<p>Unsurprisingly, and consistent with a previous <a href="https://gh.bmj.com/content/bmjgh/5/Suppl_2/e003688.full.pdf">study</a> conducted among females within the reproductive age (15-49 years), we found that girls who were abused were less likely to:</p>
<ul>
<li><p>report being satisfied with the care received</p></li>
<li><p>intend to use the facility for future births</p></li>
<li><p>be willing to recommend the facility to others.</p></li>
</ul>
<h2>Ways forward</h2>
<p>Pregnant girls endure societal stigma and discrimination. These attitudes filter into the healthcare system and healthcare workers need to be trained properly to counter the shame that pregnant girls endure. </p>
<p>These adolescents also need to be informed about their rights to respectful care. </p>
<p>There are small scale interventions in some parts of <a href="https://www.ghspjournal.org/content/early/2023/04/03/GHSP-D-22-00169">Nigeria</a> and <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0125267">Ghana</a> that show the potential to strengthen health systems to be more responsive to the needs of adolescents.</p>
<p>Until the mistreatment and abuse of adolescent girls is highlighted and addressed, professional care for pregnant girls will not be attained.</p><img src="https://counter.theconversation.com/content/218387/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Caroline Kabiru receives funding from the Swedish International Development Cooperation Agency (Sida) through a grant to the African Population and Health Research Center for the Challenging the Politics of Social Exclusion project (Sida Contribution No. 12103). She also receives funding from the International Development Research Centre (IDRC) for the Action to empower adolescent mothers in Burkina Faso and Malawi to improve their sexual and reproductive health project (Grant No. 109813-001). The views expressed herein do not necessarily represent those of IDRC or its Board of Governors or Sida.</span></em></p><p class="fine-print"><em><span>Anthony Idowu Ajayi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Adolescent girls are more at risk during childbirth. Stigma and abuse by healthcare workers makes them less likely to seek medical care, putting their lives further in danger.Anthony Idowu Ajayi, Research Scientist, African Population and Health Research CenterCaroline W. Kabiru, Senior Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2217552024-01-29T04:02:24Z2024-01-29T04:02:24ZPickle, anyone? 3 possible reasons women get cravings during pregnancy<figure><img src="https://images.theconversation.com/files/571798/original/file-20240129-27-3uvrsl.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5742%2C3828&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-woman-eating-pickles-kitchen-387211774">wavebreakmedia/Shutterstock</a></span></figcaption></figure><p>From pickles and french fries to oranges and ice cream, women and other people who are pregnant report craving a range of foods while they’re expecting. </p>
<p>A <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2015.00021/full">food craving</a> is a strong urge to eat a specific food. The intense desire to eat is not necessarily related to hunger and can be difficult to ignore or resist. Think: “I must have this now!”.</p>
<p>Food cravings during pregnancy are common, with studies reporting anywhere between <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172095/">50% and 90%</a> of pregnant women experience a food craving at least once during their pregnancy. Most women who experience food cravings will do so in their second trimester (from week 13 to 27), and the cravings may also be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172095/">most intense</a> at this time. </p>
<p>Let’s delve into the science of food cravings and what it means for the health of mum and bub.</p>
<h2>What are some typical cravings, and why do they happen?</h2>
<p>There’s an old wives’ tale which implies food cravings can predict the sex of the baby, with sweet foods being associated with a girl, and savoury foods indicating a boy. </p>
<p>This isn’t backed by science. In reality, food cravings during pregnancy are highly individual, though they <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172095/">typically include</a> carbohydrate-dense and protein-dense foods. Commonly reported cravings include biscuits, bananas, nuts, pickles, ice cream and potatoes.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pregnant-women-and-babies-can-be-vegans-but-careful-nutrition-planning-is-essential-107709">Pregnant women and babies can be vegans but careful nutrition planning is essential</a>
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</em>
</p>
<hr>
<p>We don’t know exactly why pregnant women experience food cravings, but there are a few possible reasons.</p>
<p><strong>1. Changes in nutritional needs</strong></p>
<p>Growing a baby takes a lot of work, and unsurprisingly, increases womens’ requirements for energy and specific nutrients such as iron, folic acid, magnesium and calcium. In addition, a woman’s blood volume <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928162/#:%7E:text=Maternal%20blood%20volume%20increases%20by,falls%20by%2010%20mosmol%2Fkg.">increases significantly during pregnancy</a>, meaning a greater demand for water and electrolytes (in particular sodium and potassium). </p>
<p>Some studies suggest women experiencing nutrient deficiencies are <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0276079">more likely</a> to have food cravings. This might mean women crave foods high in energy and specific nutrients based on their needs. </p>
<p>However, this link is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5054961/">not consistently seen</a>, and many women experience food cravings without being deficient in any nutrients. </p>
<figure class="align-center ">
<img alt="A pregnant woman preparing vegetables in the kitchen." src="https://images.theconversation.com/files/571800/original/file-20240129-17-azz14r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571800/original/file-20240129-17-azz14r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571800/original/file-20240129-17-azz14r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571800/original/file-20240129-17-azz14r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571800/original/file-20240129-17-azz14r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571800/original/file-20240129-17-azz14r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571800/original/file-20240129-17-azz14r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women’s nutritional needs change during pregnancy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-pregnant-woman-preparing-meal-on-586437113">NDAB Creativity/Shutterstock</a></span>
</figcaption>
</figure>
<p><strong>2. Changes in hunger and taste</strong></p>
<p>Hormonal changes that occur throughout pregnancy may change how hungry women feel. A specific hormone called neuropeptide Y has been <a href="https://doi.org/10.1006/appe.1996.0060">shown</a> to increase during pregnancy and is associated with increased hunger. </p>
<p>Also, many women report foods and drinks taste different during pregnancy. Most commonly, women <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172095/">report</a> an increased taste of bitter flavours such as those in vegetables or coffee, and a heightened sense of sweetness from fruits. </p>
<p>Changes in how foods taste combined with increased feelings of hunger may create food cravings, particularly for sweet foods such as fruits. However, studies have not been able to consistently link hormone levels in blood with reported taste changes, suggesting hormones may not be solely responsible for food cravings.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/childhood-adolescence-pregnancy-menopause-75-how-your-diet-should-change-with-each-stage-of-life-132099">Childhood, adolescence, pregnancy, menopause, 75+: how your diet should change with each stage of life</a>
</strong>
</em>
</p>
<hr>
<p><strong>3. Social and cultural influences</strong></p>
<p>Pregnant women in different parts of the world report different food cravings. For example, the most commonly reported food cravings among pregnant women in Nigeria is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172095/#B113">fruits and vegetables</a>. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172095/#B83">Rice</a> is the most common craving among all women in Japan, while in the United States, women seem to crave <a href="https://pubmed.ncbi.nlm.nih.gov/16831486/">chocolate</a> the most. These differences may be due to what foods are available, and what foods are familiar. </p>
<p>Popular commentary around pregnancy food cravings, and even the notion of “eating for two”, imply a biological need for pregnant women to indulge their food cravings. These sentiments make eating different, strange, or large amounts of food more socially acceptable. </p>
<p>Also, food cravings may normalise eating foods which may be less healthy, such as chocolates or cake. Normalising a food choice that may usually be considered a special treat can then <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172095/#B76">lead to increased urges</a> for and consumption of those foods during pregnancy. </p>
<p>Some women can struggle with food cravings they know are not healthy, but cannot resist. This can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172095/">lead to</a> shame and negative relationships with food during pregnancy.</p>
<figure class="align-center ">
<img alt="A pregnant woman on the couch with a toddler touching her stomach." src="https://images.theconversation.com/files/571801/original/file-20240129-17-xwile6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571801/original/file-20240129-17-xwile6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571801/original/file-20240129-17-xwile6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571801/original/file-20240129-17-xwile6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571801/original/file-20240129-17-xwile6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571801/original/file-20240129-17-xwile6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571801/original/file-20240129-17-xwile6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pregnant women in different parts of the world report different food cravings.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/african-american-llittle-girl-holding-her-1536419393">pixelheadphoto digitalskillet/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Cravings aren’t a big cause for concern</h2>
<p>People may think food cravings lead to excess weight gain in pregnancy, which can be related to poor health outcomes for mothers. But studies to date have shown that while women who experience food cravings in pregnancy have a slightly higher energy intake than those who don’t, there’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172095/#B167">no consistent link</a> between food cravings and diet quality, changes in body weight or size, or development of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5054961/">pregnancy complications</a> such as gestational diabetes.</p>
<p>Some people have also suspected food cravings in pregnancy might influence the baby while it’s growing. However, studies haven’t found <a href="https://www.sciencedirect.com/science/article/pii/S1658361218301070">a link</a> between the mother’s food cravings during pregnancy, the size of baby at birth, the baby’s taste preferences, or behaviours of developing children.</p>
<p>Overall, it seems food cravings have little to modest impact on the health of mothers or their babies. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/3-reasons-you-feel-hungrier-and-crave-comfort-foods-when-the-weather-turns-cold-202831">3 reasons you feel hungrier and crave comfort foods when the weather turns cold</a>
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</em>
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<h2>When to seek help</h2>
<p>While all women should feel comfortable to eat foods they desire, moderation is still key. Resolving sweet food cravings with nutritious options such as fruits, dairy and wholegrains may be beneficial, as well as limiting less healthy cravings such as chocolates, lollies and chips.</p>
<p>Particular cravings, such soil or ice, can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4635104/">indicate</a> underlying health conditions that warrant treatment.</p>
<p>If you or a loved one is concerned about food cravings or any aspect of food intake during pregnancy, make an appointment with an <a href="https://member.dietitiansaustralia.org.au/Portal/Portal/Search-Directories/Find-a-Dietitian.aspx">accredited dietitian</a>.</p><img src="https://counter.theconversation.com/content/221755/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Ball works for The University of Queensland and receives funding from the National Health and Medical Research Council, Queensland Health and Mater Misericordia. She is a Director of Dietitians Australia, a Director of the Darling Downs and West Moreton Primary Health Network and an Associate Member of the Australian Academy of Health and Medical Sciences.</span></em></p><p class="fine-print"><em><span>Katelyn Barnes is an accredited dietitian and is employed by ACT Health Directorate, University of Queensland, and the Australian National University. Katelyn is a volunteer, elected executive member of the Australasian Association for Academic Primary Care.</span></em></p>Food cravings during pregnancy are common, with studies reporting anywhere between 50% and 90% of pregnant women experience a food craving at least once during their pregnancy.Lauren Ball, Professor of Community Health and Wellbeing, The University of QueenslandKatelyn Barnes, Postdoctoral Research Fellow, School of Human Movement and Nutrition Sciences, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2173682024-01-24T23:40:59Z2024-01-24T23:40:59ZExtreme heat can be risky during pregnancy. How to look after yourself and your baby<figure><img src="https://images.theconversation.com/files/570779/original/file-20240123-25-6rr05.jpg?ixlib=rb-1.1.0&rect=0%2C20%2C6709%2C4446&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/kid-kissing-belly-her-mom-633713483">Shutterstock</a></span></figcaption></figure><p>As we face the continued effects of <a href="https://www.lancetcountdown.org/2023-report/">climate change</a>, the frequency and intensity of heatwaves is increasing. We’ve recently learnt 2023 was <a href="https://www.climatecouncil.org.au/resources/2023-named-hottest-year-record-scorching-temps-sweep-australia/">the hottest year</a> on record.</p>
<p>Extreme heat presents a major public health threat. It can be <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01208-3/fulltext">especially dangerous</a> for people who are socioeconomically disadvantaged, and people who have reduced physiological ability to adapt, such as older adults and those with certain medical conditions.</p>
<p>Pregnant people are also more vulnerable, with evidence showing exposure to extreme heat <a href="https://pubmed.ncbi.nlm.nih.gov/37501633/">is associated with</a> increased risks for the baby.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-can-stress-during-pregnancy-harm-my-baby-81825">Health Check: can stress during pregnancy harm my baby?</a>
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</em>
</p>
<hr>
<h2>What are the risks?</h2>
<p>Globally one stillbirth occurs <a href="https://www.unicef.org/reports/neglected-tragedy-global-burden-of-stillbirths-2020">every 16 seconds</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/30389451/">15 million babies</a> are born preterm (before 37 complete weeks of pregnancy) every year. Complications of preterm birth are the leading cause of death and disability for children aged under five years old. </p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/33148618/">systematic review</a> which included studies from 27 countries showed that for every 1˚C increase in ambient (environmental) temperature, the risk for preterm birth and stillbirth increased by 5%.</p>
<p>The risk of stillbirth and preterm birth attributed to heat is greater in lower- and middle-income countries where women are often employed in agriculture or other manual labour positions, and their work continues until <a href="https://pubmed.ncbi.nlm.nih.gov/35237548/">the end of their pregnancy</a>. </p>
<p>Within high-income countries the risk <a href="https://pubmed.ncbi.nlm.nih.gov/34951022/">is greater</a> in <a href="https://pubmed.ncbi.nlm.nih.gov/35710419/">disadvantaged populations</a>.</p>
<p>Recent Australian research has also suggested a mother’s exposure to extreme temperatures may <a href="https://ehp.niehs.nih.gov/doi/10.1289/EHP12660">influence a baby’s birth weight</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/570781/original/file-20240123-17-77i0s4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman drinks glass of water" src="https://images.theconversation.com/files/570781/original/file-20240123-17-77i0s4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/570781/original/file-20240123-17-77i0s4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570781/original/file-20240123-17-77i0s4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570781/original/file-20240123-17-77i0s4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570781/original/file-20240123-17-77i0s4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570781/original/file-20240123-17-77i0s4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570781/original/file-20240123-17-77i0s4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Make sure you stay hydrated while pregnant.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-water-drinking-woman-young-pregnancy-2177419759">Shutterstock</a></span>
</figcaption>
</figure>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/5-expert-tips-on-how-to-look-after-your-baby-in-a-heatwave-216906">5 expert tips on how to look after your baby in a heatwave</a>
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<hr>
<p>Pregnant people are thought to be at increased risk of heat stress due to changes in their body’s capacity to <a href="https://pubmed.ncbi.nlm.nih.gov/37501633/">regulate temperature</a>. These changes include:</p>
<ul>
<li><p>increased body mass and body fat which reduces a pregnant woman’s ability to dissipate heat to the environment </p></li>
<li><p>decreased ratio of surface area to body mass can make sweating less effective</p></li>
<li><p>additional energy produced from the baby increases the mother’s core body temperature. </p></li>
</ul>
<h2>The effects on the body and baby</h2>
<p>When the ambient environment is hotter than the pregnant woman’s core body temperature (that is when the air temperature reaches around 38 degrees or above) blood flow is diverted to the skin to allow sweating. This can decrease blood flow to the placenta, meaning less nutrition and oxygen to the baby.</p>
<p>If dehydration occurs, hormonal changes can include the release of prostaglandin and oxytocin, potentially triggering labour prematurely. </p>
<p>Heat exposure can also release heat-shock protein (a family of proteins produced by cells secondary to stressful conditions) which can damage placental cells and placental function. This can contribute to poor fetal nutrition, leading to <a href="https://pubmed.ncbi.nlm.nih.gov/30594173/">low birth weight</a>. </p>
<p>However, actual thermo-physiological data from pregnant women during heat exposure is sparse. Our <a href="https://pubmed.ncbi.nlm.nih.gov/29496695/">recent review</a> showed no study has assessed thermoregulatory function in pregnant women at temperatures higher than 25˚C. </p>
<p>Our subsequent <a href="https://pubmed.ncbi.nlm.nih.gov/34165763/">climate chamber study</a> with pregnant women showed their bodies regulate temperature up to 32˚C as well as non-pregnant women.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/570775/original/file-20240123-15-zkxgxo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman in sun hat sits with legs in swimming pool. She appears pregnant." src="https://images.theconversation.com/files/570775/original/file-20240123-15-zkxgxo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/570775/original/file-20240123-15-zkxgxo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570775/original/file-20240123-15-zkxgxo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570775/original/file-20240123-15-zkxgxo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570775/original/file-20240123-15-zkxgxo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570775/original/file-20240123-15-zkxgxo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570775/original/file-20240123-15-zkxgxo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Dipping your feet into a cool pool can help you and your baby cool off.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-young-pregnant-woman-sitting-near-422267806">Tanya Yatsenko/Shutterstock</a></span>
</figcaption>
</figure>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/dont-like-drinking-plain-water-10-healthy-ideas-for-staying-hydrated-this-summer-191859">Don’t like drinking plain water? 10 healthy ideas for staying hydrated this summer</a>
</strong>
</em>
</p>
<hr>
<h2>5 ways to beat the heat while pregnant</h2>
<p>Evidence of the effectiveness of interventions that address acute heat exposure during pregnancy specifically are limited. Air-conditioning is exceptionally protective, however it is unaffordable for many in Australia and globally. </p>
<p>More evidence of the effect of extreme heat on pregnancy outcomes at a population level in both low and high income countries will help us develop ways to protect pregnant people and the community. </p>
<p>In the meantime, with the threat of more very hot summer days, simple strategies to <a href="https://www.health.nsw.gov.au/environment/beattheheat/pages/default.aspx">beat the heat</a> when pregnant include:</p>
<p><strong>1) Drink enough water</strong> – take a water bottle with you when out and about</p>
<p><strong>2) Plan your day</strong> – avoid the hottest part of the day if you can. Take a hat or umbrella with you for shade</p>
<p><strong>3) Stay cool</strong> – use fans or air-conditioning if possible, close blinds and curtains, visit a cooled public environment </p>
<p><strong>4) Dress down</strong> – wear lightweight, long-sleeved, light-coloured, loose-fitting clothes made from natural fibres, such as cotton or linen</p>
<p><strong>5) Go to sleep on your side</strong> – at night and for daytime naps to allow the <a href="https://theconversation.com/five-ways-to-reduce-the-risk-of-stillbirth-108253">best blood flow to the baby</a>.</p>
<p>These strategies need to be adapted to personal circumstances, and of course seek medical advice if you feel unwell. Signs of heat exhaustion that can lead to <a href="https://www.healthdirect.gov.au/heatstroke">heat stroke</a> if not treated early include:</p>
<ul>
<li>sweating and pale, cool, damp skin</li>
<li>dizziness and weakness</li>
<li>a headache</li>
<li>nausea or vomiting</li>
<li>a rapid pulse and fast, shallow breathing</li>
<li>muscle cramps </li>
<li>fainting</li>
<li>feeling restless and anxious</li>
<li>heat rash.</li>
</ul>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-extremely-hot-and-im-feeling-weak-and-dizzy-could-i-have-heat-stroke-215084">It's extremely hot and I'm feeling weak and dizzy. Could I have heat stroke?</a>
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</p>
<hr>
<p>If you have these symptoms, find a cool place to rest, drink cool water or a rehydration drink, remove excess clothing, have a cool shower or bath, or sit for a while with your feet in cool water.</p>
<p>More severe symptoms indicating heatstroke include intense thirst, slurred speech, lack of coordination or confusion, and aggressive or strange behaviour. Heatstroke is a medical emergency, so call triple 0.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/five-ways-to-reduce-the-risk-of-stillbirth-108253">Five ways to reduce the risk of stillbirth</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/217368/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adrienne Gordon receives funding from MRFF, NHMRC and Wellcome Trust. She is affiliated with the International Stillbirth Alliance, the NHMRC Stillbirth Centre of Research Excellence, The Perinatal Society of Australia and New Zealand, The Sydney Institute for Women, Children and their Families, Womens Healthcare Australasia and RedNose Australia. </span></em></p><p class="fine-print"><em><span>Camille Raynes-Greenow receives funding from NHMRC, Wellcome Trust, ERLA, UK. </span></em></p><p class="fine-print"><em><span>Ollie Jay receives funding from National Health and Medical Research Council, Wellcome Trust, NSW Health, NSW Dept of Planning, Industry and Environment, and the NSW Reconstruction Authority (formerly Resilience NSW), Tennis Australia.</span></em></p>During pregnancy, the body’s capacity to regulate temperature changes. Here’s how to cool down and the overheating red flags to watch out for.Adrienne Gordon, Neonatal Staff Specialist, NHMRC Early Career Research Fellow, University of SydneyCamille Raynes-Greenow, Professor and Deputy Head of School, Sydney School of Public Health, University of SydneyOllie Jay, Professor of Heat & Health; Director of Heat & Health Research Incubator; Director of Thermal Ergonomics Laboratory, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2193292024-01-12T00:16:53Z2024-01-12T00:16:53ZFrom straight to curly, thick to thin: here’s how hormones and chemotherapy can change your hair<figure><img src="https://images.theconversation.com/files/567011/original/file-20231221-27-ytfbxc.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C6000%2C3979&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/back-view-young-beautiful-woman-white-1489934231">Orawan Pattarawimonchai/Shutterstock</a></span></figcaption></figure><p>Head hair comes in many colours, shapes and sizes, and hairstyles are often an expression of personal style or cultural identity. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/36631178/">Many different genes</a> determine our hair texture, thickness and colour. But some people’s hair changes around the time of puberty, pregnancy or after chemotherapy.</p>
<p>So, what can cause hair to become curlier, thicker, thinner or grey?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/big-hair-bald-how-much-difference-your-hair-really-makes-to-keep-you-cool-or-warm-201380">Big hair? Bald? How much difference your hair really makes to keep you cool or warm</a>
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</em>
</p>
<hr>
<h2>Curly or straight? How hair follicle shape plays a role</h2>
<p>Hair is made of <a href="https://my.clevelandclinic.org/health/body/23204-keratin">keratin</a>, a strong and insoluble protein. Each hair strand grows from its own <a href="https://www.ncbi.nlm.nih.gov/books/NBK470321/">hair follicle</a> that extends deep into the skin. </p>
<p>Curly hair forms due to asymmetry of both the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894537/">hair follicle and the keratin</a> in the hair.</p>
<p>Follicles that produce <a href="https://www.medicalnewstoday.com/articles/318524">curly hair</a> are asymmetrical and curved and lie at an angle to the surface of the skin. This kinks the hair as it first grows.</p>
<p>The asymmetry of the hair follicle also causes the keratin to bunch up on one side of the hair strand. This pulls parts of the hair strand closer together into a curl, which maintains the curl as the hair continues to grow. </p>
<p>Follicles that are symmetrical, round and perpendicular to the skin surface produce straight hair. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A diagram shows the hair follicle shape of straight, curly and coiled hair." src="https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567020/original/file-20231221-29-fp0wci.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Each hair strand grows from its own hair follicle.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/diagram-hair-follicle-shape-vector-illustration-2248429145">Mosterpiece/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-dandruff-how-do-i-get-rid-of-it-why-does-it-keep-coming-back-201082">What is dandruff? How do I get rid of it? Why does it keep coming back?</a>
</strong>
</em>
</p>
<hr>
<h2>Life changes, hair changes</h2>
<p>Our hair undergoes repeated cycles throughout life, with different stages of growth and loss.</p>
<p>Each hair follicle contains stem cells, which multiply and <a href="https://www.frontiersin.org/articles/10.3389/fcell.2022.899095/full">grow into a hair strand</a>.</p>
<p>Head hairs spend most of their time in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5905671/">the growth phase</a>, which can last for several years. This is why head hair can grow so long. </p>
<p>Let’s look at the life of a single hair strand. After the growth phase is a transitional phase of about two weeks, where the hair strand stops growing. This is followed by a resting phase where the hair remains in the follicle for a few months before it <a href="https://www.healthline.com/health/stages-of-hair-growth">naturally falls out</a>.</p>
<p>The hair follicle <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/exd.13347">remains in the skin</a> and the stems cells grow a new hair to repeat the cycle.</p>
<p>Each hair on the scalp is replaced <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606321/#b3">every three to five years</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman with curly hair works on her computer." src="https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567014/original/file-20231221-27-mq3dok.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Each hair on the scalp is replaced every three to five years.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/african-businesswoman-office-beautiful-woman-listening-1702284601">Just Life/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Hormone changes during and after pregnancy alter the usual hair cycle</h2>
<p>Many women notice their hair is <a href="https://www.medicalnewstoday.com/articles/pregnancy-hair">thicker during pregnancy</a>.</p>
<p>During pregnancy, high levels of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908443/">oestrogen, progesterone and prolactin</a> prolong the resting phase of the hair cycle. This means the hair <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432488/">stays in the hair follicle for longer</a>, with less hair loss. </p>
<p>A drop in hormones a few months after delivery causes increased hair loss. This is due to all the hairs that remained in the resting phase during pregnancy falling out in a fairly synchronised way. </p>
<h2>Hair can change around puberty, pregnancy or after chemotherapy</h2>
<p>This is related to the genetics of hair shape, which is an example of <a href="https://www.biologyonline.com/dictionary/incomplete-dominance">incomplete dominance</a>. </p>
<p>Incomplete dominance is when there is a middle version of a trait. For hair, we have curly hair and straight hair genes. But when someone has one curly hair gene and one straight hair gene, they can have wavy hair. </p>
<p>Hormonal changes that occur around <a href="https://clinicalepigeneticsjournal.biomedcentral.com/articles/10.1186/s13148-019-0780-4">puberty</a> and <a href="https://www.mdpi.com/1422-0067/23/20/12698">pregnancy</a> can affect the function of genes. This can cause the curly hair gene of someone with wavy hair to become more active. This can change their hair from wavy to curly.</p>
<p>Researchers have identified that activating specific genes can change hair in pigs <a href="https://www.frontiersin.org/articles/10.3389/fgene.2023.1184015/full">from straight to curly</a>.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759815/">Chemotherapy</a> has very visible effects on hair. Chemotherapy kills rapidly dividing cells, <a href="https://jamanetwork.com/journals/jamaoncology/fullarticle/2628766">including hair follicles</a>, which causes hair loss. Chemotherapy can also have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1988866/">genetic effects</a> that influence hair follicle shape. This can cause hair to <a href="https://www.medicalnewstoday.com/articles/chemo-curls">regrow with a different shape</a> for the first few cycles of hair regrowth.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman with wavy hair looks in a mirror" src="https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567015/original/file-20231221-17-ecswfa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Your hair can change at different stages of your life.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-redhaired-girl-bathroom-looks-mirror-2139652407">Igor Ivakhno/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Hormonal changes as we age also affect our hair</h2>
<p>Throughout life, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432488/">thyroid hormones</a> are essential for production of keratin. Low levels of thyroid hormones can cause dry and brittle hair.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/36578854/">Oestrogen and androgens</a> also regulate hair growth and loss, particularly as we age. </p>
<p>Balding in males is due to <a href="https://theconversation.com/starting-to-thin-out-hair-loss-doesnt-have-to-lead-to-baldness-34984">higher levels of androgens</a>. In particular, high dihydrotestosterone (sometimes shortened to DHT), which is produced in the body from testosterone, has a role in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269836/">male pattern baldness</a>. </p>
<p>Some women experience <a href="https://theconversation.com/health-check-why-does-womens-hair-thin-out-39126">female pattern hair loss</a>. This is caused by a combination of genetic factors plus lower levels of <a href="https://www.mdpi.com/2077-0383/12/3/893">oestrogen and higher androgens</a> after menopause. The hair follicles become smaller and smaller until they no longer produce hairs. </p>
<p>Reduced function of the cells that produce <a href="https://www.health.com/mind-body/what-going-gray-early-can-tell-you-about-your-health">melanin</a> (the pigment that gives our hair colour) is what causes greying.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-dont-burns-bleed-130792">Curious Kids: why don't burns bleed?</a>
</strong>
</em>
</p>
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<img src="https://counter.theconversation.com/content/219329/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Theresa Larkin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Changes around puberty and pregnancy can affect the function of genes influencing hair shape. And chemotherapy can cause hair to regrow in a different shape for the first few cycles of hair regrowth.Theresa Larkin, Associate professor of Medical Sciences, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2202602024-01-11T12:50:06Z2024-01-11T12:50:06ZFour ways men and women can improve their health before trying to conceive<figure><img src="https://images.theconversation.com/files/568600/original/file-20240110-19-ykaqyo.jpg?ixlib=rb-1.1.0&rect=0%2C19%2C6523%2C3823&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Exercising with your partner can help build healthy lifestyle habits for the future.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/healthier-you-happier-feel-shot-sporty-2141708349">PeopleImages.com - Yuri A/ Shutterstock</a></span></figcaption></figure><p>It’s well-known how important it is to look after your health during and after pregnancy. But it can also be just as important for both men and women to focus on their health even before they begin trying for a baby.</p>
<p><a href="https://cdn.who.int/media/docs/default-source/mca-documents/maternal-nb/preconception_care_presentation_slides.pdf?sfvrsn=c2a5dde6_5#:%7E:text=What%20is%20its%20aim%3F,and%20couples%20before%20conception%20occurs.">Preconception health</a> refers to the lifestyle changes you and your partner can make to create the best possible conditions for future pregnancies. </p>
<p>Taking care of your health before trying to conceive is crucial for both partners. But even people of reproductive age who may not be thinking of having children anytime soon might still want to <a href="https://assets.publishing.service.gov.uk/media/5b585b3a40f0b6338218d6f1/Making_the_case_for_preconception_care.pdf">improve their preconception health</a>. Doing so sets the stage for a healthier future for all, including any future generations.</p>
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<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/planning-for-a-baby-why-both-men-and-women-should-consider-quitting-alcohol-before-and-during-pregnancy-198118?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Planning for a baby? Why both men and women should consider quitting alcohol before and during pregnancy</a></em></p>
<p><em><a href="https://theconversation.com/women-still-face-unfair-pressure-about-having-children-heres-what-to-expect-if-you-dont-have-kids-when-youre-young-217135?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Women still face unfair pressure about having children – here’s what to expect if you don’t have kids when you’re young</a></em></p>
<p><em><a href="https://theconversation.com/should-i-have-children-heres-what-the-philosophers-say-218466?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Should I have children? Here’s what the philosophers say</a></em></p>
<hr>
<p>So whether or not you consider yourself a future parent, here are a few easy things you can do to improve your preconception health.</p>
<h2>1. Focus on your diet</h2>
<p>It’s well known that a healthy diet is important for your wellbeing. It should be no surprise that this is also the case for preconception health.</p>
<p>Managing weight before conception is not only important for a woman’s wellbeing, it may also reduce the risk of pregnancy complications. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075697/">Studies</a> have shown that a consistently healthy diet, up to three years before pregnancy, is associated with a lower risk of gestational diabetes, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279097/#:%7E:text=Hypertensive%20disorders%20during%20pregnancy%20are,chronic%20hypertension%2C%20and%204">preeclamspia</a> (a condition which causes high blood pressure during and after pregnancy) and pre-term birth. </p>
<p>For men, diet can influence fertility and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8910394/#:%7E:text=Lastly%2C%20a%20low%2Dprotein%20diet,common%20target%20are%20the%20mitochondria.">how healthy sperm are</a>. This is why focusing on eating healthier at least three months before conception is important.</p>
<p>For a healthy diet <a href="https://www.nhs.uk/live-well/eat-well/how-to-eat-a-balanced-diet/eating-a-balanced-diet">it’s recommended</a> both men and women:</p>
<ul>
<li>consume five portions of fruit and veg daily</li>
<li>include high-fibre, starchy foods with each meal </li>
<li>eat plenty of protein </li>
<li>avoid excess unsaturated oils and spreads</li>
<li>drink at least <a href="https://www.nhsinform.scot/campaigns/hydration/">six to eight glasses of water</a> daily.</li>
</ul>
<p>Women are also advised to take 400mg of folic acid daily, three months before getting pregnant. This decreases the risk of certain congenital defects, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3799525/">spina bifida</a> (a condition where the baby’s spinal cord doesn’t develop as it should in the womb).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-why-the-uk-should-fortify-flour-with-folic-acid-88354">Here's why the UK should fortify flour with folic acid</a>
</strong>
</em>
</p>
<hr>
<h2>2. Be more active</h2>
<p>Regular physical activity is essential when it comes to preconception health. </p>
<p>For women, exercise can help regulate weight and reduce stress. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986386/">Both of these factors</a> can also directly influence a woman’s ability to conceive and have a healthy pregnancy. <a href="https://www.rcog.org.uk/for-the-public/browse-our-patient-information/being-overweight-in-pregnancy-and-after-birth/#:%7E:text=The%20higher%20your%20BMI%2C%20the,anaesthetic%20complications%20and%20wound%20infections.">Maintaining a healthy weight</a> also reduces the risk of complications during pregnancy – including gestational diabetes, high blood pressure and pre-term birth. </p>
<p>For men, exercise not only helps keep weight stable, it can also <a href="https://pubmed.ncbi.nlm.nih.gov/31858122/">improve sperm quality</a>. In addition, maintaining a healthy weight may prevent obesity-related issues that affect fertility, such as <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1108774">hormonal imbalances and decreased sperm quality</a>.</p>
<p>During the preconception period, it’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986386/">recommended men and women</a> aim to get between 150-300 minutes of moderate-intensity physical activity or 75-150 minutes of vigorous activity per week. But any physical activity is better than none, so find activities you enjoy doing.</p>
<p><a href="https://journals.sagepub.com/doi/abs/10.1177/02654075211012086">Exercising with your partner</a> is also a good idea. Not only can this boost wellbeing, it may help you both build healthy lifestyle habits that you continue with into the future. </p>
<h2>3. Consider cutting alcohol and nicotine</h2>
<p>For couples trying to conceive, avoiding alcohol for <a href="https://journals.sagepub.com/doi/abs/10.1177/2047487319874530?journalCode=cprc">at least six months</a> before conception is advisable. Quitting drinking also offers advantages for soon-to-be parents, including <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8895623/">improved sleep</a>, as well as <a href="https://pubmed.ncbi.nlm.nih.gov/14748948/">better energy levels</a> and concentration.</p>
<p>Research shows that when fathers drink during the pregnancy, it increases the chance that their partner <a href="https://www.sciencedirect.com/science/article/pii/S0749379716000660#bib8">will also drink</a>. Considering this influence, aiming for an alcohol-free household before conception may be beneficial in supporting any future pregnancies. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/planning-for-a-baby-why-both-men-and-women-should-consider-quitting-alcohol-before-and-during-pregnancy-198118">Planning for a baby? Why both men and women should consider quitting alcohol before and during pregnancy</a>
</strong>
</em>
</p>
<hr>
<p>Similarly, nicotine negatively affects fertility, reducing both <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771515/#:%7E:text=Smoking%20has%20been%20frequently%20associated,(ROS)%20(4).">sperm quality</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/37318508/#:%7E:text=Conclusions%3A%20Smoking%20negatively%20impacts%20human,in%20women%20performing%20ICSI%20cycles.">egg quality</a>. It can also have serious consequences during pregnancy – including increasing risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969532/">miscarriage, premature birth and birth defects</a>. Even secondhand smoke <a href="https://pubmed.ncbi.nlm.nih.gov/30026189/#:%7E:text=Background%3A%20Secondhand%20smoke%20(SHS),birth%20weight%20and%20respiratory%20illnesses.">poses a risk</a> to pregnancy and foetal complications.</p>
<figure class="align-center ">
<img alt="A woman holds up her hand at a glass of red wine to say no." src="https://images.theconversation.com/files/568601/original/file-20240110-19-myosut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/568601/original/file-20240110-19-myosut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/568601/original/file-20240110-19-myosut.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/568601/original/file-20240110-19-myosut.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/568601/original/file-20240110-19-myosut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/568601/original/file-20240110-19-myosut.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/568601/original/file-20240110-19-myosut.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There are many benefits of giving up alcohol.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-refuses-drink-alcohol-female-alcoholism-1275255349">goffkein.pro/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Prioritising an alcohol-free and smoke-free environment before conceiving sets the stage for a healthier pregnancy and a brighter start for any future children. </p>
<h2>4. Prioritise your mental health</h2>
<p>Prioritising your mental health in the preconception period is essential. It can equip people to handle stress, as well as navigate the emotional ups and downs of any future pregnancies. </p>
<p>Research also shows a positive mental state can <a href="https://www.psychiatry.org/news-room/apa-blogs/infertility-the-impact-of-stress-and-mental-health#:%7E:text=Stress%2C%20Anxiety%2C%20Depression%20and%20Grief&text=Having%20anxiety%20and%20depression%20may,most%20often%20depression%20or%20anxiety.">benefit fertility</a> due to improved stress levels. </p>
<p>If you’re struggling with your mental health or have been diagnosed with a mental health condition, you can receive specialised support <a href="https://www.gov.uk/government/publications/preconception-advice-for-women-with-serious-mental-illness">in the preconception period</a>, so consider speaking with your GP.</p>
<p>Regardless of whether you’re trying to have a baby or not, taking care of your health is crucial. Preconception health includes all people of reproductive age and it lays the groundwork for a healthy future. </p>
<p>Just remember to consult your doctor before making major changes to your lifestyle.</p><img src="https://counter.theconversation.com/content/220260/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Merissa Elizabeth Hickman receives funding from the Wellcome Trust for her academic appointment. </span></em></p>Preconception health refers to the many lifestyle changes you can make to benefit a future pregnancy.Merissa Elizabeth Hickman, Postgraduate Researcher in Preconception Health and Genetics., University of LeicesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2176612024-01-08T13:35:39Z2024-01-08T13:35:39ZSouth Korea’s gender imbalance is bad news for men − outnumbering women, many face bleak marriage prospects<figure><img src="https://images.theconversation.com/files/563900/original/file-20231206-21-smw7n5.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5573%2C3699&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In South Korea, there are nor enough young Korean women for young Korean men to marry.
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/airport-business-man-royalty-free-image/166973187?phrase=south+korea+men+together&searchscope=image%2Cfilm&adppopup=true">RUNSTUDIO/Getty Images</a></span></figcaption></figure><p>South Korea’s bachelor time bomb is about to really go off. Following a historic 30-year-long imbalance in the male-to-female sex ratio at birth, young men far outnumber young women in the country. As a result, some 700,000 to 800,000 “extra” South Korean boys born since the mid-1980s may not be able to find South Korean girls to marry.</p>
<p>As a <a href="https://scholar.google.com/citations?user=jAfhO2YAAAAJ&hl=en">demographer</a> who over the past four decades has conducted extensive research on East Asian populations, I know that this increased number of South Korean boys will have huge impacts throughout South Korean society. Coincidentally, similar trends are <a href="https://doi.org/10.1080/17450128.2011.630428">playing out in China</a>, Taiwan and India. </p>
<p><iframe id="matBO" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/matBO/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>The reasons</h2>
<p>In most countries, more boys are born than girls – around 105 to 107 boys per 100 girls. That sex ratio at birth (SRB) is a near constant. The gender imbalance is likely an evolutionary adaptation to the biological fact that females live longer than males. At every year of life, men have higher death rates than women. Hence an SRB of between 105 and 107 boys <a href="https://www.cambridge.org/core/books/population-and-society/5D47EB8139ED72FD59F7379F7D41B4FB">allows for there to be roughly equal numbers of men and women </a> when the groups reach childbearing ages.</p>
<p>The SRB in the United States in 1950 was 105 and was still 105 in 2021; in fact, it has been stable in the U.S. for as long as SRB data has been gathered. In contrast, in South Korea the SRB was at the normal range from 1950 to around 1980, but increased to 110 in 1985 and to 115 in 1990.</p>
<p>After fluctuating a bit at elevated levels through the 1990s and early 2000s, it returned to the biologically normal range by 2010. In 2022, South Korea’s SRB was 105 – well within the normal level. But by then, the seeds for today’s imbalance of marriage-age South Koreans was set.</p>
<h2>A preference for sons</h2>
<p>There are several reasons why South Korea’s SRB was out of balance for 30 years.</p>
<p>South Korea experienced a rapid fertility decline in a 20- to 30-year period beginning in the 1960s. From six children per woman in 1960, fertility fell to four children in 1972, then to two children in 1984. By 2022, South Korea’s fertility rate had dropped to 0.82 – <a href="https://theconversation.com/south-korea-has-the-lowest-fertility-rate-in-the-world-and-that-doesnt-bode-well-for-its-economy-207107">the lowest fertility rate in the world</a> and far below the rate of 2.1 needed to replace the population.</p>
<p><iframe id="FNa7q" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/FNa7q/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Yet, South Korea’s long-held <a href="https://www.jstor.org/stable/2584733">cultural preference for sons</a> did not shift as quickly as childbearing declined. Having at least one son was a strong desire influencing fertility preferences in South Korea, especially up through the early years of the 21st century. </p>
<p>And the declining fertility rate posed a problem. When women have many children, the probability that at least one will be a boy is high. With only two children, the probability that neither will be a son is around 25%, and when women have only one child, it is less than 50%.</p>
<p>In order to ensure that families would continue to have boys, many South Koreans turned to readily available techniques to identify the gender of the fetus, such as screening in the early stages of pregnancy. Abortion, which is legal and socially acceptable in South Korea, was then often used to allow families to select the sex of their child. </p>
<h2>Sex by the numbers</h2>
<p>In South Korea, beginning in around 1980 and lasting up to around 2010 or so, many more extra boys were born than girls. When these extra boys reach adulthood and start looking for South Korean girls to marry, many will be unsuccessful.</p>
<p>The extra boys born in the 1980s and 1990s are now of marriage age, and many will be looking to marry and start a family. Many more will be reaching marriage age in the next two decades.</p>
<figure class="align-center ">
<img alt="Man kisses pregnant wife's belly." src="https://images.theconversation.com/files/563902/original/file-20231206-21-k1wz8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563902/original/file-20231206-21-k1wz8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563902/original/file-20231206-21-k1wz8w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563902/original/file-20231206-21-k1wz8w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563902/original/file-20231206-21-k1wz8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563902/original/file-20231206-21-k1wz8w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563902/original/file-20231206-21-k1wz8w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A deeply rooted cultural preference for sons was still influential in South Korea up through the early years of this century.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/asian-man-kissing-pregnant-wifes-belly-royalty-free-image/174522589?phrase=south+korea+abortion&searchscope=image%2Cfilm&adppopup=true">Greg Samborski via Getty Images</a></span>
</figcaption>
</figure>
<p>I have calculated that owing to the unbalanced SRBs in South Korea between 1980 and 2010, approximately 700,000 to 800,000 extra boys were born.</p>
<p>Already this is having an effect in a society where over the centuries virtually everyone was expected to marry, and where marriage was nearly universal. Recent <a href="https://www.wionews.com/world/south-koreans-losing-interest-in-marriage-report-finds-630642">research by Statistics Korea</a> showed that in 2023, over 36% of South Koreans between the ages of 19 and 34 intended to get married; this is a decline from over 56% in 2012.</p>
<h2>Foreign brides and ‘bachelor ghettos’</h2>
<p>The immigration of foreign-born women might help address the imbalance. Research by demographers <a href="https://doi.org/10.1177/0308518X18756640">Guy Abel and Nayoung Heo</a> has shown that financial assistance from the South Korean government is already supporting the immigration to South Korea of Korean women from northeastern China and of foreign women from some less wealthy countries, such as Vietnam, the Philippines and some Eastern European countries. </p>
<p>If the extra bachelors do not marry immigrant brides, they will have no alternative but to develop their own lives and livelihoods. Some might settle in “bachelor ghettos” in Seoul and in South Korea’s other big cities of Busan and Daegu, where commercial sex outlets are more prevalent. Such “ghettos” have already been <a href="https://www.aljazeera.com/news/2005/7/20/gender-imbalance-threatens-china">observed in other Asian cities</a> where men outnumber women, such as Beijing, Shanghai and Guangzhou in China.</p>
<figure class="align-center ">
<img alt="Bridegroom flashes victory sign." src="https://images.theconversation.com/files/563903/original/file-20231206-27-z2krp3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563903/original/file-20231206-27-z2krp3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563903/original/file-20231206-27-z2krp3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563903/original/file-20231206-27-z2krp3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563903/original/file-20231206-27-z2krp3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563903/original/file-20231206-27-z2krp3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563903/original/file-20231206-27-z2krp3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">While the desire for sons has been relaxed, the social issues, especially regarding the marriage market, remain.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/bridegroom-showing-victory-sign-royalty-free-image/903472740?phrase=south+korea+wedding&searchscope=image%2Cfilm&adppopup=true">RUNSTUDIO/Getty Images</a></span>
</figcaption>
</figure>
<p>The consequences for South Korean society of the higher than biologically normal SRBs is a problem of the country’s own making. South Korea’s high fertility of the mid-20th century was holding the country back economically. Its program to bring down a fertility rate of nearly six children per woman was hugely successful. But its very success has been problematic. </p>
<p>The speed of South Korea’s fertility transition meant that the evolution to a more modern familial normative structure – that is, with about two children per family and with less preference given to boys – lagged behind. Today, the SRB imbalances appear to be <a href="https://www.bbc.com/news/world-asia-38362474">a thing of the past</a>. Women in South Korea have greater access to education and employment, and there is less pressure for men to be sole wage earners. Together with the South Korean government’s efforts to reduce sex selection beginning in the late 1980s, the premium for boys over girls has dropped. </p>
<p>Yet despite the relaxed desire for sons, long-term social issues related to gender imbalance, especially regarding the marriage market, will remain in South Korea for decades to come.</p><img src="https://counter.theconversation.com/content/217661/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dudley L. Poston Jr. does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Following a 30-year boy-to-girl birth rate imbalance, up to 800,000 ‘extra’ men born since the mid-1980s will be unable to find a South Korean woman to marry. That has big demographic consequences.Dudley L. Poston Jr., Professor of Sociology, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2200692023-12-22T10:16:26Z2023-12-22T10:16:26ZMost expectant mothers miss out on vitamins important for their health and their baby’s, study finds<figure><img src="https://images.theconversation.com/files/566580/original/file-20231219-23-vklpav.jpg?ixlib=rb-1.1.0&rect=11%2C11%2C7704%2C5151&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Certain micronutrients are important for the health of the mother and baby during pregnancy.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-woman-reading-label-on-bottle-2117288603">Dragana Gordic/ Shutterstock</a></span></figcaption></figure><p>Our bodies require many important vitamins and minerals in order to function well. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9662251/">B vitamins</a>, for example, are particularly important for many of our everyday functions – including energy levels, cell health and nerve function. </p>
<p>These vitamins become even more important when a mother is pregnant, as low levels of some vitamins (such as folic acid, also known as vitamin B9) are associated with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218540/#:%7E:text=of%20the%20fetus.-,Folate%20deficiency%20has%20been%20associated%20with%20abnormalities%20in%20both%20mothers,(NTDs)%20in%20the%20offspring.">poor health outcomes</a> during pregnancy and for the infant after birth.</p>
<p>Since our body only makes many of these micronutrients in small amounts (if at all), we get the bulk of them from our diet. But <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004260">our recent study</a> showed that the majority of expectant mothers are missing out on many important vitamins – which could potentially have an affect on, not only their health, but their infant’s too.</p>
<p>We conducted a large study of over 1,700 women aged 18-38 in the UK, Singapore and New Zealand. We studied their health before, during and after pregnancy. </p>
<p>Before pregnancy, we found that nine in ten of the women had low blood levels of many important vitamins, including folic acid, riboflavin, vitamin B12 and vitamin D. <a href="https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/prenatal-vitamins/art-20046945">These vitamins are needed</a> to support the mother’s health during pregnancy, and are important for the unborn baby’s development.</p>
<p>For the next part of the study, we randomly placed participants into two different groups. One group received a standard pregnancy vitamin supplement, which contained folic acid. The other group received an “enhanced” supplement, which contained folic acid, as well as riboflavin, vitamins B6, B12 and D. The amount of vitamins in the enhanced supplement was similar to what you can buy from pharmacies and supermarkets without a prescription.</p>
<p>Both groups took these supplements daily starting from when they were trying to get pregnant and throughout their pregnancy. They stopped taking them after delivering the baby.</p>
<p>We found that the enhanced supplement helped improve blood vitamin levels and reduced the prevalence of vitamin deficiency during pregnancy – especially when it came to riboflavin, vitamin B6 and vitamin D. The standard supplement increased levels of folic acid, but levels of other vitamins worsened during pregnancy. This was probably because of the increased needs during this time.</p>
<p>Riboflavin is important during pregnancy as low levels can mean a higher chance of having a <a href="https://doi.org/10.1017/S002966512100046X">low blood count and anaemia</a>.</p>
<p>For vitamin B6, the group taking the standard supplement had lower levels in the later part of pregnancy, meaning they might not have enough of this vitamin. Previous research has suggested vitamin B6 may <a href="https://pubmed.ncbi.nlm.nih.gov/27701665/">provide some relief</a> from pregnancy-related nausea and vomiting. </p>
<figure class="align-center ">
<img alt="A nauseous pregnant woman lays on a couch." src="https://images.theconversation.com/files/566581/original/file-20231219-21-8ht821.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566581/original/file-20231219-21-8ht821.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566581/original/file-20231219-21-8ht821.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566581/original/file-20231219-21-8ht821.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566581/original/file-20231219-21-8ht821.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566581/original/file-20231219-21-8ht821.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566581/original/file-20231219-21-8ht821.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">B6 may help with pregnancy nausea.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/depressed-pregnant-woman-resting-home-alone-2273536815">christinarosepix/ Shutterstock</a></span>
</figcaption>
</figure>
<p>In both groups we saw a drop in homocysteine levels, with this being particularly marked in those taking the enhanced supplement. A lower homocysteine level is actually a good thing as it indicates a lower likelihood of vitamin deficiency. <a href="https://pubmed.ncbi.nlm.nih.gov/11641651/">High homocysteine levels</a> are linked with early pregnancy loss and a range of pregnancy complications, including preeclampsia. </p>
<p>The benefits of the enhanced supplement on the participants’ vitamin B12 levels lasted six months after having a baby. This is probably important for the mother’s ability to supply her baby with vitamin B12 if she breastfeeds. B12 helps children’s <a href="https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/diet-and-micronutrients/vitamin-b12.html#:%7E:text=Vitamin%20B12%20is%20transferred%20through,will%20receive%20enough%20vitamin%20B12.">brain development and growth</a>.</p>
<h2>Important micronutrients</h2>
<p>Though our study included women from three different countries and various ethnic backgrounds, few black and American Indian women were included in the research. This means the results might not represent the experiences of women from these specific ethnic groups. It will be important for future studies to investigate vitamin levels in these groups.</p>
<p>The precise benefits of the improved vitamin levels will also need to be investigated further in future studies. But, we might speculate that the supplements will have additional benefits, based on what previous studies have shown.</p>
<p>For example, our <a href="https://pubmed.ncbi.nlm.nih.gov/33782086/">previous research</a> has shown that women taking the same enhanced supplement had lower rates of pre-term delivery, and also a lower risk of major haemorrhage after delivery of the baby.</p>
<p>It’s also well-known that <a href="https://pubmed.ncbi.nlm.nih.gov/1677062/">folic acid</a> is important during pregnancy, as it can help prevent major defects to the developing baby’s brain and spine. Taking a folic acid supplement before conception and in the first part of pregnancy is routinely recommended. </p>
<p>But many pregnancies are unplanned and a significant number of women do not take folic acid supplements in early pregnancy. This is why around 80 countries have introduced mandatory fortification of staple foods. But many experts feel that the level of fortification in foods <a href="https://jamanetwork.com/journals/jama/article-abstract/2807770">may not be enough</a> for pregnant women, which is why a supplement will still be important. </p>
<p>Taking vitamin D supplements before and during pregnancy may also have benefits, including reducing the chances of <a href="https://pubmed.ncbi.nlm.nih.gov/35763390/">infantile atopic eczema</a> (a condition which causes patches of itchy, cracked and sore skin) and <a href="https://pubmed.ncbi.nlm.nih.gov/35866154/">improving bone health</a> in children.</p>
<p>Overall, our study showed that most women living in high-income countries don’t get enough essential vitamins in their diet – even before they get pregnant. Several of these vitamins are <a href="https://pubmed.ncbi.nlm.nih.gov/30673669/">crucial for the infant’s development</a> in the womb. </p>
<p>Although some of these vitamins can be found in meat and dairy products, it’s clear that the majority of women still aren’t getting enough of them regardless of what sort of diet they follow. As more people choose to eat more plant-based foods, better advice about vitamin-rich foods will be needed. Many women may probably need to start taking supplements to ensure they get the vitamins they and their baby need.</p><img src="https://counter.theconversation.com/content/220069/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Keith Godfrey has received funding from the UK Medical Research Council, the National Institute for Health and Care Research and the European Union. He has received reimbursement for speaking at conferences sponsored by companies selling nutritional products, and is part of an academic consortium that has received research funding from Abbott Nutrition, Nestec, BenevolentAI Bio Ltd. and Danone. He is Co-Chair of the not-for-profit UK Preconception Partnership. </span></em></p><p class="fine-print"><em><span>Sarah El-Heis has received funding from the National Institute for Health and Care Research.</span></em></p>Our study found that before pregnancy, nine in ten women had low blood levels of many important vitamins.Keith Godfrey, Professor of Epidemiology and Human Development, University of SouthamptonSarah El-Heis, Associate Professor of Dermatology, University of SouthamptonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2197072023-12-22T09:47:25Z2023-12-22T09:47:25ZMorning sickness doesn’t only occur in the morning. So why do we still call it that?<figure><img src="https://images.theconversation.com/files/565943/original/file-20231215-27-vw4i69.png?ixlib=rb-1.1.0&rect=6%2C0%2C2082%2C1384&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sick-young-woman-pain-stomach-vomiting-1575078391">Dragana Gordic/Shutterstock</a></span></figcaption></figure><p>As many as <a href="https://www.nps.org.au/assets/c54914225deb37a1-077be09b52f0-8b91fd8dbb1142caa58132e34b40b5466d337bd7268dda75dfae4a61d9f6.pdf">90%</a> or more of pregnant people experience some degree of nausea or vomiting, often colloquially referred to as “morning sickness”. </p>
<p>For some, it is relatively mild, coming and going during the first trimester without much fuss. For others, it can be severe, life-changing and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3514078/">traumatic</a>. </p>
<p>But the term “morning sickness” is a misnomer. Findings clearly show nausea and vomiting can occur throughout the day. </p>
<p>A recent and novel <a href="https://bjgp.org/content/70/697/e534.short">study</a> had pregnant women complete a symptom diary for each hour of the day across the first seven weeks of pregnancy. It found while peak symptoms occur in the morning, almost as many women experienced symptoms in the late afternoon or night as did in the morning. </p>
<p>Frequent symptoms of nausea and vomiting can become a significant problem, impacting an individual’s health, wellbeing and ability to perform basic tasks.</p>
<p>Given nausea and vomiting in pregnancy is frequently misunderstood and its effects often underestimated, its incorrect naming contributes to the stigma and lack of effective treatments faced by many women.</p>
<h2>The severe impacts of nausea and vomiting in pregnancy</h2>
<p>The most severe form of nausea and vomiting in pregnancy is called hyperemesis gravidarum and is reported to affect up to <a href="https://pubmed.ncbi.nlm.nih.gov/23863575/">3.6%</a> of pregnant women. Women with hyperemesis gravidarum have severe and persistent symptoms that can make it difficult for them to eat and drink enough. It can lead to weight loss, dehydration, and nutritional deficiencies. </p>
<p>It can also have a big impact on a person’s emotional, mental and physical health. Some people might be too sick to work, look after themselves or others, or complete normal daily activities. The economic and psychosocial effects of this can be profound. </p>
<p>In addition, <a href="https://www.ajog.org/article/S0002-9378(21)00157-5/fulltext">recent studies</a> report high rates of pregnancy termination, as well as suicidal thoughts, among hyperemesis gravidarum sufferers. This is on top of the range of <a href="https://pubmed.ncbi.nlm.nih.gov/21749625/">adverse pregnancy outcomes</a> (such as low birth weight) associated with the condition. </p>
<p>Even when not considered severe enough to constitute hyperemesis gravidarum, nausea and vomiting in pregnancy can still have profound impacts, greatly impacting women’s health, mental wellbeing, work, relationships, quality of life and experience of pregnancy. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/565921/original/file-20231214-21-9pzgmh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman covering her mouth at the breakfast table as though she's about to be sick." src="https://images.theconversation.com/files/565921/original/file-20231214-21-9pzgmh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565921/original/file-20231214-21-9pzgmh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565921/original/file-20231214-21-9pzgmh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565921/original/file-20231214-21-9pzgmh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565921/original/file-20231214-21-9pzgmh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565921/original/file-20231214-21-9pzgmh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565921/original/file-20231214-21-9pzgmh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Pregnancy sickness ranges in severity.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-feeling-nausea-during-breakfast-2193653627">Goksi/Shutterstock</a></span>
</figcaption>
</figure>
<h2>The stigma women face</h2>
<p>While the significant burden of nausea and vomiting highlights the importance of early and effective treatment, the reality faced by many women paints a different picture. A recent <a href="https://pubmed.ncbi.nlm.nih.gov/33984156/">Australian survey</a> found one in four respondents reported being denied medications for treating nausea or hyperemesis. </p>
<p>In part, this could reflect the ongoing hesitancy towards using medications during pregnancy since the <a href="https://theconversation.com/thalidomide-survivors-are-receiving-an-apology-for-the-pharmaceutical-disaster-that-changed-pregnancy-medicine-218691">thalidomide tragedy</a> in the 1960s. But it also reflects the enduring stigma those experiencing nausea and vomiting in pregnancy face when trying to receive care.</p>
<p>As recently as the early 1900s, the root cause of nausea and vomiting in pregnancy was thought to be psychological. Journal articles referred to “<a href="https://history-of-obgyn.com/uploads/3/5/4/8/35483599/1905-stevens-hyperemesis_obs-rev-jun2015.pdf">hysteria</a>” as a principal cause of nausea and vomiting, and of individuals <a href="https://pubmed.ncbi.nlm.nih.gov/13289940/">manifesting</a> symptoms as a result of being unhappy with their pregnancy or marriage, or seeking attention.</p>
<p>These erroneous beliefs have led to various dismissive and damaging practices resulting in women feeling isolated and unsupported. A <a href="https://pubmed.ncbi.nlm.nih.gov/15550881/">2004 French study</a> reported treating women admitted to hospital for hyperemesis gravidarum by subjecting them to isolation from friends or family to see if they would reveal their “secret desire” for an abortion.</p>
<p><a href="https://news.cornell.edu/stories/2000/05/morning-sickness-protects-mothers-and-their-unborn">Biologists</a> have argued nausea and vomiting in pregnancy serves a beneficial function to protect mothers and their unborn children from potentially harmful exposures. In part, this is based on evidence those experiencing nausea and vomiting in pregnancy are <a href="https://pubmed.ncbi.nlm.nih.gov/2611170/">less likely to have a miscarriage</a>.</p>
<p>While it seems to be accurate that nausea and vomiting in pregnancy has benefits, this argument presents it as a “rite of passage” and something individuals should welcome, while trivialising its associated burden.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thalidomide-survivors-are-receiving-an-apology-for-the-pharmaceutical-disaster-that-changed-pregnancy-medicine-218691">Thalidomide survivors are receiving an apology for the pharmaceutical disaster that changed pregnancy medicine</a>
</strong>
</em>
</p>
<hr>
<h2>How should nausea and vomiting in pregnancy be defined?</h2>
<p>While nausea and vomiting in pregnancy is common, when prolonged it can quickly become a debilitating medical condition. It’s important individuals experiencing nausea and vomiting in pregnancy are listened to and get the treatment they need, rather than being dismissed. </p>
<p><a href="https://www.somanz.org/content/uploads/2023/12/SOMANZ-Management-of-NVP-ExecSummary-Updated-Oct-2023-FINAL.pdf">Guidelines</a> often recommend using screening tools which classify individuals as having mild, moderate or severe nausea and vomiting based on responses to three questions about how they have been feeling over the past 24 hours. </p>
<p>While tools like this can be useful to guide or monitor treatment, they can risk causing further harm if used to restrict access to care based on perceived symptom severity. It’s crucial that treatment decisions not be based solely on a number, but rather on a comprehensive evaluation of an individual’s emotional, mental and physical health.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/565932/original/file-20231215-23-4euq92.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pregnant stomach" src="https://images.theconversation.com/files/565932/original/file-20231215-23-4euq92.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565932/original/file-20231215-23-4euq92.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565932/original/file-20231215-23-4euq92.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565932/original/file-20231215-23-4euq92.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565932/original/file-20231215-23-4euq92.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565932/original/file-20231215-23-4euq92.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565932/original/file-20231215-23-4euq92.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Pregnancy sickness should be seen as an illness to be managed, not a rite of passage.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-young-pregnant-woman-touching-her-2115089237">SeventyFour/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Time to retire the term ‘morning sickness’</h2>
<p>A term that incorrectly describes the nature and spectrum of an illness can be expected to further perpetuate stigmas faced by those seeking clinical care. Given it’s well recognised the term is felt by many to downplay the condition, we must ask ourselves why we continue to use the term “morning sickness”. </p>
<p>This description is inaccurate, simplistic, and therefore unhelpful. Referring to the illness by what it is, nausea and vomiting in pregnancy or “NVP”, could reduce stigma and lead to better outcomes for sufferers.</p>
<p>Perhaps more important is recognition that not all nausea and vomiting in pregnancy is experienced equally, and treating it as such risks trivialising the experience of each individual.</p><img src="https://counter.theconversation.com/content/219707/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Luke Grzeskowiak receives funding from the Channel 7 Children's Research Foundation, The Hospital Research Foundation and National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Hannah Jackson receives an Australian Government Research Training Program Stipend from the University of Technology Sydney.</span></em></p>We know nausea and vomiting is common all times of day during pregnancy. Calling it morning sickness contributes to the stigma and misunderstanding of the condition.Luke Grzeskowiak, Fellow in Medicines Use and Safety, Flinders UniversityHannah Jackson, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2178032023-12-18T23:18:02Z2023-12-18T23:18:02ZWomen want to see the same health provider during pregnancy, birth and beyond<figure><img src="https://images.theconversation.com/files/566233/original/file-20231218-17-b7lsjp.jpg?ixlib=rb-1.1.0&rect=8%2C146%2C5742%2C3578&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mid-adult-female-nurse-comforting-tensed-228783766">Tyler Olson/Shutterstock</a></span></figcaption></figure><p>In theory, pregnant women in Australia <a href="https://theconversation.com/explainer-what-are-womens-options-for-giving-birth-55133">can choose</a> the type of health provider they see during pregnancy, labour and after they give birth. But this is often dependent on where you live and how much you can afford in out-of-pocket costs. </p>
<p>While standard public hospital care is the <a href="https://www.aihw.gov.au/reports/mothers-babies/maternity-models-of-care/contents/about">most common</a> in Australia, accounting for 40.9% of births, the other main options are: </p>
<ul>
<li>GP shared care, where the woman sees her GP for some appointments (15% of births)</li>
<li>midwifery continuity of care in the public system, often called <a href="https://theconversation.com/call-the-midwife-playing-catch-up-with-australias-maternity-care-22544">midwifery group practice</a> or caseload care, where the woman sees the same midwife of team of midwives (14%)</li>
<li>private obstetrician care (10.6%)</li>
<li>private midwifery care (1.9%). </li>
</ul>
<p>Given the choice, which model would women prefer?</p>
<p>Our <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-06130-2">new research</a>, published BMC Pregnancy and Childbirth, found women favoured seeing the same health provider throughout pregnancy, in labour and after they have their baby – whether that’s via midwifery group practice, a private midwife or a private obstetrician. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-than-6-000-women-told-us-what-they-wanted-for-their-next-pregnancy-and-birth-heres-what-they-said-211435">More than 6,000 women told us what they wanted for their next pregnancy and birth. Here's what they said</a>
</strong>
</em>
</p>
<hr>
<h2>Assessing strengths and limitations</h2>
<p>We surveyed 8,804 Australian women for the Birth Experience Study (BESt) and 2,909 provided additional comments about their model of maternity care. The respondents were representative of state and territory population breakdowns, however fewer respondents were First Nations or from culturally or linguistically diverse backgrounds.</p>
<p>We analysed these comments in six categories – standard maternity care, high-risk maternity care, GP shared care, midwifery group practice, private obstetric care and private midwifery care – based on the perceived strengths and limitations for each model of care.</p>
<p>Overall, we found models of care that were fragmented and didn’t provide continuity through the pregnancy, birth and postnatal period (standard care, high risk care and GP shared care) were more likely to be described negatively, with more comments about limitations than strengths. </p>
<h2>What women thought of standard maternity care in hospitals</h2>
<p>Women who experienced standard maternity care, where they saw many different health care providers, were disappointed about having to retell their story at every appointment and said they would have preferred continuity of midwifery care. </p>
<p>Positive comments about this model of care were often about a midwife or doctor who went above and beyond and gave extra care within the constraints of a fragmented system. </p>
<figure class="align-center ">
<img alt="Baby being cleaned after birth" src="https://images.theconversation.com/files/566239/original/file-20231218-29-ls16h5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566239/original/file-20231218-29-ls16h5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566239/original/file-20231218-29-ls16h5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566239/original/file-20231218-29-ls16h5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566239/original/file-20231218-29-ls16h5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566239/original/file-20231218-29-ls16h5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566239/original/file-20231218-29-ls16h5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sometimes midwives and doctors in the public system exceeded expectations.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baby-being-cleaned-assessed-by-paediatrician-1118249573">Inez Carter/Shutterstock</a></span>
</figcaption>
</figure>
<p>The model of care with the highest number of comments about limitations was high-risk maternity care. For women with pregnancy complications who have their baby in the public system, this means seeing different doctors on different days. </p>
<p>Some respondents received conflicting advice from different doctors, and said the focus was on their complications instead of their pregnancy journey. One woman in high-risk care noted:</p>
<blockquote>
<p>The experience was very impersonal, their focus was my cervix, not preparing me for birth.</p>
</blockquote>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/1-in-10-women-report-disrespectful-or-abusive-care-in-childbirth-186827">1 in 10 women report disrespectful or abusive care in childbirth</a>
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<h2>Why women favoured continuity of care</h2>
<p>Overall, there were more positive comments about models of care that provided continuity of care: private midwifery care, private obstetric care and midwifery group practice in public hospitals. </p>
<p>Women recognised the benefits of continuity and how this included informed decision-making and supported their choices.</p>
<p>The model of care with the highest number of positive comments was care from a privately practising midwife. Women felt they received the “gold standard of maternity care” when they had this model. One woman described her care as:</p>
<blockquote>
<p>Extremely personable! Home visits were like having tea with a friend but very professional. Her knowledge and empathy made me feel safe and protected. She respected all of my decisions. She reminded me often that I didn’t need her help when it came to birthing my child, but she was there if I wanted it (or did need it).</p>
</blockquote>
<p>However, this is a private model of care and women need to pay for it. So there are barriers in accessing this model of care due to the <a href="https://doi.org/10.1016/j.wombi.2020.06.001">cost</a> and the small numbers working in Australia, particularly in <a href="https://www.ruralhealth.org.au/sites/default/files/publications/fact-sheet-midwives.pdf">regional, rural and remote areas</a>, among other barriers.</p>
<p>Women who had private obstetricians were also positive about their care, especially among women with medical or pregnancy complications – this type of care had the second-highest number of positive comments. </p>
<p>This was followed by women who had continuity of care from midwives in the public system, which was described as respectful and supportive. </p>
<p><iframe id="iRWBu" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/iRWBu/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>However, one of the limitations about continuity models of care is when the woman doesn’t feel connected to her midwife or doctor. Some women who experienced this wished they had the opportunity to choose a different midwife or doctor. </p>
<h2>What about shared care with a GP?</h2>
<p>While shared care between the <a href="https://raisingchildren.net.au/pregnancy/health-wellbeing/tests-appointments/gps-shared-care-pregnancy">GP</a> and hospital model of care is widely promoted in the public maternity care system as providing continuity, it had a similar number of negative comments to those who had fragmented standard hospital care. </p>
<p>Considering there is strong evidence about the <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004667.pub5/full">benefits of midwifery continuity of care</a>, and this model of care appears to be most acceptable to women, it’s time to expand access so all Australian women can access continuity of care, regardless of their location or ability to pay. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/birthing-on-country-services-centre-first-nations-cultures-and-empower-women-in-pregnancy-and-childbirth-170641">Birthing on Country services centre First Nations cultures and empower women in pregnancy and childbirth</a>
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</p>
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<img src="https://counter.theconversation.com/content/217803/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hazel Keedle is affiliated with the Australian College of Midwives. Funding for this study was from a School of Nursing and Midwifery Partnership Grant through Western Sydney University, The Qiara Vincent Thiang Memorial Award and Maridulu Budyari Gumal SPHERE Maternal, Newborn and Women’s Clinical Academic Group funding.</span></em></p><p class="fine-print"><em><span>Hannah Dahlen has received funding from the National Health and Medical Research Commission, the Australian Research Council, the Medical Research Future Fund (funding and for this study and funding from a School of Nursing and Midwifery Partnership Grant through Western Sydney University), The Qiara Vincent Thiang Memorial Award and Maridulu Budyari Gumal SPHERE Maternal, Newborn and Women’s Clinical Academic Group funding.</span></em></p>Women favour seeing the same health provider throughout pregnancy, in labour and after they have their baby – whether that’s via midwifery group practice, a private midwife or a private obstetrician.Hazel Keedle, Senior Lecturer of Midwifery, Western Sydney UniversityHannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2180452023-12-17T19:17:20Z2023-12-17T19:17:20ZIs it OK to take antidepressants while pregnant?<figure><img src="https://images.theconversation.com/files/564779/original/file-20231211-15-ucu6di.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3834%2C2160&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sad-pregnant-woman-holding-belly-sitting-1497946568">Motortion Films/Shutterstock</a></span></figcaption></figure><p>Mental health conditions including <a href="https://aps.onlinelibrary.wiley.com/doi/abs/10.1111/cp.12058">anxiety</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/34036464/">depression</a> are among the most common disorders affecting women <a href="https://pubmed.ncbi.nlm.nih.gov/25455248/">during pregnancy and after birth</a>. </p>
<p>Evidence shows <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4879174/">mental health conditions</a> in pregnancy increase the risk of complications for the mother and baby.</p>
<p>However, there is <a href="https://www.smh.com.au/national/new-guidelines-aim-to-lift-stigma-around-antidepressants-during-pregnancy-20231109-p5eivo.html">some stigma</a> around taking antidepressants while pregnant or breastfeeding. So how should women decide whether or not to take antidepressants during these periods?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/antidepressants-and-pregnancy-study-didnt-find-they-actually-cause-autism-81271">Antidepressants and pregnancy: study didn't find they actually cause autism</a>
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<h2>Mental health in pregnancy and after birth</h2>
<p>Untreated <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4879174/">anxiety and depression</a> in pregnancy have been linked to an increased risk of stillbirth, premature birth, low birth weight and low APGAR scores (a test done at birth to check the baby’s health in various domains).</p>
<p>In addition, anxiety or depression during pregnancy may lead to increased maternal weight gain, substance use or smoking. These lifestyle factors can also <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-06090-7#">lead to complications</a> for the baby. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/30196868/">Anxiety and depression</a> during and <a href="https://pubmed.ncbi.nlm.nih.gov/27993226/">after pregnancy</a> can affect bonding between mother and baby, and hinder the child’s behavioural and emotional development.</p>
<p>Meanwhile, complications in the pregnancy may worsen mental health symptoms for the mother.</p>
<figure class="align-center ">
<img alt="A pregnant woman looks out a window." src="https://images.theconversation.com/files/564782/original/file-20231211-23-wy06kc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564782/original/file-20231211-23-wy06kc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564782/original/file-20231211-23-wy06kc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564782/original/file-20231211-23-wy06kc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564782/original/file-20231211-23-wy06kc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564782/original/file-20231211-23-wy06kc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564782/original/file-20231211-23-wy06kc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women may be reluctant to take medications while pregnant.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/love-joy-mother-1007992423">Tapao/Shutterstock</a></span>
</figcaption>
</figure>
<p>Not coping during pregnancy and especially after giving birth is demoralising and puts women at risk of self-harm. Suicide is a <a href="https://www.aihw.gov.au/reports/mothers-babies/maternal-deaths-australia#cause">leading cause</a> of maternal death in Australia in the <a href="https://clinicalexcellence.qld.gov.au/sites/default/files/docs/safety-and-quality/qmpqc-report-2021.pdf">year after giving birth</a>. </p>
<h2>Treatment options</h2>
<p>Depending on the severity of symptoms, treatment options for women during and after pregnancy range from social and emotional support (for example, support groups) to psychological interventions (such as cognitive behavioural therapy) to medical treatments (for example, antidepressants).</p>
<p>Understandably, many women <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013560.pub2/full">are reluctant</a> to take medications during pregnancy and while breastfeeding due to concerns the drugs may cross over to the baby and cause complications. Historical instances such as the use of thalidomide for morning sickness, which resulted in severe structural abnormalities in thousands of children, naturally make pregnant women worried.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thalidomide-survivors-are-receiving-an-apology-for-the-pharmaceutical-disaster-that-changed-pregnancy-medicine-218691">Thalidomide survivors are receiving an apology for the pharmaceutical disaster that changed pregnancy medicine</a>
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</em>
</p>
<hr>
<p>Robust evidence about medication use in pregnancy is lacking. This may be due to ethical limitations around trialling medications in pregnant women. The limited data available, mainly from observational studies on selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6096863/">most commonly prescribed</a> antidepressants during pregnancy, has mixed results. </p>
<p>While some studies have reported no noticeable increase in the risk of <a href="https://www.psychiatrist.com/jcp/antidepressant-exposure-during-pregnancy-congenital/">congenital malformations</a>, evidence has shown a marginal rise in abnormalities such as <a href="https://www.nice.org.uk/guidance/cg192">heart defects</a> (an extra two cases per 1,000 babies with SSRIs). </p>
<h2>Collaborative decisions</h2>
<p>There is a delicate balance to strike between treating the mother and preventing harm to the baby. To make well-informed decisions, an open discussion between the patient and specialised mental health care providers on the benefits and risks of starting or continuing antidepressants is essential. </p>
<p>Given the mother’s poor mental health increases the risk of adverse outcomes for the baby, it may well be that taking antidepressants is the best way to protect the baby.</p>
<p>For women already taking antidepressants, it’s not usually necessary to stop using them during pregnancy. Sudden cessation of antidepressants increases the risk <a href="https://pubmed.ncbi.nlm.nih.gov/16449615/">of relapse</a>.</p>
<p>Continuing breastfeeding on antidepressants is likely the best decision because of the low <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013560.pub2/full">levels of drugs</a> infants are exposed to in breast milk, the advantages of breastfeeding for the baby, and the risks of not taking antidepressants when indicated. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/20-of-pregnant-australian-women-dont-receive-the-recommended-mental-health-screening-139979">20% of pregnant Australian women don't receive the recommended mental health screening</a>
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<p>Recently revised <a href="https://www.cope.org.au/health-professionals/health-professionals-3/">guidelines</a> on mental health care in the perinatal period (during pregnancy and after birth) warn health professionals against the dangers of failing to prescribe necessary medication:</p>
<blockquote>
<p>Be aware that failure to use medication where indicated for depression and/or anxiety in pregnancy or postnatally may affect mother-infant interaction, parenting, mental health and wellbeing and infant outcomes.</p>
</blockquote>
<p>These guidelines also recommend repeated screening for symptoms of depression and anxiety for all women during the perinatal period. This is crucial to providing women with an early referral to perinatal mental health services if needed.</p>
<p>At present, mental health conditions during pregnancy and after birth often go undetected and untreated. </p>
<figure class="align-center ">
<img alt="A pregnant woman talks to a therapist." src="https://images.theconversation.com/files/564784/original/file-20231211-26-u02x0q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564784/original/file-20231211-26-u02x0q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564784/original/file-20231211-26-u02x0q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564784/original/file-20231211-26-u02x0q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564784/original/file-20231211-26-u02x0q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564784/original/file-20231211-26-u02x0q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564784/original/file-20231211-26-u02x0q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There are a range of treatment options for perinatal anxiety and depression.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/depressed-pregnant-woman-consultation-psychologist-2064159131">Pormezz/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Supporting perinatal mental health</h2>
<p>Mental illness in pregnancy is a significant public health problem. Screening is not always <a href="https://theconversation.com/20-of-pregnant-australian-women-dont-receive-the-recommended-mental-health-screening-139979">delivered effectively</a>, and currently, there is <a href="https://www.aihw.gov.au/reports/mothers-babies/data-opportunities-in-perinatal-mental-health-scre/contents/about">no national data</a> regarding perinatal mental health screening service use or outcomes. </p>
<p>Mine and my colleagues’ <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2320-9">research</a> on pregnant women’s engagement with perinatal mental health services indicated only one-third of eligible women accepted a referral, and less than half attended their appointment. Women may be reluctant to engage due to stigma, time restraints, and lack of childcare or social support.</p>
<p>To address this, we should create strategies and resources in collaboration with pregnant women to identify solutions that work best for them. This might include assistance with childcare, access to telehealth, visits from a perinatal mental health professional, or written information on medications. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/considering-going-off-antidepressants-heres-what-to-think-about-first-198880">Considering going off antidepressants? Here's what to think about first</a>
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<p>Care must be holistic and include partners who may be best placed to support pregnant women in making complex decisions. Health-care providers need to be respectful of individual needs and provide compassionate care to engage vulnerable mothers who may understandably feel uncertain regarding their options.</p>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/218045/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alka Kothari does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Guidelines on mental health during pregnancy and after birth emphasise antidepressants should be prescribed if they’re needed.Alka Kothari, Associate Professor, Faculty of Medicine, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2196632023-12-14T13:19:15Z2023-12-14T13:19:15ZWe think we have found a cause of pregnancy sickness, and it may lead to a treatment<figure><img src="https://images.theconversation.com/files/565507/original/file-20231213-19-swroox.jpg?ixlib=rb-1.1.0&rect=48%2C0%2C5351%2C3540&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pregnancy sickness is believed to affect 7 in 10 women. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-suffering-morning-sickness-bathroom-home-1041217495">Monkey Business Images/Shutterstock</a></span></figcaption></figure><p>Sickness in pregnancy, or hyperemesis gravidarum, is common and is thought to <a href="https://journals.lww.com/obgynsurvey/abstract/2013/09001/the_impact_of_nausea_and_vomiting_of_pregnancy_on.1.aspx">affect</a> seven out of ten women at some time in their pregnancy. But, until recently, very little has been known about why it happens. </p>
<p><a href="https://www.nature.com/articles/s41586-023-06921-9">New research</a> by our team has identified sensitivity to a hormone made in abundance by the developing pregnancy, GDF15, as a contributor to the risk of pregnancy sickness.</p>
<p>This condition can affect pregnant women’s quality of life, even in so-called mild cases. Between 1% and 3% of women <a href="https://pubmed.ncbi.nlm.nih.gov/31515515/">suffer</a> from a severe form of pregnancy sickness when nausea and vomiting are so severe that they lose weight or become dehydrated, or both. In one study, this condition was the most common reason that women were admitted to <a href="https://pubmed.ncbi.nlm.nih.gov/12100809/">hospital</a> in the first three months of pregnancy. </p>
<p>It has been <a href="https://onlinelibrary.wiley.com/doi/10.1111/ppe.12416">associated</a> with worse pregnancy outcomes and its effect lasts beyond the end of pregnancy with some women <a href="https://pubmed.ncbi.nlm.nih.gov/21635201/">reporting</a> psychological distress and being reluctant to <a href="https://pubmed.ncbi.nlm.nih.gov/28241811/">conceive again</a>. </p>
<p>The fact that it develops in early pregnancy and invariably resolves when pregnancy ends strongly suggests that the cause of the sickness comes from the developing pregnancy. But the detail on how and why it happens has remained elusive. This dearth of understanding makes the development of treatments difficult and arguably contributes to the considerable <a href="https://www.pregnancysicknesssupport.org.uk/documents/research%20papers/stigma-of-hg.pdf">stigma</a> associated with this condition. </p>
<h2>GDF15</h2>
<p>GDF15 is a hormone that suppresses food intake in mice by acting, probably exclusively, on a small group of cells at the base of the brain which are also known to induce nausea and vomiting. As such, GDF15 has been under investigation as an <a href="https://pubmed.ncbi.nlm.nih.gov/36754014/">obesity therapy</a>. </p>
<p>Early trials confirm it suppresses appetite in people, but it also causes <a href="https://pubmed.ncbi.nlm.nih.gov/36630958/">nausea and vomiting</a>. It has long been known that it is abundant in human placenta and is present at very high concentrations in the blood of healthy pregnant women. These factors make it a plausible cause, but a detailed understanding of if GDF15 affects the severity of sickness in pregnancy has been lacking. </p>
<p>We used a variety of methods to study how GDF15 increases the risk of pregnancy sickness. We measured GDF15 in the blood of pregnant women attending hospital due to sickness and those attending hospital for other reasons. </p>
<p>We found that women with pregnancy sickness did indeed have higher levels of GDF15. While this was in keeping with GDF15 contributing to the condition, levels of GDF15 in each group overlapped substantially. This suggests that factors other than the absolute amount of GDF15 coming from the developing pregnancy might determine the risk of sickness.</p>
<p>Natural variation in DNA of future mothers contributes to risk of pregnancy sickness. Previous <a href="https://pubmed.ncbi.nlm.nih.gov/29563502/">studies</a> have identified changes in DNA near GDF15 as the biggest determinants of risk of pregnancy sickness. In particular, one rare genetic mutation (present in around one in 1,500 people) that affects the make-up of the GDF15 protein in the blood, has a large <a href="https://pubmed.ncbi.nlm.nih.gov/35218128/">effect</a> on that risk. </p>
<p>To understand the potential impact of this genetic variant on GDF15 levels in the bloodstream, we studied its effects on the protein in lab-grown cells. We discovered that this mutated GDF15 molecule gets stuck inside cells. What’s more, it actually stuck to and trapped “normal” GDF15 – this creates a double hit that hinders the transport of GDF15 out of cells. Healthy people with this mutation have markedly lower levels of GDF15 in their blood, which is consistent with these findings.</p>
<figure class="align-center ">
<img alt="A pregnant woman sits on the edge of a bed clutching her bump." src="https://images.theconversation.com/files/565574/original/file-20231213-21-z851cx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565574/original/file-20231213-21-z851cx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565574/original/file-20231213-21-z851cx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565574/original/file-20231213-21-z851cx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565574/original/file-20231213-21-z851cx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565574/original/file-20231213-21-z851cx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565574/original/file-20231213-21-z851cx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Between 1% and 3% of women suffer from a severe form of pregnancy sickness.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-woman-sitting-on-bed-holding-310309151">Monkey Business Images/Shutterstock</a></span>
</figcaption>
</figure>
<p>We discovered that DNA changes near GDF15, which are prevalent in about 15 to 30% of people, lower the levels of the hormone. These changes increase the risk of pregnancy sickness by small amounts. Conversely, women with the blood disorder <a href="https://www.nhs.uk/conditions/thalassaemia/">thalassaemia</a>, who have very high levels of GDF15 throughout life, actually reported much less nausea and vomiting in pregnancy.</p>
<h2>A roadmap to treatment</h2>
<p>The conclusion of these studies is clear –- predisposition to higher levels of GDF15 when not pregnant reduces the risk of pregnancy sickness. At first glance, this is rather perplexing because how can having higher levels of a hormone that makes you sick protect against pregnancy sickness? </p>
<p>In fact, several hormone systems exhibit a phenomenon resembling memory, where the sensitivity to a hormone is influenced by previous exposure to that hormone. This seemed like the most plausible explanation for our results. Supporting this theory, mice with persistently high levels of GDF15 in their bloodstream were relatively unresponsive to an acute surge in GDF15 levels. </p>
<p>Our findings suggest that lower levels of GDF15 before pregnancy result in women being hypersensitive to the large amounts of GDF15 being released from the developing pregnancy. This poses two obvious approaches to treatment of this condition –- desensitising women to GDF15 by increasing its levels before pregnancy or blocking its action during pregnancy. </p>
<p>The challenge now is to develop and test strategies to achieve these aims that are safe and acceptable to women at risk from this debilitating condition.</p><img src="https://counter.theconversation.com/content/219663/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sam Lockhart is supported by a Wellcome Trust Clinical PhD Fellowship (225479/Z/22). SL is a named creator of a pending patent application relating to therapy for hyperemesis gravidarum filed by Cambridge Enterprise Limited (GB application No. 2304716.0; Inventor: Professor Stephen O’Rahilly.</span></em></p><p class="fine-print"><em><span>Stephen O'Rahilly has undertaken remunerated consultancy work for Pfizer, Third Rock Ventures, AstraZeneca, NorthSea Therapeutics and Courage Therapeutics. Part of the work in this paper is the subject of a pending patent application relating to therapy for hyperemesis gravidarum filed by Cambridge Enterprise Limited (GB application No. 2304716.0; Inventor: Professor Stephen O’Rahilly). SL and NR are named creators on this patent.</span></em></p>New research has uncovered the hormone that triggers morning sickness, offering hope for millions of women.Sam Lockhart, Wellcome Trust Clinical PhD Fellow, Institute of Metabolic Science and Medical Research Council Metabolic Diseases Unit, University of CambridgeStephen O'Rahilly, Professor and Co-Director of the Institute of Metabolic Science and Director of the Medical Research Council Metabolic Diseases Unit, University of CambridgeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2136362023-12-06T13:27:05Z2023-12-06T13:27:05ZGlyphosate, the active ingredient in the weedkiller Roundup, is showing up in pregnant women living near farm fields – that raises health concerns<figure><img src="https://images.theconversation.com/files/551447/original/file-20231002-17-ifqt51.png?ixlib=rb-1.1.0&rect=156%2C760%2C1189%2C772&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As suburbs encroach on farmland, residents' risk of exposure to farm chemicals rises.</span> <span class="attribution"><span class="source">Carly Hyland</span></span></figcaption></figure><p>Living near farmland can significantly increase people’s exposure to glyphosate, the active ingredient in the widely used herbicide Roundup, new research shows. This chemical has been connected to health concerns, including non-Hodgkin lymphoma and a higher risk of preterm birth.</p>
<p>We are <a href="https://www.boisestate.edu/spph/ccurl/">environmental health</a> <a href="https://publichealth.berkeley.edu/people/carly-hyland/">scientists</a> who study <a href="https://www.cdpr.ca.gov/docs/dept/factshts/what2.pdf">pesticide</a> exposures in human populations, including exposures to herbicides. In our <a href="https://ehp.niehs.nih.gov/doi/10.1289/EHP12768">newly published research</a>, we tracked glyphosate levels in pregnant women for 10 months.</p>
<p>We found that those who were living within about a third of a mile (500 meters) of an agricultural field had significantly higher levels of glyphosate in their urine than those who lived farther away. Importantly, we only saw those differences during the time of year when farmers spray glyphosate on their fields, further suggesting agricultural spray as the source of this exposure.</p>
<p>Our <a href="https://doi.org/10.1289/EHP12155">research also found</a> that eating organic food, produced without the use of synthetic pesticides, could reduce glyphosate levels in women living far from farm fields – but not in women who lived near farm fields.</p>
<p>Together, the results provide new insight into how people are exposed to this common and potentially harmful chemical.</p>
<h2>Why it matters</h2>
<p>Glyphosate is the single <a href="https://doi.org/10.1186/s12302-016-0070-0">most heavily used agricultural pesticide in the world</a>. Its use <a href="https://water.usgs.gov/nawqa/pnsp/usage/maps/show_map.php?year=2019&map=GLYPHOSATE&hilo=L&disp=Glyphosate">grew dramatically</a> over the past two decades with the increase in production of genetically modified, herbicide-resistant crops. These crops are engineered to withstand the weed-killing effects of herbicides like glyphosate, which means that an entire field can be sprayed with these chemicals, eliminating the weeds without harm to the crop itself. This is a change from previous practices, where herbicide applications had to be more targeted. </p>
<p>While herbicides like <a href="https://ipm-drift.cfaes.ohio-state.edu/sites/hdrm/files/imce/Overview%20of%20Drift%20Issues%20FINAL.pdf">dicamba and 2,4-D</a> are known to become airborne, glyphosate is not volatile, so there has been less concern over its potential to drift when it is sprayed on crops.</p>
<p>However, our research provides evidence for the first time that agricultural use of glyphosate still reaches people living nearby.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/551449/original/file-20231002-27-n4hzko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A corn field with a road sign reading: 'This road to be extended in the future.' That extension is to build houses in the middle of what is currently a farm field." src="https://images.theconversation.com/files/551449/original/file-20231002-27-n4hzko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/551449/original/file-20231002-27-n4hzko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=430&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551449/original/file-20231002-27-n4hzko.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=430&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551449/original/file-20231002-27-n4hzko.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=430&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551449/original/file-20231002-27-n4hzko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=540&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551449/original/file-20231002-27-n4hzko.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=540&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551449/original/file-20231002-27-n4hzko.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=540&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Rural communities have dealt with risks from agriculture chemicals for many years.</span>
<span class="attribution"><span class="source">Carly Hyland</span></span>
</figcaption>
</figure>
<p>It is important to note that <a href="https://doi.org/10.1186/s12302-018-0184-7">there is no consensus</a> on whether or not this widely used herbicide causes cancer.</p>
<p>The International Agency for Research on Cancer, part of the World Health Organization, has determined that glyphosate is “<a href="https://www.iarc.who.int/featured-news/media-centre-iarc-news-glyphosate/">probably carcinogenic to humans</a>,” while the U.S. Environmental Protection Agency has concluded that it is “<a href="https://www.epa.gov/ingredients-used-pesticide-products/glyphosate">not likely to be carcinogenic to humans</a>.” This debate is playing out in <a href="https://www.forbes.com/advisor/legal/product-liability/roundup-lawsuit-update/">courtrooms across the U.S.</a>, with <a href="https://www.reuters.com/legal/litigation/bayer-winning-streak-roundup-litigation-after-huge-initial-losses-2022-09-02/">mixed results</a>.</p>
<p>In addition to concerns about cancer risk, four recent human studies found that glyphosate exposure during pregnancy was associated with <a href="https://doi.org/10.1016%2Fj.envres.2021.111811">reproductive effects</a>. These effects included <a href="https://doi.org/10.1289/EHP7295">preterm birth</a>, <a href="https://doi.org/10.1186/s12940-018-0367-0">shortened gestational duration</a> and <a href="https://doi.org/10.1186/s12940-022-00906-3">reduced fetal growth</a>.</p>
<p>However, scientists <a href="https://doi.org/10.1186/s12940-018-0435-5">know very little</a> about levels and sources of glyphosate exposure among pregnant women. The potential risk and that lack of data is why our study focused on this group.</p>
<h2>How we did our work</h2>
<p>We collected 1,395 urine samples from 40 pregnant women living in southern Idaho. This included weekly urine samples from February through December 2021. Among women living near fields, we found that urinary glyphosate levels were <a href="https://ehp.niehs.nih.gov/doi/10.1289/EHP12768">about 50% higher during the pesticide spray season</a> – May through August in southern Idaho – than they were during the rest of the year.</p>
<p>For two weeks in June, we also provided study participants with a week of <a href="https://doi.org/10.1289/EHP12155">organic food</a> and a week of conventional food, in random order, and collected daily urine samples. Glyphosate levels decreased by about 25% from the conventional to the organic-food week for participants who lived far from fields. But for the women who lived near fields, the shift to an organic diet didn’t change their glyphosate levels.</p>
<p>The results suggest that, for people living in cities and towns, an organic diet can be an effective way to reduce glyphosate exposure. However, for people living near farms, exposure from nearby agricultural applications may matter more.</p>
<h2>What still isn’t known</h2>
<p>Our finding that living near agriculture is associated with higher glyphosate levels in the body provides important new insights about who is exposed to this herbicide. However, we still don’t know exactly how this exposure is occurring.</p>
<p>While many pesticides are transported by airborne drift, it is possible that glyphosate travels in a different way. For example, it may adhere to soil that is blown or tracked into homes.</p>
<p>Understanding this is pivotal to reducing human exposure to chemicals in agricultural areas. It is also important as <a href="https://farmlandinfo.org/wp-content/uploads/sites/2/2020/09/AFT_FUT_StateoftheStates_rev.pdf">urbanization takes over land that was previously farmed</a>. As new subdivisions and residential areas expand into and fragment agricultural areas, homeowners are finding themselves with farm fields, and their chemicals, as neighbors.</p>
<p><em>The Research Brief is a short take on interesting academic work.</em></p>
<p><em><a href="https://theconversation.com/pesticida-glifosato-esta-aparecendo-em-mulheres-gravidas-que-vivem-perto-de-fazendas-nos-eua-219383">Leia em português</a></em>.</p><img src="https://counter.theconversation.com/content/213636/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cynthia Curl receives funding from the National Institute of Environmental Health Sciences NIEHS), a part of the National Institutes of Health (NIH).</span></em></p><p class="fine-print"><em><span>Carly Hyland receives funding from the National Institutes of Environmental Health Sciences (NIEHS) and the National Institute of Occupational Health and Safety (NIOSH). </span></em></p>New research provides evidence for the first time that the primary chemical in Roundup is reaching people in nearby homes, and it isn’t just from the food they eat.Cynthia Curl, Associate Professor of Public and Population Health, Boise State UniversityCarly Hyland, Assistant Professor of Cooperative Extension, University of California, BerkeleyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2103012023-11-20T14:36:06Z2023-11-20T14:36:06ZEarly births – between 34 and 37 weeks – for moms with pre-eclampsia can reduce baby and mother deaths<p>About <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9790089/">half a million</a> babies die each year as a result of pre-eclampsia, an aggressive and potentially life-threatening problem in pregnancy. Approximately <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9790089/">46,000 women also die each year due to the disorder</a>.</p>
<p>The condition – a high blood pressure (hypertension) disorder – can affect multiple organs in the woman’s body, including the liver, kidneys, heart, brain and blood clotting system, as well as the growth and development of the foetus. If severe, and untreated, it can lead to the placenta detaching from the womb (placental abruption), seizures, stroke, maternal death and stillbirth.</p>
<p>Pre-eclampsia can be difficult to predict, and it can progress rapidly. The only treatment is delivery. </p>
<p>In a <a href="https://cribs-i.org/wp-content/uploads/2023/07/Lancet-Planned-Delivery.pdf">recent paper</a> we found that planned early birth reduced the risk of stillbirth and improved most outcomes for mothers and babies. We concluded that clinicians can routinely deliver babies for mothers who have pre-eclampsia, from 34 weeks – even in a low resource setting. </p>
<p>We recommend that planned early delivery is implemented to reduce adverse pregnancy outcomes in late preterm pre-eclampsia, particularly stillbirth. We argue that the intervention should form part of a concerted global effort to end all maternal and perinatal deaths from preventable causes.</p>
<h2>When to deliver</h2>
<p>Deciding when to offer birth requires careful balancing of risks and benefits. Early preterm delivery (before 34 weeks’ gestation) is only recommended if severe complications of pre-eclampsia have developed, where the benefit of delivery outweighs the risk of potential complications of early preterm birth for the baby (for example, breathing or feeding difficulties). </p>
<p>For the period between 34 and 37 weeks, there has not been enough research to guide women and clinicians as to whether it is better to routinely offer late preterm birth to all women with pre-eclampsia, or to watch and wait until either 37 weeks’ gestation is reached, or complications develop. </p>
<p>We set out to answer this question in a trial which we carried out in India and Zambia.</p>
<p>The <a href="https://vimeo.com/amanifilms/cradle-4trial">Cradle-4 trial</a> was a randomised controlled trial which compared planned delivery (initiating delivery within 48 hours of trial entry) to usual care (watching and waiting until 37 weeks, or the development of complications needing delivery). Women who agreed to participate were randomly allocated to either planned delivery, or to usual care. A total of 565 women with pre-eclampsia, between 34 and 37 weeks of pregnancy, without an immediate indication for delivery, took part. The trial was conducted across nine sites in India and Zambia.</p>
<p>The study found that planned delivery significantly reduced the risk of stillbirth – by 75%. In addition, planned delivery did not increase the risk of the baby needing to go to the neonatal unit. Neither did it increase the risk of short-term complications after birth, such as breathing or feeding difficulties. This is an especially important finding for clinicians working with limited neonatal resources, who can be reassured that planned early birth is safe. </p>
<p>Encouragingly, planned delivery reduced the risk of severely high blood pressure in the woman, compared to usual care. Rates of other complications such as eclampsia and placental abruption (where the placenta detaches from the womb) were also lower in the planned delivery group. Mothers who delivered early were as likely as those in the usual care group to achieve a vaginal birth, and spent less time in hospital. </p>
<h2>Next steps</h2>
<p>The current maternal mortality rate in the world is 223 per 100,000. The aim under the Sustainable Development Goals is to reduce that to <a href="https://www.un.org/sustainabledevelopment/health/">70 per 100,000 live births by 2030</a>.</p>
<p>But this won’t happen unless there is a focus on interventions that address the major causes of maternal death in regions where they are most needed. These include sub-Saharan Africa and south Asia, <a href="https://www.who.int/publications/i/item/9789240068759">according to the World Health Organization</a>.
Our findings show that one such intervention should be to incorporate planned delivery from 34 weeks into routine care. </p>
<p>But this won’t be easy, particularly in low- and lower-middle income settings, due to over-stretched, under-staffed healthcare systems, where access to key resources may be variable. </p>
<p>To progress the idea, a number of steps need to be taken.</p>
<p>Firstly, early delivery should be incorporated into national and international guidelines across the globe. For this to happen there must an increased understanding around pre-eclampsia via community engagement. Women need to be better informed about what to look out for and what action to take, and need to be able to access healthcare facilities.</p>
<p>Community engagement is critical to translating research into impact and creating awareness about ways to alleviate this health issue. </p>
<p>This has already been initiated in some countries. For example, our research group has developed community engagement tools including docu-dramas designed alongside communities in Zimbabwe, Haiti and Sierra Leone. </p>
<p>A recent dynamic awareness campaign about pre-eclampsia was launched in Sierra Leone. It included creating competitions at universities to produce poems and videos about pre-eclampsia, putting stickers on taxis and motorbikes and putting up posters. </p>
<p>In Zambia, a national television broadcast encouraging women to attend antenatal care and recognise the danger signs of pre-eclampsia was shown on World Pre-eclampsia Day. </p>
<p>Secondly, planned delivery needs to be implemented alongside a range of interventions. Medical practitioners need to be enabled to provide early risk stratification, prediction of pre-eclampsia, safe labour and delivery care, and postnatal follow-up. </p>
<p>Thirdly, more research needs to be done in resource-stretched settings. Currently, only <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30539-8/fulltext">2% of clinical trials</a> take place in sub-Saharan African countries and even fewer address the most important causes of maternal mortality. </p>
<p>The <a href="https://vimeo.com/amanifilms/cradle-4trial">Cradle-4 Trial</a> acts as an important example of how this can be changed, and demonstrates the power of locally-driven evidence.</p><img src="https://counter.theconversation.com/content/210301/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alice Beardmore-Gray does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Planned early delivery is a key component of reducing child and maternal mortality.Alice Beardmore-Gray, Cradle 4 Trial Coordinator, Department of Women's Health, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2175612023-11-17T03:54:30Z2023-11-17T03:54:30ZPlay School meets Ikea: new Australian play Welcome to Your New Life hilariously captures new motherhood<figure><img src="https://images.theconversation.com/files/560092/original/file-20231116-19-nz4fa3.jpg?ixlib=rb-1.1.0&rect=30%2C10%2C6688%2C3968&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Matt Byrne/STCSA</span></span></figcaption></figure><p>Anna Goldsworthy’s hilarious and beautifully honest book Welcome To Your New Life celebrates the joy and roller-coaster ride of first-time parenting.</p>
<p>Now a new play adapted for the stage by Goldsworthy, Welcome To Your New Life takes the audience through the experience of pregnancy, delivery and new parenthood from sleep-deprived birth to toddler years. </p>
<p>Goldsworthy’s lively writing – monologues interspersed with vignettes, songs and small scenes – deftly captures the joy and wilful naivety of a first pregnancy, followed by the overwhelming love and sleep-deprivation-induced anxiety of the first months. As a mother of two I laughed, scoffed, giggled and cried in recognition and remembrance of the bliss and insanity of being a newly minted parent. </p>
<p>Erin James excels as the unnamed mum-to-be/new mum: her delight is infectious, her navigating of what other people expect when you’re expecting is razor-sharp, and her post-natal anxiety spirals heartbreaking in their relentlessness. </p>
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Read more:
<a href="https://theconversation.com/is-it-possible-to-describe-the-complexity-and-absurdity-of-motherhood-181066">Is it possible to describe the complexity and absurdity of motherhood?</a>
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<h2>A joy</h2>
<p>All three actors are a sheer joy to watch.</p>
<p>Family and friends, medical professionals, passers-by, the family dog and assorted new mothers are deftly brought to life by Kathryn Adams and Matt Crook. Crook’s breastfeeding patronising new mum is a highlight, as is Adams’ lactation consultant. Crook and Adams also each take on key roles in the new mum’s life.</p>
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<a href="https://images.theconversation.com/files/560094/original/file-20231116-15-e2ewrl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man and a woman ham for the camera." src="https://images.theconversation.com/files/560094/original/file-20231116-15-e2ewrl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/560094/original/file-20231116-15-e2ewrl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/560094/original/file-20231116-15-e2ewrl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/560094/original/file-20231116-15-e2ewrl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/560094/original/file-20231116-15-e2ewrl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/560094/original/file-20231116-15-e2ewrl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/560094/original/file-20231116-15-e2ewrl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The cast are a joy to watch.</span>
<span class="attribution"><span class="source">Matt Byrne/STCSA</span></span>
</figcaption>
</figure>
<p>The mum’s much-loved grandmother Moggie is given warmth, humour and depth by Adams in a masterful performance. The love and support between the mum and Moggie is one of the relationships we see in detail; her kind comforting of the frazzled mother is part of the human heart of this piece. Through her, we are invited to reflect on the cycle of life and death that is the human condition.</p>
<p>The other detailed relationship is the devoted, then exhausted, husband-and-father Nicholas, played by Crook with superb skill and uncanny accuracy. His scenes with James – welcome moments in the play where the story is told in duologue – are lively and nuanced. A scene where the accumulated lack of sleep while on a blackly funny holiday finally brings them to shouting point is given devastating honesty by Crook. </p>
<h2>Adoring and cooing</h2>
<p>Beautifully directed by Shannon Rush, the first act centres on the mum-to-be. Rush repeatedly seats James on a circular couch chair in the middle of a circular Mondrian-esque rug, evoking the baby in the womb. </p>
<p>As the audience, in the second act we are positioned as “you”, the much-adored new baby. The performers focus their attention on different audience members as if they are the baby – adoring and cooing, marvelling at the developmental brilliance or bodily functions of this miracle child.</p>
<p>Simon Greer’s set is a child’s playroom on a giant scale, the actors tiny among the huge letter blocks, doors, box shelves and giant hanging mobile. Huge wooden toys serve as stethoscopes and seats, even the ever-present mobile phones are flat blocks of wood: it’s Play School meets Ikea. </p>
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<a href="https://images.theconversation.com/files/560091/original/file-20231116-20-xjji4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="The stage." src="https://images.theconversation.com/files/560091/original/file-20231116-20-xjji4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/560091/original/file-20231116-20-xjji4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/560091/original/file-20231116-20-xjji4m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/560091/original/file-20231116-20-xjji4m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/560091/original/file-20231116-20-xjji4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/560091/original/file-20231116-20-xjji4m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/560091/original/file-20231116-20-xjji4m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Simon Greer’s set is a child’s playroom on a giant scale.</span>
<span class="attribution"><span class="source">Matt Byrne/STCSA</span></span>
</figcaption>
</figure>
<p>The second act is stripped back, all bleached white scandi surfaces, giant alphabet blocks now lined up neatly along the walls, centre stage starkly empty – perfectly reflecting the too-bright world of post-natal sleep deprivation and its resultant devastating anxiety. </p>
<p>Gavin Norris’ lighting is simple and elegant: the massive contemporary light circle also eerily suggesting the too-bright light above the delivery-room bed.</p>
<h2>A play with music</h2>
<p>Billed as “a play with music”, composer Alan John’s music is beautifully wrapped around and through the story. Woven through the scenes are classical piano music and John’s songs, evoking and quoting nursery rhymes, or giving voice to key moments. Heartbeats and baby screaming are part of an ebbing and flowing sound design by Andrew Howard.</p>
<p>A large toy piano is a reminder of Goldsworthy’s life as a concert pianist. Key moments play out here: the mum plays music to negotiate the challenges she faces, and the ultimate new project: birthing a baby.</p>
<p>The three performers play toy pianos, glockenspiels, guitar and percussion, and also sing beautifully in harmony. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/560093/original/file-20231116-17-hgq4yl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman stands in front of a toilet." src="https://images.theconversation.com/files/560093/original/file-20231116-17-hgq4yl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/560093/original/file-20231116-17-hgq4yl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=361&fit=crop&dpr=1 600w, https://images.theconversation.com/files/560093/original/file-20231116-17-hgq4yl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=361&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/560093/original/file-20231116-17-hgq4yl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=361&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/560093/original/file-20231116-17-hgq4yl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=453&fit=crop&dpr=1 754w, https://images.theconversation.com/files/560093/original/file-20231116-17-hgq4yl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=453&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/560093/original/file-20231116-17-hgq4yl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=453&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A song about a composting toilet is a particular delight.</span>
<span class="attribution"><span class="source">Matt Byrne/STCSA</span></span>
</figcaption>
</figure>
<p>Inevitably there is some unevenness to this new show: some of the monologue songs in act one are less melodic and more difficult to access emotionally for the audience, but James’ clear voice shines, especially in the lush and dramatic piece about the dangers to a baby of a composting toilet. </p>
<p>In her program notes, Goldsworthy reflects on childbirth and parenting, a time when “survival becomes a greater priority than making art”. </p>
<p>Thank goodness for Goldsworthy’s writer’s reflex recording all her pregnancy-birth-post-partum experiences as they happened. Hilarious, insightful, heartfelt and zinging with the ping of recognition for parents and anyone who’s watched others go through this, Welcome To Your New Life is an important and wonderful new arrival.</p>
<hr>
<p><em>Welcome to your New Life is on at the State Theatre Company South Australia until November 25.</em></p><img src="https://counter.theconversation.com/content/217561/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Campbell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Anna Goldsworthy’s lively writing deftly captures the joy and wilful naivety of a first pregnancy, followed by the overwhelming love and sleep-deprivation-induced anxiety of the first months.Catherine Campbell, Lecturer, Performing Arts, UniSA Creative, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2166012023-11-15T13:16:14Z2023-11-15T13:16:14ZFor decades, mothers have borne the brunt of scrutiny for alcohol use during pregnancy − new research points to dad’s drinking as a significant factor in fetal alcohol syndrome<figure><img src="https://images.theconversation.com/files/558858/original/file-20231110-29-4ks5yo.jpg?ixlib=rb-1.1.0&rect=24%2C36%2C8155%2C5420&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Little to no attention has been given to the father's potential contribution to fetal alcohol syndrome disorders.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/hug-support-and-pregnancy-with-couple-in-living-royalty-free-image/1486895024?phrase=dad+drinking+during+pregnancy&searchscope=image%2Cfilm&adppopup=true">Katleho Seisa/E+ via Getty Images</a></span></figcaption></figure><p>Men drink more, are more likely to binge drink and are almost four times <a href="https://www.cdc.gov/alcohol/fact-sheets/mens-health.htm">more likely to develop alcohol use disorder</a> than women, according to the Centers for Disease Control and Prevention.</p>
<p>Yet when it comes to diagnosing babies born with birth defects associated with alcohol consumption, such as <a href="https://my.clevelandclinic.org/health/diseases/15677-fetal-alcohol-syndrome">fetal alcohol syndrome</a>, historically only the <a href="https://doi.org/10.1542/peds.2015-3113">mother’s drinking habits are taken into consideration</a>.</p>
<p>Research clearly shows that <a href="https://doi.org/10.1016%2Fj.molmet.2018.02.006">sperm carry a vast amount of epigenetic information</a> – meaning heritable shifts in the way genes are expressed that don’t result from changes in the DNA sequence – that strongly influences fetal development and child health. Yet most doctors and other health care providers do not take into account the influence of paternal health and lifestyle choices on child development.</p>
<p>I am <a href="https://scholar.google.com/citations?user=mjARCbsAAAAJ&hl=en">a developmental physiologist</a>, and my research explores the ways that <a href="https://doi.org/10.1002/bdr2.2215">male drinking affects fetal development</a>.</p>
<p>While most of the attention is given to the mom’s drinking while pregnant, my team and I focus on male drinking in the weeks and months before conception. Our studies are the first to demonstrate that male drinking before pregnancy is a <a href="https://doi.org/10.1172/JCI167624">plausible yet completely unexamined factor</a> in the development of alcohol-related craniofacial abnormalities and growth deficiencies. </p>
<h2>The intense focus on mom</h2>
<p>In 1981, the U.S. surgeon general issued a public health warning that <a href="http://come-over.to/FAS/SurgeonGeneral.htm">alcohol use by women during pregnancy</a> was the cause of physical and mental birth defects in children.</p>
<p>This warning came in response to growing recognition that a group of severe physical and mental impairments in children, now commonly known as fetal alcohol syndrome, were <a href="https://pubmed.ncbi.nlm.nih.gov/7250574/">correlated with maternal alcohol use during pregnancy</a>.</p>
<p>Today, doctors and scientists recognize that <a href="https://www.cdc.gov/ncbddd/fasd/1in20.html">as many as 1 in 20 U.S. schoolchildren may exhibit some form</a> of <a href="https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-fetal-alcohol-spectrum-disorders#">fetal alcohol spectrum disorders</a>, a term referring to a wide range of <a href="https://www.cdc.gov/ncbddd/fasd/facts.html">alcohol-related physical, developmental and behavioral deficits</a>, many of which cause lifelong challenges for those affected.</p>
<p>According to the CDC, this syndrome can occur when <a href="https://www.cdc.gov/ncbddd/fasd/facts.html">alcohol in the mother’s blood</a> passes to the baby through the umbilical cord. This has led to the firmly <a href="https://www.niaaa.nih.gov/research/fetal-alcohol-spectrum-disorders">accepted</a> belief that alcohol-related birth defects are caused only by maternal alcohol use during pregnancy and are the <a href="https://www.healthychildren.org/English/health-issues/conditions/chronic/Pages/Fetal-Alcohol-Spectrum-Disorders-FAQs-of-Parents-and-Families.aspx">woman’s</a> fault.</p>
<p>The medical community reinforces this perception by requiring pediatricians to compel mothers to confirm and document their prenatal alcohol use before they can formally diagnose children with <a href="https://doi.org/10.1542/peds.2015-3113">alcohol-related birth defects</a> or <a href="https://www.cdc.gov/ncbddd/fasd/features/neurobehavioral-disorder-alcohol.html">neurobehavioral disorders associated with prenatal alcohol exposure</a>. Nonetheless, there are multiple documented instances in which children diagnosed with fetal alcohol syndrome were born to mothers who denied that they consumed alcohol during pregnancy.</p>
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<figcaption><span class="caption">Fetal alcohol syndrome disorder can take a variety of forms. For instance, some may struggle with hand-eye coordination, while others have difficulties with emotional regulation.</span></figcaption>
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<p>For example, in one study, 41 mothers denied having consumed <a href="https://doi.org/10.1016%2Fj.drugalcdep.2022.109351">alcohol during pregnancy</a> despite their child receiving a diagnosis of fetal alcohol syndrome. In this circumstance and <a href="https://doi.org/10.1542/peds.2012-1371">others like it</a> over the past 40 years, the <a href="https://doi.org/10.1542/peds.109.5.815">commonly accepted assumption and explanation</a> is that these mothers lied about their alcohol use during pregnancy.</p>
<p>According to the CDC, there is <a href="https://www.cdc.gov/ncbddd/fasd/alcohol-use.html">no known safe amount of alcohol use</a> during pregnancy or while trying to get pregnant. Despite this recommendation, <a href="https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-fetal-alcohol-spectrum-disorders">alcohol use during pregnancy</a> is widely reported.</p>
<p>However, reported drinking levels do not directly correlate with a child developing alcohol-related birth defects, and not all women who drink give birth to children with fetal alcohol syndrome. This contradiction has resulted in <a href="https://doi.org/10.1136%2Fbmj.39371.381308.AD">conflicting</a> public <a href="https://doi.org/10.1136%2Fbmj.39356.489340.AD">messaging</a>.</p>
<p>Although differences in how much and when pregnant women drink can contribute to the variation in how fetal alcohol syndrome develops, these factors alone cannot explain the wide range and severity of symptoms. Therefore, unknown factors beyond maternal alcohol use must contribute to this debilitating disorder.</p>
<h2>Dad is the missing piece</h2>
<p>Alcohol is a social drug, so when women drink, they often do so with their male partner. Building from this perspective, my laboratory used a mouse model to determine <a href="https://doi.org/10.1172/JCI167624">what happens if mom, dad or both parents drink</a>. </p>
<p>Fetal alcohol syndrome is associated with <a href="https://doi.org/10.1542/peds.2015-3113">three core birth defects</a>: facial abnormalities, including small eyes and malformations in the middle of the face; reduced growth of the head and brain; and fetal growth restriction, a condition that occurs when babies are born smaller than average. Building on a previous study in humans, we used facial recognition software to study the effects of alcohol consumption on the faces of mice born to mothers, fathers or both parents who consumed alcohol before conception.</p>
<p>In a study published early this year, we captured a <a href="https://doi.org/10.1172/JCI167624">digital image of the mouse’s face</a>. We then digitally assigned facial landmarks, including specific parts of the eyes, ears, nose and mouth. The computer program then determined if maternal, paternal or dual parental alcohol exposures changed the proportional relationships between each of these landmarks.</p>
<p>Our study using this mouse model revealed that chronic male alcohol exposure affects the <a href="https://doi.org/10.1172/JCI167624">formation of the offspring’s brain, skull and face</a>. We also observed <a href="https://www.cdc.gov/ncbddd/birthdefects/microcephaly.html#">microcephaly</a>, the underdevelopment of the head and brain, as well as lower birth weight, which became worse the more the male parent drank.</p>
<p>Therefore, our studies demonstrate that chronic male alcohol exposure – defined as consuming more than five drinks per day in a four-hour window – could drive all three of the core fetal alcohol syndrome birth defects.</p>
<p>Using this same mouse model, we also determined that these <a href="https://doi.org/10.1172/JCI174216">craniofacial changes persist into later life</a>. Specifically, we identified abnormalities in the jaw and the size and spacing of the adult teeth. Abnormal alignment of the upper and lower teeth is another <a href="https://doi.org/10.1093/alcalc/agy071">recognized symptom of fetal alcohol syndrome in humans</a>.</p>
<p>Besides our research, other studies have identified <a href="https://doi.org/10.1016/j.alcohol.2015.02.008">behavioral changes in the offspring</a> of male mice who regularly consume alcohol. In addition, clinical studies suggest that paternal drinking <a href="https://doi.org/10.1001/jamapediatrics.2021.0291">increases the risk of heart defects</a> in people. </p>
<h2>Effects on male fertility and pregnancy</h2>
<p>Our studies also support more <a href="https://doi.org/10.1093/molehr/gaad002">immediate impacts of alcohol consumption on male fertility</a> and the ability of couples to <a href="https://doi.org/10.3389/fcell.2022.930375">achieve a healthy pregnancy</a>. These observations may be especially relevant for couples struggling to have children.</p>
<p>The CDC estimates that about 2% of all babies born in the U.S. are <a href="https://www.cdc.gov/art/index.html">conceived using assisted reproductive technologies</a>. While the focus of in-vitro fertilization treatments <a href="https://www.cdc.gov/art/ivf-success-estimator/index.html">remains maternal health and lifestyle choices</a>, our studies reveal that male alcohol exposure decreases the chance of becoming pregnant after undergoing IVF.</p>
<p>Significantly, our research showed that the more a man drinks before providing sperm, the <a href="https://doi.org/10.1093/molehr/gaad002">lower the chances of his partner becoming pregnant</a> – in some cases, by almost 50%. </p>
<h2>Looking ahead</h2>
<p>Annual estimates suggest that the cumulative costs of fetal alcohol spectrum disorders to the health care and educational systems range from <a href="https://doi.org/10.1111/add.14841">US$1.29 billion to $10.1 billion annually</a>. Given these exorbitant costs and the devastating lifelong effects on affected individuals, ignoring paternal drinking habits in public health messaging overlooks a significant contributing factor.</p>
<p>The first published investigations into the effects of maternal exposure to toxins on birth defects in the 1950s and ’60s were met with skepticism and disbelief. Today, it is widely accepted that <a href="https://doi.org/10.1542/peds.113.S3.935">maternal exposures to certain drugs</a> cause birth defects.</p>
<p>I fully anticipate that some within the medical and scientific communities, as well as the public, will forcefully deny that paternal drinking matters. However, until doctors start asking the father about his drinking, we will never fully know the contributions of paternal alcohol exposure to birth defects and child health.</p><img src="https://counter.theconversation.com/content/216601/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Golding receives funding from the National Institutes of Health (R01AA028219) and a Medical Research Grant from the W.M. Keck Foundation. </span></em></p>Public health messaging has focused on the drinking habits of the mother during pregnancy. But a growing body of research shows that what dad is drinking before pregnancy matters too.Michael Golding, Professor of Physiology, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2134992023-10-19T12:36:24Z2023-10-19T12:36:24ZNew treatment for postpartum depression offers hope, but the stigma attached to the condition still lingers<figure><img src="https://images.theconversation.com/files/552646/original/file-20231008-19-k1z29z.jpg?ixlib=rb-1.1.0&rect=0%2C17%2C5991%2C3970&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A lack of interest in the child is one of the signs of postpartum depression.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-sad-mother-holding-her-sleeping-baby-in-her-royalty-free-image/1489251307?phrase=postpartum+depression&adppopup=true">Drazen Zigic/iStock via Getty Images Plus</a></span></figcaption></figure><p>Postpartum depression can affect anyone, and it often sneaks in quietly, like a shadow in the corners of a new mother’s life. It presents significant challenges for around <a href="https://www.postpartumdepression.org/resources/statistics/">1 in 7 new mothers</a>, affecting their emotional well-being and overall quality of life and that of the newborn. </p>
<p>Many – <a href="https://www.marchofdimes.org/find-support/topics/postpartum/baby-blues-after-pregnancy#">if not most</a> – women experience the “baby blues,” or generalized feelings of sadness, worry, unhappiness and exhaustion, in the initial days after giving birth. In most cases, these mood changes <a href="https://www.nimh.nih.gov/health/publications/perinatal-depression">are resolved in the first two weeks after having a baby</a>. In contrast, the symptoms of postpartum depression endure for more extended periods, sometimes lingering <a href="https://www.nih.gov/news-events/nih-research-matters/postpartum-depression-may-last-years">for up to three years</a>. </p>
<p><a href="https://healthychildren.org/English/ages-stages/prenatal/delivery-beyond/Pages/understanding-motherhood-and-mood-baby-blues-and-beyond.aspx">The symptoms can also start</a> <a href="https://www.womenshealth.gov/mental-health/mental-health-conditions/postpartum-depression">during pregnancy</a>. Research shows that more than half of women who <a href="https://doi.org/10.1186/s12888-023-05030-1">experience depression symptoms during pregnancy</a> will develop postpartum depression too.</p>
<p>A much more <a href="https://www.ncbi.nlm.nih.gov/books/NBK544304/#">rare and severe psychiatric disorder</a> following delivery is called postpartum psychosis. Its onset is rapid and severe, with hallucinations, delusions and emotional distress, along with <a href="https://theconversation.com/rare-and-tragic-cases-of-postpartum-psychosis-are-bringing-renewed-attention-to-its-risks-and-the-need-for-greater-awareness-of-psychosis-after-childbirth-201282">bizarre and sometimes dangerous behaviors</a>. About 1 or 2 in 1,000 women experience postpartum psychosis after giving birth.</p>
<p>We are a <a href="https://www.linkedin.com/in/nicole-lynch-dnp-msn-cns-cne-rnc-ob-02088813/">clinical nurse specialist</a> and a <a href="http://www.linkedin.com/in/shannon-pickett-phd-lmhc-77022a42">licensed mental health counselor</a>, and together we have over 45 years of experience as educators and clinicians.</p>
<p>With proper awareness, education and intervention, perinatal mood disorders are <a href="https://ppdil.org/legislation/ppmd-awareness-month/">nearly 100% treatable</a>. We want women to realize that they are not alone, they are not to blame, and with help <a href="https://ppdil.org/what-helps/">they can be well again</a>. </p>
<h2>Crying, sadness and lack of bonding</h2>
<p>Following pregnancy, many women experience normal changes that can mimic symptoms of depression, such as sadness, worry and exhaustion. The transition to motherhood, particularly with a new baby in the home, can be overwhelming. However, it’s essential to distinguish between these common adjustments and <a href="https://www.marchofdimes.org/find-support/topics/postpartum/postpartum-depression#">more concerning signs of depression</a>.</p>
<p>If you or someone you know finds themselves experiencing any of the following symptoms persistently for over two weeks after giving birth, it’s crucial they reach out to their doctor, nurse or midwife. Here are some of the <a href="https://www.ncbi.nlm.nih.gov/books/NBK519070/#">most-reported symptoms</a> of postpartum depression:</p>
<ul>
<li><a href="https://doi.org/10.1177%2F1745506519844044">Lack of bonding and feeling disconnected</a> from the baby or experiencing a <a href="https://ym.care/rfx">lack of interest in them</a>.</li>
<li>Restlessness or moodiness and feeling unusually agitated or irritable.</li>
<li>Persistent feelings of sadness, hopelessness or being overwhelmed.</li>
<li>Experiencing physical symptoms such as persistent headaches, other body aches and pains or digestive issues that don’t resolve.</li>
<li>A profound lack of energy or motivation, making daily tasks feel daunting.</li>
<li>Significant changes in appetite and either eating too little or too much.</li>
<li>Disturbed sleep patterns, such as sleeping too much or too little, even when given the opportunity to rest.</li>
<li>Difficulty concentrating or making decisions, or experiencing memory problems.</li>
<li>Overwhelming feelings of guilt, worthlessness or inadequacy as a mother.</li>
<li>A notable decline in interest or pleasure in activities previously enjoyed.</li>
<li>Isolating from friends and family, avoiding social interactions.</li>
<li><a href="https://www.ncbi.nlm.nih.gov/books/NBK544304/">Thoughts of</a> <a href="https://theconversation.com/rare-and-tragic-cases-of-postpartum-psychosis-are-bringing-renewed-attention-to-its-risks-and-the-need-for-greater-awareness-of-psychosis-after-childbirth-201282">harming the baby or themselves</a>. These <a href="https://doi.org/10.1007/s10597-022-01002-z">should be taken extremely seriously</a> and <a href="https://doi.org/10.1155%2F2018%2F8262043">warrant immediate attention</a>.</li>
</ul>
<p><a href="https://doi.org/10.1089/jwh.2020.8862">Some risk factors</a> associated with higher likelihood of postpartum depression include life stress, <a href="https://doi.org/10.1177%2F2167702616644894">depression history</a>, maternal anxiety, lack of social support, infrequent exercise, unintended pregnancy and <a href="https://www.nimh.nih.gov/sites/default/files/documents/health/publications/perinatal-depression/perinatal-depression.pdf">intimate partner violence</a>.</p>
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<figcaption><span class="caption">Knowing the warning signs of postpartum depression could prevent a tragedy.</span></figcaption>
</figure>
<h2>Real-life examples</h2>
<p>People dealing with depression not only have to manage their symptoms but may also <a href="https://psycnet.apa.org/doi/10.1037/sah0000431">face the stigma</a> and discrimination that these conditions often bring. There is an expectation that new parents will be happy after delivery. Sadness, stigma, shame or guilt greatly affects a person’s willingness to seek help. Studies show that many people opt not to seek treatment to avoid being <a href="https://doi.org/10.1111/jmwh.13366">perceived as unfit parents by health care providers or family</a>. </p>
<p>As a nurse and a mom who has experienced postpartum depression, I (Nicole Lynch) frequently share my story with others. Years ago, another mom shared with me how helpful it was to hear that she wasn’t alone. Knowing that other women – dedicated parents who love their children – can feel this way and that <a href="https://www.postpartum.net/learn-more/depression/">things can get better gave her hope</a>.</p>
<p>Throughout my career, I (Shannon Pickett) have worked with several mothers and prospective parents who have struggled with postpartum depression. For instance, I worked with one woman for several years about her anxiety and her struggle to conceive. After years of trying, she finally became pregnant. Both she and her husband were overjoyed and could not wait to become parents. </p>
<p>The pregnancy went smoothly and there were no complications. She had never shown any signs of depression previously, but once the baby was born, that changed. My client had trouble bonding with the baby and did not want to hold or console her new son when he needed soothing.</p>
<p>Her husband would often step in to comfort the infant and would ask my client, “What is wrong with you?” It caused frustration within their marriage because the father felt as though he was doing the caregiving alone and that my client was withdrawn. She had planned to take a break from therapy for a bit after the baby was born, but her husband encouraged her to reach out to schedule an appointment. </p>
<p>I could tell right away that she was struggling with postpartum depression. She barely smiled, had difficulty engaging in and concentrating on our conversation and cried throughout most of the session. </p>
<p>We talked a lot about the guilt she felt over not wanting to be around her son or hold him, even though she had fought for so long to become a mother. After receiving a proper diagnosis and starting an antidepressant medication, my client was able to recover and bond with her son. The medication did take a few weeks to get into her system, so the results were not instant. Maintaining her sessions and using her support system were <a href="https://doi.org/10.2147/IJWH.S6938">important for her recovery as well</a>. </p>
<h2>Heightened risk</h2>
<p>While postpartum depression can affect anyone regardless of their socioeconomic status or their background, <a href="https://iris.who.int/bitstream/handle/10665/112828/9789241506809_eng.pdf?sequence=1">some women affected by social inequalities</a> have increased risk of many common postpartum mental disorders and their <a href="https://www.who.int/publications/i/item/9789240045989">adverse consequences</a>. </p>
<p>One study found that new mothers with low incomes, those who had not earned a college degree, were unmarried or were unemployed were 11 times more likely than women with no risk factors to have <a href="https://doi.org/10.1016/j.whi.2009.11.003">clinically elevated depression scores three months after having a baby</a>.</p>
<h2>Inadequate support</h2>
<p>The Centers for Disease Control and Prevention estimates that <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6919a2.htm">about 20% of pregnant women were not asked about depression</a> during a prenatal visit, and more than half of women with postpartum depression remain untreated for their symptoms. </p>
<p>What’s worse, there is a <a href="https://iris.who.int/bitstream/handle/10665/112828/9789241506809_eng.pdf">lack of access to mental health services</a> for women after delivery. Many promising treatments are underexplored, especially in scientific studies. While more people are talking about postpartum depression, there is <a href="https://doi.org/10.1111/jmwh.13366">still stigma around seeking help</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/9085YWhyUTU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A new oral medication may begin to relieve postpartum depression within three days.</span></figcaption>
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<h2>A new medication offers hope</h2>
<p>It’s vital to remember that postpartum depression is a treatable condition. Seeking help from health care professionals is a courageous and necessary step. </p>
<p>In August 2023, the Food and Drug Administration <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-treatment-postpartum-depression">approved the first oral medication</a>, Zurzuvae, <a href="https://www.youtube.com/watch?v=9085YWhyUTU">specifically intended to treat severe depression after childbirth</a>. It holds promise for addressing the complex array of symptoms associated with postpartum depression and offers newfound hope for affected mothers and their families. </p>
<p>If you are experiencing symptoms of postpartum depression, consider <a href="https://www.psychologytoday.com/us/therapists">finding a therapist</a> in your community for either telehealth or in-person sessions.</p>
<p>There are also <a href="https://ppdil.org/">postpartum support groups</a> that meet in person and online.</p>
<p>Supportive therapies, including counseling, medication and lifestyle adjustments, can significantly alleviate symptoms and improve overall well-being. Early intervention is key to a faster and more complete recovery, ensuring that mothers can enjoy the precious moments with their baby and find fulfillment in motherhood.</p><img src="https://counter.theconversation.com/content/213499/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lynch is a volunteer with the Post Partum Depression Alliance of Illinois <a href="https://ppdil.org/">https://ppdil.org/</a>. She serves as a Visiting Professor at Purdue Global.</span></em></p><p class="fine-print"><em><span>Shannon Pickett serves as University Faculty at Purdue Global.</span></em></p>Half a million new mothers in the US suffer from postpartum depression every year, yet a lack of awareness and stigma toward the condition keep many from getting the help they need.Nicole Lynch, Clinical Nurse Specialist and Visiting Professor of Nursing, Purdue UniversityShannon Pickett, Professor of Psychology and Licensed Mental Health Counselor, Purdue UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2117472023-09-28T19:58:50Z2023-09-28T19:58:50Z‘You’re constantly worrying’: pregnant women, bushfire smoke and the impossibility of safety<p>Smoke covered large swathes of Australia during the catastrophic summer fires of 2019-2020. You could see the plumes from space. Over 20% of Australia’s forests <a href="https://www.theguardian.com/australia-news/2020/feb/25/unprecedented-globally-more-than-20-of-australias-forests-burnt-in-bushfires">went up</a> in smoke and flame. </p>
<p>As the fires spread, smoke covered towns and cities. Millions of people were suddenly confronted with bad air. Many had children. Many were pregnant. All worried about what the smoke might mean for their child. </p>
<p>Our <a href="https://bristoluniversitypress.co.uk/reproduction-kin-and-climate-crisis">new book</a> explores the worries and desperation of people who were pregnant or parenting during the unprecedented fires over the 2019–2020 summer. We drew on in-depth stories from 25 mothers (and sometimes their partners). </p>
<p>The smoke was something they had no control over. But public health advice told them they had the responsibility to keep their child safe. Mothers and their partners worried endlessly about what damage the pollutants in the air were doing. This, we argue, speaks to how those who have done little to fuel the climate crisis can be particularly at risk. </p>
<h2>What did we find?</h2>
<p>One woman, Renee, told us about the anxiety of being pregnant and with two small children in the smoke: </p>
<blockquote>
<p>I was really worried about lung damage for my kids upstairs, but I was also worried, [for] like, brain development at that point, as you get into the end of the pregnancy […] I kept having conversations with myself going, ‘I’m not in my first 12 weeks, surely that’s riskier. I’m in this safer zone’.</p>
</blockquote>
<p>Renee’s story speaks to how our interviewees tried to take responsibility for themselves and their foetuses. </p>
<p>It was a common thread. The 25 mothers and partners we interviewed were living in Canberra or on the south coast of New South Wales. These areas were among the worst affected by smoke. </p>
<p>Renee’s feelings of risk and responsibility are amplified in an era that historian of fire Stephen Pyne has <a href="https://theconversation.com/california-wildfires-signal-the-arrival-of-a-planetary-fire-age-125972">named the “Pyrocene</a>”, a time when bushfires and the burning of fossil fuels are careering out of control. </p>
<p>Our research shows pregnant people were framed as “doubly vulnerable” to smoke, due to their own exposure and that of their foetus. Health advice from organisations such as the <a href="https://www.thewomens.org.au/news/advice-for-pregnant-women-around-smoke-haze">Royal Women’s Hospital</a> urged them to stay indoors, use air-conditioning and to spend time at libraries and shopping centres to avoid exposure.</p>
<h2>Who is responsible?</h2>
<p>Given health warnings about smoke exposure, it’s not surprising our interviewees expressed considerable concern for their unborn babies. </p>
<p>Alice, pregnant during the fires: </p>
<blockquote>
<p>It was really constantly on my mind, and I tried to kind of not get too anxious about it, but it was really difficult because […] I mean, you just think about it all the time. You’re just constantly worrying when you’re pregnant what’s going to affect the baby. Like everything you do.</p>
</blockquote>
<p>Gina, pregnant during the fires: </p>
<blockquote>
<p>It was just always kind of lingering, like we were just unsure about what kind of effects it would have on the development of his organs and whatever else. I was obviously more stressed than my husband, just because, you know, the mother is carrying the baby and there’s more stress just naturally on the mum</p>
</blockquote>
<p>Even while worrying about the health of their babies, women also felt the responsibility for keeping them “safe” from smoke exposure fell primarily to them. </p>
<p>What we ask is – is this fair? As recent research <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(23)00134-1/fulltext">makes clear</a>, pollutants such as bushfire smoke are uncontrollable. </p>
<p>Feminist scholars <a href="https://press.uchicago.edu/ucp/books/book/chicago/M/bo117202096.html">note that</a> public health advice and scientific research tends to emphasise how vulnerable the foetus is and, by extension, place responsibility on the mother – even while acknowledging how little control they have over the situation. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/climate-change-hits-low-income-earners-harder-and-poor-housing-in-hotter-cities-is-a-disastrous-combination-180960">Climate change hits low-income earners harder – and poor housing in hotter cities is a disastrous combination</a>
</strong>
</em>
</p>
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<h2>When responsibility meets uncertainty</h2>
<p>Australia has long been affected by bushfires. But they’re <a href="https://theconversation.com/yes-climate-change-is-bringing-bushfires-more-often-but-some-ecosystems-in-australia-are-suffering-the-most-211683">getting worse</a> as the world heats up. </p>
<p>There’s no roadmap for how to live with sudden crises such as fires or the long, slow burn of incremental change. We’re all experimenting at individual, household and community levels as well as nationally and regionally. </p>
<p>Many of us are <a href="https://theconversation.com/climate-change-hits-low-income-earners-harder-and-poor-housing-in-hotter-cities-is-a-disastrous-combination-180960">having to tinker</a> with our machines and our homes to take care of others and to survive the new extremes. </p>
<p>Climate change is happening to the globe. But the devastation wreaked by extreme weather, disruption to farming or intensified fires is not evenly distributed, either by who did the most to cause it or by who is most hard hit. </p>
<p>Wealth magnifies unfairness. Those who have done the most to create and benefit from carbon-intensive capitalism are more likely to be able to shield themselves from <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00919-4/fulltext">its effects</a>, while people who are <a href="https://doi.org/10.1016/j.envres.2019.04.012">pregnant and parenting</a>, and <a href="https://caepr.cass.anu.edu.au/research/publications/aboriginal-peoples-and-response-2019-2020-bushfires">First Nations people</a> – especially children aged five and under – are more vulnerable. </p>
<p>What we point to is a question. How can we find ways to take care of foetuses and young children without forcing parents (and mothers, in particular) to shoulder the impossible responsibility of safety? </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-black-summer-bushfires-put-an-enormous-strain-on-families-with-young-children-we-cant-make-the-same-mistakes-again-205026">The Black Summer bushfires put an enormous strain on families with young children. We can't make the same mistakes again</a>
</strong>
</em>
</p>
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<img src="https://counter.theconversation.com/content/211747/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If you were pregnant or parenting during Australia’s 2019–20 summer of smoke and fire, chances are you felt acutely anxious – and grappling with impossible responsibility.Mary Lou Rasmussen, Professor, School of Sociology, Australian National UniversityCelia Roberts, Professor of sociology, Australian National UniversityLouisa Allen, Professor, Faculty of Education and Social Work, University of Auckland, Waipapa Taumata RauRebecca Williamson, Research Officer, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2134922023-09-28T15:52:31Z2023-09-28T15:52:31ZFace pareidolia: how pregnant women could help us understand why we see faces in inanimate objects<figure><img src="https://images.theconversation.com/files/550076/original/file-20230925-17-4zy1hu.jpg?ixlib=rb-1.1.0&rect=0%2C58%2C5615%2C3673&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/coffee-cup-funny-smiling-face-top-2300998749">Zuzha/Shutterstock</a></span></figcaption></figure><p>Sometimes we see faces that aren’t really there. You may be looking at the front of a car or a <a href="https://theconversation.com/holy-grilled-cheese-sandwich-what-is-pareidolia-14170">burnt piece of toast</a> when you notice a face-like pattern. This is called <a href="https://kids.frontiersin.org/articles/10.3389/frym.2017.00067">face pareidolia</a> and is a mistake made by the brain’s face detection system. </p>
<p>But it’s an error that can help us understand the workings of the human mind. A
<a href="https://royalsocietypublishing.org/doi/10.1098/rsbl.2023.0126">recent study</a> has argued that having a baby may affect this aspect of our brains, suggesting it may vary across our lifetimes. </p>
<p>Many scientific studies <a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">exclude pregnant women</a> out of concern that the dramatic changes to their hormone levels may affect results. But researchers from the University of Queensland in Australia realised these hormonal changes can give us interesting insights. </p>
<p>They found women who had had recently given birth were more likely to see face-like patterns than those who were pregnant. The researchers have suggested this might be because of changing levels of the hormone oxytocin. However, the full picture may be more complicated.</p>
<p>People have evolved to be sensitive to faces and face-like patterns <a href="https://publications.aap.org/pediatrics/article-abstract/56/4/544/78642/Visual-Following-and-Pattern-Discrimination-of?redirectedFrom=fulltext">from birth</a>, probably because attention to faces underlies our social interactions and may also help us stay safe (it’s how we tell friends and family from strangers). <a href="https://www.cell.com/current-biology/pdf/S0960-9822(17)30812-6.pdf">Monkeys also show face pareidolia</a>, suggesting that we share features of our face-detection system, including the mistakes that it makes, with other species.</p>
<p>It’s well established that chemical messengers in the brain play a role in our social interactions. For instance, oxytocin is often called the “love hormone” due to its links with <a href="https://www.sciencedirect.com/science/article/pii/S2666497621000813">social bonding and reproduction</a>. Studies have shown that artificially increasing levels of oxytocin, using a nasal spray, causes people to spend longer looking at the <a href="https://linkinghub.elsevier.com/retrieve/pii/S0006322307006178">eye regions of faces</a> and enhances recognition of <a href="https://link.springer.com/article/10.1007/s00213-010-1780-4">positive facial expressions</a>.</p>
<p>Oxytocin levels change naturally within women who are pregnant and after they have given birth. Previous research that compared women at different stages in their pregnancy and postpartum has found that levels of oxytocin and other hormones <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-0937-5">vary dramatically</a>. </p>
<p>The Australian researchers decided to test whether levels of oxytocin (given its role in face perception) and the likelihood of seeing face-like patterns are related to each other. They predicted that postpartum women would have higher levels of oxytocin than pregnant women, therefore making it easier for them to see faces in face-like patterns.</p>
<h2>Seeing faces in objects</h2>
<p>The researchers compared two groups of women on a test of face pareidolia. One group were pregnant while the other group had given birth in the last 12 months. During the test, all of the women were shown three types of images: human faces, ordinary objects and illusory faces (objects with face-like patterns in them). The women were asked to respond to the images using an 11-point scale from zero (no, I don’t see a face) to ten (yes, I definitely see a face). </p>
<p>The results showed that the postpartum women did indeed report seeing more faces for the illusory face images (median response was 7.08) in comparison with the pregnant women (median response of 5.30). As expected, these groups didn’t differ much in their responses to the images of human faces and ordinary objects. </p>
<p>The authors concluded that women’s sensitivity to levels of face pareidolia may be heightened during early parenthood, and might encourage social bonding, which is obviously important for mothers and their infants. This increase in sensitivity, according to the researchers, is caused by heightened levels of oxytocin in the months after giving birth.</p>
<figure class="align-center ">
<img alt="Pebble on sand, indentations in the rock seem to form a face" src="https://images.theconversation.com/files/550222/original/file-20230926-27-1l1pk3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/550222/original/file-20230926-27-1l1pk3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/550222/original/file-20230926-27-1l1pk3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/550222/original/file-20230926-27-1l1pk3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/550222/original/file-20230926-27-1l1pk3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/550222/original/file-20230926-27-1l1pk3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/550222/original/file-20230926-27-1l1pk3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Seeing faces in objects is known as face pareidolia.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pebble-on-sand-beach-background-funny-1114294052">Valeriana Y/Shutterstock</a></span>
</figcaption>
</figure>
<p>The authors of the study noted that they didn’t actually measure their participants’ oxytocin levels. Instead, they assumed oxytocin differences caused the differences in face pareidolia. </p>
<p>However, this means other differences between the two groups may have led to their result. Perhaps pregnant and postpartum women differ in their levels of anxiety, stress, or fatigue, all of which could affect their performance on the task. </p>
<p>It may also be that pregnant and postpartum women who choose to complete online psychology experiments differ in some way that we’re not aware of. Carrying out a follow-up study which compares the same women during pregnancy and after they’ve given birth could rule out some of these alternatives.</p>
<p>There is also another problem with assuming that oxytocin differences underlie the face pareidolia result. While the study’s authors reason that oxytocin levels will be higher postpartum than during pregnancy, this idea isn’t clearly supported by previous research. </p>
<p>In fact, some studies seem to show that oxytocin levels <a href="https://journals.sagepub.com/doi/10.1111/j.1467-9280.2007.02010.x">don’t differ</a> from pregnancy to postpartum, are <a href="https://doi.org/10.1111/jog.15023">lower postpartum</a>, or that they rise during pregnancy but <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2014.00001/full">then fall during the postpartum period</a>. At the very least, these studies seem to agree that <a href="https://linkinghub.elsevier.com/retrieve/pii/S0196978107001544">women vary greatly</a> in the patterns they show.</p>
<h2>Some more than others</h2>
<p>While the Australian study focused on pregnant and postpartum women, we know that most people experience seeing face-like patterns. However, <a href="https://journals.sagepub.com/doi/pdf/10.1017/prp.2019.27">there are large differences</a> in how susceptible you might be. </p>
<p>For instance, studies have shown that <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0130363">women report seeing these illusory faces</a> more often than men do, while <a href="https://onlinelibrary.wiley.com/doi/10.1002/acp.2874">strong believers in paranormal phenomena</a> and religions show more frequent experiences than sceptics and non-believers. Researchers have even found that <a href="https://journals.sagepub.com/doi/10.1111/j.1467-9280.2008.02056.x">loneliness may cause people</a> to see these face-like patterns more often. </p>
<p>Face pareidolia is also less commonly experienced by some groups like those with <a href="https://www.nature.com/articles/s41598-017-02790-1">autism spectrum disorder</a>, as well as genetic disorders like <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2016.01131/full">Williams syndrome</a> and <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2018.02583/full">Down syndrome</a>. </p>
<p>And we know that some <a href="https://theconversation.com/i-should-know-you-face-blindness-and-the-problem-of-identifying-others-8884">people are “face blind”</a> (prosopagnosic) and can struggle to recognise even their family and close friends. These people also show <a href="https://www.sciencedirect.com/science/article/pii/S0010945222001204">less sensitivity to face-like patterns</a>.</p>
<p>As a preliminary study, this team’s new finding that postpartum women show increased face pareidolia is certainly an interesting one. If sensitivity to face-like patterns changes across our lifetimes, and is also determined by underlying hormone levels, then measuring face pareidolia could represent a useful tool for monitoring more complex internal changes that might underlie mental health issues.</p><img src="https://counter.theconversation.com/content/213492/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Robin Kramer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s pretty common to see face-like patterns in objects – but this quirk can give us insights into human psychology and evolution.Robin Kramer, Senior Lecturer in the School of Psychology, University of LincolnLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2073232023-09-18T20:01:57Z2023-09-18T20:01:57ZHow a 16th century Italian anatomist came up with the word ‘placenta’: it reminded him of a cake<figure><img src="https://images.theconversation.com/files/531045/original/file-20230609-15-lw1nva.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C878%2C935&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The placenta and umbilical cord. Watercolour image, unknown artist, 19th century.</span> <span class="attribution"><a class="source" href="https://wellcomecollection.org/works/n4d6wddp">Wellcome Collection</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Ever wondered where the placenta got its name?</p>
<p>In Italy in the 1500s, the anatomist Matteo Realdo Colombo coined this term to describe the large fleshy organ of pregnancy. Colombo chose placenta because it resembled another big, round object seen in daily life: a cake.</p>
<p>In the premodern world, there existed a variety of words and concepts used to understand the placenta. </p>
<p>In <a href="https://www.journals.uchicago.edu/doi/full/10.1086/724867">my research</a>, I try to uncover the cultural significance of the placenta and afterbirth in premodern Europe (1500–1800) to help us better understand the social and medical history of this important organ.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-placenta-28851">Explainer: what is placenta?</a>
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</em>
</p>
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<h2>Afterbirths and secundines</h2>
<p>Before the anatomical term placenta appeared, men and women in medieval Europe used the terms “afterbirth” (<em>nachgeburt</em> in German, <em>arrière-faix</em> in French) and “the second” (<em>secundina</em> in Italian, <em>secondine</em> in English). </p>
<p>These terms captured the fact that placental expulsion was the “second” part of a childbirth, necessary to end the birth. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/531040/original/file-20230608-14786-m63chi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woodcut depicts a woman who has just recently finished giving birth being attended by various midwives" src="https://images.theconversation.com/files/531040/original/file-20230608-14786-m63chi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/531040/original/file-20230608-14786-m63chi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=586&fit=crop&dpr=1 600w, https://images.theconversation.com/files/531040/original/file-20230608-14786-m63chi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=586&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/531040/original/file-20230608-14786-m63chi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=586&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/531040/original/file-20230608-14786-m63chi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=736&fit=crop&dpr=1 754w, https://images.theconversation.com/files/531040/original/file-20230608-14786-m63chi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=736&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/531040/original/file-20230608-14786-m63chi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=736&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Illustrations from this 1850 obstetrical book by Jacobus Rueff show scenes of childbirth in 16th century Europe.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/jjcba979">Wellcome Library</a></span>
</figcaption>
</figure>
<p>From the medieval to late early modern period, childbirth was very much the preserve of women midwives, family members and neighbours. Much of their knowledge about the placenta was transmitted orally (women were generally not literate, unless elite) yet some of this knowledge <a href="https://blogs.bl.uk/digitisedmanuscripts/2018/03/call-the-medieval-midwife.html">survives in texts</a>. </p>
<p>Male physicians recorded women’s knowledge about childbirth to demonstrate they could access “secret” knowledge about women’s bodies. This boosted their reputation among other male physicians, and gave credibility to their expertise over women’s health and childbirth.</p>
<p>One example of this is the 12th century medical compendium, <a href="https://en.wikipedia.org/wiki/Trotula">The Trotula</a>, one of the most influential works on women’s medicine in Europe from its publication until well into the 1500s. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/531035/original/file-20230608-11102-9xg2l3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A figure of a woman is painted in a manuscript on women's medicine" src="https://images.theconversation.com/files/531035/original/file-20230608-11102-9xg2l3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/531035/original/file-20230608-11102-9xg2l3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=843&fit=crop&dpr=1 600w, https://images.theconversation.com/files/531035/original/file-20230608-11102-9xg2l3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=843&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/531035/original/file-20230608-11102-9xg2l3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=843&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/531035/original/file-20230608-11102-9xg2l3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1059&fit=crop&dpr=1 754w, https://images.theconversation.com/files/531035/original/file-20230608-11102-9xg2l3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1059&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/531035/original/file-20230608-11102-9xg2l3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1059&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Trotula of Salerno.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Trotula_of_Salerno.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>The text, a compilation of different medical treatises, was supposedly authored by the first female physician and professor, Trota, in Salerno, Italy. </p>
<p>Although modern scholars suggest that some of the text’s authors were certainly male, <a href="https://www.youtube.com/watch?v=v1iRJJT403o">historian Monica Green</a> argues that part of the work was likely shaped by a female midwife or healer, possibly called Trota. </p>
<p>At this time, there were many female healers in Salerno, and it was typically only women who had access to women’s births and bodies.</p>
<p>Examining The Trotula allows us to see earlier cultural and medical ideas about the placenta. The author describes how, during birth: </p>
<blockquote>
<p>The foetus is expelled from its bed, that is to say the afterbirth, by the force of Nature.</p>
</blockquote>
<p>The afterbirth and foetus were understood as having a close, companion-like relationship; the placenta was a “bed” for the foetus during pregnancy, providing support and comfort.</p>
<p>We can also see how the afterbirth might be used following pregnancy and birth. Trota writes:</p>
<blockquote>
<p>If [the mother] has been badly torn in birth and afterward for fear of death does not wish to conceive any more, let her put into the afterbirth as many grains of caper spurge or barley as the number of years she wishes to remain barren.</p>
</blockquote>
<p>The post-birth use of the placenta in remedies was common in Europe. The afterbirth was perceived as having “sympathetic” healing qualities relating to future fertility and the health of the infant. </p>
<h2>Anatomy and the afterbirth: new terms</h2>
<p>Women’s ideas about placental remedies were often ridiculed by university-educated male anatomists, who labelled these practices “superstitious”. Yet, many did respect women’s knowledge as experts in childbirth. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/531036/original/file-20230608-23-vl0v79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="The image depicts an anatomical theatre in which many men surround an anatomical table. In the centre above the table colombo is dissecting a man's corpse and showing organs to the students." src="https://images.theconversation.com/files/531036/original/file-20230608-23-vl0v79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/531036/original/file-20230608-23-vl0v79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=847&fit=crop&dpr=1 600w, https://images.theconversation.com/files/531036/original/file-20230608-23-vl0v79.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=847&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/531036/original/file-20230608-23-vl0v79.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=847&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/531036/original/file-20230608-23-vl0v79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1064&fit=crop&dpr=1 754w, https://images.theconversation.com/files/531036/original/file-20230608-23-vl0v79.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1064&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/531036/original/file-20230608-23-vl0v79.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1064&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">De Re Anatomica (1559), frontispiece.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:De_re_anatomica_libri_XV,_Realdo_Colombo,_1559_Wellcome_L0000134.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>When Italian anatomist Matteo Realdo Colombo coined the term “placenta” in the 16th century, he used a term directly related to women’s worlds: cooking. Colombo was professor of anatomy at the University of Padua, a hub for <a href="https://www.unipd.it/en/palazzo-bo-and-anatomical-theatre">anatomical learning</a> in Europe at the time.</p>
<p>Colombo described the shape and function of the human placenta in his anatomical treatise, <em>De Re Anatomica</em> (On Things Anatomical, 1559). </p>
<p>In this book, Colombo introduced the term “placenta” to distinguish it from other anatomical terms, as well as midwifery terms like “secundina”. </p>
<p>“Placenta” referred to a wide, flat cake, cooked in a pan with layers of cheese and honey, dating <a href="https://www.google.com.au/books/edition/M_Porci_Catonis_De_Agricultura_Sive_De_R/MamGBIYAMdIC?hl=en&gbpv=1">as far back</a> as Ancient Rome.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/tBIzqW_qp1Q?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>Colombo chose this term to describe the large, flat organ, “circular” like a placenta cake, and of a similar size. </p>
<p>In choosing the term placenta, he also associated the organ with ideas about women’s worlds, of cooking and childbirth; the placenta, like the Italian cake, provided nourishment and comfort. This idea connected with earlier ones like the Trotula, which suggested the afterbirth was the foetus’ bed.</p>
<h2>The placenta today</h2>
<p>Exploring the history of ideas about the placenta and afterbirth offer us insights into how people have valued this important organ. </p>
<p>This can tell us about the development of scientific knowledge, such as the emergence of the word placenta, providing context for <a href="https://www.sciencedirect.com/science/article/pii/S0143400414000861">urgent placental science</a> being undertaken today. History can help us determine how and why in different times and cultures, science has or has not prioritised placental research.</p>
<p>Histories of the placenta also help provide context for current cultural attitudes to and practices around the afterbirth, such as <a href="https://theconversation.com/no-you-shouldnt-eat-your-placenta-heres-why-86405">eating the placenta</a> and turning the placenta into <a href="https://midwifebalance.com.au/placenta-encapsulation/pricing/">memorabilia, jewellery or art</a>.</p>
<p>By studying past knowledge about the placenta, we can see the echoes of attitudes to this organ in our modern science and culture. </p>
<p>Our bodies are not static. They are deeply shaped by the prevailing medical and cultural perceptions of our times. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/no-you-shouldnt-eat-your-placenta-heres-why-86405">No, you shouldn't eat your placenta, here's why</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/207323/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paige Donaghy does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In my research, I try to uncover the cultural significance of the placenta and afterbirth in premodern Europe to help us better understand the social and medical history of this important organ.Paige Donaghy, Early career researcher, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2073602023-08-29T15:34:41Z2023-08-29T15:34:41ZWhen being a new mum feels overwhelming, here’s some expert advice on what you need to know<figure><img src="https://images.theconversation.com/files/542176/original/file-20230810-11401-f0k38u.jpg?ixlib=rb-1.1.0&rect=11%2C15%2C2544%2C1686&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Being a new mother can take a lot of adjustment. </span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/parents-looking-at-their-baby-3584088/">pexels?nappy</a></span></figcaption></figure><p>We are sold the idea that becoming a new mother is the <a href="https://psycnet.apa.org/record/2016-38769-001">happiest time of your life</a>. But for many women, the reality doesn’t fit that perfect picture. Yes, they may love their baby very much but the broader impact of having a baby and becoming a mother can feel far more complex. </p>
<p>Research shows that when we look at happiness over our lifetime, the year after having a baby can be one of our <a href="https://psycnet.apa.org/record/2013-15090-008">lowest points</a>. It’s not about our relationship with our baby but rather the other parts of our lives that have changed so much. Social media hasn’t helped any of this. We are all tempted to just share the best bits, thinking we need to hide our feelings because we think <a href="https://psycnet.apa.org/record/2018-45585-002">everyone else is so happy</a>. But speaking out helps everyone. </p>
<p><a href="https://www.independent.co.uk/news/health/negative-thoughts-new-parents-baby-pregnant-children-parenting-b694300.html">It’s normal</a> to experience some challenging emotions when you become a new parent. You might not immediately bond with your baby, wondering why that flash of love didn’t appear. You might grieve for your old life and identity. You might feel trapped, wanting to escape yet at the same time feeling you can’t leave your baby. </p>
<p>Worries about not being “good enough” for your baby are also common. But honestly, you don’t need to get it right all the time. You are more than enough for your baby. None of these very normal reactions to change mean that you don’t love your baby.</p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">Science experiments traditionally only used male mice – here’s why that’s a problem for women’s health</a></em></p>
<p><em><a href="https://theconversation.com/five-old-contraception-methods-that-show-why-the-pill-was-a-medical-breakthrough-207572">Five old contraception methods that show why the pill was a medical breakthrough
</a></em></p>
<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<hr>
<p>But knowing when these are normal feelings and when you might need support is important. At least <a href="https://maternalmentalhealthalliance.org/about/perinatal-mental-health/">one in five</a> new mothers will experience a mental health issue after birth. Though this is likely an underestimation because many hide these feelings. But hiding them just prevents you from getting the support you need. So here are some signs to look out for:</p>
<p><strong>Postnatal depression:</strong> <a href="https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/postnatal-and-antenatal-depression/">Depression</a> isn’t simply feelings of sadness. In fact, anxiety, about something specific or a general feeling of dread is common. You might lose pleasure in doing things, feel hopeless about the future, or feel very low about yourself. </p>
<p><strong>Anxiety and intrusive thoughts:</strong> We all have moments where we imagine ourselves dropping our baby. Sometimes however these thoughts become <a href="https://www.verywellfamily.com/overcoming-postpartum-ocd-and-intrusive-thoughts-5187982">repetitive, frequent</a> and we can’t make them go away. You might find yourself <a href="https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/perinatal-anxiety/">unable to sleep</a> or waking too early. You might feel restless, overwhelmed in public or feel shaky. </p>
<figure class="align-center ">
<img alt="Woman lying in bed with baby." src="https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s normal for life to seem radically altered and to feel a loss of identity.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/a-woman-resting-on-the-bed-with-her-baby-on-top-6849528/">pexels rdne stock project</a></span>
</figcaption>
</figure>
<p><strong>Postnatal rage:</strong> We often don’t talk about rage when it comes to mothers but it’s <a href="https://www.irishtimes.com/life-and-style/health-family/i-was-a-charging-brutal-half-animal-the-ugly-truth-about-postnatal-rage-1.2950662">more common</a> that you think. You might find yourself feeling on edge or irritable and then snap when something small goes wrong. Hormonal fluctuations and a lack of sleep might exacerbate this but more often it’s a reaction to feeling overwhelmed, powerless and unsupported. </p>
<p><strong>Birth or breastfeeding trauma:</strong> Many women have some difficult memories of birth but sometimes, even if you are able to talk them over with friends afterwards, <a href="https://www.youtube.com/watch?v=A43qlYkSMyU">these don’t go away</a>. You might find yourself having flashbacks, feel unable to go near the hospital or anything that reminds you of the birth, or feel very angry about your experience, or blame yourself. </p>
<p>Your sleep or appetite might be affected, or you might feel very jumpy or on edge. Sometimes these feelings are linked to physical events during the birth, but often they’re more about how you felt or were treated.</p>
<p>Increasingly similar feelings of trauma or grief are being recognised around <a href="https://welldoing.org/article/why-breastfeeding-grief-trauma-matter">infant feeding experiences</a>. If you experienced breastfeeding difficulties or had to stop before you were ready, you might be feeling guilt, anger or loss about that, despite your baby thriving. </p>
<h2>Getting support</h2>
<p>If you’re feeling overwhelmed by the emotions you are experiencing or find your sleep, energy or appetite is affected, here are some things to try:</p>
<figure class="align-center ">
<img alt="Woman with baby and laptop." src="https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Don’t suffer in silence, get as much support and help as you can.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/young-working-mother-cuddling-baby-and-using-laptop-at-home-7282818/">Pexels/sarah chai</a></span>
</figcaption>
</figure>
<p><strong>Talk to friends:</strong> Sometimes just sharing how we feel and realising that others feel this way can help us realise we are not alone </p>
<p><strong>Discuss with your health visitor or GP:</strong> They can help you understand how you are feeling and discuss different treatments such as counselling and medication</p>
<p><strong>Contact one of the many organisations that can help:</strong> The <a href="https://maternalmentalhealthalliance.org/resources/mums-and-families/">Maternal Mental Health Alliance</a> has a list of contacts. You can talk through difficult infant feeding experiences with a <a href="https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding/help-and-support/">breastfeeding charity</a>. Many doulas (a person who can support you through pregnancy, labour and birth) also offer help to explore <a href="https://doula.org.uk">how you are feeling</a> about your birth and caring for your baby. </p>
<p><strong>Focus on looking after yourself, too:</strong> Your diet, activity levels and time outdoors can all affect how you feel. Do not be afraid to ask others for help or to use sources such as childcare to get some time for you to be able to do this. Explain to them how you feel and what you need. </p>
<p><strong>Creativity is good:</strong> The <a href="https://www.maternaljournal.org/">Maternal Journal</a> project holds in-person and online group sessions supporting you to explore how art can help, while also caring for your baby. </p>
<p><strong>Try baby massage:</strong> It can help you to slow down and connect with your baby. And it can help increase <a href="https://pubmed.ncbi.nlm.nih.gov/11246096/">oxytocin levels</a> in you both, calming your system.</p>
<p><strong>Explore some grounding techniques:</strong> <a href="https://www.healthline.com/health/grounding-techniques#physical-techniques">These can help you</a> to manage your anxiety. When you feel symptoms of anxiety, look for things in the environment around you. Try and find five things that are blue. Or five things that are soft. Count them and say them out loud. </p>
<p>Most of all remember that none of these feelings are anything to do with how much you love your baby or how well you care for them. Often mothers experiencing mental health difficulties are highly attuned to their baby’s needs because they are so worried about not getting it right. Your baby will be fine, but it’s important that you are too.</p><img src="https://counter.theconversation.com/content/207360/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has received funding from the ESRC, MRC, NIHR, HEFCW, UKRI, Infant feeding charities and Public Health Wales. She is a trustee for First Steps Nutrition Trust.</span></em></p>New motherhood is often portrayed as a time of joy but it can also be filled with fears and complicated feelings. Here’s how you can get help and support.Amy Brown, Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2118572023-08-28T12:01:32Z2023-08-28T12:01:32ZFDA’s greenlighting of maternal RSV vaccine represents a major step forward in protecting young babies against the virus<figure><img src="https://images.theconversation.com/files/544842/original/file-20230825-28-j8m5d5.jpg?ixlib=rb-1.1.0&rect=126%2C34%2C7542%2C4276&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Expecting parents and those with infants have new options to consider to protect against RSV.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctor-visiting-young-mother-at-home-for-routine-royalty-free-image/1471833049?phrase=respiratory+illness+infant&adppopup=true">martin-dm/E+ via Getty Images</a></span></figcaption></figure><p>With the Food and Drug Administration’s Aug. 21, 2023, <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-vaccine-pregnant-individuals-prevent-rsv-infants?ftag=MSF0951a18">approval of the first vaccine against respiratory syncytial virus, or RSV</a>, for use during late pregnancy, the U.S. will soon have a major new tool at its disposal to protect infants against the highly contagious virus. </p>
<p>RSV is the <a href="https://doi.org/10.1016/S0140-6736(22)00478-0">most common cause of lower respiratory infections</a> in young children and can be especially severe for infants under 6 months of age. It is the leading cause of infant hospitalization in the U.S., according to the Centers for Disease Control and Prevention. Each year, RSV is associated with <a href="https://doi.org/10.1056/NEJMoa0804877">half a million emergency room visits</a>, nearly 100,000 hospitalizations and 300 deaths in young U.S. children. </p>
<p>The vaccine, sold under the brand name Abrysvo, is approved for use between 32 and 36 weeks of pregnancy to protect infants from birth through 6 months of age.</p>
<p>The CDC plans to meet in October to set recommendations for the use of Abrysvo. That means this vaccine could become available for use during pregnancy in a matter of months.</p>
<p>In mid-July, the FDA also approved a <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-prevent-rsv-babies-and-toddlers">long-acting, single-dose monoclonal antibody</a>, called nirsevimab, which is sold as Beyfortus, for newborns and young children up to the age of 2 years old.</p>
<p>We are an <a href="https://www.usfca.edu/faculty/annette-regan">infectious disease epidemiologist</a> and <a href="https://www.bcm.edu/people-search/flor-munoz-rivas-27227">pediatric infectious disease physician</a>. We have experienced the frustration of previously limited options available for the prevention of RSV, especially during the <a href="https://theconversation.com/rsv-a-pediatric-disease-expert-answers-5-questions-about-the-surging-outbreak-of-respiratory-syncytial-virus-193275">heavier-than-usual RSV season</a> in late 2022. The approval of a maternal vaccine and monoclonal antibody signals a major milestone in the medical profession’s ability to prevent RSV disease in children.</p>
<p>With these two new options soon to be available, parents of young children, along with people who are currently expecting, are likely wondering about the pros and cons of each and which to take to best protect their child from RSV.</p>
<h2>A game-changer in the fight against RSV</h2>
<p>The newly approved protein-based vaccine takes a similar approach as the <a href="https://www.cdc.gov/vaccines/pregnancy/hcp-toolkit/tdap-vaccine-pregnancy.html">Tdap, or whooping cough, vaccine</a>, which is given between 27 and 36 weeks of pregnancy <a href="https://www.cdc.gov/vaccines/pregnancy/hcp-toolkit/tdap-vaccine-pregnancy.html">to protect babies against tetanus, diphtheria and pertussis (whooping cough)</a>. Abrysvo stimulates the mother’s immune system to produce antibodies that cross the placenta and offer protection to the newborn against RSV illness, starting at birth.</p>
<p>The FDA based its approval on clinical trial data from more than 7,000 participants across 18 countries who either received the RSV vaccine between 24 and 36 weeks of pregnancy or received a placebo shot. In the trial, the maternal RSV vaccine <a href="https://doi.org/10.1056/NEJMoa2216480">prevented 82% of severe lower-respiratory illnesses</a> caused by RSV in infants in the first 3 months of life, and 69.4% through 6 months of age. </p>
<p>While there were <a href="https://doi.org/10.1056/NEJMoa2216480">no vaccine-related safety concerns raised in the trial</a>, including preterm birth, low birth weight, birth defects, developmental delay or death, the vaccine will come with a warning about a less-than-1% increase in preterm birth that was seen in the group that received the RSV vaccination in the clinical trial. There is currently no proof that the vaccine is causally linked with preterm birth, and the 1% increase was not significant.</p>
<p>The FDA also requires the vaccine manufacturer to continue monitoring the safety of the vaccine for use during pregnancy. </p>
<p>Abrysvo <a href="https://www.nytimes.com/2023/05/31/health/fda-rsv-vaccine-older-adults.html">was also approved by the FDA</a> in May 2023 to prevent RSV illness in adults 60 years and older.</p>
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<figcaption><span class="caption">There are now tools available to protect the most vulnerable members of the population – infants and older Americans – against RSV.</span></figcaption>
</figure>
<h2>Monoclonal antibodies also provide protection</h2>
<p>For those who are unable to get the RSV vaccine during their pregnancy, there is also an option to provide ready-made antibodies to protect the baby.</p>
<p>Nirsevimab, also known as Beyfortus, is a monoclonal antibody approved for babies up to 8 months of age during the RSV season and children up to 24 months of age who are at high risk of severe RSV. Beyfortus is given as a single shot of laboratory-made human antibodies. These antibodies help protect against lower-respiratory tract disease, including <a href="https://www.mayoclinic.org/diseases-conditions/bronchiolitis/symptoms-causes/syc-20351565#">bronchiolitis</a> and <a href="https://www.nhlbi.nih.gov/health/pneumonia#">pneumonia</a>, caused by RSV. </p>
<p>Clinical trial data <a href="https://doi.org/10.1056/NEJMoa2110275">from 350 sites across 31 countries</a> showed that Beyfortus was 75% effective against RSV-associated lower respiratory illness and 62% effective against RSV-associated hospitalization in the first 5 months after birth. Mild adverse reactions associated with Beyfortus included rashes and swelling or pain at the place where the injection was made. </p>
<p>There are some children who should not receive Beyfortus or should be cautious about receiving Beyfortus, including those with a history of serious reactions to the ingredients in that medication and children with bleeding disorders.</p>
<h2>Parsing the differences</h2>
<p>Both the maternal vaccine and the monoclonal antibody have been shown to work in reducing the risk of severe RSV disease in young infants, and the efficacy and duration of protection appears to be similar. Clinical trials showed that the vaccine was protective up to <a href="https://doi.org/10.1056/NEJMoa2216480">6 months of age</a> and the antibody up to <a href="https://www.beyfortus.com/hcp/?">5 months of age</a>. </p>
<p>While Abrysvo stimulates the production of the mother’s own antibodies that get passed on to the baby, Beyfortus is not actually a vaccine. It instead provides ready-made antibodies given as an injection to protect the child. Beyfortus will go to work immediately after administration, and babies of mothers who are vaccinated during pregnancy will be protected from birth, but Abrysvo takes approximately 14 days after the shot to build up effective antibodies in the mother. The vaccine should be taken at least 14 days before expected delivery – and ideally even before then – in order to adequately protect the baby.</p>
<p>Both the vaccine and the monoclonal antibody target the F-protein of the virus, the protein that helps the virus enter cells and spread infection. However, the vaccine creates antibodies that target all sites on the F-protein, while Beyfortus antibodies target a single site – known as “site zero” – of the F-protein. Both result in passive immunity to the baby, providing protection during a time that babies are most susceptible to severe RSV disease. </p>
<p>When mothers are vaccinated within the specified window and babies are born at term, the protection from Abrysvo is sufficient for the babies. When the mother is not vaccinated in pregnancy, then Beyfortus is available for infants from birth.</p>
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<figcaption><span class="caption">Beyfortus can prevent RSV in children up to age 2.</span></figcaption>
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<p>Another big difference between the two products is cost. Pre-prepared antibodies like Beyfortus can be expensive to produce and carry a higher cost compared to the Abrysvo vaccine – about <a href="https://www.cnn.com/2023/08/03/health/rsv-infant-nirsevimab-beyfortus-acip/index.html">US$395 to $500</a> per Beyfortus shot compared to <a href="https://www.cbsnews.com/news/cost-of-vaccines-vary-by-virus-and-health-insurance-status-kff/">$180 to $295</a> per Abrysvo shot. The cost of Abrysvo and how it will be covered by insurance will depend on what the CDC says in October. Regardless, both shots need to be given by a health care professional, which will require a medical visit.</p>
<p>While both provide a substantial opportunity to prevent severe illness associated with RSV in newborns and young infants, most children will not need both. </p>
<p>In special cases, Beyfortus could be offered to an infant of a mother who received the vaccine. For example, this might be appropriate if birth occurs less than 14 days after the administration of the vaccine, or if the baby is born prematurely. In addition, the monoclonal antibody can be given to protect infants with high-risk conditions for RSV, such as immune deficiency and chronic lung or heart disease, through their second year of life. </p>
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<a href="https://images.theconversation.com/files/544817/original/file-20230825-17-nt7ejh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A pregnant mother gazes down at her arm as she receives a shot from a medical provider." src="https://images.theconversation.com/files/544817/original/file-20230825-17-nt7ejh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544817/original/file-20230825-17-nt7ejh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544817/original/file-20230825-17-nt7ejh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544817/original/file-20230825-17-nt7ejh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544817/original/file-20230825-17-nt7ejh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544817/original/file-20230825-17-nt7ejh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544817/original/file-20230825-17-nt7ejh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The newly approved maternal vaccine can be taken between 32 and 36 weeks of pregnancy.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/expectant-mother-watches-as-tech-gives-her-vaccine-royalty-free-image/1340094898?phrase=maternal+RSV+vaccine&adppopup=true">SDI ProductionsE+ via Getty Images</a></span>
</figcaption>
</figure>
<h2>The bottom line</h2>
<p>Both products are safe and effective, and it is important to protect young infants and children at risk from RSV. </p>
<p>Until now, effective monoclonal antibodies were only available for the most premature babies. But many of the infants who <a href="https://doi.org/10.1016/S2213-2600(22)00414-3">get RSV are born full term</a>. </p>
<p>Families should discuss their options for RSV prevention with their pregnancy care provider and pediatrician.</p><img src="https://counter.theconversation.com/content/211857/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Annette Regan receives funding from the National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the US Centers for Disease Control and Prevention, and the Pan American Health Organization.</span></em></p><p class="fine-print"><em><span>Flor M. Munoz is a member of the data safety committee or advisory boards to Pfizer, Sanofi, AztraZeneca, GSK, Moderna, and Meissa vaccines. She receives research funding from the National Institutes of Health, the US Centers for Disease Control and Prevention, Pfizer and Gilead. She is a member of the board of the National Foundation of Infectious Diseases (NFID).</span></em></p>Nearly 100,000 US children under age 5 are hospitalized each year for an RSV infection.Annette Regan, Associate Professor of Epidemiology, University of San FranciscoFlor M. Munoz, Associate Professor of Pediatric Infectious Diseases, Baylor College of Medicine Licensed as Creative Commons – attribution, no derivatives.