Category Archives: SMFM

Key Committee Votes to Create Task Force on Pregnant and Lactating Women to Ensure Safer Medications, Collaboration on Research and Wider Dissemination of Information

WASHINGTON, April 18, 2016—The Society for Maternal-Fetal Medicine announced today that the Senate Health Education Labor & Pensions (HELP) Committee has approved bill S. 2745 by voice vote, a bill intended to promote the inclusion of minorities in clinical research. This legislation includes a key provision that would create a Task Force on Pregnant Women and Lactating Women.

SMFM held a workshop on the issue of medications in pregnancy and breastfeeding at its annual meeting in February 2015, which was co-sponsored by the National Institute of Child Health and Human Development, American Academy of Pediatrics and American Congress of Obstetricians and Gynecologists.

“We are thrilled to see this initiative move to the next step in the legislative process,” stated Mary Norton, M.D., president of SMFM. “As more women with chronic diseases, such as diabetes, hypertension, depression and asthma are becoming pregnant, safe and effective medications to manage these ongoing conditions throughout their pregnancy and beyond are needed. This legislation is a great first step toward greater collaboration and communication among federal agencies and public stakeholders on this important issue.”

In her opening statement, HELP Committee Ranking Member Senator Patty Murray (D-WA), noted her thanks to the legislation’s cosponsors, including Senators Susan Collins (R-ME), Kirk (R-IL), Baldwin (D-WI), Warren (D-MA) and Chairman Alexander (R-TN) and herself. She noted specifically the inclusion of this task force to ensure safer medications and greater information for pregnant women and new mothers.

In 2014, SMFM began working with the March of Dimes, the American Congress of Obstetricians and Gynecologists, and the American Academy of Pediatrics to form the Coalition to Advance Maternal Therapeutics. The Coalition has been working to educate and inform Congress and other policymakers on the issues related to lack of data and information on medications in pregnancy and breastfeeding.

The provision included in S. 2745 will created a task force housed within the U.S. Department of Health and Human Services that will improve federal interagency and key stakeholder communication, coordination and collaboration to advance research and information sharing on medications in pregnancy and breastfeeding.  It will include federal agencies such as National Institutes of Health, U.S. Food & Drug Administration and Centers for Disease Control and Prevention as well as public stakeholders from professional societies, consumer representation and industry representation to prioritize and identify gaps in research and recommend a path forward on greater inclusion of pregnant and breastfeeding women in research.

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SMFM Releases Statement on Ultrasound Screening for Fetal Microcephaly following Zika Virus Exposure

WASHINGTON (April 13, 2016)— The Society for Maternal-Fetal Medicine released a statement on the use of ultrasound screening for fetal microcephaly following Zika virus exposure.

Microcephaly is a condition in which the size of the head is smaller than expected for age. This condition in fetuses and infants has been associated with the recent outbreak of Zika virus.  Due to this association, the Centers for Disease Control and Prevention, American Congress of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine have suggested ultrasound evaluation to measure the baby’s head in pregnant women who have been infected or potentially exposed.  Diagnosis of microcephaly by ultrasound is not always straightforward and can be complex. The Society for Maternal-Fetal Medicine provided recommendations on how to interpret the findings, including when to perform follow up ultrasound, as well as a table of values at each week of pregnancy that would define the lower limit of normal. The goal is to provide the tools to health care providers to counsel women who may have been exposed to the Zika virus. The Society for Maternal-Fetal will continue to assist clinicians in tackling this new health threat.

For more information on the Society of Maternal-Fetal Medicine’s recommendations and the Zika virus, go to www.smfm.org/education/zika or visit SMFM’s publications www.smfm.org/publications.

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Society for Maternal-Fetal Medicine Releases Statement on use of Antenatal Corticosteroids in the Late Preterm Birth Period in Women at Risk for Preterm Birth

WASHINGTON (April 6, 2016)— The Society for Maternal-Fetal Medicine released a statement on the use of antenatal corticosteroids during the late preterm birth period for women at risk of preterm birth. The statement, is currently available online and will be published in the July issue of the American Journal of Obstetrics and Gynecology. It comes on the heels of a study and a presentation at SMFM’s annual meeting in Atlanta in February where researchers with the Eunice Kennedy Shriver National Institute of Child Health and Human Development and Maternal-Fetal Medicine Units Network (MFMU) presented findings that the administration of antenatal steroids in pregnancies at risk for late preterm delivery prevents respiratory and other neonatal complications.

The study, titled Antenatal Late Preterm Steroids (ALPS): a Randomized Trial to Reduce Neonatal Respiratory Morbidity was a randomized, double-blind, placebo-controlled trial at 17 tertiary medical centers around the United States from Oct. 2010 to Feb. 2015.  The study enrolled 2,831 women with singleton pregnancies at high risk for late preterm delivery (34 0/7 to 36 6/7 weeks) who were randomized to receive antenatal betamethasone intramuscularly or a matching placebo.  This study found a significant decrease in neonatal respiratory complications in the group given the steroid treatment.  Investigators also found that these babies were less likely to have prolonged intensive care nursery stays, less likely to need postnatal treatment for respiratory complications, and less likely to develop bronchopulmonary dysplasia, which is a sign of chronic lung disease. Prior to this report, such treatment was only recommended with risk of preterm delivery before 34 weeks of gestation, as infants in the late preterm period were thought to be at little, if any, increased risk of complications.

Lead investigator, Cynthia Gyamfi-Bannerman, M.D., MSc, the Ellen Jacobson Levine and Eugene Jacobson Associate Professor of Women’s Health (in Obstetrics and Gynecology) from Columbia University Medical Center, put the findings in context: “The majority of preterm deliveries occur in the late preterm period.  We now have a treatment that can significantly improve outcomes for these at risk babies.”  The study was co-funded by the NHLBI, with the aid of program officer Carol Blaisdell, M.D. and the NICHD under the guidance of Uma Reddy, M.D.

In their statement, the Society for Maternal-Fetal Medicine recommends:

  • In women with a singleton pregnancy between 34 weeks to 36 6/7 weeks of gestation who are at high risk for preterm birth within the next seven days (but before 37 weeks of gestation), SMFM recommends treatment with betamethasone, a corticosteroid demonstrated to decrease neonatal complications in preterm infants.
  • In women with preterm labor symptoms in the late preterm period, SMFM recommends waiting for evidence of true preterm labor, such as a cervical dilatation of at least three centimeters or effacement of at least 75% before treatment with betamethasone.
  • In women with late preterm pregnancies receiving betamethasone, SMFM recommends against the use of tocolysis in an attempt to delay delivery to complete the steroid course since it is unclear if the benefits are outweighed by the risks of attempts to delay delivery.
  • In women with late preterm pregnancies with a potential medical indication for delivery, SMFM recommends betamethasone not be given unless there is a definitive plan for late preterm delivery.
  • SMFM also recommends against the implementation of antenatal late preterm steroids protocol for conditions not studied in the randomized controlled trials.

Given that more than 300,000 pregnancies deliver in the late preterm period each year in the U.S., the study along with recommendations for adoption by the Society for Maternal-Fetal Medicine will have a significant impact on the health of newborns and infants.

For more information on SMFM publications, go to https://www.smfm.org/publications.

Study Finds Maternal Intake of High Fructose Leads to Fetal Programming of Adult Obesity, Hypertension and Metabolic Dysfunction Especially in Female Offspring

ATLANTA (Feb. 4, 2016)—In a study to be presented on Feb. 5 in the oral session at 1:15 p.m. EST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings on the effects of antenatal exposure to a high fructose diet on the offspring’s development of metabolic syndrome-like phenotype and cardiovascular disease later in life.

The study, titled High fructose diet in pregnancy leads to fetal programming of hypertension, insulin resistance and obesity in adult offspring, randomly allocated either a fructose solution or water as the only drinking fluid for pregnant mice from first day of pregnancy through delivery. Offspring were then started on regular chow and evaluated after one year of life.  Percent of visceral adipose tissue was measured along with liver fat infiltrates using computed tomography, and blood pressure using a non-invasive monitor. Glucose tolerance testing was also performed and serum concentrations of glucose, insulin, triglycerides, total cholesterol, leptin and adiponectin were measured.

Maternal weight, pup number and average weight at birth were similar between the two groups. Male and female offspring born to mothers who received the fructose solution group had higher peak glucose compared with controls. Female offspring from the fructose group were heavier and had a higher percent of visceral adipose tissue, liver fat infiltrates, fasting homeostatic model assessment scores, higher serum concentrations of leptin and lower concentrations of adiponectin.

No significant differences in these parameters were noted in male offspring. Serum concentrations of triglycerides and total cholesterol were not different between the two groups or either gender.

“While this study was done in a mouse model, it is an important indicator of the effect of the mothers’ diet during pregnancy on the health of their children later in life,” explained Antonio Saad, M.D. with UTMB Galveston and the lead researcher of the study. “Through this study, we know that consuming high fructose during pregnancy putts the child at future risk for a variety of health conditions including obesity and the many complications it causes.”

The study concluded that, while maternal intake of high fructose leads to fetal programming of adult obesity, hypertension, and metabolic dysfunction—all of which risk factors for cardiovascular disease; limiting high fructose enriched diets in pregnancy may have a significant impact on long term health.

 

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A copy of the abstract is available at http://www.smfmnewsroom.org and below. For interviews please contact Vicki Bendure at Vicki@bendurepr.com 202-374-9259 (cell).

 

The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine. The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed.  For more information visit www.smfm.org.

 

Abstract 67    High Fructose Diet in Pregnancy Leads to Fetal Programming of Hypertension, Insulin Resistance and Obesity in Adult Offspring

 

Authors: Antonio Saad1, Joshua Disckerson1, Phyllis Gamble1, Huaizhi Yin1, Talar Kechichian1, Ashley Salazar1, Igor Patrikeev2, Massoud Motamedi2, George Saade1, Maged Costantine1

1UTMB Galveston, Galveston, TX, 2UTMB Center of Biomedical Engineering, Galveston, TX

 

Objective: Consumption of fructose rich diets in the U.S is on the rise and thought to be associated with obesity and cardio-metabolic diseases. Our objective was to determine the effects of antenatal exposure to high fructose diet on offspring’s development of metabolic syndrome-like phenotype and other cardiovascular disease (CVD) risk factors later in life.
Study Design: Pregnant C57BL/6J dams were randomly allocated to fructose solution (FRC, 10% W/V, n=10) as only drinking fluid or water (CTR, n=10) from day 1 of pregnancy until delivery. Pups were then started on regular chow, and evaluated at 1 year of life. We measured % visceral adipose tissue (VAT) and liver fat infiltrates using computed tomography (CT), and blood pressure using CODA/ non-invasive monitor. Intraperitoneal glucose tolerance testing (IPGTT), with corresponding insulin concentrations were obtained. Serum concentrations of glucose, insulin, triglycerides (TG), total cholesterol (TC), leptin, and adiponectin were measured in duplicate using standardized assays. Fasting homeostatic model assessment (HOMA- IR) was also calculated to assess insulin resistance.
Results: Maternal weight, pup number and average weight at birth were similar between the two groups. Male and female FRC offspring had higher peak glucose and area under the IPGTT curve, compared with CTR (Figures 1A&B), and higher mean arterial pressure compared to CTR (Figure 1C). Female FRC offspring were heavier and had higher % VAT (Figure 1D), liver fat infiltrates, HOMA-IR scores, insulin area under the IPGTT curve, serum concentrations of leptin, and lower concentrations of adiponectin compared to female CTR offspring (Table). No significant differences in these parameters were noted in male offspring. Serum concentrations of TG or TC were not different between the 2 groups for either gender.
Conclusion: Maternal intake of high fructose leads to fetal programming of adult obesity, hypertension and metabolic dysfunction, all risk factors for CVD. This fetal programming is more pronounced in female offspring. Limiting intake of high fructose enriched diets in pregnancy may have significant impact on long term health.

 

Abstract 67a

Abstract 67b

Study Shows Maternal Diet Alters the Breast Milk Microbiome and Microbial Gene Content

ATLANTA (Feb. 1, 2016)—In a study to be presented on Feb. 5 at 2:30 p.m. EST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings from a study titled, Maternal Diet Alters the Breast Milk Microbiome and Microbial Gene Content.

Breast milk contains a diverse microbiome that is presumed to colonize the infant gastrointestinal tract and contribute to the establishment of the infant gut microbiome. The composition of the breast milk microbiome varies over time and among individuals, though the factors driving the variation are largely unknown. Since maternal diet during gestation and lactation has been previously shown to independently alter the offspring microbiome and offspring disease susceptibility, researchers speculated that the breast milk microbiome may be a mediator of this dietary impact. Two groups of lactating women participated in highly-controlled single-blinded cross-over dietary intervention studies to evaluate if maternal diet plays a significant role in structuring the taxonomic and metagenomic composition of the breast milk microbiome.

“We saw considerable differences based on maternal diet,” explained Kristen Meyer, with the Baylor College of Medicine, one of the researchers of the study and the presenter at the SMFM annual meeting. “Based on this, we speculate that the maternal diet serves as a significant driver of the early infant microbiome, reinforcing the gestational dietary impact,” added Meyer.

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A copy of the abstract is available at http://www.smfmnewsroom.org and below. For interviews please contact Vicki Bendure at Vicki@bendurepr.com 202-374-9259 (cell).

 

The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine. The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed.  For more information visit www.smfm.org.

 

abstract 66

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