Newborns

It’s time to remove skin color from the Apgar Score for newborns

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Health care workers checking a new born baby's heart rate. -- first opinion coverage from STAT

In medicine, inertia can be a strangely powerful force, but Virginia Apgar never succumbed to it. She brought incredible energy to her work in anesthesia, neonatology, and dysmorphology (the study of birth defects) and questioned the status quo when she thought it might save lives.

With gratitude for her tireless work, we have reevaluated the eponymous health assessment Apgar developed more than 70 years ago and concluded that one of its components — skin color — should be abandoned. It’s a step Apgar herself might have encouraged; she knew this part of her evaluation method was weaker than the others. We have a chance now to correct that bias.

Apgar developed her scoring system in the early 1950s to help identify newborns who might need immediate medical attention after birth. The Apgar Score, performed one minute and five minutes after a baby is born, called for a consistent, rapid evaluation of five categories associated with a newborn’s health: heart rate, respiration, muscle tone or activity, reflex response to stimulation, and skin color. Her method worked, reducing infant mortality (although the original articles do not say by how much), and is still used today.

Thank you, your records have been updated!

Apgar’s system also was flawed — and she knew it. In her original paper presenting the scoring method, she wrote that color “is by far the most unsatisfactory sign” of newborn health because it did not work on darker skin.

The Apgar Score offers four limited choices for the skin color score: completely pink, acrocyanotic (bluish discoloration from a lack of oxygen), pale, and blue. Put simply, children of color cannot turn “completely pink” and may not seem to turn bluish due to a lack of oxygen as others might.

The skin color component’s utility is also limited by perception. Apgar meant to introduce objective measures to assess newborns, but color perception is subjective. People from different cultures, of different genders, and who have different visual abilities perceive color differently.

Apgar’s perspective was rooted in her own education and experience. The first part of her medical work was in anesthesiology, where she learned to identify how well oxygenated a patient was based on the patient’s skin color. At the time, it was a standard way to evaluate patients.

We conducted a study that reviewed a comprehensive, reliable national database to see which newborns received perfect Apgar Scores. Not surprisingly, white newborns had a significantly higher chance of receiving a “perfect” or “optimal” score of 10. We found that the harm is that more healthy babies of color may end up in the neonatal intensive care unit with more unnecessary interventions.

We also found studies that report unreliability and high variability in how medical observers perceive color. Perhaps most important, many medical professionals say the color score contributes little to the Apgar Score’s value, and there are regions of the world where those evaluating newborns ignore this part of the assessment. Hopefully, that’s where we’re headed, too.

To be clear, the Apgar Score has saved countless newborns, and Apgar was not racist.

However, today we have an opportunity — and a responsibility — to uncover and eliminate racial bias wherever it exists. Using skin color to evaluate and score newborns does not advance health equity or promote better outcomes for patients. It advances racial bias, systemically, from a child’s first minute.

It is time to part ways with this component of Apgar’s method, and the score would be out of eight, not 10.

The comprehensive adoption of the Apgar Score has led it to be said that every newborn is seen through the “eyes” of Virginia Apgar. That vision was not racist, but it did introduce a racial element to the assessment of newborn health for babies of color, one that is both subjective and not clinically useful. If we keep using it out of a sense of medical tradition, we are giving in to inertia, something Apgar never did.

Throughout her career, Apgar pushed herself and pushed boundaries. She established a new department of anesthesia soon after she graduated from medical school, attended more than 17,000 births, drew attention to newborn health and birth defects, and carried around a resuscitation kit because she didn’t want anyone dying on her watch. She never retired.

In keeping with her boundless energy and passion for progress in medicine and education, we must see what Apgar herself had noted: Skin color is the least useful way to evaluate a newborn.

Newborns Exposed to Endocrine Disruption

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Even newborns can’t escape plastic contaminants

Measurement of Bisphenol A Diglycidyl Ether (BADGE), BADGE derivatives, and Bisphenol F Diglycidyl Ether (BFDGE) in Japanese infants with NICU hospitalization history; BMC Pediatrics, Jan. 8, 2024.

Bisphenol A diglycidyl ether (BADGE) and Bisphenol F diglycidyl ether (BFDGE) are plastics used to construct intravenous sets, syringes, catheters and other single-use equipment used in hospitals.

To quantify neonatal exposure to BADGE and BFDGE investigators enrolled 10 infants admitted to the neonatal intensive care unit (NICU) and analyzed their blood at 1-2 months and 7 months after their discharge. The researchers also surveyed the infants’ parents about their diet and home environment.

One form of BADGE, BADGE-2H2O was found at various concentrations in all infants at both time points. However, blood values were lower at 7 months. Researchers could not detect BADGE-H2O, BADGE and BFDGE at either time point.

One of two children who received mechanical ventilation showed “substantially increased” levels of the plastic BADGE-2H2O. There was no significant difference between children who ate commercial baby food at least once per week and those who did not.

Studies have shown that BADGE and BFDGE disrupt the endocrine system and are toxic to both genes and cells. Endocrine disruption was of particular concern to researchers for its potential to affect newborn growth and development.

More microbiome science, please

Boosting microbiome science worldwide could save millions of children’s lives; Nature, Jan. 8, 2024.

Promoting microbiome science beyond its current European and North American leanings could save millions of children’s lives per year, according to a study in Nature.

The human microbiome is the collection of bacteria, viruses, yeast, fungi and other microorganisms that inhabit our bodies.

Although Europe and the U.S. make up just 15% of the world’s population they are the subjects of 70% of published human microbiomes and about 85% of the high-quality microbiomes of children under age 4.

Just one component of the human microbiome, the gut microbiome, has been implicated in both beneficial and harmful events — for example, heart disease and inflammation.

Scientists are working on drugs that target the microbiome, but because microbiomes vary regionally the drugs must be designed for specific populations. If world health authorities pursue this tack, 17 million children’s lives could be saved each year.

Low vitamin A levels linked to increased risk of respiratory infections

Recurrent respiratory tract infections in children might be associated with vitamin A status: a case-control study; Frontiers in Pediatrics, Jan. 5, 2024.

A Chinese study found that the less vitamin A in a child’s bloodstream the greater their risk for having recurrent respiratory tract infections (RRTIs).

Investigators recruited 2,592 children ages 6 months to 14 years from China’s Heilongjiang province. Parents completed a diet questionnaire on behalf of 1,039 children experiencing RRTIs and 1,553 who did not.

Blood concentrations of vitamin A in the RRTI group were significantly lower than for healthy control subjects. Children with moderately low vitamin levels had a 32% higher chance of being in the RRTI group, and those who were seriously deficient were 50% more likely.

Among children with respiratory tract infections on the day they entered the study, those with moderately low vitamin A were 48% more likely to have started in the RRTI group, and those with severely low levels were 5.5 times more likely.

Children with low intake of vitamin A-rich foods (carrots, spinach, broccoli and meat, especially organ meats) also had a lower incidence of RRTIs.

Autism associated with inflammation

Evaluation of serum interleukin-17 A and interleukin-22 levels in pediatric patients with autism spectrum disorder: a pilot study; BMC Pediatrics, Jan. 5, 2024.

Egyptian investigators found a connection between elevated levels of interleukin-17 A (IL-17A) and interleukin-22 (IL-22), cytokines involved in systemic inflammation, in children with autism spectrum disorder (ASD).

The group enrolled 24 children with ASD (median age 5.25) and 24 non-autistic controls (age 6).

Combined elevated cytokine levels strongly associated with an ASD diagnosis and IL-22 levels predicted ASD severity. But when the cytokines were analyzed together no link emerged between IL-17A plus IL-22 levels and ASD symptom severity.

Children with pre-existing inflammatory or allergic diseases were excluded from the study as they likely already had high cytokine levels.

The authors were attempting to establish the cytokine-ASD link to lay the groundwork for the discovery of future ASD treatments targeting inflammatory processes.

However, they note that factors like breastfeeding and gut microbiome composition, which were not controlled in their study, could also contribute to the development of ASD.

Why some kids are more vulnerable to mercury exposure

Factors associated with blood mercury concentrations and their interactions with three glutathione S-transferase genes (GSTT1, GSTM1, and GSTP1): an exposure assessment study of typically developing Jamaican children; BMC Pediatrics, Jan. 4, 2024.

Mercury exposure through consumption of canned fish and plant foods high in mercury leads to higher-than-normal blood mercury levels — but this effect is most pronounced in children carrying one specific gene.

U.S. and Jamaican researchers enrolled 375 typically developing 2- to 8-year-olds to explore the association between the consumption of canned fish (a staple of Jamaican diets), starches, grains and beans — sources of mercury exposure — and blood-mercury concentrations.

The only significant difference among subjects was which version of the GST (glutathione S-transferase) gene they carried.

GST is an enzyme that helps the body eliminate mercury, lead and other dangerous heavy metals. Some variants of this gene are more effective than others.

The researchers found that the consumption of canned sardines and mackerel significantly raised blood mercury concentrations, but only among children with two specific GST variants. Humans express eight different families of GST and dozens of subvariants.

By identifying subgroups of children most likely to experience the ill effects of mercury exposure, the study points toward future mercury exposure studies that concentrate on this particularly vulnerable population.

Newborns Receive Mom’s Microbiome Regardless of Birth Method

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As the microbiome field has matured over the past decade, some questions have been answered easily, while others have remained more difficult. One of the most complicated and challenging biological questions has been whether the method that a baby is delivered (vaginally or by cesarean section) affects their microbiome. Research papers have been published that support both sides of the hypothesis. Although some researchers suggest that there is no difference, others have adopted the practice of manually applying the missing microbiome (sampled from the mother) to their newborn babies.

But now, new research suggests that cesarean-born babies may not be missing out on essential microbes. The team of scientists found that, whether born vaginally or via cesarean section, babies receive essential microbes from their mothers. The reduction in transfer of their mother’s gut microbiome through fecal microbes, when babies are born via C-section, may be compensated for by other niches—for example, breastmilk.

This research is published in Cell Host & Microbe in the paper, “Mother-infant microbiota transmission and infant microbiota development across multiple body sites.”

“We wanted to have a better idea of how the infant microbiome develops in different parts of their bodies and how it’s influenced by factors such as birth mode, antibiotic use, and lack of breastfeeding,” said Wouter de Steenhuijsen Piters, MD, PhD, a postdoc in the Bogaert lab at the University Medical Center Utrecht, Netherlands.

To do this, the team recruited and repeatedly sampled 120 Dutch mothers and soon-to-be-born babies. From the babies, they collected skin, nose, saliva, and gut microbiome samples two hours after they were born and when they were one day old, one week old, two weeks old, and one month old.

The team also collected six different microbiome samples from the mothers—skin, breastmilk, nose, throat, fecal, and vaginal—to determine which of these sources were “seeding” the babies’ various microbiomes. Then, they analyzed these results in the context of several factors that are thought to impact microbiome transfer, including mode of delivery, antibiotic use, and breastfeeding.

“We saw that many niches of the mother are important for the transmission of microbes, and if some of these pathways are blocked for one reason or another—in this case, we saw that happening with the cesarean section—then these microbes can still reach the infant through other paths,” said de Steenhuijsen Piters.

Regardless of birth route, the researchers found that approximately 58.5% of a baby’s microbiome is derived from its mother. However, different maternal microbial communities contributed to different infant microbiomes. Cesarean-born babies received fewer microbes from their mother’s vaginal and fecal microbiomes, and acquired more microbes from breastmilk.

“Microbiome transfer and development are so important that evolution has ensured that those microbes are transferred one or another way from mother to child,” said Debby Bogaert, PhD, physician scientist at the University of Edinburgh. “Breastfeeding becomes even more important for children born by cesarean section who do not receive gut and vaginal microbes from their mom.”

“It’s a smart system, and it makes sense from an evolutionary perspective that these types of pathways are redundant to ensure that the child can begin life with the appropriate ‘starter kit,’” said de Steenhuijsen Piters.

Now, the team plans to investigate non-maternal influences on infant microbiome development. “We could see that the maternal microbiome explains almost 60% of the infant’s total microbiome, but there’s still 40% that we don’t know about,” said de Steenhuijsen Piters. “It would be interesting to stratify that unknown fraction to see where all the microbes come from; whether fathers contribute, for example, or siblings, or the environment.”

Ultimately, the researchers want to understand how microbiome development in infants relates to long-term health. “Next, we want to explore whether this early life process, influenced by mom, is affecting not only short-term infection risk in the first year of life but also longer-term health in terms of things like allergies and asthma,” said Bogaert. “In the future, we might be able to utilize this knowledge to help prevent, diagnose, or treat health problems.”

Studies confirm COVID-19 vaccination during pregnancy benefits newborns

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Findings have shown that COVID-19 mRNA vaccines are safe and effective during pregnancy, and evidence also suggests that the benefits of maternal vaccination extend to newborns.

However, despite the track record of the vaccines and the negative health outcomes associated COVID-19 during pregnancy, vaccine uptake among pregnant women has remained lower compared with that of the general population.

Key takeaways of COVID-19 vaccination during pregnancy: Safe for mothers and newborns; Mothers pass anti-spike IgG antibodies to infants; Infants retain antibodies at 6 months
Key takeaways of COVID-19 vaccination during pregnancy: Safe for mothers and newborns; Mothers pass anti-spike IgG antibodies to infants; Infants retain antibodies at 6 months

A recent analysis showed that pregnant women are motivated to get vaccinated if health care workers explain how immunization benefits their baby. We spoke with experts about the safety of COVID-19 vaccines during pregnancy and the studies showing how maternal vaccination can protect infants.

‘Primum non nocere’

In a study published this year, Goldshtein and colleagues found that rates of preterm birth, all-cause neonatal hospitalization, post-neonatal hospitalization, congenital anomalies and infant mortality were similar between newborns who were and were not exposed to the Pfizer-BioNTech vaccine in utero.

Mary Jane Minkin

Mary Jane Minkin

“The two important tenets of medicine are ‘primum non nocere’ and ‘secundum bene facere’ — first do no harm; second, do good,” Mary Jane Minkin, MD, clinical professor in the department of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine, told Healio. “[This study] clearly outlines no harm … and there are also other studies out there confirming this.”

One such study found that babies exposed to the vaccine during their mothers’ pregnancy did not hinder fetal brain development.

‘Secundum bene facere’

Multiple studies have shown that newborns may benefit from maternal vaccination, fulfilling the “do good” principle to which Minkin alluded.

In one study, Yang and colleagues evaluated levels of anti-spike immunoglobin G (IgG) antibodies in pregnant women who had received at least one dose of either the Moderna, Pfizer-BioNTech or Johnson & Johnson vaccines. Their data showed that being fully vaccinated at any time during pregnancy was associated with the presence of maternal antibodies.

Conti and colleagues studied a contrasting cohort — mothers with COVID-19 — and found that infants had antibodies in their saliva, “which may partly explain why newborns are resistant to SARS-CoV-2 infection,” they said. They also found that antibodies can be transferred via breast milk to newborns.

Despite this seeming benefit of infection, Yang and colleagues discovered that vaccination during the third trimester yielded maternal and umbilical antibody titers comparable to those observed in women with previous SARS-CoV-2 infection. Additionally, they found that receiving a booster shot during the third trimester was associated with an even greater concentration of antibodies than natural infection.

Another study conducted by Kugelman and colleagues supported these findings, specifically regarding the Pfizer-BioNTech vaccine administered during the second trimester. Though both mothers and their babies in this study had humoral responses, newborns had a 2.6-times higher level of antibodies compared with their mothers.

This transfer of antibodies is crucial for protecting the youngest children, Minkin emphasized.

“Newborns are basically immunocompromised; they cannot make antibodies when they are born,” said Minkin, who is also a Healio Women’s Health & OB/GYN Peer Perspective Board Member. “No trials on immunization to kids are going to look at newborns under 6 months old, so getting this vulnerable group antibodies is key.”

Looking past the newborn stage, Shook and colleagues found that 57% of infants aged 6 months whose mothers had been vaccinated during pregnancy had retained antibodies, compared with 8% of those whose mothers were infected with SARS-CoV-2 during pregnancy. Though this study was small, “these findings provide further incentive for pregnant individuals to pursue COVID-19 vaccination,” the researchers wrote.

Importance of vaccination

As data continue to support the benefits of maternal COVID-19 vaccination for newborns, doctors must continue to advocate for vaccination of pregnant women, according to experts.

Sarah Stock, MD, PhD

Sarah Stock

“There is now good evidence that vaccination is the safest and most effective way for pregnant women to protect themselves and their babies against COVID-19 infection,” Sarah Stock, MD, PhD, a reader in maternal and fetal health and an honorary consultant and subspecialist in maternal and fetal medicine at the University of Edinburgh Usher Institute, told Healio. “If you are at any stage in pregnancy or hoping to become pregnant, I would strongly encourage you to get vaccinated.”

Given these data and the increased risk for pregnancy complications associated with COVID-19, Minkin said it is best for pregnant women to get vaccinated than risk infection.

“All these [studies] demonstrate that maternal vaccination is safer for the mother, but also safer for her newborn, so why not get the vaccination?” she said. “We often don’t get the opportunity to take a win-win situation.”

References:

Best Diaper Changing Technique for Newborns to Reduce Colic

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Watch the video.URL:https://youtu.be/l9IDpEVkemM

Could 99% of those who change diapers be doing it wrong? It is dumbfounding to learn that by pulling a babies legs up with one hand it can be causing nerve interference leading to colic in infants. 

I’ll never forget the moment, sitting there in a post-graduate seminar in Chicago, when I realized that as a chiropractor I had been really, really messing something up.  I wasn’t a newbie by any means- I’d been in family practices for 7 years by this point, served my profession at the state and national level, and won a major award for my alternative health news podcast.  But here I was at the Doubletree being shown the most basic concept about changing an infant’s diaper, and I was dumbfounded.

Most of us do the double-leg lift.  Okay, let me write that another way:  Almost all of us do the sniff check, undo the diaper, lift the baby up by the legs to get the dirty out, wipe the creases and insert the clean one in.  A couple swipes of the tape, Velcro or snaps and it’s all done.  It’s the way we’ve seen it done in the movies, on TV, and in our own living rooms for generations.  It’s even rational- once new babies discover their feet, it’s almost impossible to keep them out of their mouths!  But I’ll tell you this- the way most of us have intuitively changed a diaper is not sound spinal biomechanics, and it very well may be the cause of your baby’s colic.

That’s where the face to palm moment came for me.  As a chiropractor in family practice, I’d seen plenty of colicky babies.  We’ve done plenty of research on it as a profession and have witnessed pretty impressive results- one study showed adjustments were more effective than medication for colic, and another showed a 93% success rate in helping children with the symptoms of gas, bloating and pain.  We understand that the intestines get a large portion of their nerve information from the area of the spine near the bottom of the rib cage and the upper portion of the low back.

It’s one of the areas we check when a parent brings their child in with colic symptoms because interference to that flow keeps the intestines from functioning properly.   If the area is being interfered with, or subluxated, than adjustments help restore normal function and allow the body to heal.  The reason chiropractic works so well for babies is that it deals directly with the nerve system, and that’s the system running the whole show.  I’d been doing this in practice for years, but I was missing something pretty important.

When we’re born we have one spinal curve.  It’s the fetal position, the c-shape that our middle backs keep, which is necessary to stay tucked nice and snuggly inside our moms.  That primary curve is the only curve we have as an infant until we build the other two in our spine.  The first re-shaping of the cervical spine happens in our necks when we learn to lift our bobbly heads and hold them up.  The second, called the lumbar curve, happens in the low back, and it forms when we learn how to crawl.  We need these secondary curves to support our body weight for standing, bending, and lifting.

But until we build them, the mechanics of the spine function very differently.  If you think of a baby’s spine like a bridge, one that doesn’t have a cervical or lumbar curve, then the peak of the bridge is between the 9th and 11th vertebra in the thoracic spine.  To give you an idea of where that is on you, the ribs that make up your ribcage exit at the 8th thoracic vertebra, and the “floater” ribs exit from the 9th to the 12th.  Compare that to where an adult’s peak is -right between the shoulder blades- and you’re going to come to the same realization I did.

If you were hunched over a lot, like if you were working on a laptop or driving for too long, most people start feeling tightness in their middle backs as their vertebra start creeping backwards out of position.  The more you do it, the more sore it gets.  In a way this is exactly what is going on with our babies when we raise their legs over and over again to change their diapers- a lot of parents without realizing it are causing the subluxations and nerve interference that results in the colic I see in the office.  Yet until that class, I had no idea why I kept seeing the same colicky kids over and over again!

The double leg lift is pretty intuitive, so I don’t blame us for thinking it was the right way to change a baby.  Infants are folded inside mom, and once they discover their feet it’s virtually impossible to keep them out of their mouths.  But the difference in the bending here is at the hip joint.  The femur heads in infants are barely developed because they don’t need the bony structure for standing or the muscle strength and tension for walking.

That lets them fling their feet over their heads and giggle without even thinking about it.  But when we use those legs for handles for a child who doesn’t have that secondary lumbar curve, we’re folding the spine at its peak, pushing the vertebra out of alignment where the nerve flow for the intestines comes out, and we’re doing this how many times?  Three?  Five?   Seven times a day?  No wonder chiropractic has such a high success rate with colicky babies– we just put back what parents keep putting out!

We need to break this cycle, for everyone’s sanity.  This is why I advocate the roll technique for diaper changing babies who haven’t started crawling yet.  It takes a little practice, but after a few days you’ll get used to it.  Holding the baby by her chest and rolling side to side keeps her spine in alignment and will help hold her adjustments so much better.  To see this in action, visit http://youtu.be/l9IDpEVkemM

To find a chiropractor near you with a special focus on the needs of infants and children, please visit the International Chiropractic Pediatrics Association’s website, http://icpa4kids.org/Find-a-Chiropractor/.

Dr. John “Doc” Edwards is the founder of Mama’s Chiropractic Clinic in Cape Coral, FL.  He runs a family practice with a special focus on the needs of expecting moms and children.  To find out more, like the Mama’s Chiropractic page on Facebook or subscribe to Doc’s channel on YouTube.

Zika Virus Can Persist for Months in Newborns, Case Study Suggests

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With prolonged infection may come more tissue damage.

An infant born with microcephaly, but with an otherwise normal physical examination at birth, had evidence of the Zika virus in serum, saliva, and urine nearly 2 months after birth, a case report from Brazil found.

The mother of the male infant was potentially infected during her third trimester of pregnancy, and the baby was born at term (40 weeks) with microcephaly. Laboratory testing found evidence of Zika virus in the infant up through 2 months of age, and he began displaying neurological symptoms at 6 months of age, Danielle B.L. Oliveira, PhD, of Universidade de São Paulo in Brazil, and colleagues, reported in a research letter in theNew England Journal of Medicine.

The authors said that despite being born with microcephaly, the infant had a normal vision and hearing test, and analysis of cerebrospinal fluid was normal at birth, with no abnormalities detected during an initial physical examination. In fact, the infant showed “no obvious illness or evidence of any immunocompromising condition” on day 54 of life.

“If Zika is shown to persist as a threat to infected newborns long after in utero exposure, there are serious implications for monitoring and managing exposed babies, even if there are no clinical manifestations noted at birth,” Irwin Redlener, MD, of Columbia University Mailman School of Public Health in New York City, who was not involved with the research, told MedPage Today via email.

But similar to the findings in a recent study, brain imaging revealed that the infant had reduced brain volume in the frontal and parietal lobes, with calcifications in subcortical areas. A polymerase chain reaction test was positive for Zika in serum, urine, and saliva at day 54 of life and positive for serum on day 67. The test was negative on day 216, although the authors noted that Zika-specific IgG titers were higher than in the first and second samples — potentially indicating that the infant had mounted an immune response to the virus.

“Prolonged viral shedding in the infant … may have had a role in the damage the virus was able to incite,” said Amesh Adalja, MD, a spokesperson for the Infectious Diseases Society of America. “It will be important to conduct more research in this vein in order to determine how common prolonged shedding is and if it is associated with a worsened clinical course,” he told MedPage Today via email.

At 6 months of age, the infant showed evidence of neuropsychomotor developmental delay, with global hypertonia, or spasticity, and spastic hemiplegia — a constant state of contraction of muscles on one side of the body, often associated with cerebral palsy. This is also consistent with recent research showing a delayed onset of symptoms in some infants with congenital Zika virus infection.

 The other interesting detail about this case was that not only did the mother appear to contract Zika virus later in her pregnancy, but she may have done so through “suspected” sexual transmission from the father. The authors reported that the mother stayed in São Paulo for the duration of her pregnancy, but the father traveled to northeastern Brazil. The father then had symptoms of Zika virus infection when the mother was 23 weeks pregnant, but she did not show symptoms until 26 weeks.

“This report provides evidence that a third trimester infection with Zika, which has been generally considered to be lower risk than earlier periods in a pregnancy, is not always benign and can lead to microcephaly,” added Adalja.

The Effect Of Cannabis On Pregnant Women & Newborns

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It’s almost too taboo to discuss: pregnant women & marijuana. It’s a dirty little secret for women, particularly during the harrowing first trimester, who turn to cannabis for relief from nausea and stress.

Pregnant women in Jamaica use marijuana regularly to relieve nausea, as well as to relieve stress and depression, often in the form of a tea or tonic.

In the late 1960s, grad student Melanie Dreher was chosen by her professors to perform an ethnographic study on marijuana use in Jamaica to observe and document its usage and its consequences among pregnant women.

the-effect-of-cannabis-on-pregnant-women-newborns

Dreher studied 24 Jamaican infants exposed to marijuana prenatally and 20 infants that were not exposed. Her work evolved into the book Women and Cannabis: Medicine, Science and Sociology, part of which included her field studies.

Most North American studies have shown marijuana use can cause birth defects and developmental problems. Those studies did not isolate marijuana use, however, lumping cannabis with more destructive substances ranging from alcohol and tobacco to meth and heroin.

In Jamaica, Dreher found a culture that policed its own ganja intake and considers its use spiritual. For the herb’s impact when used during pregnancy, she handed over reports utilizing the Brazelton Scale, the highly recognized neonatal behavioral assessment that evaluates behavior.

The profile identifies the baby’s strengths, adaptive responses and possible vulnerabilities. The researchers continued to evaluate the children from the study up to 5 years old. The results showed no negative impact on the children, on the contrary they seemed to excel.

Plenty of people did not like that answer, particularly her funders, the National Institute on Drug Abuse. They did not continue to flip the bill for the study and did not readily release its results.

“March of Dimes was supportive,” Dreher says. “But it was clear that NIDA was not interested in continuing to fund a study that didn’t produce negative results. I was told not to resubmit. We missed an opportunity to follow the study through adolescence and through adulthood.”

Now dean of nursing at Rush University with degrees in nursing, anthropology and philosophy, plus a Ph.D. in anthropology from Columbia University, Dreher did not have experience with marijuana before she shipped off for Jamaica.

She understands that medical professionals shy from doing anything that might damage any support of their professionalism, despite marijuana’s proven medicinal effects, particularly for pregnant women.

Dr. Melanie Dreher’s study isn’t the first time Jamaican ganja smoking was subjected to a scientific study. One of the most exhausting studies is Ganja in Jamaica—A Medical Anthropological Study of Chronic Marijuana Use by Vera Rubin and Lambros Comitas, published in 1975. Unfortunately for the National Institute of Mental Health’s Center for Studies of Narcotic and Drug Abuse, the medical anthropological study concluded:

Despite its illegality, ganja use is pervasive, and duration and frequency are very high; it is smoked over a longer period in heavier quantities with greater THC potency than in the U.S. without deleterious social or psychological consequences [our emphasis].

The Other Entrepreneurs: Giving Ailing Newborns a Fighting Chance From Vietnam

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Hospitals of the world’s poorest countries.

Nga Tuyet Trang, the founder of Medical Technology Transfer and Services, orMTTS, is trying to make this happen.

After spending a year studying in Denmark in 2003, Nga returned home to Vietnam imagining a world where every infant, no matter where they were born, had an equal chance for a healthy life. Assembling an international team of specialists in biomedicine, mechanics, electronics and industrial design, she tasked them with adapting developed world medical equipment and practices to meet the needs of treating the most common problems affecting newborn babies at hospitals and clinics in developing countries.

Twelve years later, the outcome is MTTS’ range of low-cost, high-quality neonatal intensive care equipment. All made in Hanoi using readily available materials and parts, the machines are durable, easy to use and do not require expensive materials. Installed in more than 250 hospitals, MTTS equipment has so far been used to treat more than three-quarters of a million babies suffering from infant respiratory distress system, jaundice or hypothermia.

Hanoi, Vietnam

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