Moms May Think Softer Is Safer for Sleeping Babies

From Reuters Health Information By Genevra Pittman NEW YORK (Reuters Health) Aug 23 - Lots of African American moms put soft bedding such as pillows and blankets where babies sleep, despite warnings that the cushioning increases the risk of infant death, according to a new study. That's because many parents are under the impression that a soft sleeping environment means the baby will be more comfortable or will be protected from injuries, said Dr. Rachel Moon. "There's this impression that soft is safe," said Dr. Moon, one of the authors of the new study from Children's National Medical Center in Washington, D.C. "But when it comes to babies' sleep environment, soft is not safe, it's actually dangerous." Researchers know that black babies are at least twice as likely as white, Latino, and Asian babies to die of accidental suffocation, strangulation or sudden infant death syndrome (SIDS). While some of that higher incidence may be related to genetics, much of it is probably due to parents unknowingly putting infants in a dangerous sleeping place or position, Dr. Moon said. To find out whether black families know about the risks, Dr. Moon and her colleagues conducted one-on-one interviews and small group discussions with 83 black mothers in D.C. and Maryland with a new baby at home. The researchers asked women if they used soft bedding and bumper pads in their baby's crib or other sleeping location -- and why or why not. More than of half of the moms reported using soft bedding for their baby, according to findings published August 22nd in Pediatrics. They told researchers they wanted to make sure the babies were comfortable and warm, or that they used pillows as a barricade on beds and sofas, or to prop babies up. "We were surprised that people use (soft bedding) because they think it's going to make their baby safer," Dr. Moon told Reuters Health. "We weren't that surprised that people use it to make the babies comfortable." Some mothers thought doctors' recommendations to use a "firm sleep surface" included a bed where a sheet was tucked tightly over pillows -- but that's still a dangerous sleep situation, the researchers warned. Moms also used bumper pads on cribs if they worried that a baby would hit its head on the railings or get an arm or leg stuck. Some, the researchers found, also thought the bumper pads were cute. But just like with pillows and blankets, bumper pads pose a suffocation risk to babies, Dr. Moon said. "There really isn't any need for bumper pads," especially for very young babies, she added. Dr. Fern Hauck, a SIDS researcher at the University of Virginia in Charlottesville, said she understood the desire to make babies comfortable with soft bedding in hopes that they'll sleep better and longer. But, "babies can pretty much sleep anywhere," she told Reuters Health. "If you get them used to a firm crib mattress, they're going to sleep fine on a firm crib mattress." She said that pediatricians have to talk to new parents about all SIDS and suffocation risks, and "really get a little more of a dialogue going" about the safest way for a baby to sleep. Grandparents, friends, and anyone else who would be taking care of the baby also need to have that conversation, Dr. Hauck added. And it's important to know that although the interviews were only done with black mothers, parents of all races may misinterpret a pediatrician's recommendations or what constitutes a safe sleeping environment, said Dr. Debra Weese-Mayer, a pediatrician at Northwestern University Feinberg School of Medicine in Chicago. The study "is a very humbling lesson that even though we think we're giving a very clear message (about sleep surfaces), if the parent and the caretaker are interpreting it in a way different from what we intended, we're not doing a very good job," Dr. Weese-Mayer said. "If it can save some babies because we do a better job of translating our recommendations, that's wonderfully important." SOURCE: http://bit.ly/oqyquw Pediatrics 2011.

Women May Not Need to Delay Pregnancy After an Initial Miscarriage

From Medscape Medical News

Laurie Barclay, MD

August 11, 2010 — Women may not need to delay pregnancy after an initial miscarriage, according to the results of a retrospective, Scottish population–based cohort study reported Online First August 5 in the BMJ.
"How long a couple should wait before trying for another pregnancy after a miscarriage is controversial," write Eleanor R. Love, from the University of Aberdeen in Aberdeen, Scotland, and colleagues.
"Some clinicians believe that there is little justification for delaying the next pregnancy, as an increased interpregnancy interval is unlikely to improve perinatal outcomes, whereas a new viable pregnancy and the birth of a child could enhance the women's chances of recovery....

Current guidelines from the World Health Organization recommend that women should wait for at least six months before trying again, whereas others suggest a delay of up to 18 months, based on reports that interpregnancy intervals of 18-23 months after a live birth can enhance maternal and perinatal outcomes in the next pregnancy."

The goal of this study was to evaluate the optimal interval to subsequent pregnancy after miscarriage in a first recorded pregnancy. At Scottish hospitals between 1981 and 2000, a total of 30,937 women who had a miscarriage in their first recorded pregnancy and subsequently became pregnant were followed up during the second pregnancy. The main study outcome was miscarriage, live birth, termination, stillbirth, or ectopic pregnancy in the second pregnancy, and secondary endpoints were rates of cesarean and preterm delivery, low birth weight infants, preeclampsia, placenta previa, placental abruption, and induced labor in the second pregnancy.

Compared with an interval of 6 to 12 months between the miscarriage and second conception, an interval less than 6 months was associated with lower risks for repeated miscarriage (adjusted odds ratio [OR], 0.66; 95% confidence interval [CI], 0.57 - 0.77), termination (OR, 0.43; 95% CI, 0.33 - 0.57), and ectopic pregnancy (OR, 0.48; 95% CI, 0.34 - 0.69). The risk for an ectopic second pregnancy was greater with an interpregnancy interval exceeding 24 months (OR, 1.97; 95% CI, 1.42 - 2.72), as was the risk for termination (OR, 2.40; 95% CI, 1.91 - 3.01).

Compared with women who had an interpregnancy interval of 6 to 12 months, those who conceived again within 6 months and had a live birth in the second pregnancy were less likely to have a cesarean delivery (OR, 0.90; 95% CI, 0.83 - 0.98), preterm delivery (OR, 0.89; 95% CI, 0.81 - 0.98), or low-birth-weight infant (OR, 0.84; 95% CI, 0.71 - 0.89). However, they were more likely to have labor induced (OR, 1.08; 95% CI, 1.02 - 1.23).

"Women who conceive within six months of an initial miscarriage have the best reproductive outcomes and lowest complication rates in a subsequent pregnancy," the study authors write.

Limitations of this study include potential lack of uniformity in documenting gestational age and outcomes of interest as well as possible misclassification. This study also evaluated only miscarriages that led to hospital contact, and the findings therefore cannot be generalized to all women with a miscarriage.
"Our research shows that it is unnecessary for women to delay conception after a miscarriage," the study authors conclude. "As such the current WHO [World Health Organization] guidelines may need to be reconsidered. In accordance with our results, women wanting to become pregnant soon after a miscarriage should not be discouraged."

In an accompanying editorial, Julia Shelley, associate professor of health and social development at Deakin University in Melbourne, Australia, discusses some of the methodologic issues regarding this study and earlier studies.
"[A]ll of the studies have selection and measurement biases that cast doubt on the value and generalisability of their findings," Dr. Shelley writes. "Of greatest concern is that women with short interpregnancy intervals are more fertile than those whose subsequent pregnancy occurs later because these women seem to have better pregnancy outcomes and fewer complications. Further research into this question may need to wait for data from more sophisticated linked primary care and hospital datasets or specifically designed research studies that can measure and account for such differences, even if they will not be able to control for them."


BMJ. 2010;341:c3967. Abstract