Pregnancy and Low Birth Weight

Low birth weight is a condition of a baby who was born below the weight of gestational age due to several reasons, including, the baby was born too soon, were small for gestational age, the poor health of the mother, nutritional deficiency, certain diseases, etc. According to the statistic of the World health organization, globally, more than 20 million infants were born with low birth weight.

The consequences of low birth baby (Symptoms)
Some LBW babies can have life-long health problems as well as the risk of dying in the first year of life. Most common diseases of low birth weight baby include
1. Respiratory distress syndrome (RDS)
As the lung is a last organ to develop of the fetus during 40 weeks of pregnancy, respiratory problem is a very common for baby who was born with low weight. Babies who were born before the week of 34 are at risk of lacking surfactant to keep the small air sacs in the lungs from collapsing. The introduction of additional oxygen is very helpful to keep the baby lung to expand, but according to the antioxidant theory, it can also induce the chain of oxidation, causing vary health problem to the baby, if the additional oxygen has to be used it for a prolonged period of time, as the baby has weakened immune system to defend it due to low birth weight.

2. Intraventricular hemorrhages (IVH) (bleeding in the brain
Bleeding can occurs within the first days of life in the brain of some very low-birthweight. According to the article of "Treatment reduces brain hemorrhages in very low birthweight babies" posted in the National Institue of neorological institutes, "between 20 to 40 percent of very low birthweight infants have intracranial hemorrhages, putting them at very high risk for major neurodevelopmental problems" and "Very low-birthweight babies who are treated with indomethacin within 6-12 hours after birth have a lower incidence and reduced severity of brain hemorrhage, a frequent and often debilitating complication of such births".

3. Patent ductus arteriosus (PDA)
PDA is a heart problem that is common in premature babies. It is defined as a condition of a congenital disorder in the heart with persistent opening between two major blood vessels leading from the heart.
According to the study of Patent ductus arteriosus in infants of low birth weight.
D R Smith, D H Cook, T Izukawa, P M Olley, P R Swyer, and R D Rowe, researchers found that In 48 patients whose heart failure could not be controlled by other medical therapy indomethacin was given, and in 20 (42%) it was judged successful. Surgical ligation of the ductus was performed at a median age of 30 days in 33 infants who either failed to respond to indomethacin or in whom its use was contraindicated; there were no intraoperative deaths, but 11 (33%) of the infants died 4 days to 6 months after the operation.

3. Necrotizing enterocolitis (NEC)
Necrotizing enterocolitis (NEC) is defined as a condition of premature death of cells of portions of the bowel tissue after 2-3 weeks of birth, causing feeding intolerance, increased gastric residuals, abdominal distension, bloody stools, etc.. Treatments of babies with NEC include supportive care antibiotics and in some case, clostomy may be necesesary depending to the disgnosis.

4. Retinopathy of prematurity (ROP)
Retinopathy of prematurity (ROP) is defined as acondition of a blinding eye disease of premature babies and very low birth weight infants born before 32 weeks of pregnancy as a result of an abnormal growth of blood vessels in the eye. According to the strudy of Retinopathy of "Prematurity in Extremely Low Birth Weight Infants" by C. Gregory Keith, Lex W. Doyle, researchers found that the increase in the survival rate of ELBW infants is not always accompanied by an increase in the rate of severe ROP or blindness, at least for ELBW infants born in some large level-3 centers. In most cases, the disease can heal themselves with little or no vision loss. In severe cases, laser therapy or cryotherapy is necessary to destroy the peripheral areas of the retina but it may cause some vision loss. In latest stage of ROP, Scleral buckle and vitrectomy may be necessaery depending to retcam screening.

5. Psychological effects
According to the study of "Psychiatric symptoms in low birth weight adolescents, assessed by screening questionnaires." by Indredavik MS, Vik T, Heyerdahl S, Kulseng S, Brubakk AM., researchers found that very low birth weight(VLBW) adolescents are at risk of developing psychiatric symptoms, and reduced social and academic skills by the age of 14. Term SGA adolescents may have discrete emotional, behavioural and attention deficit symptoms. ASEBA and SDQ provide a useful supplement to psychiatric interview.

6. Later in the baby life
In a study of Emotional, behavioral, social, and academic outcomes in adolescents born with very low birth weight. by Dahl LB, Kaaresen PI, Tunby J, Handegård BH, Kvernmo S, Rønning JA., researchers found that From parents' point of view, significant proportions of very low birth weight adolescents experience more emotional and behavioral problems and less competence than normative adolescents. In contrast, very low birth weight adolescents state less problems and similar or higher competence than normative adolescents. Very low birth weight adolescent girls report more emotional and behavioral problems compared with their parents than very low birth weight adolescent boys do. Externalizing problems in very low birth weight adolescent girls are often not recognized by parents. To better understand these seemingly paradoxical findings and to develop adequate intervention programs, there is a need for prospective longitudinal studies.

7. Short stature
In a study of "Low birth weight--additional important factor of diagnosis in children with short stature". [Article in Polish] by Majcher A, Pyrżak B, Bielecka-Jasiocha J, Witkowska-Sędek E., researchers found that
a. Low birth weight is diagnosed in every sixth child with short stature in the Clinic of Endocrinology.
b. Children born on time with low birth weight should be diagnosed early towards congenital genetic disorders and development defects.

8. Metabolic syndrome and ischemic heart disease.
Baby who was born low birth weight is at higher risk of heart diseases and diabetes as a result of inflammatory processes in adulthood. According to the study of "Low birth weight and markers of inflammation and endothelial activation in adulthood", The ARIC study by Lucia C. Pellanda, Bruce B. Duncan, Alvaro Vigo, Kathryn Rose, Aaron R. Folsom, Thomas P. Erlinger, researchers found that LBW predicted greater inflammation and endothelial activation, as indicated by the higher score of blood markers, consistent with the hypothesis that early life events may result in a hyper-responsive innate immune system. Such a pro-inflammatory tendency could help explain the association of low birth weight with elements of the metabolic syndrome and ischemic heart disease.

9. Etc.

Causes
1. Mother’s poor nutrition
According to the World health organization, Once pregnant, the mother’s nutrition and diet,
lifestyle, such as alcohol, tobacco or drug abusehave greatly affected the weight of the fetus. In most cases, it is caused by long-term maternal malnutrition,

2. sexual tramitting diseases during pregnancy
Certain sexual tramitting diseases can increase the risk of low birth weight of the newborn, including syphilis
2.1. Infectious diseases HIV
It is an disease caused by the human immunodeficiency virus (HIV) which can severe damaging the immune system that can lead to infection and inflammation as a result of weakened immune system in fighting against foreign invasion. Symptoms include acute infection, fever, swollen lymph nodes,etc. Your baby may be infected by the virus as a result of sharing blood supply with you or you can transmit the disease during childbirth.

2.2.Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacteria Treponema pallidum. The disease is developed into your stages with no symptom in the first stage, rash in the palm, soles of the feet,, etc. in the second stage. In the latent (hidden) stage of syphilis, no symptoms, the disease is hidden but it can be transmitted through sexual activity. In the final stage, is also known as Tertiary Syphilis, the infectious person may experience symptoms of Heart, Eyes, Brain , Nervous system, etc. damages. According to the statistics, more than 6000 cases of syphilis are reported in the United States alone each year. It is a concern that you may transmit the disease to your baby during child birth.

2.3. Etc.

3. Low income family
Women who are low income earner may be suceptible to low birth weight baby as a result of nutritional deficiency according to the World health Organization.

4. Birth defects
Certain genetic birth defects may be result in low birth weight baby, including
a. Chromosomal abnormalities The diseases can be caused by genetic passing through from the parent or an error in cell division. Chromosomal abnormalities can be divided into two basic groups, numerical and structural anomalies.

b. Single gene defects
It is a result of single gene defect out of 40-60,000 genes presented in the human body leading to the leads to alternation of the DNA code as a result of an defect amino acid sequence in the proteins.

c. X-Chromosome abnormality
Women who carry the mutated genes of the X chromosome have 50% risk in giving birth to a X-link related birth defects. Types of disorder is depended to the degrees of expression of the mutation. In X chromosome abnormality, men are affected and women are carriers.

d. Multifactorial problems
It is a type of genes mutation involved many factors, including the environment in the causation of birth defection, including cleft lip or cleft palate, neural tube defects, etc.

e. Teratogenic problems
It is type of mutation gene abnormality caused by exposure to certain chemicals, radiation, alcohol, heavy chemicals, certain medication, etc.

f. Etc.

5. Chronic health problems
Certain chronic illness such as anemia, high blood pressure, diabetes, and heart, lung and kidney if left untreated or uncotrolled can affect the weight of the baby, including low birth weight due to nutritional deficiency.

6. Inadequate maternal weight gain
Women who don’t gain enough or gain too much weight during pregnancy increase their risk of having a low-birthweight baby (2, 6). According to the study of "Maternal prepregnant body mass index and weight gain related to low birth weight in South Carolina" Posted in the free library by Farlex researchers found that Eight percent of the very low birth weight (VLBW)rate in South Carolina can be attributed to inadequate weight gain in pregnancy. Approximately 19% of the state's VLBW rate can be attributed to either underweight or overweight BMI at conception.

7. Certain exposures and smoking
a. Expose to indoor air pollution, can increase the risk of low birth weight bady.
b.Women who smoke during pregnancy smoke are twice as likely to give birth to low-birth weight infants.
According to the study of "Air pollution combustion emissions: characterization of causative agents and mechanisms associated with cancer, reproductive, and cardiovascular effects." by Lewtas J., researchers found that Long-term epidemiologic studies have reported an increased risk of all causes of mortality, cardiopulmonary mortality, and lung cancer mortality associated with increasing exposures to air pollution. Adverse reproductive effects (e.g., risk for low birth weight) have also recently been reported in Eastern Europe and North America. Although there is substantial evidence that PAH or substituted PAH may be causative agents in cancer and reproductive effects, an increasing number of studies investigating cardiopulmonary and cardiovascular effects are investigating these and other potential causative agents from air pollution combustion sources.

8. Etc.

Diagnosis
If you have previous low weight birth, if you feel the baby is not growth large enough, please consult with your doctor. Since there is no symptom to identify the abnormality, follow-up exams are necessary including ultrasound.

Prevention
A. How to avoid
1. If you have previous low birth weight baby, it is imporant that you make sure your are at the optimal health and all chronic illness are under controlled before you get pregnant again to lower the risk of low birth weight incidence. Believe or not, the rate of 2 consecutive low birth weight baby is very low in a healthy woman.

2. Stop smoking
Women who smoking during pregnancy are at twice as risk to give birth of a low eight baby that non smoking women.

3. 17 alpha-hydroxyprogesterone caproate (17P).
In some case, when it is absolutely necessary, injection P17 may be given, depending to the diagnosis. Acording to the study reported in the New England Journal of Medicine (N Engl J Med 2003; 348:2379-85), showed that 17P treatment reduced preterm birth by 34 percent in women pregnant with a single baby who had a previous preterm delivery.

4. Balancing diet
For more information of healthy diet, please visit 100+ Healthy Foods Classification
The American Pregnancy Association recommends alterations to your diet, including
4.1. Protein
Protein in your foods positively affects the growth of fetal tissue, including the brain. It also helps your breast and uterine tissue to grow during pregnancy,
a. 75 to 100 grams of protein per day as it can be divided into 2-3 servings of meat (1 serving = approximately 3 ounces/ size of a deck of cards) from chicken lean beef, lamb, pork, nut and tofu (1 serving = approximately ⅓ cup), etc.
b. 2-3 servings of legumes (1 serving = approximately ½ cup) such as red and white kidney beans,black beans, navy beans etc..

4.2. Calcium
Daily requirement of calcium is around 1000 milligrams during pregnancy. Calcium helps your body regulate fluids, and it helps build your baby’s bones and tooth buds, such as milk (1 serving = 1 cup), eggs (1 serving = 1 large egg), yogurt (1 serving = 1cup),pasteurized cheese (1 serving = approximately 1.5 ounces/ or 4 playing dice stacked together), tofu (1 serving = ½ cup), etc.

4.3. Iron
In combination with sodium, potassium, and water, iron helps increase your blood volume and prevent anemia. A daily intake of 27 milligrams is ideal during pregnancy.
a. 2-3 servings of green leafy vegetables (1 serving = approximately 1 cup)such as collard turnip, spinach, lettuce, etc.
b. 3 servings of whole grains (1 serving = approximately. ½ cup or one slice), such as bread, cornmeal, cereal, oatmeal, etc.

4.4. Folate/Folic Acid
Folic acid plays a key role in reducing the risk of neural tube defects, including spina bifida. Experts recommend 600 to 800 micrograms (.6 to .8 milligrams) daily.
a. 2 servings of dark green leafy vegetables (1 serving = approximately 1 cup), such as collard, turnip, spinach, lettuce. etc.
b. 2-3 servings of fruit (1 serving = approximately ½ cup), such as orange, strawberry, lemon, mango, tomato, etc.

4.5. Vitamin C
Fruits and vegetables rich in Vitamin C will help with wound healing, tooth and bone development, and promotes metabolic processes. Experts recommend at least 85 milligrams per day. 3 servings of fruit or vegetables (1 serving = approximately ½ cup), such as orange, strawberry, lemon, mango, tomato, etc. (Source)

4.6. Etc.

Treatment
A. In conventional medicine
Since there is no specific treatment or prevention, closely monitors the growth of the fetus with nutritional modification and making sure all chronic illness are under controlled and the baby is catching up with growth in the 18 and 24 months.

B. Herbs
Please do not use these herbs until you have consult with your herbal medicine practitioner
1. Chamomile flowers
Chamomile flowers, the dried flower heads of the herb Matricaria recutita is effectively used in herbal medicine to get rid of nauseating feeling, a common symptoms during pregnancy, as well as inducing sleep.

2. Yellow dock
Yellow Dock has been used extensively as herb to cleanse or purify the blood, thus preventing jaundice in newly born baby. Since it contains high amount of vitamin C and iron, it ensures the pregnant women and baby getting enough oxygen for a healthy pregnancy.

3. Ginger root
In a study of Complementary therapies for nausea and vomiting in early pregnancy, researcher concluded that nausea and vomiting are uncomfortable and sometimes debilitating symptoms encountered in early pregnancy. Many of the more conventional remedies offer only partial to negligible relief. Some pregnant women also express scepticism regarding the safety of the more traditionally prescribed pharmacological agents used to combat morning sickness. Vitamin B6, ginger root and acupressure are three complementary modalities that may help alleviate these self-limiting discomforts. Ginger is admired world wide for its anti-inflammatory and anti- bacterial properties. Thus, it works amazingly on morning sickness.

4. Echinacea
Echinacea, a genus of herbaceous flowering plants in the daisy family, Asteraceae has been used traditionally to treat or prevent colds, flu, and other infections by enhancing the immune system. In a study of pregnancy outcome following gestational exposure to echinacea: a prospective controlled study by Gallo M, Sarkar M, Au W, Pietrzak K, Comas B, Smith M, Jaeger TV, Einarson A, Koren G. researchers found that gestational use of echinacea during organogenesis is not associated with an increased risk for major malformations.

5. Red Raspberry leaf
Red Raspberry leaf has been used in herbal medicine as herbal tonic for pregnancy by tonifying the uterus, preventing miscarriage and decreasing constipation due to containing many minerals and vitamins, including vitamin C, calcium and an alkaloid uterus tonifier called fragrine.

6. Nettles
Nettles are species of flowering plants of the genus Urtica in the family Urticaceae contained Vitamins A, C, D and K, calcium, potassium, phosphorous, iron and sulphur of which are necessary for providing nutrients a healthy mother and her baby. The herb has been used in herbal medicine to stop excessive bleeding (vitamin K), prevent hemorrhoids, ease leg cramps and other spasms, nourish and protect the mother and unborn.

7. Etc.
C. Traditional Chinese medicine
Please do not use these herbs until you have consult with your traditional Chinese medicine practitioner
Dang Gui Shao Yao San is one the recommended formula because it is extensively used in China and Japan and has been monitored in many large-scale clinical trials with pregnant women. The formula was first recommended for use during pregnancy in the Jin Gui Yao Lue, and has been used regularly for the past 1,800 years. In animal studies researchers found that Dang Gui Shao Yao San showed no teratogenic effects (tendency to cause birth defects). The formula has been used to treat female infertility, morning sickness, anemia during pregnancy, and to prevent miscarriage and approved by the Japanese Ministry of Health. The formula used to avoid miscarriage or to treat a variety of pregnancy disorders, but it is also employed as a blood tonic and treatment for mental distress associated with blood deficiency. It includes peony, Chinese angelica root, cnidium, atractylodes, hoelen and alisma.

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