Fetal kicks help detect malformations

Researchers have found that monitoring fetal movements in pregnant women can help in detecting fetal musculoskeletal malformations.

The research team with Imperial College London and Great Ormond Street Hospital analysed MRI scans, which allowed them to create computerised models of fetal movement.

The models produced animated representations of a fetus inside the uterus as it stretched, kicked and moved around, allowing the team to track how much force the fetus exerted.

The study found that the stresses caused by forceful kicking is like a form of exercise for the fetus and can help with bone and joint development. Abnormal or absent movements were implicated in multiple congenital disorders.

The study also found that fetal kick force increases significantly from 20 to 30 weeks’ gestation, with the fetus able to exert up to 4kg of force against the uterus walls at 30 weeks, before decreasing towards term due to a lack of space.

The team concludes that by revealing a potential link between fetal biomechanics and skeletal malformations, their work will stimulate future research in tissue engineering and mechanobiology.

The study was published in Journal of the Royal Society Interface.

Planned birth at or near term for pregnant women with gestational diabetes and their infants

What is the issue?

The aim of this Cochrane review was to find out if planning an elective birth at or near the term of pregnancy, compared to waiting for labour to start spontaneously, has an impact on the health of women with gestational diabetes and the health of their babies. Planned early birth means either induction of labour or caesarean birth, and ‘at or near term’ means 37 to 40 weeks gestation. To answer this question, we collected and analysed all relevant studies conducted up to August 2017.

Why is this important?

Women with gestational diabetes (glucose intolerance arising during pregnancy) and their babies are at increased risk of health complications (e.g. high blood pressure, bigger babies). Because of the complications sometimes associated with birthing a big baby, many clinicians have recommended that women with gestational diabetes have an elective birth (generally an induction of labour) at or near term (37 to 40 weeksgestation) rather than waiting for labour to start spontaneously, or until 41 weeks gestation if all is well. Induction has disadvantages of increasing the incidence of forceps or ventouse births, and women often find it difficult to cope with an induced labour. Caesarean section is a major operation which can lead to blood loss, infections and increased chance of problems with subsequent births. Early birth can increase the chance of breathing problems for babies. It is important to know which approach to birth has a better impact on the health outcomes of women with gestational diabetes and their babies.

What evidence did we find?

Our search identified one trial involving 425 women and their babies. In this trial, 214 women had an induction of their labour at term, the other 211 women waited for a spontaneous onset of their labour.

The findings of this trial highlighted no clear difference between the babies of women in either group in relation to the number of large babies, baby’s shoulder getting stuck during birth or babies with breathing problems, low blood sugar and admission to a neonatal intensive care unit. No baby in the trial experienced birth trauma. In the group of women whose labour was induced, there were more incidences of jaundice in the babies. There was no clear difference between women in either group in relation to serious health problems for women, caesarean section, instrumental vaginal birth, postpartum haemorrhage, admission to an intensive care unit and intact perineum. There were no reports in either group of maternal deaths. It should be noted that most of the evidence was found to be of very low quality.

The following outcomes were not reported: postnatal depression, maternal satisfaction, length of postnatal stay (mother), babies with high blood acid, bleeding in the baby’s brain, other brain problems for the babies, babies small-for- gestational age and length of baby’s postnatal stay.

What does this mean?

There is insufficient evidence to clearly identify if there are differences in health outcomes for women with gestational diabetes and their babies when elective birth is undertaken compared to waiting for labour to start spontaneously or until 41 weeks gestation if all is well. More research is needed to answer this question.

Author’s conclusions:

There is limited evidence to inform implications for practice. The available data are not of high quality and lack power to detect possible important differences in either benefit or harm. There is an urgent need for high-quality trials evaluating the effectiveness of planned birth at or near term gestation for women with gestational diabetes compared with an expectant approach.

High glucose levels in pregnancy can affect baby’s heart

New research shows how high glucose in pregnancy can keep cardiac cells of fetuses from maturing normally. The researchers say their findings help explain why babies born to women with diabetes are more likely to develop congenital heart disease. The study, which was published today in the journal eLife, found that heart cells generate more building blocks of DNA than usual when exposed to high levels of glucose, leading the cells to continue reproducing rather than maturing. While the researchers highlight that genetics plays a large role in the development of congenital heart disease, the leading non-genetic risk factor for the disease is a mother having diabetes during pregnancy. Babies born to women with high levels of glucose in their blood during pregnancy are two to five times more likely to develop the disorder than other babies. However, researchers have never been able to define the precise effect of glucose on the developing fetus.

Study lead and UCLA associate professor of molecular, cell, and developmental biology Atsushi Nakano and his colleagues used human embryonic stem cells to grow heart muscle cells (cardiomyocytes) in the lab and then exposed them to varying levels of glucose. Cells that were exposed to small amounts of glucose matured normally. But cardiomyocytes that had been mixed with high levels of glucose matured late or failed to mature altogether, and instead generated more immature cells. Atsushi said that high blood sugar levels are not only unhealthy for adults; they’re unhealthy for developing fetuses. He added that understanding the mechanism by which high blood sugar levels cause disease in the fetus may eventually lead to new therapies.

‘More nutrition is generally thought to be better for cells, but here we see the exact opposite,’ Atsushi said. ‘By depleting glucose at the right point in development, we can limit the proliferation of the cells, which coaxes them to mature and makes the heart muscle stronger.’

IMUK – Message to our supporters

We are devastated to have to tell you all that our legal challenge of the Nursing and Midwifery Council (NMC) has been unsuccessful. The court has heard the evidence and decided that the NMC did not act unfairly, did not act unlawfully.  Sadly, we must accept that decision since we don’t have the resources to take this legal action any further and the advice is that it is unlikely to be successful.

We believed strongly in our case against the NMC, which was why we brought this judicial review.  But we wouldn’t have been able to do so without the enormous warmth and passion and financial backing of all of you, our supporters. We owe you a deep debt of gratitude, and we are only sorry that the outcome hasn’t been what we hoped.

We believe that women deserve real continuity of care, respect and informed choice – including being able to choose their midwives. We also believe that the future lies in creating an insurance product for midwifery care that is women centred, that does not restrict women’s choices and that is ideally owned and run by women for women so that it is affordable for as many women as want it.  For this to happen we would need to find new ways of raising capital and we will need your involvement and support.

We cannot tell you how inspired we have been by the support we have received from women across the UK and internationally. IMUK will now evaluate the ideas and options available to us and develop these for the New Year. Please stay with us while we do this and we will update you as soon as we can on how you can become involved.

Deepest sadness IMUK midwives.