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Babies born to obese mothers and exposed to passive smoking are more likely to face health
problems, a new study claims.

The conclusion is based on evidence of elevated levels of nucleated red blood cells in the umbilical
cord reported in the International Journal of Food Safety, Nutrition and Public Health.

Pediatrician Abd ElBaky of the National Research Centre, in Cairo, and colleagues there and at
Cairo University, Egypt, have found that obesity and passive smoking are risk factors for elevated
umbilical cord neonatal immature, or nucleated red blood cells (NRBCs). Raised levels of NRBCs
are indicative of a degraded oxygen supply to the baby during the pregnancy.

The team compared NRBC count in umbilical blood in three groups. Group I neonates (29 infants)
were born to obese mothers. Group II (21 babies) were born to mothers exposed to tobacco smoke
during pregnancy and a control group III (15 members). The team found that NRBC count was
higher in groups I and II compared to the control group III. They also found that maternal body
mass index (BMI) and infant birth weight were significantly higher in group I.

The team explains that, obesity in young and women is on the increase and is a known risk factor
for a range of health problems. Maternal obesity at conception affects gestational metabolic
adjustments, the placenta, and fetal growth and development. They add that neural tube defects and
other developmental anomalies are more common in infants born to obese women. Pre-eclampsia,
a potentially life-threatening condition involving raised blood pressure, is also more common in
obese pregnant women.

The researchers say fetal development during the last half of pregnancy depends on maternal
metabolic adjustments detected by placental hormones and the subsequent oxygen and nutrient
supply. If these are compromised, through obesity issues or exposure to tobacco smoke, then
serious problems can occur.

The mechanisms that link the raised levels of immature blood cells in the samples to obesity and
passive smoking or complicated. Obesity is known to affect metabolism, hormones, blood pressure
and other physiological factors. Tobacco smoke inhalation whether direct or indirect may affect the
amount of oxygen reaching the unborn child, because hemoglobin is poorly oxygenated. Nicotine
can also cause narrowing of blood vessels, vasoconstriction, and so reduce oxygen supply through
that mechanism too.

The team speculates that even apparently healthy newborns of obese mothers and passive smokers
may suffer subtle effects of the reduced oxygen levels during the pregnancy.c
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ScienceDaily (Feb. 23, 2010) ² A new study confirms that rates of obesity and other
chronic health problems have risen in American children in recent years, but it also shows
that many children's conditions will improve or resolve over time. The findings that appear
in the Feb. 17 °   

  
      support the need for
continuous access to health services and suggest directions for future research.

"Although about half of all children will be obese or have another chronic health condition
at some point during their childhood, less than half of them will have the same conditions
six years later," says Jeanne Van Cleave, MD, of the Center for Child and Adolescent
Health Policy at MassGeneral Hospital for Children, the study's lead author. "It looks like
these chronic conditions may not be so permanent as we once thought."

Chronic health conditions are those -- such as asthma, diabetes or attention-deficit


hyperactivity disorder -- that require long-term treatment or interfere with a child's ability to
perform the typical activities of children of the same age. Previous studies of the extent of
these conditions in children have always looked at rates at a specific time. The current
study was designed to analyze rates of chronic conditions over time and especially
whether the incidence was increasing and if conditions persist or resolve over time.

The research team analyzed data collected in annual surveys conducted by the U.S.
Bureau of Labor Statistics. Focusing on the children of women who became participants
in a larger survey in 1986, the current study analyzed information from three groups of
children who were ages 2 through 8 in 1988, in 1994 and in 2000. Every two years, in-
home interviews -- including height and weight measurement -- were conducted with both
the children in these three groups and their mothers; and each group was followed for six
years. Complete data were compiled for 2,337 children in the first group, 1,759 children in
the second and 905 in the third group.

The results showed that the presence of chronic conditions when children entered the
study increased from 11 percent in the 1988 group, to 16 percent in the 1994 group and
25 percent in the 2000 group. The likelihood of reporting a chronic condition during any
part of the study period rose about 10 percent with each subsequent group -- from 30
percent in the first group to 50 percent in the third -- but conditions persisted until the end
of each study period only 40 percent of the time.

The authors note that some of the increase in chronic health conditions could be
attributed to the fact that children in later groups were born to older mothers, which is
known to increase the risk of health problems. While the study did not examine factors
underlying the rise in obesity and other conditions, the investigators speculate that
involved factors could range from food choices and lifestyle, to the greater survival of
children with serious health problems, and the increased likelihood that health problems
will be diagnosed.

"The prevalence of these chronic conditions speaks to the continuing need for high quality
health care, especially primary care, where a lot of these conditions are diagnosed and
treated," says Van Cleave, who is an instructor in Pediatrics at Harvard Medical School.
"What we need to investigate now is why conditions resolve for some children and not for
others -- the rates of persistence didn't vary according to the type of health condition --
and ways to prevent these conditions from developing in the first place."

James Perrin, MD, of the MGHfC Center for Child and Adolescent Health Policy and
Steven Gortmaker, PhD, Harvard School of Public Health, are co-authors of the JAMA
study, which was supported by an Investigator in Health Policy Award from the Robert
Wood Johnson Foundation and grants from the U.S. Centers for Disease Control and
Prevention and the Maternal and Child Health Bureau.

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Chronic childhood health problems such as obesity , asthma ,


and learning and behavioral problems are on the rise, more than doubling over a
12-year period, according to a new study.

Chronic health conditions were found in 12.8% of children studied in 1994,


compared with 26.6% of another group of same-aged children studied in 2006, the
researchers found.

''We knew before we started this study that childhood chronic diseases were
generally on the rise," says study researcher Jeanne Van Cleave, MD, a
pediatrician at Mass General Hospital for Children and an instructor of
pediatrics at Harvard Medical School in Boston.

"But this study really gives a better picture," she tells WebMD. That's
partly because the researchers were able to study three groups of children over
time to better figure out what was happening.

As bleak as the findings may sound, Van Cleave tells WebMD she sees a bright
spot: ''The most important finding is that a lot of children will have chronic
conditions during childhood, but a lot of these conditions will go away, will
resolve over time."

The study findings are published in TheJournal of the American


Medical Association.

Tracking Childhood Chronic Disease

Van Cleave's team looked at four types of health conditions, as reported by


parents:

p Obesity, using the accepted definition of a body mass index at or above the
95th percentile for age and sex
p Asthma
p Other physical conditions, such as hearing or vision difficulties,
allergies , or chronic ear infections
p Behavior or learning problems such as hyperactivity, emotional
disturbances, or attention deficit disorder .
To be considered chronic, the condition had to limit activities or schooling
or require medicine, special equipment, or special health services, and had to
last at least 12 months.

The data was retrieved from the National Longitudinal Survey of Youth-Child
Cohort. Children were ages 2 through 8 at the beginning of each study period.
Each group was followed up for six years -- from 1988 to 1994, 1994 to 2000,
and 2000 to 2006.

Group one had 2,337 participants, group two had 1,759, and group three
included 905.

Chronic conditions increased with each group, with group three having the
highest percent of children with chronic conditions both at the start and end
of the study period.

''For each of those three groups, the rate of having a chronic condition
during the study increased by about 10% for each subsequent group," Van Cleave
says.

The chances of having a chronic condition during any part of the six-year
study was greatest for the third group, with 51.5% of them affected at some
time (and more than half of that 51% having obesity), Van Cleve says. Rates
were higher among boys and Hispanic and black children. Older children were
more likely than younger children to have a chronic health conditions, she
found.

Some children did outgrow the problems, however. When Van Cleave combined
all three groups, she found that 9.3% of the children who had a chronic
condition at the start of the study did not have it at the end. "Chronic
conditions during childhood do not appear to be as permanent as once thought,"
she tells WebMD.

The study was funded and supported by the Robert Wood Johnson Foundation,
the CDC, and the Maternal and Child Health Bureau of the U.S. Health Resources
Services Administration.

econd Opinion

The study findings, while not surprising, are of concern, says Geetha
Raghuveer, MD, associate professor of cardiology at the University of
Missouri-Kansas City School of Medicine and pediatric cardiologist at
Children's Mercy Hospital in Kansas City, Mo., who reviewed the study findings
for WebMD.

''I was taken away by one comment in the paper that at least one in two
children in the recent [group] had som sort of chronic condition," she says.
"And that's a lot."

"Many of these problems are lifestyle-related," she says, citing the high
percent of obesity found in the children.

The study findings point to the need for parents to pay more attention to
nutrition for their children and to be sure they get enough physical activity ,
she says.

"Parents can make small changes in their child's diet and see a big
improvement in overall health," she says. "It can be as simple as taking liquid
calories out of your child's diet. That may be all that's necessary to prevent
excess weight gain and all the problems."

The study findings are of concern, agrees Neal Halfon, MD, MPH, University
of California, Los Angeles professor of pediatrics, health sciences, and policy
studies, who also directs the UCLA Center for Healthier Children, Families and
Communities. "It shows that over that time period that the rates are going up
quite significantly," says Halfon, who co-wrote an editorial that accompanies
the study. He reports receiving support from the Maternal and Child Health
Bureau.

''I was surprised at the magnitude of the increase, but I wasn't surprised
at the overall trend," he says, ''because that trend has been emerging for the
past 30 or 40 years."

Part of the increase, he tells WebMD, can be attributed to the generally


broader definition of childhood health problems. But not all, he says, blaming
''the social environment and social ecology of childhood" for some of the
increase in chronic health conditions such as obesity. For instance, he says,
higher-calorie foods and an increase in ''screen time" with excess television
and computer use contribute to the obesity epidemic.

Halfon suspects there may be common pathways for some of the conditions, as
some children have multiple conditions. "The good news here is, it's really
shining a light on a problem that we have that in a sense we have been
ignoring," he says.c
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Two new government studies suggest autism spectrum disorders are becoming more
common in children in the USA. However, researchers say, it is not clear how much of the
increase is a result of more frequent and earlier diagnoses and how much is a result of a
real rise in the conditions.

"The concern here is that buried in these numbers is a true increase," Tom Insel, director
of the National Institute of Mental Health, said Friday at a news conference. "We're not
sure how big it is."

Insel noted that President Obama wants to increase spending on autism research by the
National Institutes of Health by 16% ² a bigger bump than in any other area of NIH
research.

One of the studies, published today in the journal ¢


   by researchers at the Health
Resources and Services Administration, found that one in every 91 children ages 3 to 17
have such a disorder, as determined by a survey of the parents of 78,000 children. That's
an estimated 673,000 children, the authors write. In half the cases, parents report their
children's symptoms as "mild."

Prompted by the ¢
   study, the Centers for Disease Control and Prevention is
announcing not-yet published results of a second study. It finds about one in 100 8-year-
olds has an autism spectrum disorder, or ASD. In a similar 2007 study, the CDC placed
the rate at one in 150. Details of the study are due this year.

The ¢
   paper discusses several possible explanations for the apparent increase in
ASD diagnoses. They include a broader definition of autism disorders and a heightened
awareness of them on the part of parents and doctors.

"This is something that further research is going to have to look at," Michael Kogan, lead
author of the ¢
   paper, said in an interview. Kogan is a scientist at the Health
Resources and Services Administration's Maternal and Child Health Bureau.

Pediatrician Susan Levy, founder and director of the Regional Autism Center at Children's
Hospital of Philadelphia, notes that Kogan's study is based only on what parents said
about their children, not information from doctors involved in their care.

"For what it is, it's very well done, and I don't mean that critically," she said in an
interview. "It is one method of getting a handle of how many people in the country have
this disorder. Is it the best method? No, but it is one way of approaching it."

Surprisingly, Kogan's survey found that the parents of nearly 40% of children reported to
have been diagnosed with ASD said they no longer had the disorder. Perhaps their doctor
labeled them as having ASD so they could get services for developmental delay, Kogan
speculated.
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PORTLAND, Ore. ² A recent federal survey of children's health shows more than 6.7 million
children in the United States don't have health insurance, and nearly 1 in 4 insured children lack
adequate insurance coverage. The national survey also reveals that rates of obesity increased from
14.8 percent in 2003 to 16.4 percent in 2007. Today more than 10 million youths ages 10 to 17 are
overweight or obese.

The new findings are available on the Data Resource Center for Child and Adolescent Health, a
project of the Child and Adolescent Health Measurement Initiative (CAHMI) housed at Oregon
Health & Science University (www.childhealthdata.org).

"The survey highlights disparities in health and health care quality across states and groups of
children. The state a child lives in, a child's race, income and neighborhood all significantly impact
his or her health," explained Christina Bethell, Ph.D., an associate professor of pediatrics at OHSU
who directs the CAHMI team. "That's why it is more important than ever to ensure health care
reform efforts address the range of health and health care needs of all children."

The new National Survey of Children's Health 2007 also reveals significant state-to-state
differences on a broad range of health issues for children. For example, 23 percent of adolescents
in Utah are overweight or obese compared with 44 percent in Mississippi. Insured children in
Minnesota are almost twice as likely as children in Hawaii to have insurance that does not meet
their needs. And while 82 percent of children in Pennsylvania received needed mental health care
services, only 42 percent of children in Texas received the same access to mental health care.

The national survey comprises 91,642 interviews representing an average of 1,700 children
younger than 18 in each of the 50 states and the District of Columbia. It is sponsored by the
Maternal and Child Health Bureau and administered through the National Center for Health
Statistics, both of the U.S. Department of Health and Human Services.

The data is available to anyone and can be searched state by state, or by other factors such as
income or race/ethnicity at www.childhealthdata.org. A federal report on the survey, "The Health
and Well-Being of Children: A Portrait of States and the Nation 2007," is available at
mchb.hrsa.gov/nsch07.

Additional survey findings include:

p More than 4 in 10 children are not receiving care within a "medical home," defined by the
American Academy of Pediatrics as care that is accessible, continuous, comprehensive,
family-centered, coordinated and compassionate.
p More than 1 in 4, or more than 6 million children younger than 5, are at moderate or high
risk for developmental, behavioral or social delays. Yet, less than 1 in 5 of these children
received recommended screening during a well-child visit.
p 2 in 5 children who needed mental health services did not receive those services,
representing no improvement since 2003

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SUNDAY, Dec. 27 (HealthDay News) -- Though a growing percentage of American moms start
their infants on human milk, relatively few continue breast-feeding for the baby's first six months
of life, let alone an entire year.

Why not stick it out longer? Numerous obstacles can prove difficult for new moms, but California
researchers say they found that returning to work soon after giving birth presents a major barrier to
successful breast-feeding.

"What we saw is if women take very short maternity leaves, of six weeks or less, they run more
than a three times higher risk of quitting breast-feeding compared to those still at home who
haven't returned to work," said Sylvia Guendelman, a professor who chairs the maternal and child
health program at the University of California, Berkeley, School of Public Health.

Their study, published earlier this year in ¢ediatrics, was part of a larger analysis called "Juggling
Work and Life During Pregnancy," funded by the U.S. government's Maternal and Child Health
Bureau.

The American Academy of Pediatrics recommends that women breast-feed exclusively for six
months and continue breast-feeding for at least an infant's first year of life. Exclusive breast-
feeding -- meaning no water, juice, formula or foods -- has been shown to improve protection
against many diseases, including bacterial meningitis, diarrhea and ear infections, the academy
says.

In the first half of the decade, the number of breast-fed infants increased somewhat, from 71
percent in 2000 to 74 percent by the end of 2006, according to a report from the U.S. Centers for
Disease Control and Prevention.

But those figures doesn't tell the whole story.

"Initiation of breast-feeding, although it is one measure, doesn't mean much," Guendelman said.
"You can put your baby to the breast for two times and say, 'Well, I tried it and I didn't like it,' or,
'I didn't succeed,'" she said. "But what you really want to look at is, of women who initiate, how
many breast-fed successfully for at least six months?"

On that score, the United States has made little progress. Of infants born in 2006, 43 percent were
breast-feeding at 6 months and 23 percent at 12 months. Just 14 percent, however, had been
exclusively breast-fed for six months.

The numbers fall short of national objectives for breast-feeding. Healthy People 2010, the
government's health promotion and disease prevention agenda, seeks to boost the number of
breast-feeding women to 75 percent by 2010. The six-month and one-year targets are 50 percent
and 25 percent, respectively.

Unlike other industrialized counties, the United States does not have a national maternity leave
policy.

To find out whether maternity leave makes a difference for breast-feeding success, Guendelman
and her team examined data from 770 full-time working women in Southern California.

Full-time workers with short postpartum maternity leaves were more likely to quit breast-feeding
early. Those at highest risk were women in non-managerial and inflexible positions and women
with higher stress levels.

Women who had access to workplace benefits such as paid maternity leave or a private office
might have greater success, noted Chris Mulford, a retired lactation consultant in Delaware
County, Pennsylvania, and member of the U.S. Breastfeeding Committee, a nonprofit group.
"They're usually more able to sustain breast-feeding as they return to work than women who work
without their own office, without a place at the job where they can express their milk," she said.

Laws related to breast-feeding in the workplace are in place in 24 states, the District of Columbia
and Puerto Rico, according to the National Conference of State Legislatures. An Oregon law, for
example, allows women to take a 30-minute, unpaid break during each four-hour shift to breast-
feed or pump. Oregon has the highest rate of breast-feeding at 12 months, at 37 percent, and the
second-highest rate of breast-feeding at six months, at 63 percent, after Utah, where the rate is 69.5
percent, according to the CDC.

All things considered, though, working moms might have a tougher time with breast-feeding than
women who are able to take more time with their infants, said Kay Hoover, a lactation consultant
at a Philadelphia-area hospital. "If you're separated from your baby, it's hard to maintain milk
production," she said.

Guendelman said she would like physicians to advocate for extended postpartum maternity leaves
for working women. "If you know you have some time off," she said, "you are more likely to
establish breast-feeding in the first 30 days and not just give up so quickly."

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