NEW YORK (Reuters Health) – Though most doctors will give you a definition of when pregnancy begins, it’s not always the same one, according to a new survey.

Most of the polled obstetrician-gynecologists believe pregnancy begins when the sperm fertilizes the egg. But a minority say it doesn’t begin until a week later when the fertilized egg implants in the uterus — the definition given by the American College of Obstetrics and Gynecology (ACOG).

“People say that the medical profession has settled on this,” said Dr. Farr Curlin, the senior author of the study and a professor at the University of Chicago. “And what our data show rather clearly is that it is not at all settled among the medical profession.”

The definition of pregnancy can have a major impact on law and policy.

For example, embryonic stem cells are often derived from surplus embryos that aren’t implanted into a woman after in vitro fertilization.

And some contraceptives, such as intrauterine devices, prevent implantation. So if pregnancy is considered to begin at fertilization, “then you see why any technology that prevents implantation would be problematic,” Curlin said.

Federal policies have used implantation as the beginning of pregnancy.

For the survey, published in the American Journal of Obstetrics and Gynecology, Curlin and his colleagues sent questionnaires to more than 1,000 ob-gyns. The questions asked whether pregnancy begins at conception, at implantation, or if the doctor was unsure.

Most of the doctors, 57 out of every 100, said that pregnancy begins at conception, while 28 out of every 100 said it begins at implantation. The rest were unsure.

Implantation happens about a week after fertilization. That’s when the blastocyst, a tiny group of cells that will later become the foetus, embeds itself into the wall of the uterus.

Physicians who responded that they were religious or opposed to abortion or contraceptives that prevent implantation were more likely to believe that conception is the start of pregnancy.

Curlin said he was surprised that most of the doctors in his study disagree with ACOG, which is the leading organisation for this field of medicine.

ACOG did not respond to requests for comment.

“In this case, the science shows exactly what happens, but what you define as pregnancy is not what science can settle,” Curlin told Reuters Health.

One of the weaknesses in the survey is the use of the word “conception” rather than fertilization in the questionnaire. While conception is usually defined as fertilization, others interchange it with implantation, Curlin said.

The length of pregnancy — typically 40 weeks — remains the same regardless of how doctors define the beginning of pregnancy, because the 40 weeks are not counted from the time of fertilization or implantation, but from the time of the mother’s last menstrual period.

SOURCE: http://bit.ly/uyX2P4 American Journal of Obstetrics and Gynecology, online November 9, 2011.

Pregnant Jessica Simpson loves to wear tight clothing in order to ”show off” her baby bump.

Jessica Simpson loves to ‘show off’ her baby bump.

The 31-year-old singer-and-actress is expecting her first child with fiance Eric Johnson, and though she didn’t announce her pregnancy until late last month, she is now happy to flaunt her changing shape.

She said: ‘I like wearing things more fitted. You want to show off your bump! It’s just so fun. You don’t want to wear muumuus so you can moo around town.’

‘I’m definitely bigger than I’ve ever been [but I've] never felt so connected with my body in my life.’

The ‘Fashion Star’ mentor also claimed she plans to give birth while wearing her high heels because she isn’t ready to give up her beloved footwear.

She told the new issue of Us Weekly magazine: ‘I’m probably going to deliver my baby in these [four-inch heels]. I went to the doctor yesterday and he said, ‘You’re gonna need to get out of those heels!’

‘I was like, ‘Excuse me! I’ll be delivering in these heels!’

Jessica announced her pregnancy on Halloween (31.10.11) by tweeting a picture of herself dressed as a mummy to confirm she was ‘going to be a mummy’ and she thinks it is something that will make her child think she is a ‘cool’ parent.

She said: ‘My kid’s going to think I’m pretty cool. This is a cool thing to welcome him to the world with.’

The specialist: Dr. Carol Levy, treatment of gestational diabetes

As the director of clinical trials operations at Mount Sinai, Dr. Carol Levy is an endocrinologist who specializes in diabetes and pregnancy. Over the past 15 years, she has treated more than 1,000 women with gestational diabetes.

Who’s at risk

Doctors estimate that 5% to 10% of pregnant women have gestational diabetes, a condition that causes elevated glucose levels during pregnancy.

“The placenta produces hormones that make the body not respond as well to insulin, the hormone that normally lowers blood sugar,” says Levy. “As a result, the glucose levels become elevated — but in pregnancy even moderately elevated glucose levels can be harmful to the baby.”

All pregnant women produce extra insulin to overcome the placenta’s hormones, but women with gestational diabetes can’t make enough. As the placenta grows bigger and bigger, it becomes harder to make enough insulin to compensate.

“Ob-gyns test women for gestational diabetes typically between weeks 25 and 28 of pregnancy, because that’s when the placenta gets much bigger and makes more hormones,” says Levy. “The test is done by giving the woman a sweet sugary drink called ‘glucola’ and then testing her glucose levels after a certain interval to see if they are elevated.”

Doctors recommend that almost all pregnant woman be tested for gestational diabetes.

“Women are considered at higher risk if they are over age 25, are obese, Hispanic, African-American or Asian, or have a family or personal history of any diabetes,” says Levy. “These include the general risk factors for type 2 diabetes.”

Twin pregnancies are also at higher risk because there are two placentas, thus producing more hormones.

One misconception is that eating sugary meals during pregnancy causes gestational diabetes.
“Patients come in and say, ‘I’m such a failure, I ate a piece of cake last week,’ ” says Levy. “But it’s not what you ate last week — you can’t change your genetics or your age.”

Signs and symptoms

Gestational diabetes is invisible and silent to most patients. “Most women will not have any signs and symptoms, which is what makes screening so important,” says Levy. “Glucose levels that might not be of concern outside of pregnancy become associated with serious risks during pregnancy.”

Katy Perry got celebrity bump watchers wondering “is she or isn’t she” after pictures of her performing in a tight sheath on Sunday’s MTV European Music Awards surfaced — and showed a bit of belly.

But she seemed to quash those pregnancy rumors this morning on Ellen. “I would love to have children. I think that’s one of the reasons you get married,” Perry, 27, said. “You think, that person is going to be a good partner, a good parent. But I’m not sure it’s time yet. We’ll see, ya know?”

Sounds like she and Russell Brand, 36, are looking to raise a gaggle of California girls (or boys): “If it doesn’t hurt the first time, I’ll keep popping them out!”

Meanwhile, good news for Perry fans: She wants to thank you. She announced on Ellen that she’s added a free second show at the Staples Center in Los Angeles to thank fans for their support in 2011. The “Katy Perry Gives Thanks” show will be Nov. 23rd (the day after her sold-out Nov. 22 show), wrapping up her 122-date California Dreams World Tour, which sold out.

She has a lot to be thankful for this year, including four Grammy Award nominations for Teenage Dream, which launched five hit singles; the 2011 MTV Video Music Award for “Video of the Year;” three American Music Award nominations; and seven People’s Choice Awards nominations.

She appeared on Ellen to debut the video for her new single The One That Got Away.

Mid-pregnancy test predicts late-pregnancy complication
High blood pressure during pregnancy spells trouble later in life

Highlights
• A test done mid-pregnancy accurately predicts which women will later develop preeclampsia, a late-pregnancy disorder characterized by high blood pressure and excess protein in the urine. Left untreated, preeclampsia can lead to serious—even fatal—complications for a pregnant woman and her baby.
• Women with high blood pressure during pregnancy risk experiencing high blood pressure, kidney problems, and stroke in the future compared to women with normal blood pressure during pregnancy.

Two studies from the Mayo Clinic presented during the American Society of Nephrology’s Annual Kidney Week provide new information related to high blood pressure during pregnancy.

In one study, Vesna Garovic, MD and her team examined the potential of a test done mid-pregnancy to predict which women will later develop preeclampsia, a late-pregnancy disorder that is characterized by high blood pressure and excess protein in the urine and that affects 3% to 5% of pregnancies. Left untreated, preeclampsia can lead to serious—even fatal—complications for a pregnant woman and her baby.

Among a group of 315 patients, 15 developed preeclampsia and 15 developed high blood pressure (but not preeclampsia) during pregnancy. All of the patients who developed preeclampsia tested positive in mid-pregnancy for a test that detects the shedding of certain kidney cells called podocytes in the urine. None of those with only high blood pressure tested positive, and none of 44 women with normal pregnancies tested positive. Therefore, this test is highly accurate for predicting preeclampsia, which could alert clinicians to take steps to safeguard against the condition.

In another study, Dr. Garovic’s team looked at the long-term health effects of high blood pressure during pregnancy. They identified female residents of Rochester, Minnesota and the surrounding townships in Olmsted County who delivered between 1976 and 1982. The investigators divided the women into two groups—those with high blood pressure during pregnancy and those without —and followed them after they reached 40 years of age to monitor their heart and kidney health.

A total of 6,051 mothers delivered between 1976 and1982, and 607 women had high blood pressure at the time while 5,444 did not. After the women reached age 40, women who had high blood pressure during pregnancy were much more likely to experience high blood pressure, kidney disease, and strokes than women who did not have high blood pressure during pregnancy (51% vs 31%, 14% vs 10%, and 8% vs 4%, respectively).

“Studies of the associations of hypertensive pregnancy disorders with maternal risks for future cardiovascular disease could lead to new guidelines for screening and treatment of women at risk, with the ultimate goal of improving cardiovascular health in women,” said Dr. Garovic.

Study authors for “Podocyturia Is an Early Marker That Distinguishes among Normotensive Pregnancy, Gestational Hypertension, and Preeclampsia” (abstract FR-OR292) include Steven Wagner, MD, Iasmina Craici, MD, Juan C. Calle, MD, Christina Wood-wentz, Kent R. Bailey, PhD, Stephen T. Turner, MD, Joseph P. Grande, MD, PhD and Vesna D. Garovic, MD.

Study authors for “Women with a History of Hypertensive Pregnancy Disorders Are at Increased Risk for Future Cardiovascular and Renal Disease: A Population-Based Cohort Study” (abstract TH-OR115) include Catherine M. Brown, MD, Slavica Katusic, Cynthia L. Leibson, Jeanine Ransom, Stephen T. Turner, MD, Veronique L. Roger and Vesna D. Garovic, MD.

Disclosures available at http://www.asn-online.org/press/.

ASN Kidney Week 2011, the largest nephrology meeting of its kind, will provide a forum for 13,000 professionals to discuss the latest findings in renal research and engage in educational sessions related to advances in the care of patients with kidney and related disorders. Kidney Week 2011 will take place November 8 – November 13 at the Pennsylvania Convention Center in Philadelphia, PA.

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Founded in 1966, and with more than 12,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

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