New Research Study Goes Against Popular Belief On “39-week” Pregnancy Rule

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pregnantThis article is courtesy of the Baylor College of Medicine, please share your comments below. Questions or concerns about the article should be addressed directly to the Baylor College of Medicine.

Women who are managing low-risk pregnancies are advised to follow the “39-week rule” – waiting until they are 39 weeks to deliver. This rule is intended to eliminate elective inductions and cesarean deliveries at 37 and 38 weeks, when outcomes for the newborns are believed to be worse than those born at full term.

But new research by a Baylor College of Medicine epidemiologist suggests that babies delivered after elective induction at 37 to 38 weeks may not have an increased risk of adverse neonatal outcomes, compared to those infants who are expectantly managed (i.e., medical observation or “watchful waiting”) and delivered at 39 to 40 weeks. The findings appear in the current issue of Obstetrics and Gynecology.

“Our findings caution against a general avoidance of all elective early-term inductions and call for continued research, based on better data, in what is still a relatively new arena,” said Dr. Jason Salemi, assistant professor of family and community medicine at Baylor and lead author of the study.

The national initiative to eliminate all elective deliveries before 39 weeks began to gain momentum around 2008, Salemi said, and was supported by professional organizations and adopted by healthcare institutions.

“Until then, I had never observed a campaign so enthusiastically embraced and that resulted in such widespread implementation of practice improvement efforts,” Salemi said.

But he saw limitations in many studies used to justify the 39-week rule. Most notably, he recognized what he believed to be an inappropriate choice of comparison group for elective early-term deliveries.

“A number of studies reporting worse outcomes for elective early-term deliveries compared them with later term spontaneous deliveries, a low-risk group. However, the clinical decision that must be made is not between elective early-term delivery and later spontaneous delivery, but between elective early-term delivery and expectant management, in which the outcome remains unknown,” Salemi said.

Salemi and his colleagues conducted a retrospective cohort study that used data on more than 675,000 infants from a statewide database. All live births were classified on the basis of the timing and reason for delivery. The research study compared elective inductions and cesarean deliveries at 37 to 38 weeks to expectantly managed pregnancies delivered at 39 to 40 weeks.

“We focused on serious conditions in early life. Our outcomes included neonatal respiratory morbidity, sepsis, feeding difficulties, admission to the neonatal intensive care unit and infant mortality,” Salemi said.

Salemi cautions that the research findings do not lend support for elective deliveries before 39 weeks and, in fact, provide evidence that supports the avoidance of elective early-term cesarean deliveries. The study found that infants delivered after cesarean delivery at 37 to 38 weeks had a 13 to 66 percent increase in the odds of damaging outcomes.

However, infants delivered after elective early-term induction experienced odds of adverse neonatal outcomes that were largely the same as infants who were expectantly managed and delivered at 39 to 40 weeks. Through the research findings, Salemi hopes to increase awareness on the many issues that surround the timing and reasons for delivery.

“Each pregnancy is unique,” He said. “I cannot overstate the importance of open and ongoing communication between pregnant women and their healthcare providers so that the potential risks and benefits of any pregnancy-related decision are understood fully.”

Other authors that contributed to this research study and article are Dr. Elizabeth Pathak, during her time as an associate professor of epidemiology at the University of South Florida Morsani College of Medicine, and Dr. Hamisu Salihu, professor and vice chair for research in family and community medicine at Baylor.

This research was funded by the Agency for Healthcare Research and Quality (grant number R01HS019997).

Picky Eaters: Two Requirements For Making The One-Bite Rule Work

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By Kristen Yarker, MSc, RD

kidseatinghealthyPicky eating is common amongst kids, particularly toddlers and preschoolers.

One strategy that many parents try with their picky eaters is the one-bite rule. The one-bite rule is when kids need to try one bite of every food on their plate (yes, even the vegetables).

While this rule works in many households, other parents try this technique and find that it not only doesn’t work, but it can backfire and cause their child to be more resistant to trying new foods.

In five years of working with families of picky eaters, I’ve discovered two requirements for making the one-bite rule work.

Requirement #1: Your Child’s Temperament

Temperament is the term used to describe the inherent way that a child responds emotionally and behaviorally to challenges or new situations. Some children are more outgoing and adventurous and some are more reserved and cautious. A child’s temperament will influence how he/she approaches eating.

The one-bite rule works well for kids who are more adventurous because they’re more comfortable jumping into new situations. For reserved kids, forcing them to take action before they’re ready just causes them to dig their heels. For more reserved kids, instead of the one-bite rule, let them choose whether or not to try foods on their plate. This way the cautious child can trust that he/she truly is in control and then he/she will try new foods on his/her own schedule.

Requirement #2: That it’s Okay to Not Like a Food

twokidsunBecause parents put so much effort and love into dishes, they want their family to enjoy it. So, it’s easy to respond to kids’ trying of the one bite with “It’s good right?” or perhaps “See, it’s not so bad. Try another bite”. These responses come from good intentions, but unfortunately they take away children’s ability to express their true feelings. The unfortunate side effect is that this pressure will make little ones less likely to try something because now they not only have to try it – they have to like it too!

If you choose to have the one-bite rule, it truly needs to be okay for your child to try a food and not like it.

Instead of attaching your feelings to how much kids like a food, enjoy connecting with them and sharing time as a family. This kind of unconditional love creates a pleasant environment at meals. Creating a pleasant environment at meals will have a great side effect of creating an environment that encourages (even cautious) kids to try new foods and get the nutrition that they need.

– Kristen Yarker, MSc, RD is known as The Dietitian Who Transforms Picky Eaters into Food Confident Kids. From introducing solids through the picky eating years, she helps Moms and Dads be confident that they’re giving their kids good nutrition today… and instilling a life-long LOVE of healthy eating. Get scientific evidence-based answers to real questions from real parents (recipes too!) by signing up for her 101 Healthy Snack Ideas at: vitaminkconsulting.com

New School Snacks Rule Coming

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obesechildFrom Your Health Journal…..”A great story today on Yahoo! via Reuters about healthier school snacks. Schools in the United States will see new government rules targeting the kinds of snacks sold to students, a move many experts say could play an important role in fighting childhood obesity. As we have discussed so many times here, childhood obesity is reaching epidermic levels all over the world – with so many children showing risk factors for heart disease or type 2 diabetes (as well as other health concerns). Students are getting less physical activity, and eating unhealthy foods during the day, not to mention cutbacks in recess, physical education, and recreation programs. So now, it appears there may be some restrictions on candy bars, chips, and soda at schools across the US. The government does not want to get rid of all vending machines, just what is inside them. According to the USDA, vending machines are in just 13 percent of elementary schools for young children, but are in 67 percent of middle schools, where students are around 11 to 14 years old, and 85 percent of high schools. The USDA also found more than 80 percent of school districts have either restricted or banned sugary drinks. More than 75 percent also have some kind of limit or ban on snack foods. Please visit the Yahoo! site (link provided below) to read this very important article.”

From the article…..

After more than a year’s delay, American schools will soon see new U.S. government rules targeting the kinds of snacks sold to students, a move nutritionists say could play an important role in fighting childhood obesity.

Anxious schools have waited more than a year to find out how sales of potato chips, candy bars, sodas and similar treats to students will be restricted. These rules on food sold outside traditional cafeteria meals are a key part of the first major overhaul on school food in more than three decades.

Agriculture Secretary Tom Vilsack recently told Reuters that the rules on what snacks may be offered in vending machines, school stores and the like, originally due in late 2011, are expected to be finished in the early part of this year.

Officially, USDA said it expects the proposal by April, at which point a 60-day public comment period would kick in before final rules are issued – potentially for the next school year.

Vilsack said the delay was in part to give food and drink manufacturers, as well as schools, time to adjust to a revamp of cafeteria breakfasts and lunches in early 2012.

Those earlier sweeping changes, dictating more whole grains, fruits and vegetables on school menus, led to a few complaints and some hungry children. USDA later gave schools more flexibility on the new menus.

“The whole idea is that they eat more fruits and vegetables … that’s not going to happen overnight,” said Gail Koutroubas, who oversees food services for the public school district in Andover, Massachusetts, near Boston.

The school nutrition overhaul seeks to make a dent in the nation’s obesity epidemic at a time when government statistics show more than one-third of those younger than 18 are too heavy.

Health advocates want the snack changes to include smaller portions, reduced fat and less sugar. Acceptable drinks for most students would include low- or no-fat milks, 100 percent juices and water.

“We’re not saying get rid of the vending machines. Just change what’s in them,” said Margo Wootan, head of nutrition policy at the Center for Science in the Public Interest, an advocacy group. “We, as parents, don’t want our kids eating candy bars and Gatorade for lunch.”

To read the full article…..Click here