̽��ֱ�� of Cambridge - baby

Combined steroid and statin treatment could reduce ‘accelerated ageing’ in preterm babies, study in rats suggests

cg605 — Thu, 02 Feb 2023 09:20:05 +0000

Cambridge scientists gave new-born rats, which are naturally born prematurely, combined glucocorticoid steroids and statin therapy. ̽��ֱ��results, published today in Hypertension, show that the combined treatment led to the elimination of negative effects of steroids on the cardiovascular system while retaining their positive effects on the developing respiratory system.

Preterm birth (before 37 weeks) is one of the greatest killers in perinatal medicine today. One in ten babies is born preterm in high-income countries; this can increase to almost 40% in low- and middle-income countries.

Preterm babies are extremely vulnerable because they miss out on a crucial final developmental stage in which the hormone cortisol is produced and released exponentially into the unborn baby’s blood. Cortisol is vital to the maturation of organs and systems that are needed to keep the baby alive once born.

For example, in the lungs, cortisol ensures that they become more elastic. This allows the lungs to expand so the baby can take its first breath. Without cortisol the new-born lungs would be too stiff, which leads to respiratory distress syndrome (RDS) and could be fatal.

̽��ֱ��established clinical treatment for any pregnancy threatened with preterm birth is glucocorticoid therapy, given via the mother before the baby is born and/or directly to the baby after birth. These synthetic steroids mimic the natural cortisol by speeding up the development of organs – including the lungs – which means the preterm baby is much more likely to survive.

Lead author Professor Dino Giussani from the Department of Physiology, Development and Neuroscience at the ̽��ֱ�� of Cambridge said: “Glucocorticoids are a clear lifesaver, but the problem with steroids is that they speed up the maturation of all organs. For the baby’s lungs this is beneficial, but for the heart and circulation system it can be damaging – it resembles accelerated ageing.”

A previous clinical study by Professor Paul Leeson’s laboratory at Oxford ̽��ֱ�� found that people who had been exposed to glucocorticoid therapy as unborn babies, via their mothers, showed measures of cardiovascular health typical of people a decade older.

Cambridge researcher Dr Andrew Kane, involved in the rat study, thought that this accelerated ageing could result from steroids causing oxidative stress Steroids lead to an imbalance of molecules known as free radicals, which result in a reduction in nitric oxide. Nitric oxide is very beneficial to the cardiovascular system – it increases blood flow and has anti-oxidant and anti-inflammatory properties.

To test if a lack of nitric oxide could be the origin of the adverse negative cardiovascular side-effects associated with glucocorticoid therapy, the researchers combined the steroid treatment with statins, which are widely used to lower cholesterol and are known to increase nitric oxide.

Researchers gave the synthetic steroid, dexamethasone, combined with the statin, pravastatin, to rat pups. There were three other groups – one receiving dexamethasone alone, one receiving pravastatin alone and a control group that received saline. Measures of respiratory and cardiovascular function were then taken when the rats had grown to ‘childhood’.

̽��ֱ��Cambridge scientists found that steroids produced adverse effects on heart and blood vessels, and molecular indices associated with cardiovascular problems. But if statins were given at the same time, the rats were protected from these effects. Crucially, the statins did not affect any of the beneficial effects of steroids on the respiratory system.

“Our discovery suggests that combined glucocorticoid and statin therapy may be safer than glucocorticoids alone for the treatment of preterm babies,” said Professor Giussani.

“We’re not saying to stop using glucocorticoids, as they are clearly a life-saving treatment. We’re saying that to improve this therapy – to fine tune it – we could combine it with statins. This gives us the best of both worlds – we can maintain the benefits of steroids on the developing lungs, but ‘weed out’ their adverse side-effects on the developing heart and circulation, thereby making therapy much safer for the treatment of preterm birth.”

̽��ֱ��team plan to replicate the experiment in sheep, which have a similar physiology to humans, before conducting human clinical trials.

̽��ֱ��research was funded by the British Heart Foundation and the Biotechnology and Biological Sciences Research Council (BBSRC). Dr Andrew Kane was supported by the Frank Edward Elmore Fund and the James Baird Fund.

Giussani, DA et al. Combined statin and glucocorticoid therapy for the safer treatment of preterm birth. Hypertension; 1 Feb 2023; DOI: 10.1161/HYPERTENSIONAHA.122.19647

Potentially life-saving steroids commonly given to preterm babies also increase the risk of long-term cardiovascular problems, but a new study in rats has found that if given in conjunction with statins, their positive effects remain while the potential negative side-effects are ‘weeded out’.

We’re not saying to stop using glucocorticoids, as they are clearly a life-saving treatment. We’re saying that to improve this therapy – to fine tune it – we could combine it with statins.

IvanJekic / E+ via Getty Images

Mother is holding a tiny hand of her preterm baby that is in the NICU.

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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Surviving birth

lw355 — Thu, 10 Dec 2020 09:00:28 +0000

Researchers at one of the busiest maternity hospitals in the world aim to help more women survive complications giving birth.

Premature babies could benefit from changes to drugs administered to at-risk mothers

cjb250 — Wed, 20 Mar 2019 18:20:22 +0000

While the current practice of using glucocorticoid therapy shows life-saving benefits for the preterm infant, the researchers say that combining them with antioxidants would overcome potential safety concerns associated with existing treatment.

One in ten babies is born prematurely and up to three-quarters of these are at significant risk of death or long-term illness because premature babies are born with immature lungs and hence are at risk of dying from respiratory problems.

̽��ֱ��clinical use of glucocorticoids both in mothers at risk of premature labour and in premature babies has become common practice in the last 40 years. ̽��ֱ��treatment is based on research which discovered the important role played by glucocorticoids in fetal development and that giving premature babies synthetic glucocorticoids could accelerate the development of their lungs and respiratory system.

Now, every mother at risk of preterm birth gets this treatment worldwide in developed societies. It is regarded as one of the best examples of successfully translating basic experimental science into efficient human clinical practice and it has saved millions of preterm children every year.

However, despite the very clear life-saving effects of antenatal and postnatal glucocorticoid therapy to accelerate lung maturation in the infant, new research has identified some potential adverse side effects on the offspring’s growth, central nervous and cardiovascular systems. Some of these effects will not be seen until the child is fully grown and is in adulthood.

“ ̽��ֱ��evidence supporting the life-saving benefits of glucocorticoid treatment for premature babies is overwhelming. Without it, preterm babies would mostly die or suffer significantly from conditions associated with prematurity, leaving them with significant disability,” says Professor Dino Giussani from the Department of Physiology, Development & Neuroscience at the ̽��ֱ�� of Cambridge.

“Unfortunately, there can be subtle adverse effects from the therapy that suggest we need to fine-tune current clinical therapy to maintain its beneficial effects but weed out any potential negative adverse effects later in life.”

In a review published online in the journal Trends in Endocrinology and Metabolism, Professor Giussani and PhD student Tessa Garrud propose that in future, combined therapy of glucocorticoids with specific antioxidants may be safer for the treatment of the premature baby.

In their article, the researchers argue that while much is known about the physiological mechanisms via which glucocorticoids have a beneficial effect, far less is understood about those mechanisms by which the treatment can cause subtle negative effects. In part this is because it is difficult to ascertain which long term health problems are as a result of glucocorticoid treatment and which are due to the detrimental effects of preterm birth.

Professor Giussani and Ms Garrud point to research that suggests one likely culprit mechanism is the capacity of synthetic glucocorticoids to induce what is so-called ‘oxidative stress’, caused by an imbalance in the body of unstable atoms known as free radicals. While the body needs a certain number of free radicals for cell signalling or to stimulate repair, an overabundance can cause damage. Oxidative stress has been shown to lead to restricted blood flow and can damage the cardiovascular system in the long-term.

“When we bring together the research out there on this issue, we find strong evidence to suggest that combined antioxidant and glucocorticoid therapy may be safer than glucocorticoid therapy alone for the treatment of preterm birth,” says Ms Garrud.

Professor Giussani adds: “We believe it is time to study these further potential benefits in clinical trials. Glucocorticoid therapy is clearly a life-saver and is here to stay, but we support that treatment could be improved even further to maintain benefits while improving safety.”

̽��ֱ��research was supported by the British Heart Foundation and Wellcome.

Reference
Garrud, TAC and Giussani, DA. Combined antioxidant and glucocorticoid therapy for safer treatment of preterm birth. Trends in Endocrinology and Metabolism; April 2019; DOI: 10.1016/j.tem.2019.02.003

Scientists at the ̽��ֱ�� of Cambridge have suggested that subtle changes to the drugs administered to mothers threatened with preterm birth or to premature babies could further improve clinical treatment and help increase their safety.

We need to fine-tune current clinical therapy to maintain its beneficial effects but weed out any potential negative adverse effects later in life

Dino Giussani

César Rincón

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Mother’s attitude towards baby during pregnancy may have implications for child’s development

cjb250 — Tue, 12 Jun 2018 08:38:02 +0000

Researchers at the Centre for Family Research carried out a meta-analysis, reviewing all published studies in the field, in an attempt to demonstrate conclusively whether there was a link with the way parents think about their child during pregnancy and their behaviour towards them postnatally.

̽��ֱ��results of their work, which draws data from 14 studies involving 1,862 mothers and fathers, are published in the journal Developmental Review.

Studies included in the meta-analysis examined parents’ thoughts and feelings about their child during pregnancy through interviews and questionnaires. For example, in interviews expectant parents were considered to have a ‘balanced’ representation of their child if they showed positive anticipation of their relationship with the child or showed ‘mind-mindedness’ – a propensity to see their child as an individual, with its own thoughts and feelings. This was contrasted by parents who had a ‘distorted’ representation of their child, with a narrow, idealised description of their child, and incomplete or inconsistent descriptions of them.

Once the child had been born, researchers in these studies would observe the interactions between parent and child. One measure they were looking for was ‘sensitivity’ – the ability to notice, interpret and respond in a timely and appropriate manner to children’s signals, for example if the baby was upset.

Combining the results from all 14 studies, the Cambridge team showed a modest association between positive thoughts and feelings about the infant during pregnancy and later interaction with the infant, but only in mothers.

“Studies have shown that parent-child interaction is crucial for a child’s development and learning, so we wanted to understand if there were prenatal signs that might predict a parent’s behaviour,” says Dr Sarah Foley, the study’s first author, who carried out the research as part of her PhD.

“Although we found a relationship between a mother’s attitude towards her baby during pregnancy and her later interactions, this link was only modest. This suggests it is likely to be a part of the jigsaw, rather than the whole story.”

Research has also shown that increased awareness of the baby during pregnancy is associated with healthy behaviours during pregnancy, such as giving up smoking or attending antenatal appointments.

While more work is needed to determine what form such interventions might take, options might include the midwife encouraging the mother to think about what her baby may be like, or asking the mother to imagine activities they think she and her baby might like to do together.

“This is a relatively new area of research, but could have important implications for children’s development,” adds Dr Foley. “We need more research in this area, but hope it will inform new interventions that could help new mothers engage more with their children.”

Dr Foley says there may be a number of factors that contribute to low levels of attachment with the baby during pregnancy. These include: previous experience of miscarriage, depression or anxiety, a mother’s relationship with her own parents, or cultures in which focusing on the baby is considered inappropriate. However, she says, the paucity of evidence means it is difficult to determine which of these factors would impact on prenatal thoughts about the infant, which might in turn influence the quality of later interaction with the infant.

̽��ֱ��study was funded by the Economic and Social Research Council.

Reference
Foley, S and Hughes, C. Great expectations? Do mothers’ and fathers’ prenatal thoughts and feelings about the infant predict parent-infant interaction quality? A meta-analytic review. Developmental Review; June 2018; DOI: 10.1016/j.dr.2018.03.007

Mothers who ‘connect’ with their baby during pregnancy are more likely to interact in a more positive way with their infant after it is born, according to a study carried out at the ̽��ֱ�� of Cambridge. Interaction is important for helping infants learn and develop.

Although we found a relationship between a mother’s attitude towards her baby during pregnancy and her later interactions, this link was only modest. This suggests it is likely to be a part of the jigsaw, rather than the whole story

Sarah Foley

Meagan

Baby shoes (cropped)

Researcher Profile: Dr Sarah Foley

Sarah and her cousin's baby, Sophia Murphy

“Working with children throws up lots of unexpected and fun moments,” says Dr Sarah Foley. “One day you’re being splashed while standing on a toilet-seat filming bath-times, the next you’re catching YouTube-worthy vomiting action shots and being used as a climbing frame by one child to ensure you can film another!”

Sarah has just completed an ESRC-funded PhD at the Centre for Family Research, working with Professor Claire Hughes. She has spent several years at Cambridge now, having completed her undergraduate degree in Social and Political Sciences at St Catharine’s College. ̽��ֱ��Centre, she says, “is an incredibly stimulating academic environment with immense support and lively discussions over cake on a Friday morning!”

Her doctoral research looked at expectant mothers’ and fathers’ thoughts and feelings in the last trimester of pregnancy as predictors of their adjustment to parenthood and subsequent parenting over the first two years of life. “Despite an increase in fathers’ involvement in childcare, the majority of research remains focused on mothers,” she says.

Her current research involves, in part, looking at parents’ expectations of their roles and division of childcare, and the consequences when these expectations are not met. This is timely in light of recent changes to parental leave in the UK and societal shifts in notions of the involved father, she says.

Sarah’s research is part of the ESRC-funded New Fathers and Mothers Study, a longitudinal study of 200 first time parents from Cambridge, and 200 from the Netherlands and New York.

“ ̽��ֱ��children in the study are turning three this year and we’re busy seeing how they are getting on at nursery,” she explains. “This typically involves me getting down on the floor and testing the children’s social understanding and thinking skills through a variety of fun tasks.”

She hopes that her research will lead to changes in antenatal education and early parent support that promote discussion of parents’ thoughts and feelings about parenthood and their future infant. In November 2017, as part of the ESRC Festival of Social Science, she ran a free ante-natal class for new parents that discussed the realities of parenthood, the importance of self-care and simple parenting tips rather than simply focusing on birth plans.

“ ̽��ֱ��journey through parenthood is filled with joy, but also elements of confusion, and sometimes pain. Crucially, parents should not feel alone and I hope that through greater dissemination of my research findings, through classes or perhaps a book or an app, we can support new parents and encourage more ‘honest conversations’ about parenthood.”

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High fat, high sugar diet during pregnancy 'programs' for health complications in mother and child

tdk25 — Thu, 06 Apr 2017 03:00:53 +0000

In a study carried out in pregnant mice, a team of academics found that an obesity-causing high fat and high sugar diet disrupted processes within the pregnant mother’s body, leading to poor metabolic control. These changes were found just prior to birth and may make her more susceptible to conditions such as type 2 diabetes and heart disease, as well as to further fat accumulation, in later motherhood.

̽��ֱ��exact impact on her child during pregnancy was harder to ascertain, but the researchers found that metabolic dysfunction in the mother compromised the flow of nutrients to the foetus, altering its growth and metabolism at critical stages during its development. This strongly suggests that an obesogenic diet (a diet which promotes obesity) also has consequences for foetal development. It may also explain why babies from mothers who are obese or eat obesogenic diets during pregnancy have a tendency to develop conditions such as obesity, hypertension and type 2 diabetes as adults.

In particular, the researchers found that a higher than recommended intake of fat and sugar exacerbates and distorts metabolic changes which occur naturally as a result of the pregnancy, so that the mother can appropriately allocate nutrients to the foetus.

̽��ֱ��study was carried out by a team of researchers at the ̽��ֱ�� of Cambridge. ̽��ֱ��lead author is Dr Amanda Sferruzzi-Perri, from St John’s College, Cambridge, and the Centre for Trophoblast Research in the Department of Physiology, Development and Neuroscience. She said that the findings were especially relevant for women in western countries.

“In places like the UK, the US and Australia, many women of child-bearing age are also eating higher amounts of fat and sugar than the National Dietary Recommendations,” she said. “We know that obesity during pregnancy is a risk factor for health complications for mother and baby both during and after pregnancy. This study offers insight into the mechanisms operating during pregnancy that may cause this.”

̽��ֱ��study involved feeding a diet that contained high amounts of fat and sugar to pregnant mice. ̽��ֱ��researchers then assessed the impact of this on both the metabolism of the mother and her levels of body fat, compared to mice which were fed a more balanced diet.

They related these changes in whole-body metabolism to the expression of proteins in the mother’s tissues, which are responsible for processing and storing nutrients, as well as to the supply of nutrients, growth and metabolism of her developing foetuses. All of the experiments were carried out in line with the UK Home Office Animals (Scientific Procedures) Act 1986.

Overall, the researchers found that excessive consumption of sugar and fat compromised the mother’s glucose tolerance and her sensitivity to insulin – the hormone that controls blood sugar levels.

Specifically, they found that the mother’s ability to respond to insulin was reduced in tissues like her muscle and fat, which take up glucose from the circulation. By contrast, the sensitivity of the maternal liver to insulin was increased, which reduces glucose production during pregnancy. As a result, the mother was unable adequately to control glucose levels or produce enough glucose to support the pregnancy.

̽��ֱ��high fat, high sugar diet also changed the expression of proteins in the mother’s body that control fat storage, leading to an increase in body fat. Collectively, the researchers suggest that these effects promote a “pre-diabetic state” in the mother, resembling many aspects of gestational diabetes; a pregnancy complication which affects up to 5% of women in the UK.

One of the main reasons for this may be that an obesogenic diet exaggerates natural metabolic changes associated with pregnancy. “During a normal pregnancy, the mother’s body will change the way it handles nutrients so that some can be freed up for the foetus,” Sferruzzi-Perri explained. “ ̽��ֱ��mother’s metabolism is shifted to an insulin resistant, glucose intolerant state, such that her own glucose use is limited in favour of foetal supply. We think that in cases where the mother has a high fat, high sugar diet, these metabolic changes are exacerbated or perturbed.”

These effects, the researchers suggest, may alter the mother’s disposition to develop health complications after she has given birth as well – a phenomenon that they refer to as a “metabolic memory”, putting her at greater risk of type 2 diabetes, obesity and cardiovascular problems in later life.

̽��ֱ��study also found that the defects in the mother’s metabolism impaired nutrient flow to the foetus, as they resulted in the preferential storage of nutrients within the mother’s tissues, in favour of allocating these to the developing foetus.

Because the placenta also plays an important role in nutrient allocation (as previous studies have shown), the babies of mice fed the obesogenic diet were still born at a normal size. However, because the foetus receives different amounts of nutrients and shows defects in its ability to use these during development, the researchers believe that the child will still be more susceptible to metabolic dysfunction later in life.

“We still don’t know what the exact consequences for the foetus are, but the findings match existing research which already suggests that the individual will suffer from these metabolic problems during adulthood,” Sferruzzi-Perri said. “This is because changes to the nutrient and oxygen supply, at a stage when individual organs are developing, can cause a permanent change in the structure and function of certain tissues.”

̽��ֱ��full study, A Western-style obesogenic diet alters maternal metabolic physiology with consequences for fetal nutrient acquisition in mice is published in ̽��ֱ��Journal of Physiology. DOI: 10.1113/JP273684.

Eating a high fat and high sugar diet when pregnant leads to metabolic impairments in both the mother and her unborn child, which may 'program' them for potential health complications later in life, a study in mice has shown.

We know that obesity during pregnancy is a risk factor for health complications for mother and baby both during and after pregnancy. This study offers insight into the mechanisms operating during pregnancy that may cause this.

Amanda Sferruzzi-Perri

Free image via Max Pixel

̽��ֱ��researchers found that a high fat and high sugar diet exaggerates metabolic changes in the mother which occur naturally during pregnancy, potentially rendering her more susceptible to health complications.

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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Placenta plays pivotal “umpire” role to influence pregnancy outcomes

tdk25 — Mon, 12 Sep 2016 19:00:56 +0000

Researchers have shown for the first time how the placenta “umpires” a fight for nutrients between a pregnant mother and her unborn baby. ̽��ֱ��study suggests that the placenta will adjust the amount of nutrients transported to the foetus for growth in line with the mother’s physical ability to supply.

̽��ֱ��findings, published in the journal PNAS, suggest that if the bodily environment that a mother provides for her baby is unfavourable, for example through small body size or metabolic dysfunction, the placenta will change the flow of nutrients to the foetus relative to her own state. This can affect foetal development, resulting in complications at birth.

It is the first time that scientists have been able to provide clear evidence that the placenta plays the decisive role in this delicate balancing act, rather than merely acting as a passive interface which enables the transfer of nutrients from mother to foetus.

̽��ֱ��study, by researchers at the ̽��ֱ�� of Cambridge, involved making a precise genetic change in mice, which caused poor growth and changed the mother’s bodily environment. They then observed how the placenta developed and acted in response, finding that in mothers in which this alteration had been made, the structure of the placenta was different, and fewer nutrients reached the foetus.

A better understanding of how the placenta manages the trade-off will eventually enable researchers to reduce pregnancy complications in both humans and other mammals.

̽��ֱ��study was led by Dr Amanda Sferruzzi-Perri, a Research Associate at St John’s College, ̽��ֱ�� of Cambridge, and is part of a five-year project in the Department of Physiology, Development and Neuroscience examining the relationship between the placenta and pregnancy complications.

“During pregnancy there is a kind of ‘tug-of-war’ going on between the mother and the foetus over who gets the nutrients that the mother ingests,” Sferruzzi-Perri said. “This work shows for the first time that the placenta is the umpire which controls that fight. Understanding more about the placenta’s role is extremely important. If nutrients cannot be divided correctly during pregnancy, it can lead to life-threatening complications for expectant mothers, and long-term health consequences for both mother and child.”

At least one in every eight pregnancies in the UK is affected by complications stemming from impairment of the placenta. In the developing world the rate is even higher, with at least one in every five pregnant women affected. ̽��ֱ��potential consequences include abnormal birth weight, premature delivery, pre-eclampsia, and maternal diabetes.

A major cause appears to be the placenta’s response to unfavourable biological changes in the mother herself. These may, for example, be the result of poor nutrition, high stress levels, metabolic dysfunction, or obesity.

How the placenta allocates nutrients in these situations, however, and the hormonal signals that the placenta may be releasing while doing so, is not fully understood. By understanding these processes better, researchers hope to identify both the biological early warning signals that a problem has arisen, and their relationship to specific causes, enabling them to develop therapeutic interventions that reduce the number of complications overall.

̽��ֱ��new study represents a step towards those aims because researchers were able to directly influence the balancing act that the placenta performs and observe it in relation to both the physiology of the mother, and the actual growth and nutrient supply of the foetus.

To achieve this they used a model system where an enzyme called p110 alpha was genetically modified in mice. In a healthy mother, this enzyme is activated by hormones like insulin and insulin-growth factors (IGFs), kick-starting a relay race within cells which stimulates nutrient uptake and, as a result, normal growth and metabolic function. By altering this enzyme, the team reduced the mother’s overall responsiveness to such hormones, creating an unfavourable environment.

̽��ֱ��results showed that in mothers which carried the altered form of p110 alpha, the placenta’s growth and structure was impaired. As well as being physically different, it was also found to be transporting fewer nutrients to the unborn offspring.

Because of the way in which the experiments were set up, the team were also able to see what would happen to the placenta if the foetus carried the altered form of p110 alpha, but the mother was normal. They found that in these cases, the placenta also showed defects, but was able to compensate for this by transporting more nutrients to the foetus, and thus optimising nutrition.

This shows that the placenta will fine-tune the distribution of nutrients between the mother and foetus, in response to the circumstances in which it finds itself. It also indicates that, because the mother needs to be able to support her baby both during pregnancy and after birth, the placenta will do its best to judge how much nutrition the foetus receives, so that the mother’s health is not compromised.

“ ̽��ֱ��placenta is taking in signals all the time from the mother and the foetus,” Sferruzzi-Perri explained. “If the mother has some sort of defect in her ability to grow, the placenta will limit the amount of nutrients it allocates to the foetus to try and preserve her health.”

“What this tells us is that the mother’s environment is a very strong, modifiable characteristic to which we should be paying more attention, in particular to see if there are specific factors that we can change to improve the outcome of pregnancies. Being able to influence the mother’s environment through changes in p110 alpha gives us a means to study this in a controlled way, and to work out what those critical factors are.”

̽��ֱ��next stage of the research will involve examining the signals that the placenta sends to the mother to affect the way she uses the nutrients she ingests, potentially providing important clues about biomarkers which provide an early warning of pregnancy complications.

Dr Sferruzzi-Perri’s research is supported by a Dorothy Hodgkin Fellowship from the Royal Society. Her paper, Maternal and fetal genomes interplay through phosphoinositol 3-kinase(PI3K)-p110α signalling to modify placental resource allocation, is published in PNAS. ̽��ֱ��work was supported by a Next Generation Fellowship from the Centre for Trophoblast Research.

New research provides the first clear evidence that the amount of nutrients transported to the foetus by the placenta adjusts according to both the foetal drive for growth, and the mother’s physical ability to provide.

During pregnancy there is a kind of ‘tug-of-war’ going on between the mother and the foetus over who gets the nutrients that the mother ingests. This work shows for the first time that the placenta is the umpire which controls that fight

Amanda Sferruzzi-Perri

Free stock image via Pexels.

"Pregnant".

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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Too big to cry: when war ended, the damage began

amb206 — Sat, 07 Nov 2015 10:00:00 +0000

When we think of the First World War, we remember the many millions of men who died. But, as dangerous it was to be a soldier in the horror of the trenches, it was more dangerous to be a baby back at home. This parlous state of affairs was described by the Bishop of London at the launch of an initiative called Baby Week designed to improve infant survival rates: “100,000 babies died during the first twelve months from their birth… While nine soldiers died every hour in 1915 twelve babies died each hour.”

This bleak picture, and the urgent efforts made to redress it, is one backdrop to ̽��ֱ��Silent Morning: Culture and Memory after the Armistice a collection of essays edited by Cambridge academics Drs Trudi Tate and Kate Kennedy. ̽��ֱ��book, which comes out in paperback on Armistice Day (11 November 2015) looks at the cultural and societal narrative of a Britain struggling to find itself in the wake of conflict. Part of this struggle was a national drive to increase the health of the nation and produce a generation raised on safe milk, housed in sanitary conditions and provided with a secure framework.

̽��ֱ��book explores how selected writers, artists and composers sought to bear witness to the war and the disappointment of peace. It’s one of the few volumes to look comparatively at British, German and Austrian sources, reading Virginia Woolf alongside Arthur Schnitzler and Alfred Döblin, Käthe Kollwitz and Ernst Krenek alongside Arthur Bliss, Elizabeth Bowen and Ford Madox Ford, and unpublished letters by both German and British soldiers. Contributors include Andrew Frayn, Alison Hennegan, Klaus Hofmann, Jane Potter, George Simmers, and Alexander Watson. Adrian Barlow discusses British and German war memorials.

Both Tate and Kennedy study the First World War but neither is a historian in the conventional sense. Tate is a specialist in the literature of conflict and Kennedy is a biographer with an interest in the relationship between words and music. ̽��ֱ��essays they bring together in Silent Morning look behind the practical measures taken to improve hygiene and housing to reveal the deeper cultural forces at work. Evident in art, literature and music, these ways of seeing the world shaped much more than government policies: they had a profound and enduring impact on people’s lives on both sides of the conflict.

̽��ֱ��chapter in Silent Morning contributed by Tate is titled ‘King Baby’. It covers new ground in its analysis of underlying attitudes to child development and how these were shaped by the not-quite peace that unfolded when an Armistice was declared in November 1918. In her exploration of the literature of the period, Tate focuses first and foremost on babies. Her journey into the unconscious of the domestic sphere embraces the work of writers such as Virginia Woolf, Elizabeth Bowen and Katherine Mansfield as well as the manuals that exerted strong influences on childcare practice.

Tate argues that, while many soldiers and civilians felt infantilised by war, babies were, in a sense, militarised. She reminds us that war traumatises – but also that peace, and the absence of the sound of guns, can be traumatic too. ̽��ֱ��uncertain and sullied cease of conflict that followed was described by the poet Eleanor Farjeon in chilling terms:

I am awful as my brother War,
I am the sudden silence after clamour.
I am the face that shows the seamy scar
When blood has lost its frenzy and its glamour.

When Woolf too describes the disappointment of peace, she turns to childhood as her point of reference. ̽��ֱ��build-up to Armistice is like the excitement of a birthday. Inevitably, the day itself disappoints yet the charade that everything’s lovely has to be maintained. “So on a birthday,” she writes, “when for some reason things have gone wrong, it was a point of honour in the nursery to pretend. Years later one could confess what a horrid fraud it seemed.”

Rather than returning as heroes, many men who came back from the First World War were broken and stripped of individual agency. Some were empty and angry; some could be violent. Many of those who went to war never came back. Bowen’s ‘Tears, Idle Tears’ describes a young widow, Mrs Dickinson, containing her grief for her dead husband Toppy beneath a mask of elegance and poise. ̽��ֱ��Dickinsons’ seven-year-old son, Frederick, who had been just a baby when his father died, cries and cries. His mother is embarrassed by this “great blubbering boy” who is “too big to cry”.

Perhaps poor Frederick had been raised according to the method set out by Truby King, a pioneer in modern parenting. Enthusiastically embraced in the wake of the First World War, King’s views made a perfect partner for the nationwide programmes (such as Baby Week) aimed at raising standards of hygiene and nutrition.

King recommended a strict, and largely loveless, schedule. An extraordinary man, whose career took in dairy farming and the cultivation of roses, King was also superintendent of a lunatic asylum. He observed that calves thrived when they were fed regularly. Babies, believed King, should be fed every four hours (not at night) with sleep in between. Even their bowel movements should be regulated. Over-stimulation (too much play and excitement) was to be avoided; physical contact was spoiling.

When the guns went silent, and a semblance of normality crept into the lives of those who had survived the war, a gaping absence asserted itself. “Babies born after the Armistice come into what seems like a formless, unpredictable world,” writes Tate. “In the many families which take up the Truby King method, babies’ tiny lives are vigorously regulated, thus providing a comforting structure – a ‘container’ which at least makes the adults feel more secure.”

A caption below a photo of two bonny girls in King’s book ̽��ֱ��Expectant Mother and Baby’s First Month reads: “A doctor’s children. Healthy, hardy, happy little girls, aged two and nearly four years. Good jaws and sound teeth. Nursed four-hourly from birth – never more than five times in twenty-four hours; plenty of fresh air and exercise – never any coddling.”

By mechanising babies, and raising them in a sterile environment, parents perhaps tried to make the world secure for themselves. King’s literature on the best way to bring up baby was devoured by many of the professionals seeking to improve the nation’s health. His methods were ‘scientific’. A new generation of maternity nurses was trained in the ‘Truby King method’. ̽��ֱ��Plunket nurses (named after King’s patrons Lord and Lady Plunket) helped mothers to breastfeed and guided them through their babies’ early development. Plunket nurses adhered to routine; they wouldn’t ‘give in’ to a crying child.

Tate shows how Mansfield captures the cruel effects of this detached style of parenting in her short story ‘Bliss’. Bertha is a middle class mother who employs a full-time nanny. Her husband boasts of his lack of interest in his child. “Don’t ask me about my baby. I never see her.” When Bertha visits her daughter one evening, the child is delighted while nanny experiences the unscheduled visit as a disruption to a regime that must be maintained at all costs. Bertha suddenly realises that the situation is tragic for both for herself and her child.

̽��ֱ��focus of Mansfield’s story is not Bertha’s marriage but her relationship with her daughter. “Many of her [Mansfield’s] stories of modern life are miniature tragedies, rooted, in many cases, in the unwitting neglect of children,” Tate writes. For Truby King, children had no point of view: a regulated regime was best for them, regardless of how much they screamed with hunger. King’s inflexible routine for baby-rearing imposed military discipline on the messy chaos that is small babies.

King did face criticism from contemporaries – among those who argued against him was Dr GD Laing who experienced the pitiful cries of little ones being ignored until the allotted hour for feeding. Research by psychoanalysts John Bowlby, Melanie Klein, Donald Winnicott and Wilfred Bion later showed that King’s system, though it succeeded with some babies, was disastrous for many. ̽��ֱ��infants who, desperately hungry or hurting, screamed themselves into silence may well have been traumatised – and early trauma has been linked to depression.

Those who suffer terribly in war seldom speak of their experiences as there are no words to describe it. They pass on their distress in other ways. In her memoir Alfred and Emily (2008), the novelist Doris Lessing (born in 1919) revisited her childhood. Her father lost a leg fighting in the First World War; her mother was a nurse looking after the war-wounded. “Do children feel their parents’ emotions,” Lessing wonders. “Yes, they do… ̽��ֱ��Great War… squatted over my childhood. And here I still am, trying to get out from under that monstrous legacy, trying to get free.”

̽��ֱ��Silent Morning: Culture and Memory after the Armistice is published by Manchester ̽��ֱ�� Press.

Inset images: newspaper advert for Nestle; images from Mothercraft by Truby King's daughter, Mary; newspaper advert for Cow & Gate.

A collection of essays edited by Drs Trudi Tate and Kate Kennedy looks at the legacy of the First World War through the lens of the creative arts. As a specialist in the literature of conflict, Tate explores the ways in which writers expressed the impact of trauma on families – and child rearing in particular.

Tate argues that, while many soldiers and civilians felt infantilised by war, babies were, in a sense, militarised

Figure from Mothercare, published by Truby King's daughter, Mary

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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Much ado about babies

amb206 — Tue, 23 Jul 2013 15:04:44 +0000

In 1697, Matthew Henry, a Presbyterian minister, wrote to his mother about the health of his family. His letter survives in a collection of family correspondence in the British Library, although its immediate context is hazy. Matthew recalls returning from business to find his infant daughter, Nancy, close to death.

A doctor is called. Matthew states that the physician “was very apprehensive of her peril” and attributed Nancy’s illness to “the badness of her Mother’s Milk”. Matthew’s wife was forbidden by the doctor from breastfeeding the child any longer, an instruction which Matthew recorded “put her in much adoe”. He concluded his letter by informing his mother that “we got a wet nurse into the house”, which, as the doctor promised, returned Nancy to health.

Contemporary documents like this one reveal that early modern women from relatively affluent families desired to breastfeed, and in some cases were successful at breastfeeding, their infants themselves. Hiring a wet nurse was not a universal practice, and when parents were compelled to resort to outside help, the infant and wet nurse were sometimes accommodated within the home itself.

Scholars have previously argued that only royal babies enjoyed the proximity of both their mother and wet nurse, and that middling and upper class families invariably sent their infants away from home to live with the wet nurse and her family until weaning was judged appropriate.

Henry’s letter provides a small but intimate window into the relationship of parents, medical practitioners and infants in 17th-century England. Mortality rates in early modern England were high and parents knew that their children might well not survive infancy, let alone reach adulthood. It has been estimated that a quarter of all infants did not reach their first birthday. Neonatal death was particularly common.

Nevertheless, parents were eager to employ all kinds of means to secure the ongoing health of their offspring after birth. Matthew and his wife knew the life of the infant Nancy was precarious but they also knew that she could be saved. Vignettes such as theirs indicate that when infant illness occurred, parents were flexible in their post-natal regimes, willing to make changes, and loving and tender in their concern for their offspring.

My research looks at the theory and practice of maternal and infant health, and how their respective bodies were perceived to function in relation to one another. I am part of the Wellcome Trust funded Generation to Reproduction project at the ̽��ֱ�� of Cambridge, a group of scholars investigating the history of reproduction from ancient to contemporary times. My work focuses on pregnancy, childbirth and post-natal care, bringing personal documents to bear on published medical literature in order to investigate the intersection between prescriptive advice and practice.

Sources such as diaries, correspondence and journals offer a fresh perspective on older debates about the practice of medicine within the home and bodily understanding in the past. Still at an early stage, my research into documents such as these has already thrown up a number of surprises.

Perhaps the most interesting discovery is the frequency with which babies were bathed and cleaned in the 16th and 17th centuries. Current NHS guidelines recommend refraining from submersing newborns in water for a full week after birth, to preserve the protective white substance that covers the baby’s skin at birth to prevent dryness and cracking. After this initial period, the NHS recommends washing newborn babies in plain water once or twice a week. In contrast, 16th- and 17th-century medical authorities recommend baths at least once a day and sometimes as often as three or four times a day.

This finding – evident in the regimes printed in childbearing manuals - challenges popular assumptions about the comparatively lax attitude to personal hygiene of Tudor and Stuart society.

Early modern infants were swaddled (tightly wrapped) shortly after birth. Medical texts provided instructions to parents and nurses as the best way to bind the infant body to support the body and make the limbs grow straight. Other sources indicate that this appears to have been standard practice. Infancy is typically represented on funerary monuments as a swaddled figure. Other representations of swaddling include the famous image, on display at Tate Britain, of the Cholmondeley sisters tenderly holding their wrapped infants.

No clear time limit confined the period of swaddling. Parents were advised by medical writers to observe the baby’s movement. When infants appeared frustrated by their bindings and moved their arms, their limbs were released, usually at four months old. ̽��ֱ��entire body was freed at a later stage, sometimes up to a year after birth, depending on an assessment of the baby’s health.

Older histories of the early modern family have tended to see swaddling as emblematic of the perceived negligence and abuse of children by their parents.
However, post-natal schedules set out in medical literature suggest that the process of swaddling and changing the infant was couched in terms that allowed regular periods of physical intimacy and affection between mother or nurse and infant.

Contemporary sources suggest that the infant was ritually bathed, rubbed and stroked, before being carefully dried and wrapped in clean swaddling cloths. Wadges of ‘clouts’, or cloths, were placed to act as a kind of nappy. To me, it seems that swaddling provided an opportunity for parents and other caregivers to be physically close to the infant; it was not an act of emotionally distancing the newborn as previous scholars have argued.

̽��ֱ��fact that wrapping of newborns remains popular today is one of the many reasons why I have chosen to do my research. So many of our social, cultural, emotional and medical values and understandings are reflected in the way we care for our young. Pregnancy, childbirth and post-natal care are subject to trends and fashions, whether they are endorsed through social or medical arguments. Infant and maternal healthcare has always been hotly contested, because it is an activity involving not just parental reputation and identity but also the perpetuation of communities.

An examination of things which we care about deeply can reveal the discontinuities but also equally as important the continuities between past and present. ̽��ֱ��media coverage surrounding the arrival of the Duke and Duchess of Cambridge’s baby is picking up the same themes that were prominent in early modern sources, among them pain relief during labour and the post-natal schedule of sleeping and feeding.

Even our concept of demand feeding, which has recently become part of the new movement of attachment parenting, has an earlier precedent. Correspondence between two sisters – Ann D’Ewes and Joan Ellyot – that survives in the D’Ewes family papers at the British Library shows that debate about the pros and cons of imposing a regime on a baby or allowing it to sleep and feed on demand was as alive in the mid-17th century as it has been over the past few decades.

When Ann’s infant son was ailing, Joan wrote to her with urgent advice. Joan told Ann to stop breastfeeding the infant herself, for the baby’s ailing state was a powerful indication that Ann’s breast milk was corrupt and “stale”. Instead, Joan suggested that Ann should hire a wet nurse, whom she should house at home so she could monitor the diet and conduct of the hired nurse. ̽��ֱ��baby ought not to be “kept from sleepe or suck which I know has bin the way of very good docters in this case but let it haue a full breast of new milke at command and all the quiet and content”.

In a similarly liberal vein, that would find favour with many modern baby manuals, the Welsh medical writer John Jones wrote in 1579 parents and nurses must “take it [the baby] uppe and laye it downe as ofte as neede shal require”.

An exploration of the way in which the infant body was perceived to function, and how its needs were to be met, in the past reveals the impressive flexibility of parents in attending to their offspring. Parents engaged actively in the care of their babies and read bodily signs to predict infants’ medical needs. Most strikingly however, post-natal narratives reveal the physical affection which parents bestowed on their offspring in bathing, swaddling, feeding and lulling babies to sleep and how parents were deeply concerned to ensure their offspring survived.

For more information on this story contact Alex Buxton, Office of Communications, ̽��ֱ�� of Cambridge amb206@admin.cam.ac.uk 01223 761673.

̽��ֱ��management of childbirth and care of newborns have always been hotly-debated topics. PhD candidate Leah Astbury looks at narratives of reproduction in the 16th and 17th centuries and finds evidence for many of the same concerns.

Let it [the baby] haue a full breast of new milke at command and all the quiet and content

Joan D'Ewes writing to her sister Ann, mid-17th century

Wellcome Library, London

Aristotle's compleat and experienc'd midwife

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