Maternal Age; Always Too Young Until You’re Too Old

Danielle’s presentation sparked my interest, especially the comparative age of African American mothers due to stress and the disparity of maternal age in characterizing black Americans versus other populations in our country. Though African Americans see better birth outcomes at younger ages due to this, young teenage mothers in general within the U. S. (13-17 years old) see a much higher rate of low birth weight babies, premature deliveries, and infants who are small for their gestational age, when the mother’s living situation and education level as well as prenatal care were controlled for. This results in longer NICU visits, more instances of diminished lung development and growth deficits, and higher infant mortality.

Though these differences were less extreme in the 17-20 and 20-24 age populations, it was increased compared to those born to mothers older than 24. This may in part be related to these studies being conducted on the babies being born, unable to control a population and select candidates to get pregnant; most women in American and almost all women of higher education in America are choosing to wait longer for marriage and children than ever before, which brings us to the other end of the spectrum.

The number of first births per 1000 women 35 to 39 years of age increased by 36 percent between 1991 and 2001, and the rate among women 40 to 44 years of age leaped by a remarkable 70 percent. Regardless, the relatively stable spontaneous abortion rate among mothers (10%) doubles in mothers 35-39 (20%) and continues to 50% in the early 40’s and 90% in the late 40’s, with points to an increase in congenital abnormalities that cause this or uterine insufficiency, the inability to form a placenta that can adequately feed and foster the child’s growth. The rate of pregnancy related hypertensive issues also increases in older mothers. Additionally, once born, the risk of Down’s syndrome goes from 1/1000 in mothers age 30 to 1/400 at 35, and 1/100 at 40, and other congenital abnormalities show a similar if not so drastic incline.
In professional journals to lectures by the successful that we see so frequently at Emory, it is often said that the late 20’s (post-graduate school) and early 30’s are the years to lay groundwork and establish the path of your career, highly necessary for later success and higher earning, but in the U. S. today, we have little protection for working mothers. With no guaranteed return employment or paid maternal leave, it has become a financially inadvisable decision to become pregnant during the times when it is most healthy to do so, and many economists point to this as yet another reason and solid barrier creating the 23 cent gap and keeping women from high powered careers like CEOs.
Other than providing nationally mandated access to maternal leave (as we’ve discussed, and I’m sure mostly agree upon) how do you think we could make children less devastating to women’s careers? Were you born to a mother over 35 or under 24? Have you considered when in your life to have children, should you choose to do so, and what qualifiers are most important to you in determining the “right” time?

Anderson, A. N., Wohlfahrt, J., Christens, P., Olsen, J., & Melbye, M. (2000). Maternal age and fetal loss: population based register linkage study. The British Medical Journal, 320. 1708.

Fraser, A. M., Brockert, J. E., & Ward, R. H. (1995). Association of young maternal age with adverse reproductive outcomes, 332. 1113-8.

Geronimus, A. T. (1996). Black/white differences in the relationship of maternal age to birthweight: A population-based test of the weathering hypothesis. Social Science & Medicine, 42(4). 589-97.

Heffner, L. J. (2004). Advanced maternal age – how old is too old? New England Journal of Medicine, 351(19). 1927-9.

Fresh Eggs or Frozen: Beyond the Grocery Aisle

While discussing pregnancy and birth, it only seems right to discuss infertility and our new technological ways of circumventing it. As science advances, so has birth, and infertility is no longer considered an untreatable problem. In vitro fertilization (IVF), the process of placing fertilized eggs within a woman’s uterus for implantation, and intrauterine insemination (IUI), inserting washed sperm into the uterus, better known as artificial insemination, are allowing women that previously could not bear children to do so. However, they are far from perfect.
The biggest barrier in IVT use is cost, ranging from $8,000 to $15,000, often not covered by insurance. Though it does not solve many of the problems IVT does, the average artificial insemination treatment is much less expensive at an average of $895, but still wildly more expensive than the typical manner of getting pregnant, and beyond what many couples are able to easilyafford. The constraint of price becomes even clearer with the caveat of success; these are prices per treatment, with no guaranteed success.  With fertility treatments, IVF succeeds 45% of the time with mothers under 35 and IUI succeeds in a viable pregnancy 8-17% (also variable with maternal age.) The few insurances that do offer these procedures only pay for one treatment, so a positive outcome is a coin toss at best, for those that can afford it.
There are problems with the method itself as well. Anecdotally, having worked in the Emory Midtown NICU, the nurses told me every baby to stay there over 20 days was IVF, or at least most were, and scientifically, there is data to back this up; the freezing process used on IVF embryos results in hypomethylation, meaning genetically, there are fewer markers turning genes off, and leaving excessive genes active can lead to numerous problems, from autism to schizophrenia to higher cancer rates. Very few longitudinal studies have been conducted to discover how frequently or severely this presents, but any significant change in the DNA as such is worth noting.
Additionally, from fertility treatments come multiple fertilizations, and though the mother can choose to opt for having a one-child pregnancy, or keeping three or more, in the majority of cases mother’s choose to keep two. Twins, most often, are born pre-term, already more likely to have an extended stay in the NICU due to incomplete lung development, and suffer more frequent childhood illnesses and growth deficits. With mothers already in advanced maternal age, as is often the case, this pregnancy is especially difficult and is more commonly lost, in which case, the effort has all been for naught.
Clearly, we have a long way to go in these pregnancy methods, but despite this panoply of difficulties, since its 1978 conception there are now five million IVF babies (many adults) in the world today, a testament to its success. How would you improve access to these treatments, and/or delivery of them? If you or your partner were infertile, would you choose to use one of these methods? How can we better advocate for all mothers struggling to get pregnant?
Bolnick, J. M., Bolnick, A. D., Estill, M. S., & Diamond, M. P. (2014). Epigenetics: are babies healthier conceived through IUI compared with fresh or frozen IVF cycles? Fertility and Sterility, 102(3). 85.
Eden, A., Gaudet, F., Waghmare, A., & Jaenisch, R. (2003). Chromosomal instability and tumors promoted by DNA hypomethylation. Science, 300. 455.
Evans, J., Hannan, N. J., Edgell, T. A., Vollenhoven, B. J., Lutjen, P. J., Osianlis, T., Salamonsen, L. A., & Rombauts, L. J. F. (2014). Fresh versus frozen embryo transfer: backing clinical decisions with scientific and clinical evidence. Human Reproduction Update, 20(6). 808-21.

And a Baby Makes Three; Gay Parenting and a Gender-Neutral Society

(Not even going to lie; I was really, really excited to see a presentation in our class about lesbian mothers. This is my little add-on.)

The Atlantic published and article recently stating, according to the data of nations that have had gay marriage a few more years than us, they are longer lived than straight marriages, as far as we can tell. The author attributed this to going into the relationship without assumptions about roles and responsibilities, but hashing everything out and fostering communication; there are no boxes to force this couple to fit into, while the dead goose of 50’s stereotypes hangs over straight couples from the moment they walk down the aisle (Mundy, 2013). Though two lesbians may both be effeminate, that doesn’t determine the way their home life is run, but men, some of the most unacknowledged victims of gender stereotyping, still feel inherent shame if, say, their wife makes more money than them and they are not “the provider”. The Atlantic suggests those roles be redefined, considering the harm, and this follows the trend of society today.

Gender-neutral is coming in vogue as we lose stereotypes right and left; at Emory, we have a women’s rugby team, and this week on TV began the seventh season of RuPaul’s Drag Race. College campuses are instituting gender neutral housing, and 2013 was dubbed the Year of Gender Neutral Names, such as Riley, Peyton, or Rowan. Facebook has more than 50 new gender categories (Jayson, 2014). This can in no way be neatly separated from an acceptance of gay culture and integration into the fold of new value sets, but then again, that begets a chicken and egg argument. So this begs the question, how does this affect parenting?

Well, from extensive survey work, it’s been shown that the only difference between gay parents and heterosexuals is that gay parents are more likely to adopt ‘less conventional parenting standards,’ into which ‘gender-neutral’ fits neatly. In this practice, “walk it off”, “be a man”, and “boys will be boys” are no longer acceptable ways to approach raising a son, and “bossy” is no longer a word to put down girls with, but even less radical parents are coming over to this mindset. In fact, the trans community urges parents to consider that though parents may believe they are raising a son or a daughter, they may be wrong about which they think their child is, as biological sex deviates from gender.

Research tells us raising children in a gender-neutral way, listening to their desires as opposed to what you might expect them to be, results in children that exhibit less anxiety, aggression, and depression. Considering the resentment fostered by role strain in traditional relationships and the pressure society puts on heterosexuals to fit those boxes, it makes you wonder if adult life is suffering those consequences, too.

How has gender affected your life and relationships? How do you think it impacts health settings, family life, or the raising of a child? How would you raise a boy differently from a girl, if you would? What good things do you think are lost if we let go of heteronormativity and what is gained?

Jayson, S. (2/7/2014). Gender loses its impact with the young. USA Today

Martin, K. A. (2005). William wants a doll. Can he have one? Feminists, child care advisors, and gender-neutral child rearing. Gender & Society, 19(4). 456-79.

Mundy, L. (22/5/2013). The gay guide to wedded bliss: Research finds that same-sex unions are happier than heterosexual marriages. What can gay and lesbian couples teach straight ones about living in harmony? The Atlantic.

Japan, America, and The Right To Be Fat

After the presentation given on Japan and the quarantine period after birth and the very strict traditions regarding feeding and bathing, I was inspired to look further into Japanese health practices and found many other things were strict and different.

Firstly, due to the impetus of a significant other toward settling and having babies, rather than fewer women marrying, as you see in the U. S., there are much fewer young people in Japan dating or having sex (Haworth, 2013). The combination of conservative culture, preventing casual relationships, and marriage being, as they put it, the “death” of a woman’s career there, the population is gradually decreasing to the point that it concerns the government, and they are providing incentives. Personally, if I knew my mom would want to shut me indoors and tell me not to shower if I had a baby, I would be deterred too.

But speaking of incentives, it seems the Japanese government has no qualms about being involved in the health of its citizens and their life choices rather personally. 2008 heralded the institution of The Metabo Law to fight metabolic syndrome by regulating waistlines, with mandatory checks and counseling, treatment, therapy, and later monitoring for men with waistlines more than 33.5 inches and women more than 35.4 inches.

My first response to this was concern; it seems a bit totalitarian and unaccepting of various body types. However, recognizing the relative homogeneity of Japan in racial and ethnic backgrounds and thereby, likely, fewer deviations from the typical body structure, it made more sense than it would here. And additionally, isn’t our First Lady always telling us the American weight is out of control? As a healthcare provider, I have come to see this first hand. The estimated annual health care costs of obesity-related illness are a staggering $190.2 billion or nearly 21% of annual medical spending in the United States (Cawley & Meyerhoefer, 2012), so it makes sense for the government to be invested. With regard to birth, the complications of obesity in a pregnant woman present as subfertility, miscarriage, thrombo-embolism, hypertensive disorders, metabolic syndrome, preterm delivery and higher frequency of cesarean section, and complications for the baby include intrauterine death, congenital anomalies and macrosomia (Sirimi & Goulis, 2010). (For the non-nursing students, those are all very bad.)

Somehow, as an American, I just take for granted that it’s a right to be fat, just as it is a right to smoke, even if it is unhealthy and unwise. We talk a great deal in our culture about not fat-shaming and loving and accepting all bodies, though on top of the hypertension, diabetes, and other bone and organ problems caused by obesity, obese people are the most depressed and misdiagnosed in the country, so it’s not just moderately unwise but can actually be an immediate risk. How much excess weight goes past choice and aesthetic to health? People, especially fit people, debate the validity of BMIs. But by having a measured cut-off, it prevents rather than treats, and we know it is easier to not gain weight than to shed it; could this theoretically stop people before their weight is dangerous? Regardless, however successful this measure proved to be in Japan (and it was very successful), due to the different relationship with the government here, I think, however wise, it would clash culturally with Americans.

What are your thoughts? Is it moral, to save people from themselves, or immoral to take away choice? Is their government over-reaching? Is ours not fighting obesity hard enough? Let me know. (And good luck with finals.)

Cawley, J., & Meyerhoefer, C. (2012). The medical care costs of obesity: an instrumental variables approach. Journal of Health Economics, 31(1). 219-30.

Haworth, A. (20/10/2013). Why have young people in Japan stopped having sex? The Guardian.

Jayarajan, N. (25/5/2011). The Fat’s on Fire: Curbing Obesity in Japan. The Boston University School of Public Health, The Movement.

Sirimi, N., & Goulis, D. (2010). Obesity in pregnancy. Hormones, 9(4). 299-306.

“Parentese” and a Positive Affect: What really matters?

Weeks ago there was a tangential discussion in class during which I unfairly mischaracterized a phenomenon known as “baby talk”; I meant to get back and correct my error, but there is surprisingly little data on this after the 1980s. From what I can gather that still applies and the few more recent studies, here’s the down low on infant communication.

There are about four ways scientists typically characterize the speech with which caretakers address infants: inflection, affect, repetition, and emphasis. All of this is exaggerated in the universal application of “parentese”, found in most every country and every language for a very good reason. Each one of these categories shows benefits to the child; inflection is comforting, engaging, and teaches conversational patterns, while affect works on connecting words and emotions, and both repetition and emphasis aid in the child’s ability to learn by imitation and understand before they are attuned to perceiving meaning through less exaggerated cues. In studies where parents do not use this ridiculous speech pattern, children show less ability to engage with others and experience more temperamental fits. “Parentese” has long been compared to adult-directed speech, and in such a comparison, adult-directed speech is found wanting. It does not have the comforting and attention-grabbing inflections of so-called “baby-talk” and thus is found less engaging to the infant. All signs point to the necessity of the four traits we call “parentese” and tout its benefits quite clearly.

However, while we frequently promote speaking to babies in this theatrical manner, we fail to define what it is to most parents. Comparing only baby-directed and adult-directed makes it sound as though any maturity to speech is a negative, which is incorrect; adult-directed fails in affect and emphasis, but certainly not content. Adopting a lisp, for example, or making up new and non-English words do not fit within this framework of beneficial parentese features. To be blunt, there is a vast difference between “baby talk” and stupid talk. Parents often excuse improper “cute” grammar and simplistic lingual redundancy as a typical manner of communication with infants, but that disregards the intent of this communication: emphasis for ease of imitation. Repetition is positive for infant learning, but deliberate lisping, low vocab levels, and improper grammar result in improper speech patterns and diminished vocabulary when the child is learning to speak, and in this sense, “baby talk” can be damaging when applied incorrectly. Additionally, prolonged use of baby-talk into the speaking years for toddlers can even result in speech impediments, as children parrot and learn what they hear.

In summary, “baby talk” is a net positive when used in a conscious way, focused primarily on happy, repetitive exaggeration. Using infancy as an excuse to not address your child with words used in everyday life, however, is simply dampening their abilities at word acquisition, and though you may understand that your lisp or silly word is not meant to be taken or used seriously, your infant and later toddler does not yet have the framework to understand that. Every day and daily experience shapes your child’s mindset, so play with nonsense words when your school-age child is old enough to understand the rules you’re breaking. Make sure your language use, also, is age appropriate; this is baby-talk, not toddler talk. Language has a strong impact on children, and just as people are conscious of not cussing around children, parents should be cautioned not to give them any other habits they do not desire to later see in their school-age child.

Best, C. T., Singh, L., & Morgan, J. L. (2002). Infants’ listening preferences: baby talk or happy talk? Infancy, 3(3). 365-95.

Papousek, M. (2007). Communication in early infancy: An arena of intersubjective learning. Infant Behavior and Development, 30(2). 258-66.