Differential effects of cigarette smoking on birth weight by maternal body mass index

Does the cigarette smoke have any impact on the birth weight of an unborn child? This question led Gynaecologist Dr Max Mongelli of the Nepean Hospital from Penrith, New South Wales, Australia and his colleague Dr G.Condous of the Early Pregnancy and Endosurgery Unit, Nepean Hospital, Sydney, New South Wales, Australia to conduct a research on soon-to-be mothers with varying body mass index all of whom were smokers.

Methods implemented in the study
This research was published on 1 October 2013 after studying an obstetric database of 13,473 live singleton pregnancies delivered at the Nepean Hospital between 1998 and 2003.

 For the purpose of this study, pregnancy characteristics included in the research were self-reported figures given by expecting mothers such as the number of cigarettes smoked, age, parity, weight, height, and BMI.

Also, the maternal body mass index was broken into three distinct categories: 

BMI<25
BMI>30
BMI 25-30

This offered the researchers a simpler understanding of the effects of cigarette smoke on the birth weight of a fetus.

Another important decision made by Dr Max Mongelli and Dr G.Condous was to perform a multivariate regression analysis for each of the three categories of maternal body mass index. This helped them identify any important predictors of the changes in fetal birth weight caused due to the adverse effect of smoking.

Results obtained from the analysis
An essential consideration made in this study was to include the mean maternal age, which was 27.2. Whereas, mean birth was 3377 g (or 7.445 lbs) with a standard deviation of 588 g, and the mean body mass index was 27.1 with a standard deviation of 6.1.

It was also found that there was no correlation between the body mass index and the number of cigarettes smoked. In fact, the regression analysis performed by Max Mongelli and G.Condous clearly displayed that for women with BMI<25, the effects of cigarette smoking on the fetal birth weight was -13.4 g per cigarette, for BMI 25-30, the effect was -12.9 g per cigarette and for BMI>30, the effect was -10.9 g per cigarette.

Conclusions from the research
The researchers found that the untoward effects of cigarette smoking on the fetal birth weight are altered by the mother's body mass index. The fetuses of obese mothers were found to be less receptive to the effect of tobacco smoke than the mothers who had a leaner body shape.

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Calculation of Pregnancy Weeks and Months

When does a woman give birth to a child? After completing 40 weeks or 9 months of pregnancy? Are  both these durations same? Women who have recently found that they are pregnant often find it very confusing to calculate their due date. Renowned obstetricians like Max Mongelli have made it easier for pregnant women to find at least approximate week and month in pregnancy. 

Calculating Pregnancy Due Date
Add 280 days (40 weeks) to the day on which your LMP (Last Menstrual Period) started. This calculation is on the basis of a normal woman who has a menstrual cycle of 28-days. Ovulation and menstrual period calculation are done as the initial 14 days of pregnancy. This is because ovulation only takes place after 14 days from the beginning of LMP. 
Dr Max Mongelli suggests that if a woman has missed her first period, she is probably four weeks pregnant. This will include 14 days of ovulation and menstruation. 

Calculating Pregnancy Weeks
LMP is used for calculating pregnancy. The first week of pregnancy begins when LMP begins. The calculation of following weeks is done in the same manner. While this might sound strange, the method is used for finding the right due date to make sure that the woman receives timely and proper medical care. 
Dr. Max Mongelli says that unless the conception is assisted, LMP is the best way to know an approximate conception and ovulation date.  

Doctors Calculating Pregnancy Weeks
There are three methods with the help of which medical professionals calculate pregnancy weeks. These methods are a physical examination, ultrasound, and LMP. A physical examination is done by a medical professional feeling the size of the uterus. 

Ultrasound involves measuring of the fetus and gestational sac. Dr. Max Mongelli mentions that ultrasound is also useful if a woman is not aware of her LMP or has irregular periods. In case of there are no major differences in the LMP and ultrasound measurements, the LMP is generally used to assume the due date. 

While there is no single method to know the exact weeks of pregnancy or the due date, the methods mentioned above have been developed after years of research and are used by the professionals all over the world to calculate pregnancy weeks and months.

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Bipolar Disorder and Pregnancy

Pregnancy can be very challenging for a woman suffering from bipolar disorder. Not just the patient but even medical professionals have to face a number of difficult choices, and every approach comes with its own set of risks. It is very important for a bipolar pregnant patient to consult with a psychiatrist as well as an obstetrician to understand the benefits and risks of bipolar medications during pregnancy. 

Bipolar disorder complications during pregnancy
It is often seen that the bipolar disorder in women can worsen at the time of pregnancy. As compared to a normal woman, new mothers or pregnant women with bipolar disorder have seven times more chances of getting admitted to a hospital. 

Renowned obstetrician Dr. Max Mongelli suggests that a lot of bipolar women stop their effective pharmacotherapy when they find that they are pregnant. However, this only exposes the woman as well as the baby to risks associated with mood-related dysfunction and bipolar relapses. As not many studies are conducted on this subject, the effects of bipolar medications on the offspring are not very clear. 

Continue bipolar medications during pregnancy
A lot of women suffering from bipolar disorder give birth to healthy babies even when they continue taking bipolar medications. However, there are a few medications which are, known to have higher congenital disability risk like heart defects, neural tube defects, or neurobehavioral problems, especially in the first trimester. 

Dr. Max Mongelli suggests that a patient should compare the risks with what untreated bipolar disorder can lead into. For instance, the mood symptoms if not treated can result in behaviours like-
•Stress
•Increased use of tobacco or alcohol
•Poor nutrition
•Poor prenatal care

Popular bipolar medications used during pregnancy 
In most cases, doctors usually suggest that the patient should continue taking some medicines and stop some. This is because the risks related to mental health on stopping medication varies between patients. Expert psychiatrists advise patients to continue taking some medications, and regular tests are advised to monitor the health of the baby and the mother. Some of the most common bipolar medications which a patient might or might not be advised to continue include-

•Antipsychotic medications like Olanzapine, Aripiprazole, or Risperidone 
•Mood stabilizers like Valproate or Carbamazepine
•Antidepressants
•ECT (Electroconvulsive Therapy) during pregnancy

No matter what a patient decides, Max Mongelli suggests that it is very important for a bipolar pregnant woman not to stop taking any medication or treating without first consulting with a psychiatrist and an obstetrician.

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Everything a New Mother Needs for Herself

The nine months of pregnancy is an experience that no woman ever forgets. While it is an enchanting time, it also adds a lot of extra pounds that requires a proper follow-up of diet and exercise.

With a bit of discipline and changes in your diet, you can enjoy being a new mother & an active person. Here is a list of things that a new mother would find handy.

Balanced diet
A balanced diet is a key to getting your body back. 

Follow this diet plan-
Consider consuming nutritious food that contains:

●Proteins found in chicken, fish, lean meat.
●Iron produced in chickpeas and soy or beans.
●Vitamin B that is found in peas, broccoli, tomato, peas, & broccoli.
●Calcium contained in yogurt, cheese, and milk.

Gynecologist Dr. Max Mongelli recommends a new mother to eat in moderate quantities every 3 hours.

You might want to split the menu into 6 proportioned meals:
●Breakfast
●Morning snack
●Lunch
●Afternoon snack
●Dinner
●Fruits  

Due to the increase of progesterone hormone or dilatation of the uterus that causes compression of the intestine, a woman's digestive system becomes slower. 

Consequently, it entails constipation but it will remain balanced if you consume fibers contained in cereal and fruits. This diet will help with those killer cravings for fatty and sugary food substances. Also, it decreases heartburn and gas. 
 Other healthy eating lifestyle tips are to consume meat and vegetables that are very well cooked or baked but consume only after decontaminating the latter.

Eat natural food to help control your weight
Oats: These are delicious with milk or hot water for breakfast or the perfect replacement for fatty alternatives. It is a rich source of fiber and contains iron, carbohydrates, calcium, and protein. 

Pulse: If you are not into oats much, pulses are a perfect option. These are also abundant in fiber, protein, minerals, and vitamins.

Brown rice is yet another potential energy source for your body during or after childbirth nourishing your body with essential minerals, calcium, and iron.

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ORM- Doctor- What Your Gynecologist Wants You to Know

When it comes to understanding the challenging task of womanhood who would know it better other than your gynecologist? Your visits to the gynecologist can sometimes seem puzzling and yet it is one of the most valuable experiences in a woman's life. For intimate details that seem too awkward to share, here are a few essential points that your gynecologist really wants you to know and abide by.

Understand the importance of annual checkups.
According to the gynecologist Dr. Max Mongelli, your body is a territory that needs to be explored and understood by you and your doctor to plan out the best preventative measures.

Furthermore, it helps you to become more familiar with the anatomy and identify anything that seems unusual. 

Your trusted doctor will be in a better position to offer the most qualified advice and explain any issue in great detail. In this way, you can have an open conversation and eliminate all the doubts.

Keep your doctor updated on your medical & sexual history.
"As a crucial step to this health-related issue, keep your doctor updated on your medical history like an unprescribed medication with the exact dosage you consume," says Max Mongelli.

You must include any vitamin pills, herbal products, supplements, cold medicines or energy boosters, for example. 

 Another daunting point is to share your sexual history. As a result, if you feel any uncommon physical pain or abnormality on or around your intimate parts, your doctor needs to know about that.

Add as much detail as possible including changes in your diet, recent changes in mood, the rate of sexual activity and menstrual cycles, etc. 

Keep your well-being above personal embarrassment.
Some women only visit their gynecologist once a year and yet feel embarrassed to share. 

Dr. Max Mongelli says that it is essential to know that a gynecologist does not judge their patients. At the end of the day, they only want to help you achieve a good health and stay safe. 

For some, this awkwardness may either stick or wear off in due course. Regardless, the focus must be on your well-being. 

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Gestation-adjusted projection of estimated fetal weight

Many parents want to know the weight of the upcoming baby in advance. It is also desired to know the health of the baby, and weight calculation helps in better monitoring of birth and reduces health risks to both mother and baby.
Dr. Max Mongelli’s study was carried out in order to estimate the weight of the baby/fetus on birth, few months prior to the actual birth event. The study involved 276 women. The birth or delivery from all the women was achieved in the next 35 days. For estimating and forecasting the fetal weight, the following techniques and measures were used:

● Hadlock formula, femur length, and abdominal circumference
● The Campbell formula that involved measuring the circumference of the abdomen

According to the extrapolation techniques and measurements, it can be hypotheses that the median weight: fetal weight ratio remains uniform and consistent throughout the 3rd trimester of the gestational period. Hence the weights observed and recorded were either left unchanged or were recorded on the basis of extrapolation, for the subsequent delivery. The weights recorded by the above-said methods were also compared with the technique given by researchers Spinnato and his colleagues. Later the non-parametric (tests that make fewer assumptions and are also known as the distribution free tests) were used and the weight predictions were analyzed for their accuracy, by comparing them to the real birth weights.

Results of the test, study, and analysis

While the Spinnato method suffered from 8.8% mean and systematic errors, the Hadlock method suffered from around 5.9% error. When no adjustments were made, the error was around 6.5%. All kinds of errors that occur randomly were also reduced and stood at around 11.2%, the earlier figure is 12.3%. When Campbell formula was used, the error was around 3.8%. The methods used also produced lesser absolute errors.

Conclusion of the study and test 

During pregnancy, an ultrasound prediction or estimation of the delivery-time fetal weight should be done. This weight can be extrapolated and projected so that the birth weight at delivery can be calculated. The forecasted weight should also take into account the time lapse, which would occur in between the ultrasound and the delivery time. The method and technique that has been detailed and described above can easily find out the birth weight of the baby with least of errors and possesses excellent accuracy. 

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Ultrasound Dating Formulae used for Pregnancies with Artificial Reproductive Techniques

With the advancement of science and technology, artificial conception is common among women today. It, however, has certain issues associated with it, the unavailability of the right dating formulae being one of them. To overcome this problem, the doctors and researchers have come up with a new invention- an ultrasound dating formulae! Read along to know more about it:
A database of a number of pregnancies conceived with artificial reproductive techniques are studied in order to get accurate results of second-trimester dating formulae as these are applied in different centres where routine ultrasounds are performed by Max Mongelli. The dating formulae for biparietal diameter and femur length are derived for a gestational age ranging from 14-23 weeks from pregnancy. Ultimately, the curves in the result represent linear equations and twelve formulae were published for biparietal diameter and femur length measurements. During the implementation of these formulae, systematic, random errors are calculated as they are applied to the second-trimester scan in precisely dated pregnancies. As a result, the published dating formulae were good for predicting gestational age. 

This comparative study confirms the accuracy of ultrasound dating in the respective clinics like Dr. Max Mongelli’s, thus, supporting the usage of the ultrasound measurements in accordance with the menstrual history for dating pregnancies. Estimating the gestational age by early ultrasound reduces the estimated age when compared to the menstrual dating. These databases include a range of collected data on the maternal and the fetal characteristics with data on pregnancy and delivery. The crown-rump-length based formula is used to calculate the GA at 8-12 weeks of gestation in this analysis. The foetal weight is estimated with sonographic parameters around the mid-trimester ultrasound scan. The exclusion criteria for the process were- multiple pregnancies, gestational and pre-gestational diabetes, preeclampsia, stillbirth and congenital abnormalities. In the third table, the pregnancy duration in the IVF (in vitro fertilisation) pregnancies are presented along with the term rates in fourth table.

There are no differences in the mean pregnancy durations when the delivery is done, between the early and late scan groups irrespective of the process of calculating their gestational age. The gestational age at birth for the singletons had a high correlation assessed from the time of in vitro fertilisation (IVF) and crown-rump length (CRL), from IVF and biparietal diameter (BPD).  In the time of artificial pregnancies, the gestational age measured using all the three methods shows agreeable results. The usage of ultrasound facility is thus a reliable method for estimating the gestational age accurately.

9 Thoughts Every Woman Has Had At The Gynaecologist

For some women, it is not an option to skip an appointment with their Gynaecologist. Essential or otherwise, here are 9 thoughts every woman has had at the gynaecologist.

Always feels weird.

A Gynaecologist is one of the doctors who can cause a bit of discomfort to pay a visit. Not because of the circumstances, but perhaps because a stranger will be touching a woman’s private parts, which might feel a bit shameful at first.

I should have shaved there.

Being a woman is difficult sometimes. A common thought prevailing among women is, “maybe, I should have shaved, because then I would have examined it better or have nothing blocking the passage of a medical instrument.”

I wonder what the doctor is thinking at a given time.

Curiosity is felt in every second sitting in that chair and having someone looking at your private parts. Thousands of thoughts go through the patient’s mind who wonder and worry, “if the gynaecologist feels or wonder the same,” according to Dr Max Mongelli.

Is it just me or is this normal?

Is it me or is the situation very complicated for other women as well. Am I exaggerating this whole thing? It is perfectly understandable that you want to know if you are healthy, but if it is your first time and you barely know the person, it is normal to feel anxious.

This place could offer more good treats.

I have to go through a very delicate moment and everything in this room reminds me of a hospital. Could it offer some good treats. Be more colourful and impart a friendly feeling. Anything that helps calm my afflictions and makes it all easier.

Time is ticking.

Anticipations arise as the time ticks further ahead. The doctor is adorable and very professional, but I am hoping that he/she cuts out the talking & lets me go as soon as possible!

I will never take breast checking for granted again. 

Now is the time to check my breasts! Next time, I will not take self-breast examination for granted and perform the self-check each week.

An Introduction to Fetal Growth Disorders by Dr. Max mongelli

Dr Max mongelli is a name which needs no introduction in the world of obstetrics. He has abundantly contributed to the field and has helped obstetricians throughout the world to offer better medical help to pregnant women. Some of the most important points from his research on fetal growth disorders are mentioned in this post. Keep reading to know more.
 

Obstetrics has advanced by leaps and bounds in the last decade. The medical fraternity now has answers to several pregnancy and fetal growth related questions which were a mystery in the past. And it is with the help of accomplished obstetricians like Dr Max Mongelli that this branch of medicine has advanced so extensively.

Dr. Mongelli has published his findings on fetal growth disorders recently and some of the most important excerpts from this report are mentioned below.

Birth Weight Determinants

As per Dr. Mongelli’s research, some of the most important determinants of birth weight are-

• Maternal size
• Gestational age
• Parity
• Fetal gender
• Ethnic group

Apart from these determinants, Dr. Mongelli has also focused on the common causes of IUGR (Intrauterine Growth Restrictions) to help obstetricians prevent this condition. Some of these causes which Dr. Mongelli has focused on include; deficiency of Vitamin D, uterine malformations, chronic mental stress, etc.

Causes of IUGR

As per the research, Dr Max Mongelli suggests that IUGR is generally caused due to problems related to fetuses, like genetic, chromosomal, multiple pregnancy or congenital malformations. Other common causes of IUGR include placental factors and maternal factors.

Birth Weight and Macrosomia

Macrosomia is a condition wherein the birth weight of a baby is higher than average. Dr. Max Mongelli suggests that this is generally caused due to gestational diabetes, genetic disorders, hyperinsulinemia and constitutional factors.

Apart from pointing out the common causes of IUGR and Macrosomia, Dr. Mongelli’s research also talks about prevention, screening, diagnosis and management of these conditions to help obstetricians all over the world offer better medical care to pregnant women. Not just care to pregnant women, research by Dr Mongelli also aims to provide better knowledge about fetal growth and healthy child birth.

Dr. Max Mongelli: An Introduction to Abnormal Vaginal Discharge

While slight vaginal discharge is common in women, abnormal discharge caused can result in severe consequences if not treated on time. In this report from Dr. Max Mongelli, we’ll have a look at what abnormal vaginal discharge is, what are its common symptoms and causes. 

Slight vaginal discharge is common among women. However, it is important for a woman to understand the difference between normal and abnormal discharge. The latter can be caused due to several reasons and can result in severe complications if not treated on time. Dr. Max Mongelli in his report has highlighted the difference between normal and abnormal discharge and has listed some of the common causes of abnormal discharge.

Normal and Abnormal Discharge

A slight discharge which increases around two weeks before the menses is normal. It is white or clear and doesn’t have any odor. This discharge is non-irritant and often increases during ovulation. On the other hand, abnormal discharge results in irritation, itching and burning sensation. Moreover, it often has an unpleasant odor.

Common Causes of Abnormal Vaginal Discharge

Some of the most common causes of abnormal vaginal discharge include-

• Vaginitis- One of the most common reasons for abnormal discharge is vaginitis. It can be atropic, irritant or infectious vaginitis. Atropic vaginitis is caused due to deficiency of estrogen. More than 40% of the post-menopausal women suffer from this. Irritant vaginitis can be due to the use of harsh soap, deodorized tampons, fabric softeners, and perfumed toilet papers. Infectious vaginitis is usually caused due to bacteria, fungi, viruses or protozoa. 

• Cervicitis- Cervicitis results in inflammation of cervix which is the lower end of the uterus which opens into the vagina. It can be caused due to several reasons like infections, STDs, physical or chemical irritations and allergies. 

• Bacterial Vaginosis- This is usually transmitted sexually or due to a sudden change in the balance of bacterial flora. Bacteroides, Gardnerella, Mycoplasma and Mobiluncus commonly cause bacterial vaginosis.

As per Dr. Max Mongelli’s report, these are some of the most common causes that can result in abnormal vaginal discharge. Apart from the ones mentioned above, some other causes include Vulvovaginal Candidiasis, Chlamydia, Colon Bacilli Vaginitis, Herpes Simplex Virus, Trichomoniasis, and Foreign Bodies. A woman should immediately seek medical help if they notice any of the symptoms of abnormal discharge for timely cure.

Important Drugs for Pregnancy

Many babies in our country born with birth defects and this are because of the poor or bad medications that their mother takes during pregnancy. There are some medicines that can interfere with functional development of organ systems in the second and third trimesters. They can produce serious consequences..

So, in this article Dr. Max Mongeli have suggested some detailed information about the drugs during pregnancy-

Types of Drug Induced Effects

• Structural Effects
• Effects on Neonatal Adaptation
• Behavioral Effects

Antibiotics that should be taken during pregnancy-

• Penicillins and Cephalosporins safe
• Augmentin, carboxypenicillins not provento be safe
• Erythromycin proven safe
• Gentamycin only for serious infections -
• Metronidazole: avoid in first trimester
• Vancomycin: reserved for resistant m/oand intrapartum prophylaxis (valvular disease)

Antibiotics that should be avoided during pregnancy –

• Sulphonamides: fetal albumin bindingand neonatal jaundice
• Chloramphenicol: grey baby syndrome
• Tetracyclines: fetal bone dysplasia anddiscoloured teeth (yellow-brown)
• Ciprofloxacin: changes in joint cartilagein puppies

Impact of Drugs on Developement

• Drugs implicated as the definitive cause in a smallnumber of birth defects
• Drugs contribute significantly to the multifactorialaetiology of birth defects
• Effects of drugs vary from fetal death, teratogenic effects to growth retardation & functional effects
• No deleterious effects can be found in many mothers who have taken several drugs.

The Australian categorization consists of the following categories:

• Category A

These drugs have been taken by a large number of pregnant women.

• Category C

These drugs owing to their pharmacological effects, have caused or may be suspected of causing, harmful effects on the human fetus or neonate without causing malformations.

• Category B1

Drugs which have been taken by only a limited number of pregnant women and womenof childbearing age, without an increase in the frequency of malformation or other director indirect harmful effects on the human fetus having been observed.

• Category B2

Drugs which have been taken by only a limited number of pregnant women and womenof childbearing age, without an increase in the frequency of malformation or other director indirect harmful effects on the human fetus having been observed.

• Category B3

Drugs which have been taken by only a limited number of pregnant women and womenof childbearing age, without an increase in the frequency of malformation or other director indirect harmful effects on the human fetus having been observed.

• Category D

Drugs which have caused, are suspected to have caused or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage.

• Category X

Drugs which have such a high risk of causing permanent damage to the fetus that theyshould not be used in pregnancy or when there is a possibility of pregnancy

What is Evidence-Base Medicine: Explained by Dr. Max Mongelli

Dr. Max Mongelli is a respected name in the world of Obstetrics. His research on fetal growth, ultrasound, and early pregnancy problems has been detailed in several papers and doctoral thesis. He has also co-authored a book on fetal growth and has contributed to the development of software for creating customized antenatal growth charts which are now used all over the world. In this post, his take on the importance of evidence-based medicine is explained in detail.

Evidence-based medicine is a term which was first used for describing an approach which was used to teach medicine practice and improve the decisions taken by medical professionals for individual patients. Now, it has spread rapidly and is used for describing a decision-making approach which is used at every level in the healthcare industry.

What is EBM?

As per Dr. Max Mongelli, Evidence-Based Medicine (EBM) is a medical approach which is intended to improve the decision-making process by laying a major emphasis on evidence from past research. It can be defined as the use of currently available best evidence for taking decisions with respect to the care provided to individual patients.

Common Sources of EMB

Max Mongelli suggests that some of the most common sources of EMB include-

• Textbooks
• Observational studies
• Traditional teaching
• Decision analysis
• Basic Sciences
• Meta-analysis
• RCT (Random Controlled Trials)
• Computer simulation

Importance of RCT

Random Controlled Trials (RCT) according to Dr. Max Mongelli, play an important role in evidence-based medicine. These trials are very useful for evaluating new surgical and evaluating techniques. Moreover, they can also be applied to new diagnostic tests.

 

The main objective of these trials is to reduce the randomization bias, analyze techniques with the intention to treat patients and achieve statistical knowledge with the help of adequate size of the samples. Sealed envelope technique, computer software linked with a central monitoring station and block randomization are some of the most common randomization techniques used for these trials.

Evidence-base Medicine eliminates subjectivity in the medical decision making process. It aims at making it more objective by making it based on evidence rather than opinions.