26. Be the Match. "Cord Blood is Changing Lives." [Web fact sheet.] Web. [cited April 19, 2016]
Tiffany Werbin-Silver MD, FACOG
4. Ballen KK, Verter F, Kurtzberg J. Umbilical cord blood donation: public or private? Bone Marrow Transplantation. 2015 Oct;50(10):1271-8.
3. Broxmeyer HE, Lee M-R, Hangoc G, et al. Hematopoietic stem/progenitor cells, generation of induced pluripotent stem cells, and isolation of endothelial progenitors from 21- to 23.5-year cryopreserved cord blood. Blood. 2011;117(18):4773-4777
35. American Congress of Obstetricians and Gynecologists. Delayed Umbilical Cord Clamping After Birth. Committee Opinion No. 684. January 2017. 36. Sun J, Allison J, McLaughlin C, Sledge L, Waters-Pick B, Wease S, et al. Differences in quality between privately and publicly banked umbilical cord blood units: a pilot study of autologous cord blood infusion in children with acquired neurologic disorders. Transfusion. 2010;50:1980–1987.
33. Be the Match. "Cord Blood Banks." [Web fact sheet.] Web. [cited May 9, 2016] `
26. Be the Match. "Cord Blood is Changing Lives." [Web fact sheet.] Web. [cited April 19, 2016] https://bethematch.org/Support-the-Cause/Donate-cord-blood/Cord-blood-is-changing-lives 27. Grupp SA, Dvorak CC, Nieder ML, et al. Children’s Oncology Group’s 2013 blueprint for research: Stem cell transplantation. Pediatric Blood Cancer. 2013;60:1044–1047. 1. Waller-Wise R. Umbilical Cord Blood: Information for Childbirth Educators. The Journal of Perinatal Education. 2011; 20(1):54-60.
31. Health Resources and Services Administration, Blood Cell Transplant; US Department of Health and Human Services. "Donating Umbilical Cord Blood to a Public Bank." [Web fact sheet] Web. [cited April 19, 2016] 32. Kurtzberg J. Personal communication. February 10, 2016.
31. Verter, Frances. "FAQs." [Web site post.] Parent's Guide to Cord Blood. Parent's Guide to Cord Blood Foundation. Web. [cited April 19, 2016]
30. Verter, Frances. "How Banks Work." [Web site post.] Parent's Guide to Cord Blood. Parent's Guide to Cord Blood Foundation, November 28 2015. Web. [cited April 19, 2016]
27. Be the Match. "Cord Blood is Changing Lives." [Web fact sheet.] Web. [cited April 19, 2016] https://bethematch.org/Support-the-Cause/Donate-cord-blood/Cord-blood-is-changing-lives 28. Grupp SA, Dvorak CC, Nieder ML, et al. Children’s Oncology Group’s 2013 blueprint for research: Stem cell transplantation. Pediatric Blood Cancer. 2013;60:1044–1047. 29. The Leukemia & Lymphoma Society, "Cord Blood Stem Cell Transplantation Facts." Web fact sheet. June 2016. Web. [cited June 13, 2016]. http://www.lls.org/sites/default/files/file_assets/FS2_Cord_Blood_Transplantation_FINAL%206.1.16.pdf 4. Ballen KK, Verter F, Kurtzberg J. Umbilical cord blood donation: public or private? Bone Marrow Transplantation. 2015 Oct;50(10):1271-8.
26. FDA US Food and Drug Administration, US Department of Health and Human Services, "Cord Blood Banking - Information for Consumers." Web Fact Sheet. July 23, 2012. Web. [cited April 19, 2016]
24. Data on file. 25. Morran, Chris. "Average American Worker Spends Nearly $1,100/Year On Coffee." [Web blog post.] Consumerist, January 20, 2012. Web. [cited April 20, 2016] http://consumerist.com/2012/01/20/most-american- workers-spend- more-than- 1000year-on- coffee
19. Nakanishi K, et al. Rat umbilical cord blood cells attenuate hypoxic–ischemic brain injury in neonatal rats. Scientific Reports. 2017; 7: 44111. 20. Kurtzberg J; Roberson Foundation. A Randomized Study of Autologous Umbilical Cord Blood Reinfusion in Children With Cerebral Palsy. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [19 April 2016]. Available from: https://clinicaltrials.gov/ct2/show/NCT01147653 NLM Identifier: NCT01147653. 21. The University of Texas Health Science Center, Houston. Safety and Effectiveness of Banked Cord Blood or Bone Morrow Stem Cells in Children With Cerebral Palsy. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [9 May 2016]. Available from: https://clinicaltrials.gov/ct2/show/NCT01988584: NCT01988584. 22. Georgia Regents University. Safety and Effectiveness of Cord Blood Stem Cell Infusion for the Treatment of Cerebral Palsy in Children. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [9 May 2016]. Available from: https://clinicaltrials.gov/ct2/show/NCT01072370: NCT01072370. 23. Christensen D, Van Naarden Braun K, Doernberg NS, et al. "Prevalence of cerebral palsy, co-occurring autism spectrum disorders, and motor functioning - Autism and Developmental Disabilities Monitoring Network, USA, 2008." Developmental Medicine & Child Neurology. 2014 Jan;56(1):59-65.
15. Florida Hospital; Cord Blood Registry, Inc. Safety of Autologous Human Umbilical Cord Blood Treatment for Perinatal Arterial Ischemic Stroke. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [2016 April 19]. Available from: https://clinicaltrials.gov/ct2/show/NCT02460484 NLM Identifier: NCT02460484. 16. Baumgartner J; Save the Cord Foundation; Mediware. (2015 December 4). "Autologous Cord Blood Stem Cell Applications for Pediatric Stroke and Acquired Hearing Loss." [Webinar]. Share the Science Speaker Series. Retrieved from http://www.savethecordfoundation.org/share-the-science-with-dr-baumgartner-focus-on-stroke-hearing-loss/ [cited April 19, 2016] 17. Baumgartner J, Personal communication. January 28, 2016 18. Lloyd-Jones d, Adams R, et al. Heart Disease and Stroke Statistics. 2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119:e1-e161.
12. Dawson G., et al. Autologous Cord Blood Infusions Are Safe and Feasible in Young Children with Autism Spectrum Disorder: Results of a Single-Center Phase I Open-Label Trial. Stem Cells Translational Medicine. 2017; doi:10.1002/sctm.16-0474. 13. Kurtzberg, J.; Duke University Medical Center. Cord Blood Infusion for Children With Autism Spectrum Disorder. In: ClinicalTrials.gov [Internet}. Available from: https://clinicaltrials.gov/ct2/show/NCT02847182 NLM Identifier: NCT02847182. 14. Autism and Developmental Disabilities Monitoring Network Surveillance, CDC, "Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years. 2010Surveillance Summaries." March 28, 2014 / 63(SS02);1-21 [cited April 19, 2016] http://www.cdc.gov
9. Florida Hospital; CBR Systems, Inc. Safety of Autologous Stem Cell Infusion for Children With Acquired Hearing Loss. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [2016 March 14]. Available from: https://clinicaltrials.gov/ct2/show/NCT02038972 NLM Identifier: NCT02038972. 10. Baumgartner J, Personal communication. January 28, 2016 11. Niskar AS, Kieszak SM, Holmes A, et al. Prevalence of Hearing Loss Among Children 6 to 19 Years of Age. The Third National Health and Nutrition Examination Survey. JAMA. 1998;279(14):1071-1075.
8. Duke Medicine News and Communications. http://Psychiatry.Duke.Edu/News/News-Archive/Marcus-Foundation-Grant. 2016. Web. [cited April 19, 2016.]
6. Cord Blood Registry. "Doctors Recommend Cord Blood Banking With Cord Blood Registry." Online video clip. YouTube. February 10, 2015. Web. [cited April, 19, 2016.] 7. Baumgartner L, Personal communication. February 18, 2016
Vaccines
PRETERM BIRTH
PRENATAL TESTING
CORD BLOOD
Protecting baby is job number one as a new parent. Learn more about four key topics—prenatal testing, cord blood banking, preterm birth and vaccines—and you'll be off to a healthy, happy beginning.
Sponsored by
Plan. Prep. Protect.
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Compare that to $1,092, the average amount Americans spend annually on a daily coffee. Kick that Starbucks habit for one year and you’re more than halfway there.
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The average cost of private cord blood banking.
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Beyond transplants and lifesaving treatments, scientists are exploring new and exciting ways stem cell therapy can potentially treat conditions that currently have no cure, like autism, cerebral palsy, acquired hearing loss and pediatric stroke. (Truly cutting-edge research!) At Duke University alone, there’s a planned $41 million project to study in clinical trials the use of cord blood stem cells in patients with autism and certain brain disorders and injuries. Check out some of the areas of active research.
THE Future Potential of Cord Blood Stem Cells
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One clinical trial tested whether giving children an infusion of their own saved cord blood might improve inner ear function—as well as speech and language abilities. “There's a lot of hope here, and we're excited that we're part of the first step in this kind of research,” says James Baumgartner, MD, surgical director of Florida Hospital for Children’s Comprehensive Pediatric Epilepsy Center, and one of the study’s principal investigators. *14.9: Percentage of US children who have low-frequency or high-frequency hearing loss in one or both ears.
Acquired Hearing Loss
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Researchers are studying if an infusion of cord blood may help improve language and behavior in children with autism. One hypothesis is that the cells from the cord blood could trigger changes in the immune system, which may, in turn, positively change some of the connections in the brain. One study recently evaluated the safety of this method in 25 patients with autism. The researchers found that the cord blood infusion was safe. Preliminary results suggest that there were also some improvements in behaviors, but researchers don’t know yet if the cord blood contributed to these improvements or not. A larger trial is now underway to evaluate the potential benefit of cord blood in children with autism. *1 in 68: Estimated number of children identified with autism spectrum disorder (ASD).
Autism
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Dr. Baumgartner is also the lead investigator of a clinical trial studying the use of cord blood in children who suffered a stroke in utero or soon after birth. The hypothesis is that the cord blood cells may trigger the immune system to help repair damaged cells in the brain. *1 in 4,000: Odds of a stroke occurring at birth.
Pediatric Stroke
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Research in animal models has shown that cord blood cells can reduce damage and restore motor function in the brain after injury. Based on encouraging lab results such as these, clinical trials have been conducted to learn whether cord blood infusion may help children with cerebral palsy, a serious congenital condition that affects their ability to move. *1 in 323: Rate of children diagnosed with cerebral palsy.
Cerebral Palsy
Some private banks, like CBR, have been asked to help recruit participants for these trials—so if you're banking with them and your child has a condition that could potentially benefit from this research, they'll let you know if you're eligible, based on your family medical history and other factors.
Get Involved
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Public banks generally work with specific participating hospitals. If yours isn’t on the list, check into whether you can request a mail-in kit from a local cord bank.
What to look for:
PUBLiC Cord Blood DONATION
Do you want to potentially help others with life-threatening conditions? Are you delivering at a participating hospital? Are you a minority or mixed-race couple? (Since it's harder to find matches for certain ethnic groups, there’s a greater need for these donors in the public system.)
Things to consider:
None. Public banks cover the fees associated with processing, testing and storage.
Average cost:
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Cord blood has been used in the treatment of more than 80 diseases , including blood cancers like leukemia and lymphoma, blood disorders like anemia, certain metabolic disorders and disorders of the immune system.
Potential uses:
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Public banks are regulated by the FDA and require informed consent, medical health history, and screenings for certain infectious diseases. Some banks require 900 million to a billion nucleated cells—that's more than two ounces of blood —in order for the unit to be more likely to meet the cell dose thresholds for treating an adult patient. (Smaller donations may be used in quality control or process-related research.)
What to know:
The blood is stored and listed on the Be the Match registry, where it’ll be available to anyone around the world who needs a stem cell transplant and is an acceptable match.
How it works:
Choose an accredited bank with significant experience, says Frances Verter, PhD, the founder of the Parent's Guide to Cord Blood. "You want to be confident they'll still be around in 10 years if you need them," says Dr. Verter.
Private Cord Blood Banking
Do you have a family history of certain health conditions that may be treated with a stem cell transplant? Do you have another child with a medical condition that could benefit from a stem cell transplant or potential future application of cord blood? Do you feel optimistic about the future of medicine? Does this make financial sense for you?
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It can range from $1,500 to $2,000 for the first year, followed by $100 to $150 for annual storage fees.
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Cord blood, in general, has been used in the treatment of more than 80 conditions, including various cancers. Note that for certain cancers and genetic conditions (e.g, leukemia, lymphoma) a treating physician will choose to use a donor’s stem cells rather than the child’s own cord blood for a stem cell transplant. In addition to the established uses in transplant medicine, clinical trials are testing ways that one's own cord blood could be used for regenerative treatments. Should these techniques prove effective, private cord blood banking may serve as a kind of medical insurance for families. Many clinical trials require that children have access to their own saved cells. (There are also some clinical trials using donated stem cells.)
Private family banks, which are regulated by the FDA, require informed consent and medical health history, and also screen for certain infectious diseases. They'll let you know if the number of cells in your unit falls below their quality threshold or doesn’t meet other bank-specific criteria.
The cord blood is stored and available for your immediate family's exclusive use. If it’s ever needed, it can be quickly accessed. (Heads up: There may be costs associated with release and transport.)
—Kristin and Mital, with Liam, 4, and Rahm, 1
We want to make sure we're looking out for our kids. My husband, Mital, received an organ transplant from his mother about six years ago. So when we had our own children, it was important to us to think ahead and take steps so we have options to help protect their health in the future. That's why banking cord blood and tissue was a no-brainer for us.
—Lauren & Adam, with 6-month-old George
We are believers in science. After first hearing about banking, I did some more research and talked to our doctor about it (she banked both of her kids’ cord blood). While we didn't have any immediate medical issues, we also didn't want to regret not saving it. We hope we'll never need to use George's cord blood, but we feel safer knowing it’s there if we need it.
—Lesley and Mike, with Everett, 3 (they also have a one-month-old baby girl, Evan, not pictured)
We found out during my first pregnancy that our son had a congenital heart defect that would likely require multiple heart surgeries. Even though stem cells from cord blood can't currently provide a cure or treatment, I hope that scientists can eventually find a way to use them to alleviate the need for additional surgeries for our son. I tell myself that a lot can happen and if a breakthrough happens, my son's cord blood will be there. Saving it makes me feel empowered—like I have some control over this situation.
At public banks, the unit is listed on the Be the Match Registry, where it’ll be available for transplant patients all over the world.
The cord blood is transported to the bank (transport options vary by bank) where it is processed and prepared for storage. The cord blood will need to undergo some processing before it is ready for cryogenic storage. This is done as soon as possible. All regulated banks have timeframes from the cord blood collection beyond which they are unable to accept a unit for processing. After testing, the stem cell–containing cord blood is then cryogenically frozen and stored.
You will be asked to give a blood sample that will be tested for infectious diseases. Keep a copy of the informed consent form in case you need to contact the cord blood bank at a later date.
Let your labor and delivery team know your plans (tell them if you're saving it for a private bank or donating it to a public program). Confirm that you have your collection kit (if you were given one). After baby is delivered, the umbilical cord will be clamped and blood from the umbilical cord and placenta will be collected in a sterile bag. You won't feel a thing, and you'll be so focused on baby you may not even realize it’s happening.`
If you've been given a cord blood collection kit from either a private bank or a public program, pack it in your hospital bag.
Deadline for registration at many private banks.
Deadline for sign-up with many public donation programs (In some cases, you may not have to do anything in advance, but check to be sure.)
Register with your chosen family bank. You will be asked to give informed consent and complete a health history form.
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34. Scaradavou A. Personal communication. January 29, 2016
Check to see if your hospital partners with a public cord blood bank and contact that bank to find out next steps. (You must register before 34 weeks.) If your hospital isn't listed, ask a local bank if they offer cord blood collection kits. (Because of the banks’ limited capacity, they unfortunately can’t accept donations from every mother who wants to help— although they appreciate the goodwill, says Andromachi Scaradavou, MD, program medical director of the National Cord Blood Program. )
Talk to your doctor or midwife about your decision.
Ask private banks about their restrictions and requirements.
Check to see if you meet cord blood donation guidelines.
Research your options. The nonprofit Parent's Guide to Cord Blood is a great place to start. Then check out websites for different private cord blood banks, like CBR®. Talk to your partner about what you'd like to do with the umbilical cord after baby is born.
Public Both
after baby's birth
Both
34 Weeks Until Contractions Start
at the hospital
Public Private
34 Week
Public Private Both
Third Trimester Week 28-34
SEcond Trimester Week 14-26
A recent study from JAMA suggests that waiting this long to clamp may boost neurodevelopment in healthy infants even several years later.
3 minutes
The American College of Obstetricians and Gynecologists (ACOG) recommended wait time for pre-term infants.
30-60 seconds
The amount of time recommended by the World Health Organization (WHO).
1-3 minutes
The average time before clamping in US deliveries.
15-20 seconds
sources +
Researchers are studying if cord blood could potentially be used as part of a self-repair kit, helping the body to heal itself. Read on to learn about the potential future applications for cord blood stem cells.
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They can help treat certain cancers (such as leukemia and lymphoma), blood disorders, congenital metabolic disorders and immunodeficiencies.
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While there's currently no agreed-upon expiration date, one study has shown that, under proper cryopreservation conditions, functional cord blood stem cells can be recovered for at least up to 23 years.
These simple, unspecialized cells are the basis of all tissue and organ cells in the body. But what makes them so unique is that they have the ability to develop into a variety of specialized cells. For example, the stem cells in cord blood are the building blocks of the body’s blood and immune system.
Stem cells are biological building blocks
Cord blood STEM cells can be frozen and stored for decades
Cord blood stem cells can be used in lifesaving transplants
The cells in cord blood are being studied for their regenerative potential.
5. Munoz J et al. Concise review: umbilical cord blood transplantation: past, present, and future. Stem Cells Translational Medicine. 2014 Dec;3(12):1435-43.
Read on to learn more about this amazing medical gift, how it can help people now and what it may be able to do in the future. We’ll give you all the info you need to decide if banking is right for your family as well as tips to make the process feel easy and empowering. Get ready to develop a new understanding of—and a powerful respect for—your umbilical cord.
You may have even heard that the cord blood and tissue can be saved after you give birth, but you're probably not quite sure how or why someone would do that. The short answer is that your cord blood contains stem cells that can be used in lifesaving treatments, and saving it is something super-easy that moms-to-be can do with the hope of helping to protect their children (or helping others!).
Let’s face it: You probably haven't spent much time thinking about the fate of your umbilical cord after baby is born. That's understandable; you have a lot of other things to get excited about (hello, baby!). You know that right now, the cord is baby's lifeline, delivering oxygen, nutrients and antibodies to him or her throughout your pregnancy.
That’s pretty exciting news considering how easy (not to mention, pain free) it is to collect cord blood versus bone marrow. Plus, cord blood matching is less restrictive than bone marrow, so it can be easier to find a suitable donor for a patient in need of a stem cell transplant. However, there's only one opportunity to collect these cells, and that’s at birth. Here's more about what makes cord blood stem cells so special:
1. Waller-Wise R. Umbilical Cord Blood: Information for Childbirth Educators. The Journal of Perinatal Education. 2011; 20(1):54-60. 2. Paiuk, Cara. "A Parent's Wild Ride To Cord Blood." [Web blog post.] Parent's Guide to Cord Blood. Parent's Guide to Cord Blood Foundation, July 2013. Web. [cited Apr. 2016]
In the past, the umbilical cord's job ended when baby arrived and it was simply tossed out as medical waste. But in 1978 scientists realized that the small amount of blood left in the cord after birth contained valuable blood-forming stem cells—the same type that are used in a bone marrow transplant. In fact, it turns out that the concentration of stem cells in cord blood is generally higher than it is in adult bone marrow!
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Dr. Preete Bhanot, MD, FACOG
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Linda Baumgartner, MS, speech language pathologist and co-principal investigator of a clinical trial evaluating the safety of cord blood cells in children with acquired hearing loss
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PHOTO CREDIT: Sarah Love Photography
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The median size of cord blood collections in family banks. (That small amount contains approximately 1.8 million blood-forming stem cells. )
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You may have heard some talk about this practice, and whether or not it’s compatible with saving your cord blood. Basically, delayed clamping means your doctor waits a little while after birth before clamping and cutting the umbilical cord to let the blood from the placenta flow to the baby immediately after delivery. While the amount of time before clamping varies depending on your doctor (and your baby), ACOG recommends delayed cord blood clamping for at least 30 to 60 seconds after birth. This is thought to improve baby’s circulation, increase red blood cell volume, and enhance iron stores—all of which may be beneficial for baby. Though delayed cord clamping can reduce the volume of cord blood that can be collected, it is still very possible to do both delayed cord clamping and cord blood storage. Since you’ll probably be just a little distracted after you give birth, talk with your doctor now about her or his standard procedure when discussing your birth plans.
oz
The Lowdown on Delayed Cord Clamping
Cord blood has been used in the treatment of over 80 diseases.
Plan. Prep. Protect. was created through a partnership with The Bump and CBR. Visit CBR to learn more about how you can save baby's precious stem cells. This information is provided for educational purposes only and should not be used for medical advice, diagnosis or treatment. You should consult your healthcare provider about your specific health needs. This site (and any opinions expressed herein) does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned.
Thinking of saving your cord blood? Whether you go the public or private route, it's easy and painless—there are just a few key things (and dates) to remember. We'll walk you through the process step-by-step.
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Cord Blood Banking: What Happens When
Estimated percentage of cord blood that’s discarded as medical waste
“Critical trials are going on to use these cells for children with autism, with hearing loss. In five years, we may have so many more things that we can use these cells for...[saving cord blood] is a great investment."
“We personally believe in cord blood banking and chose to bank our first grandchild’s cord blood."
“I believe in the research. I really do. I believe that this is going to be the way of the future.”
Click to learn more about each
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Estimated number of worldwide cord blood stem cell transplants from both public and private banks (so far!).
35,000+
Certain private banks, like CBR, help recruit participants for some of these trials—so if you're banking with them and your child has a condition that could potentially benefit from this research, they'll let you know if you're eligible, based on your family medical history and other factors.
PRIVATE CORD BLOOD BANKING
PUBLIC CORD BLOOD DONATION
"Why we decided to SAVE"
PRiVATE OR PUBLIC?
GET iNVOLVED
Meet three families who chose to save with CBR.
If a child in your immediate family already has a life-threatening disease that could be treated with a cord blood transplant, you may be able to save baby's umbilical cord blood for the sibling’s potential use for free or at a reduced fee. Both public and private cord banks have special programs to help families with a qualifying medical need.
Help for Families Who Need It
If the info we’ve shared so far has inspired you to save those precious stem cells, read on. There are two options: You can store them in a private family bank, like CBR, or you can donate them to a public bank. The chart below breaks down the differences to help you decide which option might be right for you.
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So What Can You Do With Your Child’s Cord Blood?
PHOTO CREDIT: LEA CSONTOS
WHAT THE EXPERTS ARE SAYinG
THE POWER OF STEM CELLS
What Every Parent Needs to Know About Cord Blood
Linda Baumgartner, MS, speech language pathologist
PHOTO CREDIT: Tiny Sparrow Photography
Here's why: The FDA and the American Congress of Obstetricians and Gynecologists discourage unnecessary ulttrasounds. While they're considered to be very safe, extra exposure to ultrasound technology can heat tissues slightly. This is unlikely to have any clinical impact, but it's best to limit your exposure as much as possible. Also, the technicians at these facilities don't know your medical history and haven't been following your pregnancy, so their services could lead to misinformation and needless worry. Try to hang in there: After all, you'll soon have more adorable baby pictures than you'll know what to do with.
2009
Connecticut becomes the first (and only) state to ban "keepsake ultrasound" studios.
Those flat, two-dimensional ultrasounds are so last year! The latest rage these days are 3-D and even 4-D ultrasounds, which give you a super-detailed and live-action sneak peek at what baby’s up to in utero. They’ve become so popular, in fact, there are now even stand-alone imaging centers that offer these ultrasounds, along with keepsakes like a DVD or stuffed bear that plays a recording of baby’s heartbeat. It might be tempting to head to one of these centers, but experts say you should stick to what's offered in your doctor’s office.
4-D Ultrasounds: Should You Get One?
The placenta plays a huge role in the health of your growing baby, but it can be a bit of a stealth operator. “By the time you find out that the baby isn’t growing because the placenta isn’t functioning well, there isn't much we can do,” Ghidini says. But the National Institute of Health recently put $46 million toward a strategy for getting ahead of common placenta-related problems. As part of the Human Placenta Project, scientists will keep tabs on the organ's function throughout pregnancy in order to predict—and prevent—conditions like preeclampsia, intrauterine growth restriction, preterm birth and even stillbirth.
A plan to prioritize the placenta
As we learn more about the human genome, researchers are developing predictive tests that can detect a greater number of genetic conditions, hopefully with a lower rate of false positives. Some of these tests are already available, like the cell-free DNA test. But before considering more expansive testing, talk with your doctor or genetic counselor. The American Congress of Obstetricians and Gynecologists still recommends testing only for high-risk women, and only for more common conditions.
Safer ways to predict baby's risks
Symptoms of autism don’t usually emerge until age 2 or beyond, but researchers at Seattle Children’s Hospital have identified gene mutations that can increase the chances baby will develop autism. Another small study at the University of Edinburgh in Scotland suggests that ultrasounds could also reveal clues. The team discovered babies who had larger heads and abdomens around the 20-week ultrasound were more likely to later have autism spectrum disorders. These findings are very preliminary and there's no current recommendation for prenatal genetic testing for ASD; however the research offers some hope that an earlier diagnosis may be possible in the future.
A way to detect possible autism in utero
For some babies with spina bifida (a birth defect in which the spinal column doesn’t close all the way), accurate surgery can be performed before baby is even born. In certain cases, doctors do a type of cesarean section during the second trimester in which they take the fetus out, surgically repair the spinal cord, put the fetus back in, and close up the uterus, says Alessandro Ghidini, MD, an obstetrician in Alexandria, VA who specializes in maternal-fetal medicine and genetics. “The problem is, opening and closing the uterine wall causes a high risk for preterm delivery,” he says. But now surgeons are pioneering a new method in which they use a scope to perform the procedure internally—and which requires just a small uterine incision.
Surgeries that can be done before birth
Prenatal testing has come a long way. Before ultrasound use became common in the 1970s, you had to wait until baby was born to find out his or her gender (or their gender, if you were unknowingly carrying multiples). Now thanks to safer, more accurate screenings, you can shop for blue or pink onesies much earlier in your pregnancy. But scientists aren’t stopping there. Check out the newest advancements.
The Latest Breakthroughs in Prenatal Care
72
Estimated percentage of women who choose to get prenatal testing (that's up from 25 percent in 1988).
Click the numbers to learn more
s
1970
Ultrasounds (aka sonograms) are first used to track pregnancies and quickly become a standard tool of prenatal care.
6. Amniotic fluid
Your doctor will keep track of your amniotic fluid levels throughout your pregnancy (on an ultrasound, fluid appears black, while bone is bright white). Low levels can be a sign that baby is growing too slowly or even a sign of placental failure (in late pregnancy).
5. Extremities
Sometimes baby's arms or legs will be tucked under him or bent at his side, so your doctor will want to check them from all angles. If something looks a little off or isn’t developing properly, it's much better to catch it early. That way you can talk to your doctor about a potential treatment or surgical plan for after birth (and also have time to wrap your mind around that possibility).
4. Stomach bubble
The dark circle in the chest cavity under the chin is noted at the 14-week ultrasound and is where the stomach is beginning to form. “The bowels won't quite be working yet, but it’s helpful to see that bubble and note that there’s nothing abnormal happening,” Ross says. It means baby's stomach is growing right where it should be.
3. Nuchal fold
This refers to the thickness of baby's neck fold, and it's another visible marker that can be linked with chromosomal conditions. Between 11 and 14 weeks, a normal thickness would be less than four millimeters. “If this area is enlarged or thickened, we would send you to see a perinatologist,” Ross says. (That's an obstetrics specialist who deals with complicated, high-risk pregnancies.)
2. Nasal bones
Your doctor will check out baby’s nasal bones— underdevelopment in this area has been linked to a higher risk of Down syndrome. “You either see something or you don’t, but it’s an easy landmark to spot at just 12 weeks,” Ross says.
1. head
The “crown to rump length” is actually a better predictor of your due date than the date of your last period. “A lot of people don’t know the first day of their last menstrual period, and even if they do, they don’t know for sure when they ovulated,” says Sherry Ross, MD, a Santa Monica, California–based ob-gyn. For figuring out your due date, the earlier the ultrasound, the better—ideally between 6 and 10 weeks.
It's the moment you've been waiting for: The first time you get to see the little person that's been camping out in your uterus. The timing depends on your doctor, but expect your first ultrasound sometime between 6 and 12 weeks. (Note: This image was taken at about 12 weeks.) The ultrasound isn't just amazing for sentimental reasons; it dates and confirms your pregnancy—there really is a baby in there!—and can also detect potential problems. Here's what your doctor will be looking for:
Your Ultrasound—Decoded
eat right—especially before the glucose challenge.
Loading up on carbs before this test for gestational diabetes can lead to a false positive result. The morning of the test, eat a breakfast with high-quality protein, like eggs. “Protein helps to temper the effect of carbs on blood sugar to promote a more stable breakdown,” says Jessica Cording, a registered dietitian based in New York City. (It's a good idea to eat this way throughout your pregnancy too.)
Drink up.
For the clearest abdominal ultrasound results before 24 weeks, drink water at least an hour before the test, and try to hold off on using the restroom. A partially full bladder helps elevate the uterus out of the pelvis to aid in visualization. Avoid sugary or caffeinated drinks, which can jolt baby and result in blurry images. And don't drink so much that you're uncomfortable— anatomy scans can take 30 minutes or more.
Bring your partner to your first appointment.
That way you can both chime in with details about your family histories, and answer the doctor's questions about things you may not have talked about. It’s also a good opportunity for the three of you to discuss options for genetic testing.
Do some homework.
Having family conversations before your first prenatal checkup can eliminate the guesswork. Ask your mom if she had preeclampsia, hypertension, gestational diabetes or preterm labor, since these conditions can be familial and could affect your pregnancy too. Also find out if anyone in you or your partner’s family was born prematurely, had a birth defect or a genetic condition like sickle cell anemia, cystic fibrosis or Tay-Sachs disease.
4 Tips to Help You Ace Your Prenatal Tests
1. Do some homework. 2. Bring your partner to your first appointment. 3. Drink up. 4. Eat right—especially before the glucose challenge.
Type As, take heart: There are plenty of ways you can prep for all of these prenatal tests throughout your pregnancy. Here’s how to make sure they’re as accurate as possible—and how to avoid false positives and do-overs.
Estimated percentage of pregnancies affected by gestational diabetes in the US.
Your doctor may check your cervix to see if it’s dilating or becoming effaced, two signs your body is preparing for labor and birth. This can happen gradually over weeks—or within an hour. At this point, there’s not much left to do but wait to meet baby!
If you go past your due date or have other risk factors like diabetes, hypertension or advanced maternal age, your doctor may suggest this 20-minute test that monitors your contractions and baby’s heartbeat to check that baby is stable enough to stay in utero another few days. (The test is done twice a week.)
A vaginal and rectal swab will test for this type of bacteria that’s harmless to adults, but can be dangerous if passed on to baby during birth. (About 25 percent of women have Group B strep without knowing it, meaning they have no symptoms.) If you test positive, don’t stress—you’ll just be given antibiotics during labor to protect baby from being infected.
In this routine screening test for gestational diabetes, you’ll drink a sugary beverage, wait an hour, and then have your blood drawn to see if your body processes the sugar correctly.
In this optional screening to determine baby’s risk of certain conditions, your blood will be tested for four different hormones. (It's most accurate between week 16 and 18.)
It’s time for baby’s photo op! The doctor or ultrasound tech takes lots of different measurements and checks many things, including baby’s kidneys, bladder, stomach, brain, spine, sex organs and all four chambers of the heart to make sure everything is on track. If you haven’t yet, now’s the time you can usually find out baby’s gender.
To diagnose certain genetic conditions and birth defects in high-risk pregnancies, a needle is inserted through your belly into the uterus to take a sample of amniotic fluid. There is a small risk (less than 1 percent) of miscarriage and other complications.
This test screens for Down syndrome and other chromosomal conditions.
This more invasive test may be offered between weeks 10 and 13 for high-risk pregnancies. It carries a very small but real risk of miscarriage and other compli-cations, but can diagnose or rule out certain conditions (except neural tube defects) with almost 100 percent accuracy.
This newer blood test can screen for certain chromosomal conditions like Down syndrome.
If you do get pictures this early, your doctor will use them to confirm the gestation age, check for the heartbeat—and look for twins (or more).
Bacteria: like the kind that causes UTIs Sugar: an indicator of diabetes Protein: a sign of preeclampsia, or high blood pressure during pregnancy
You’ll become a pro at peeing in a cup, because you’ll probably be asked to do it at every visit. Your urine gets screened for:
A complete blood count (CBC) to test for anemia Certain autoantibodies in your blood that could cause a problem with a current or future pregnancy STDs including HIV, chlamydia and syphilis, which can all cause complications for you and baby Immunity against chicken pox, rubella and measles
At your first visit, you'll have your blood drawn and tested for:
As you come into the homestretch, you’ll typically check in weekly with your ob-gyn, but visits should be quick and uneventful.
Fetal nonstress test Internal exam
Week 37+
Group B Streptococcus
week 35
As you head into your third trimester, you’ll have appointments about every two to three weeks until your last month, when you'll start seeing your doctor weekly.
Third trimester (Weeks 27–40)
Anatomy scan
week 20
Glucose challenge screening test
Week 24
Quadruple screen test
Week 16
Amniocentesis
week 15
Typically, you’ll have an appointment about every four weeks through the second trimester.
second Trimester (Weeks 14–26)
Nuchal translucency screening
week 12
Cell-free fetal DNA test Chorionic villus sampling (CVS)
Week 10
Blood test Urine test Ultrasound
week 8 first visit
Don’t be surprised if your doctor doesn’t schedule your first checkup until around week eight. Your pregnancy is pretty much on autopilot for now.
First Trimester (Weeks 1–13)
What Happens When: A Timeline of Prenatal Tests
After testing, the genetic counselor can help you make sense of the results. They're trained to help you fully understand your risks and walk you through your options. Depending on your test results and where you are in your family planning, you may consider in vitro fertilization (IVF) or preimplantation genetic diagnosis (PGD), in which case you could even test the fertilized embryo before implanting it. Using a donor egg/sperm or adoption are some other options to consider.
Next steps
Diagnostic TESTS
Do you have other risk factors, like a screening test with an abnormal result? What will you do if this test comes back positive? Have you talked to your doctor or genetic counselor about the risks and benefits of taking the test?
Questions to ask yourself:
Yes. Diagnostic tests are close to 99 percent accurate.
Can diagnose health condition:
There are rare but serious risks associated with the tests, including a less than 1 percent chance of miscarriage, as well as a small risk of infection or leaking of amniotic fluid.
Risk:
With amniocentesis, a long, thin needle is inserted into your uterus to take a sample of amniotic fluid to analyze. With chorionic villus sampling, cells are taken from your placenta, either by going through your belly with a needle or through your cervix using a speculum.
What it involves:
For CVS, it’s typically between weeks 10 and 13; for amnio, between weeks 15 and 20
Timing:
Typically only recommended for high-risk women: They're 35 or over, had a previous child with a birth defect, have a family history of a genetic condition, or had a positive result on a screening test.
WHO GETS THEM:
Certain chromosomal conditions (including Down syndrome, Trisomy 18 and Trisomy 13)
conditions diagnosed:
Amniocentesis, chorionic villus sampling
TYPES:
SCREENING TESTS
If baby was going to be born with a birth defect or chromosomal condition like Down syndrome, would you want to know ahead of time? What would you do with this information?
No. It can only show risk estimates, which give baby’s chances of being born with a condition in terms of one out of hundreds or thousands, for example.
No risk of miscarriage or infection
A combination of blood tests and ultrasound scans
First trimester for cfDNA and nuchal screen (ultrasound measurement of the neck fold); second trimester for quad screen test (a maternal blood test)
Typically higher-risk women: They're 35 or over, have a family history of chromosomal conditions, or previously had a baby with one of these conditions.
Chromosomal conditions (including Down syndrome, Trisomy 18 and Trisomy 13)
SCREENS FOR:
cfDNA, nuchal translucency screening, quadruple screen test
& CHECKUPS: What to expect
pregnancy check-ins
This gives you time to mentally prepare and come up with a plan. All of this checking can give you and your doctor peace of mind. Plus, each visit means another chance to ask your doctor your most pressing questions (Do I have to give up coffee? Is this cramping sensation normal?), and get advice on things like exercising during pregnancy or how best to prepare for labor. Read on for the lowdown on the types of tests and measurements you can expect, the different choices you’ll have to make along the way, and what it all means for you and baby.
& Checkups: What to expect
At each visit she’ll do basic checks, like taking your blood pressure and a urine sample, seeing how you and baby are growing, and listening to baby’s heartbeat. Along the way, you’ll also be offered more expansive screenings to assess baby’s risk for certain conditions like Down syndrome and spina bifida. Depending on your age and other risk factors, you might also consider tests that are more invasive, but more accurate in diagnosing issues.
& Checkups—Explained
Your pregnancy check-ins
Women have been growing babies since, well, the beginning of time. But thanks to modern technology, life-threatening conditions that once may have gone undetected until baby was born are now typically much easier for doctors to identify and evaluate early on. Over the course of your pregnancy, you’ll see your doctor or midwife around 14 times.
If you do have an abnormal screening result, you'll be offered counseling and further diagnostic testing if warranted. Talk to your doctor about whether you want to proceed. Diagnostic tests like amniocentesis and CVS (chorionic villus sampling) are more invasive and carry more risks of complications, but they’re the only way to get a diagnosis before baby is born (and they're nearly 99 percent accurate).
Most screenings are blood tests or ultrasounds, so the physical risks are low. However, there is a potential emotional risk if you're not properly counseled on the rate of false positive results. That's why it's important to talk with your doctor about the accuracy of these tests and what that means for you. For example, cfDNA screening is better at identifying certain conditions more than others, and results can be affected by many factors, including your age.
You might have heard about new cell-free DNA (cfDNA) prenatal screening. This noninvasive blood test screens for chromosomal abnormalities and can tell baby's gender much earlier than the 20-week anatomy scan. But it can't tell you for sure if baby has Down syndrome, for example—it only tells you if there is an increased chance. That's the point of screening tests: They're a preliminary look at whether baby has a higher or lower risk of a condition. Diagnostic tests, which you’ll decide if you want to take once the screening test results come back, give a more definitive answer about whether or not baby has a specific condition.
in
1 25
Number of non-Hispanic Caucasians who are carriers for cystic fibrosis.
• You’ve had a child with an inherited disorder, birth defect or intellectual disability. • You’ve had two or more miscarriages or a stillbirth. • You’re at a higher risk because you’re over 35.
You might also consider preconception testing for these reasons
Before you head to the lab, talk with your doctor—and the genetic counselor you've been referred to by your doctor—about any tests you're considering. Don't forget to check with your insurance provider to see what they'll cover; the pricing can range broadly and may cost thousands of dollars. It's also important to consult with your doctor or genetic counselor before using DIY mail-order genetic tests, since the info they reveal could be misread or misinterpreted.
Where to start
Depending on the disease in question, you and/or your partner will give a sample of blood or saliva to be tested in a lab to find out if you're carriers.
How testing works
• Though risks may vary depending on the disease for which you're being tested, with autosomal recessive genetic disorders (like cystic fibrosis), if one parent is found to be a carrier, your child won't have the disease, but there’s a 50 percent chance he or she could be a carrier. • If both parents are carriers, there’s a 25 percent chance baby will inherit the disorder, and a 50 percent chance baby will be a carrier like you or your partner.
What the results mean
Non-Hispanic whites
Elevated risk for certain conditions including cystic fibrosis
African Americans, Mediterraneans and Southeast Asians
Elevated risks for conditions including thalassemias and sickle cell disease
Eastern European or Ashkenazi Jews
Elevated risk for certain conditions including Tay-Sachs disease, cystic fibrosis, Canavan disease, familial dysautonomia, Niemann-Pick disease (type A), Bloom syndrome, Fanconi anemia group C, mucolipidosis type IV and Gaucher disease
African-Americans, Mediterraneans and Southeast Asians
Eastern european or Ashkenazi Jews
Should you consider preconception genetic testing?
If you or your partner have a family or medical history of genetic disorders (for example Huntington’s disease or certain cancers), or if either of you is part of an ethnic group that has elevated risks for certain conditions, you should consider meeting with a genetic counselor before trying to conceive. Click below to reveal the conditions that are more common in each ethnic group.
HOw Early is too early for a genetic test?
If it makes sense to move forward (insurance coverage varies, by the way), blood tests can find out if you and your partner are carriers—meaning you could pass on a hereditary condition to your future child.
The short answer: Never, depending on your family history as well as your partner’s. If you have certain risk factors or questions about your family medical history, it might be worth scheduling a preconception visit with your ob-gyn or family doctor to talk about genetic testing. They'll ask you lots of questions and may refer you to a genetic counselor who can help pinpoint your risk.
Plan. Prep. Protect. was created through a partnership with The Bump and CBR. Visit CBR to learn more about how you can save baby's precious stem cells. This information is provided for educational purposes only and should not be used for medical advice, diagnosis or treatment. You should consult your health care provider about your specific health needs. This site (and any opinions expressed herein) does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned.
The age at which your ob-gyn considers you “advanced maternal age.” (Hey, isn’t 35 the new 25?)
Number of weeks by which you should already be getting prenatal care.
Screening Tests
Diagnostic tests
Learn the differences between the two types of tests
Screening vs. Diagnostic Tests: What’s the Difference?
Plan. Prep. Protect. was created in collaboration with The Bump and AMAG Pharmaceuticals, Inc. Visit GrowthYouCantSee.com to learn more about preterm birth. PP-MKN-US-00332 10/17 This information is provided for educational purposes only and should not be used for medical advice, diagnosis or treatment. You should consult your healthcare provider about your specific health needs. This site (and any opinions expressed herein) does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned.
39 American Congress of Obstetricians and Gynecologists. FAQ004. May 2011. How to Tell When Labor Begins. Web. [cited July 27, 2017] http://www.acog.org/Patients/FAQs/How-to-Tell-When-Labor-Begins 40 American Congress of Obstetricians and Gynecologists, Preterm (Premature) Labor and Birth FAQ087, November 2016. Web. [cited July 27, 2017] http://www.acog.org/Patients/FAQs/Preterm-Premature-Labor-and-Birth#are 41 American Congress of Obstetricians and Gynecologists. FAQ004. May 2011. How to Tell When Labor Begins. Web. [cited July 27, 2017] http://www.acog.org/Patients/FAQs/How-to-Tell-When-Labor-Begins
+ Sources
Are usually felt in the front; labor contractions are usually felt in the back before moving to the front
Tend to go away if you change positions; labor contractions don’t
Are usually weak and don’t increase in intensity over time, whereas labor contractions do increase in intensity over time
Are usually irregular and infrequent; labor contractions tend to become regular and more frequent over time
Braxton Hicks contractions:
If you experience any of these symptoms at any point in your pregnancy, call your doctor and listen to her instructions. She may tell you to drink several glasses of water and empty your bladder regularly, because dehydration and a full bladder are separate factors that can trigger contractions. You’ll also probably be told to monitor your contractions as best you can. Be sure to keep your doctor updated on your status and to follow any other directions she has for you.
what to do:
be on the lookout for these symptoms:
40
What to do
Constant, dull ache in your lower back
Regular or frequent contractions or uterine tightening
A slow trickle of water leaking from the vagina, an indicator that your water has broken
Pelvic or lower abdominal pressure
Vaginal discharge consisting of blood, mucus or water
Mild abdominal cramps—these often feel like menstrual cramps—with or without diarrhea
If you experience any of these symptoms at any point in your pregnancy, call your doctor and listen to her instructions. She may tell you to drink several glasses of water and empty your bladder regularly, because dehydration and a full bladder are separate factors that can trigger contractions. You’ll also probably be told to monitor your contractios as best you can. Be sure to keep your doctor updated on your status andto follow any other directions she may have for you.
39
While pop culture tends to depict labor as a sudden and obvious onset of symptoms, in real life, it doesn’t always work that way. Many women, especially first-time moms, aren’t quite sure whether or not they’re experiencing labor.
Though Braxton Hicks contractions can seem like the real deal, there are some telltale signs it’s just a practice round.
41
Is it real labor or Braxton hicks contractions?
Signs of Preterm Labor to Watch For
38 March of Dimes, Premature babies page. October 2013. Web. [cited July 27, 2017] http://www.marchofdimes.org/complications/premature-babies.aspx
37 American Academy of Pediatrics. Health Issues of Premature Babies. February 26, 2016. Web. [cited July 27, 2017] https://www.healthychildren.org/English/ages-stages/baby/preemie/Pages/Health-Issues-of-Premature-Babies.aspx
35 March of Dimes, Premature babies page. October 2013. Web. [cited July 27, 2017] http://www.marchofdimes.org/complications/premature-babies.aspx 36 American Lung Association. Bronchopulmonary Dysplasia. Web. [cited July 27, 2017] http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/bronchopulmonary-dysplasia/?referrer=https://www.google.com/
32 American Academy of Pediatrics. Health Issues of Premature Babies. February 26, 2016. Web. [cited July 27, 2017] https://www.healthychildren.org/English/ages-stages/baby/preemie/Pages/Health-Issues-of-Premature-Babies.aspx 33 March of Dimes, Retinopathy of prematurity page. February 2013. Web. [cited July 27, 2017] http://www.marchofdimes.org/complications/retinopathy-of-prematurity.aspx 34 March of Dimes, Hearing loss page. June 2014. Web. [cited July 27, 2017] http://www.marchofdimes.org/complications/hearing-impairment.aspx
38
Intestinal problems, sometimes due to an underdeveloped intestinal tract or necrotizing enterocolitis (NEC), a disease that causes tissue in the bowel to die Infections, since preemies—with their underdeveloped immune systems—are especially vulnerable to pathogens
An early arrival could lead to:
Digestions and Infection
Retinopathy of prematurity (ROP), an eye disease that affects 14,000 to 16,000 babies in the US and can cause vision problems or blindness; most cases are mild and don’t cause permanent damage to baby’s vision, but it’s important for preemies to get tested and treated immediately Hearing loss, likely caused by an underdeveloped auditory system
When baby is born before eyes and ears are finished maturing, it can cause issues, both temporary and long-term, including:
Eyes and Ears
37
Heart Irregularities
The most common condition is a heart murmur, which could indicate a heart abnormality that requires monitoring, medication or even surgery. Bradycardia, a decline in heart rate that most infants outgrow soon after birth, is another irregularity. These conditions sound scary, but the sooner a problem is detected, the faster doctors can begin treatment.
These include:
Asthma Respiratory distress syndrome (RSD), a breathing problem that occurs when baby’s lungs don’t have enough time in the womb to produce enough surfactant, a substance the lungs need to expand. Preemies might receive artificial surfactants as treatment and be put on a ventilator. Bronchopulmonary dysplasia (BPD), a chronic lung disease caused by long-term use of a respirator and oxygen treatment; BPD often resolves itself as baby gets older, though it can cause continual breathing issues
Asthma Respiratory distress syndrome (RSD), a breathing problem that occurs when baby’s lungs don’t have enough time in the womb to produce enough surfactant, a substance the lungs need to expand Bronchopulmonary dysplasia (BPD), a chronic lung disease caused by long-term use of a respirator and oxygen treatment; BPD often resolves itself as baby gets older, though it can cause continual breathing issues
Lung Development
The more time babies have in the womb to develop their lungs, the stronger and more functional those lungs will be in the outside world. Depending on how early you give birth and how many steroid treatments doctors are able to give baby before delivery to speed lung growth, preemies could be affected by these conditions:
31 Brumbaugh, JE, et al. Altered Brain Function, Structure, and Developmental Trajectory in Children Born Late Preterm. Pediatric Research. 2016 Aug; 80(2):197-203
Behavioral problems such as anxiety, attention deficit disorder (ADD), or attention deficit hyperactivity disorder (ADHD) and anxiety Autism Cerebral palsy, an impairment of the brain that can cause nerve damage, poor motor control and paralysis
Brain Development
The brain develops fastest toward the end of pregnancy, so when baby is born early, it cuts short an important growth opportunity and can lead to neurological impairments. The earlier the birth, the greater the chance of lasting complications. These include:
30 American Academy of Pediatrics. Health Issues of Premature Babies. February 26, 2016. Web. [cited July 27, 2017] https://www.healthychildren.org/English/ages-stages/baby/preemie/Pages/Health-Issues-of-Premature-Babies.aspx
Because they’re not done developing, babies born preterm are at risk for serious complications. Though there are a variety of medical interventions doctors can try to lower the chance that preemies will have long-term disabilities, it’s important to be aware of the potential health concerns. Click the numbers at left to learn more
Potential Complications for Preemies
44 Fellen D. Personal communication. May 8, 2017
42 Fusaro K. Personal communication. May 7, 2017
43 Paul J. Personal communication. May 7, 2017
44
gave birth at 26 weeks and 6 days
Diana Fellen wishes she had asked the NICU staff for help more often—especially the day she was released from the hospital, and her son stayed behind in the NICU. “I was so worried I was going to see a mother leaving with her newborn. I think that would have killed me at the time,” Fellen says. “If I had it to do over again, I would’ve asked a nurse to let me know the coast was clear before walking out of the hospital.” Requests like these are easy enough to accommodate, so do yourself a favor and ask.
Ask for What You Need
Diana Fellen
43
gave birth at 27 weeks and 6 days
Jody Paul says she wishes there had been a support group for parents with babies in the NICU. “My husband and I needed to talk with other parents who were going through it at the time,” Paul says. If your hospital doesn’t have one, ask a friend to help you find a support group, or look for one online to connect virtually with other parents in your situation. Good online resources include The Bump preemie forum and Sidelines, a nonprofit group that offers support for women and their families experiencing complicated pregnancies and premature births.
Seek Out Support
Jody Paul
42
GAVE BIRTH at 33 weeks
Ask a family member or friend to answer calls and emails from concerned friends and family. When Kimberly Fusaro’s baby was born, her husband and best friend kept everyone else in the loop. “I had no desire to repeat myself or field people’s concerns while I was on bed rest in the hospital or while my daughter was in the NICU for three weeks. So I basically went dark until she was home—and I was so grateful that my friend and husband were in charge of sending out updates,” Fusaro says.
Delegate Correspondence
Kimberly Fusaro
Dealing with a preterm birth—which in many cases requires a stay in the NICU—can take a big toll on parents. If you know you’re at risk, the best thing you can do is line up support from friends and family now, so you’ll have people to lean on after delivery. Not sure exactly what you’ll need if you have a preterm birth?
Tips From Moms Who’ve Been Through It
American College of Obstetricians and Gynecologists, Practice Bulletin Number 171, October 2016, Clinical Management Guidelines For Obstetrician-Gynecologists, Management of Preterm Labor.
World Health Organization, Preterm Birth Fact Sheet. November 2016. Web. [cited July 27, 2017] http://www.who.int/mediacentre/factsheets/fs363/en/
American Congress of Obstetricians and Gynecologists, Preterm (Premature) Labor and Birth FAQ087, November 2016. Web. [cited July 27, 2017] http://www.acog.org/Patients/FAQs/Preterm-Premature-Labor-and-Birth#what
March of Dimes, Premature babies page. October 2013. Web. [cited July 27, 2017] http://www.marchofdimes.org/complications/premature-babies.aspx
Centers for Disease Control and Prevention, Preterm Birth page. June 26, 2017.. Web. [cited July 27, 2017] https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm
+Sources
Estimated medical cost per premature infant in the US.
$51,000
Exactly when you’ll go into labor is notoriously hard to control, but there are several things moms-to-be can try to help lower the risk of preterm birth. There are also some interventions doctors can offer to improve your chances of staying pregnant until you’re full term. Read on to learn more about the risk factors and complications for preterm birth.
If baby is born before you reach 37 weeks, he’s considered preterm.
weeks
But take note: Not all preterm births have the same consequences. The level of risk varies based on how early baby comes. Experts have identified different categories of preterm births: Babies born between 32 and 37 weeks of pregnancy are considered moderately to late preterm; those born between 28 and 32 weeks are very preterm; and babies born before 28 weeks are extremely preterm. As you’d expect, babies born the earliest tend to face the greatest challenges, so the longer they can stay in the womb and continue developing, the better off they’ll be.
The number of babies born preterm in the US.
1 10
PHOTO CREDIT: The Harris Company
After months of planning and prepping (and marveling at your expanding waistline), you probably can’t wait to finally hold baby in your arms. But patience and timing is key: Babies are considered full term at 39 to 40 weeks of pregnancy, and an early arrival isn’t in baby’s best interest. In fact, it could put him or her at risk. A preterm birth means baby is born before the 37th week of pregnancy. When this happens, critical fetal development is cut short, which can lead to serious medical complications like breathing problems, hearing impairment and developmental delays. Scary to hear, we know, but preterm birth is actually the leading cause of infant mortality.
Preterm Birth: What It Means for You and Baby
27 American College of Obstetricians and Gynecologists, Practice Bulletin Number 171, October 2016, Clinical Management Guidelines For Obstetrician-Gynecologists, Management of Preterm Labor 28 American College of Obstetricians and Gynecologists, Practice Bulletin Number 171, October 2016, Clinical Management Guidelines For Obstetrician-Gynecologists, Management of Preterm Labor
Approximate percent of preterm labor that subsides
30%
Of women who are hospitalized for the condition go on to give birth at term.
50%
Centers for Disease Control and Prevention, Preterm Birth page. June 26, 2017. Web. [cited July 27, 2017] https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm
Berghella, Vincenzo. UpToDate, Cervical insufficiency. July 19, 2017. Web. [cited July 27, 2017] https://www.uptodate.com/contents/cervical-insufficiency
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Murphy NJ, Quinlan JD. Trauma in Pregnancy: Assessment, Management, and Prevention. American Family Physician. 2014 Nov 15;90(10):717-724
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American Congress of Obstetricians and Gynecologists, Bleeding During Pregnancy FAQ038, July 2016. Web. [cited August 10, 2017] https://www.acog.org/Patients/FAQs/Bleeding-During-Pregnancy
20
March of Dimes. Weight gain during pregnancy. November 2016. Web. [cited July 27, 2017] http://www.marchofdimes.org/pregnancy/weight-gain-during-pregnancy.aspx
Spong, C. Y., Mercer, B. M., D’Alton, M., Kilpatrick, S., Blackwell, S., & Saade, G. (2011). Timing of Indicated Late-Preterm and Early-Term Birth. Obstetrics and Gynecology, 118(2 Pt 1), 323–333. http://doi.org/10.1097/AOG.0b013e3182255999
Wisborg K, Ingerslev HJ, Henriksen TB. In vitro fertilization and preterm delivery, low birth weight, and admission to the neonatal intensive care unit: a prospective follow-up study. Fertility and Sterility. 2010 November; 94(6):2102-2106. DOI: http://dx.doi.org/10.1016/j.fertnstert.2010.01.014
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March of Dimes. How long should you wait before getting pregnant again? July 2017. Web. [cited July 27, 2017] http://www.marchofdimes.org/pregnancy/how-long-should-you-wait-before-getting-pregnant-again.aspx
16
DeFranco EA, Ehrlich S, Muglia LJ. Influence of interpregnancy interval on birth timing. BJOG. 2014;121:1633–1641
Lengyel CS, Ehrlich S, Iams JD, Muglia LJ, DeFranco EA. Effect of Modifiable Risk Factors on Preterm Birth: A Population Based-Cohort. Maternal and Child Health Journal. 2017 April;21(4):777-785
Martin, JA, et al. Births: Final Data for 2015. National Vital Statistics Report, Volume 66, Number 1. National Center for Health Statistics. January 5, 2017. Web. [cited July 27, 2017] https://www.cdc.gov/nchs/data/nvsr/nvsr66/nvsr66_01.p
Committee on Practice Bulletins—Obstetrics, The American College of Obstetricians and Gynecologists. Practice bulletin no. 130: prediction and prevention of preterm birth. Obstetrics and Gynecology. 2012;120(4):964-973.
Physical and emotional stress, drugs and alcohol are all factors that can increase the likelihood of preterm birth, according to the Centers for Disease Control and Prevention. As soon as you find out you’re pregnant, quit smoking, drinking alcohol and using recreational drugs. Also, take it easy on your body and allow time for mental and physical rest and relaxation. If you can, try doing activities that help relieve stress, such as exercise, yoga, meditation, or simply reading a good book.
Stress, or using cigarettes, alcohol or drugs during pregnancy
Prevent these infections by practicing safe sex and getting screened throughout your pregnancy.
Certain infections of the urinary or genital tract, such as sexually transmitted infections
If you have an ongoing health concern, be sure to stay on top of your treatment to minimize any threats to your or baby’s health. That could mean getting prenatal care from a high-risk ob-gyn and going for extra visits with specialized physicians.
Certain chronic conditions, such as high blood pressure, blood clotting problems and diabetes (including gestational diabetes)
When a woman’s cervix is weak or shortened, it might open up too early and initiate preterm labor. Similarly, when an abnormality of the uterus or placenta develops, this can make it more difficult to carry a pregnancy to term. If diagnosed with one of these issues, talk with your doctor about ways to offset the risks.
Existing abnormalities of the uterus, cervix or placenta
One out of 12 pregnancies is complicated by a physical trauma, such as a fall or a car accident. While nine out of 10 traumatic injuries during pregnancy are classified as minor, even minor ones can be harmful to an unborn baby. It’s crucial to receive fetal monitoring in the hours directly following a physical trauma.
Physical injury or trauma during pregnancy
Vaginal bleeding during pregnancy can have many causes and doesn’t always indicate a problem. In the first trimester, about 15 to 25 percent of women experience bleeding or spotting that is not symptomatic of a serious complication. Still, if you notice any bleeding or spotting, contact your doctor; in some cases, bleeding early in pregnancy could signal a miscarriage or an ectopic pregnancy. Later in pregnancy, bleeding could signal a complication with the placenta and should be addressed right away.
Vaginal bleeding during pregnancy
The American Congress of Obstetricians and Gynecologists (ACOG) has specific recommendations for women depending on prepregnancy weight and other factors. Talk with your doctor about your weight and body mass index (BMI) before getting pregnant to find out how much weight you should aim to gain throughout your pregnancy.
Poor nutrition; being underweight or obese before pregnancy; or not gaining enough weight during pregnancy
A number of fetal conditions can increase the likelihood of preterm birth. In some cases, doctors may determine that late preterm birth or early term birth is necessary or beneficial to reduce the risk of harm to the baby.
Diagnosed abnormalities in the fetus
Research shows that fertility treatments involving hormonal stimulation can increase the risk of preterm birth. One study found that women who conceived through fertility treatments, such as in vitro fertilization, had a 53 percent greater risk of preterm delivery—and the increased risk was not related to the higher rates of multiples associated with fertility treatments.
Pregnancy conceived via in vitro fertilization
05
The risk of delivering preterm goes up if you become pregnant again too soon after a previous pregnancy. Research shows there is an estimated 20 percent increased risk of preterm birth when moms conceive between six and 12 months of a previous birth. If moms conceive within six months of a previous birth, there is a 50 percent increased risk of delivering preterm. Experts suggest waiting at least 18 months after giving birth before getting pregnant again.
Interval of less than 12 months between pregnancies
04
One out of every two twins are born preterm or with low birth weights (defined as less than 5 pounds, 8 ounces), and nine out of 10 triplets are born preterm or with low birth weight.
Pregnant with multiples
03
As soon as you find out you’re expecting, seek out a qualified ob-gyn to ensure you get the best support possible, as early as possible. Regular prenatal care visits—which should include medical, genetic and nutritional guidance, along with prenatal screenings to evaluate baby’s ongoing development—are the most effective way for doctors to identify and minimize problems during your pregnancy.
Delayed or lack of prenatal care
02
You are two times more likely to have a preterm birth if you have had a preterm delivery in the past.
Previous preterm labor or preterm birth
Oliver-Williams, C., Fleming, M., Wood, A., & Smith, G. (2015). Previous miscarriage and the subsequent risk of preterm birth in Scotland, 1980–2008: a historical cohort study. Bjog, 122(11), 1525–1534. http://doi.org/10.1111/1471-0528.13276
• Being African-American: The preterm birth rate among African-American women in the US is 13 percent, nearly 50 percent higher than the rate among white women. • A history of multiple miscarriages or abortions: Studies show that women who have had three or more miscarriages have the greatest risk of preterm birth. Check out more risks in detail at right.
NIH, Eunice Kennedy Shriver National Institute of Child Health and Human Development, “What are the risk factors for preterm labor and birth?” Web. [cited July 27, 2017] https://www.nichd.nih.gov/health/topics/preterm/conditioninfo/Pages/who_risk.aspx
Khashan AS, Baker PN, Kenny LC: Preterm birth and reduced birthweight in first and second teenage pregnancies: a register-based cohort study. BMC Pregnancy and Childbirth. 2010, 10(1):10-36. DOI: https://doi.org/10.1186/1471-2393-10-36
These risk factors include: • Being younger than 18 years old or older than 35 years old: Researchers speculate teens have a higher risk because they may not have sufficient prenatal care and education, while women over 35 are more likely to have health conditions such as high blood pressure, which may cause complications that result in preterm birth.
What’s more, it’s also possible to deliver preterm without having any identifiable risk factors. But since these factors have been shown to increase the chances of a preterm birth, it’s crucial to talk honestly with your doctor about your medical history and do whatever you can to reduce your risk.
Though experts haven’t identified a surefire way to predict preterm birth, they’ve found that certain circumstances make it more likely to occur. Keep in mind: Having a risk factor or two doesn’t guarantee baby will be born early.
Are You At Risk?
http://www.marchofdimes.org/pregnancy/what-is-full-term.aspx https://www.ncbi.nlm.nih.gov/books/NBK349423/ http://www.who.int/mediacentre/factsheets/fs363/en/ http://www.marchofdimes.org/complications/premature-babies.aspx http://www.acog.org/Patients/FAQs/Preterm-Premature-Labor-and-Birth#is
<28
extremely preterm
28-31
very preterm
moderately to late preterm
32-36
37-38
early term
39-40
full term
late term
>42
post term
Baby is as big as a head of lettuce. The lungs have started to make surfactant, a substance that will help her breathe. If baby were to arrive now, she would require a long stay in the NICU.
Week 27
Baby is the size of a cantaloupe. The lungs are continuing to develop, but they’re not mature enough for baby to breathe on her own yet. This is generally when baby is considered viable to live outside of the womb (though some even younger preemies have survived). But if she were to be born now, she would require an extensive stay in the neonatal intensive care unit (NICU).
An ultrasound should be able to detect if you’re carrying a boy or girl. If it’s a girl, her uterus is fully formed. If it’s a boy, his testicles have started to descend from the abdomen. Baby’s body has developed a waxy exterior coating called vernix, which protects baby’s sensitive skin from the amniotic fluid.
Week 20
Week 31
Baby’s brain is making new neural connections every day and is able to process signals from all five senses and regulate her body temperature. A birth now would require a stay in the NICU.
Baby can now suck, cough, hiccup, take practice breaths, and open and close his eyes. But at just 2.5 pounds (the size of an acorn squash!), baby will triple his weight before making a full-term debut. As baby continues to put on fat, be sure to eat nutritiously. If baby were to arrive now, he would likely need a couple of months in the NICU.
Week 29
Week 35
Baby is as big as a pineapple and weighs about 5.3 pounds, and her hearing has fully developed. She won’t get much longer, but she’ll keep plumping up until she’s born. An arrival now would still require special medical care.
Baby continues to add fat to his body and is now the size of a head of celery. His lungs and immune system continue to develop. If he were to be born now, he would require a stint in the NICU.
week 33
This is the sweet spot!
week 38
Baby may weigh 6 to 7 pounds this week (as big as a winter melon), and her head may have dropped into your pelvis in advance of birth. But she’s still not quite ready to be born: Baby is busy shedding the vernix that protected her skin in utero, and her lungs are still producing surfactant to help her breathe when the time comes.
Though giving birth now is considered early term, it’s not ideal for baby to arrive just yet. Baby is still accumulating fat, and the brain, lungs and liver could still use more time to develop in the womb.
week 37
If the bay hasn't arrived by 42 weeks, your doctor may suggest inducing labor.
week 40
You’ve reached your due date! Baby is likely the size of a watermelon. At full term, his organs and systems should have developed enough for him to function fully in the outside world.
Baby is full term and nearly ready to be born. But unless you’re experiencing complications or are carrying multiples, don’t try to induce labor. Wait for baby’s cue.
week 39
Because of baby's extra time in the womb, she'll likely be heavier and more alert at birth than a baby born earlier would be. Don’t worry about being late, plenty of moms-to-be go past their due date and everything turns out just fine.
week 41
You’re officially post term. But don’t worry, 98 percent of babies emerge by the end of week 42. Because pregnancy risks increase this late in the game, your doctor may recommend a medical labor induction if tests show it isn’t safe for baby to stay in utero much longer.
week 42
29 Office on Women’s Health, U.S. Department of Health and Human Services. Stages of Pregnancy. May 10, 2017. Web. [cited July 27, 2017] https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/stages-pregnancy
>28
extremely term
Click through the timeline to see baby’s in utero milestones.
Every Week of pregnancy matters
Below, read tips from moms who’ve been there, then hear from a few other moms here.
https://www.cdc.gov/mmwr/volumes/65/wr/mm6539a3.htm
VACCINES
Plan. Prep. Protect. by
Canadian researchers are studying a vaccine that targets gut bacteria associated with gastrointestinal disorders in children with autism. The vaccine is intended to control the constipation and diarrhea linked to that bacteria. So far it’s only been tested in animals, and while it may take another decade to get through human trials—and even longer before a drug is ready for market—scientists believe this is a significant step.
A vaccine to help tummy troubles in autistic kids
Researchers at the University of Missouri School of Medicine recently identified a naturally occurring protein that, when added to the flu vaccine, may offer protection to infants—particularly during those first six months when babies are still too young for the flu shot. While more research is needed, the result could be a flu vaccine that would be particularly important for premature or other high-risk babies.
A flu vaccine for the tiniest and most vulnerable
Scientists are looking at the medication currently used to help protect against RSV—respiratory syncytial virus, which can cause severe lung infections—to evaluate whether it’s safe to give to pregnant mothers in the third trimester. This pre-treatment could pass immunity to babies in utero.
A new way to protect infants' lungs
Japanese researchers at Osaka University have created a dissolvable patch to administer flu vaccines. Tiny (and painless!) cone-shaped micro-needles quickly penetrate the top layer of skin, administering the vaccination as they dissolve into the body. The patch can be discarded after just a few minutes. Because it can be administered by anyone—no doctor or nurse needed—and can reduce needle-related risks, researchers are optimistic about the patch helping to increase vaccination rates in developing countries. Learn More
A patch that could replace the needle
Major childhood vaccines are doing their job (huzzah!) and the CDC only makes occasional minor tweaks to the recommended schedule. But researchers are always on the hunt for ways to improve the formulation and delivery method (see ya, scary needles) of current vaccines, particularly the flu shot, which doesn’t offer 100 percent protection. Read on for some exciting projects in the works.
What’s Next: The (Near) Future of Vaccines
Kentucky: .9 percent of kindergartners are unvaccinated due to exemptions.
West Virginia: .2 percent of kindergartners are unvaccinated due to exemptions.
Vermont: 5.7 percent of kindergartners are unvaccinated due to exemptions.
Oregon has the highest number of unvaccinated kindergartners—with 6.3 percent claiming exemptions.
New York: .9 percent of kindergartners are unvaccinated due to exemptions.
Mississippi: Less than .1 percent claim any exemption, making it the state with the highest level of vaccination among kindergartners.
Louisiana; .8 percent of kindergartners are unvaccinated due to exemptions.
Idaho: 6.1 percent of kindergartners were unvaccinated due to exemptions.
Arizona: 4.7 percent of kindergartners are unvaccinated due to exemptions.
Alaska: 5.9 percent of kindergartners are unvaccinated due to exemptions.
Alabama: .8 percent of kindergartners are unvaccinated due to exemptions.
Religious and philosophical exemptions allowed
No religious or philosophical exemptions are allowed
Religious exemptions allowed
Eighteen states currently allow exemptions for those who object to immunizations because of philosophical, personal or conscientiously held beliefs.
As of 2016, all US states allow a religious exemption to vaccination except California, Mississippi and West Virginia.
All 50 states allow medical exemptions—for example, for those undergoing cancer treatment or who had an organ transplant and can't tolerate a vaccine at this time; or people who have an allergy to the vaccine or its ingredients.
philosophical exemptions
religious exemptions
medical exemptions
Click the icons to read more about the exemption
types of exemptions
Keep in mind that states have different policies on how to deal with these exemptions during a disease outbreak, epidemic or medical emergency. Some will require unvaccinated students to stay home from school, and some might stop recognizing exemptions during that time.
While every state in the US has legislation requiring specified vaccines for students and allows medical exemptions, some let parents choose not to vaccinate based on religious or philosophical beliefs. Check out the map below to see what is (and isn’t) allowed where you live—and find out which states had the highest and lowest vaccination rates for US kindergartners in the 2015-2016 school year. You might be surprised!
The state of vaccination across the 50 states
Median percentage of American kindergartners who are unvaccinated due to nonmedical exemptions.
1.6
During the few seconds after the injection, before the pain sets in, try singing, clapping, cheering or offering a toy or pacifier. Capturing baby's attention can help him quickly forget the discomfort, Harrington says.
Offer a cool or warm washcloth. “Placing a compress—cool in summer or warm in winter— on the vaccinated area can help ease pain,” Harrington says.
(You can also try nursing baby while he’s getting the shot.) “Beyond the sugar aspect, nursing is comforting for baby,” Harrington says. If you aren't nursing, you can give a bottle of formula (which also has sugar, just not as much), or offer a pacifier, since many infants find sucking to be soothing.
The sugar in breast milk can help blunt pain receptors, Harrington says.
Use the art of distraction
Offer a cool or warm washcloth
Consider nursing baby immediately after the shot
Swaddle baby as soon as the shot is over and gently sway from side to side. Keep shushing! It’s all about layering the techniques until you find out what works, says Harrington, who led the study.
Offer soothing shushing sounds while the needle is being prepped and during the shot.
Hold baby so she's resting comfortably on her side in your arms (or you can hold her upright so her stomach is against your chest and shoulder).
Swaddle baby
Offer soothing shushing sounds
Hold baby
While there’s no way to make those needle sticks 100 percent pain free, there are things you can do to help minimize baby’s discomfort during and after the shot. Harvey Karp, MD, FAAP, developed the famous five S’s—swaddling, side/stomach position, shushing, swinging and sucking—to help put baby at ease. According to a recent study, babies whose caregivers used these appeared to experience less pain and distress. Follow these steps at baby's next vaccination:
How to Make Vaccines Easier on Everyone
The first chickenpox (varicella) vaccine is released in the U.S. Countless kids miss out on the funny rite of passage of wearing oven mitts to prevent scratching.
1995
Polio is declared eliminated from the Americas. Hurrah! It’s eradicated from Europe in 2002...which is really not that long ago, if you think about it. We still have clothing from that era.
1994
The first vaccine against Hib, Haemophilus influenzae type b, is released. Big name, huge deal: This used to be one of the biggest causes of bacterial infection in children and led to diseases such as meningitis, bloodstream infections, pneumonia and more.
1985
The first vaccine for influenza is approved for military use in the US. A year later, it's approved for civilians. Fast- forward to the 21st century, when you can get the flu shot at many local drug stores—who’d a thunk it?
1945
Mary Mallon, an Irish immigrant working as a cook in New York City, is dubbed “Typhoid Mary” by the New York American. Despite never getting the disease herself, Mallon will be officially blamed for 10 outbreaks leading to 51 cases of typhoid fever (including three deaths).
1909
Pasteur successfully treats rabies in a human, kicking off a vaccine boom that lasts until the 1930s. Scientists are on a roll, developing antitoxins and vaccines against diphtheria, tetanus, anthrax, cholera, plague, typhoid, tuberculosis and more.
1885
President Lincoln may have contracted smallpox, but it doesn't let it stop him from delivering the Gettysburg Address.
1863
English physician Edward Jenner has the brilliant idea to use cowpox material to immunize an 8-year-old boy to the dreaded smallpox. It works!
1796
French chemist and microbiologist Louis Pasteur develops the first lab-made vaccine: It protects chickens from cholera.
1879
The US forms the National Vaccine Agency—James Smith, a physician from Baltimore, is appointed the National Vaccine Agent. Smallpox vaccines can be sent through the mail, and the US Post Office is required to carry mail weighing up to 0.5 ounces for free if it contained smallpox vaccine material. (Makes you wonder how many got lost in the mail.)
1813
The Chinese inoculated against smallpox by slicing open a healthy person's skin and rubbing in powdered smallpox scabs or fluid from an infected person. Doesn’t a needle jab sound a lot better by comparison?
Around 1000 CE
11 Little-Known Facts About Vaccines: A Timeline
Vaccinations against certain communicable diseases are required for entry to public schools, daycares and most private schools in all 50 states. But every state has medical exemptions and some states allow exemptions for religious or philosophical reasons—see our map for more details on the rules in your area. That said, remember that “vaccines are about saving lives,” Harrington says. Not only are you taking steps to protect baby, you’re also protecting other children, particularly those who can’t be vaccinated (like very young infants, cancer and transplant patients, or those with compromised immune systems).
1. Are vaccines required or just suggested?
No. The American Academy of Pediatrics, CDC, World Health Organization and the Institute of Medicine all agree that there’s no connection between autism and vaccinations. Need more evidence? More than 200 medical articles show no causal relationship between vaccines and autism, Harrington says. One of the reasons vaccines got a bad rap has to do with thimerosal, the mercury-containing preservative used in some multi-dose childhood vaccines until 2001. There were concerns that this preservative could cause negative side effects including autism, and those worries snowballed out of control. But according to the CDC, there’s never been any evidence of a link between autism and thimerosal. (In fact, autism rates continued to increase after thimerosal was removed from vaccines.) “The preservative was removed from all vaccines back in 2001, with the exception of multi-dose vials of influenza,” Harrington says. When it comes time for baby’s flu shot, not to worry, though—there’s a thimerosal-free version of that vaccine you can ask your doctor for.
2. Once and for all, do vaccines cause autism?
Baby will likely be exposed to many more viruses in the supermarket, mall and even the doctor's waiting room than the five to seven antigens (those are what trigger the body to produce antibodies) they get in their vaccines, Harrington says. Unfortunately, some parents still decide to delay vaccines, placing their children at risk during the critical time when they need to be protected. “I tell parents that delaying vaccines is like wearing a seatbelt just some of the time,” Harrington says. For parents who are still nervous, the schedules do allow for a little wiggle room so you can space out the shots, says Candice Robinson, MD, MPH, a medical expert with the CDC. Many vaccines can be given within windows of time that the CDC has determined to still be safe and effective. (For example, the second dose of Hep B can be given at 1 or 2 months; the third Hep B shot can be given anywhere between 6 and 18 months.) But you should never deviate from that recommended CDC timeline, Robinson says.
3. Can giving multiple vaccines at once take a toll on baby's immune system?
Different states have different protocols on who can administer vaccines. In some states, physicians' assistants, nurses and pharmacists can give the shots. (Doctors can give the shots too, but rarely have time.) Some states require every person who administers a vaccine to receive special certification; others don't. You can ask the person administering the shot if she's been certified if you want, and you can also ask to speak to a nurse or doctor if you're uncertain. Keep in mind that every person administering the shot has been trained to handle adverse reactions, Harrington says.
4. Who administers vaccines?
The most common side effect of vaccines is mild: redness and swelling around the injection site that goes away within a few days or a few hours. (Treating the area with a cool, wet cloth can help.) Mild fevers can also occur later that day. Serious side effects, such as severe allergic reaction, are very rare. Your doctor will likely go over symptoms to look for, and the CDC has an extensive fact sheet listing possible side effects from all recommended childhood vaccines. If you notice anything that concerns you after the shot (like a high fever or extreme fussiness), call your pediatrician.
5. Are there potential side effects I should be on the lookout for?
To bust the most common myths and clear up confusion about childhood vaccines, we talked to John Harrington, MD, a pediatrician in Norfolk, Virginia. (Feel free to run these questions by your own doctor for extra reassurance.)
The Top 5 Questions to Ask Your Doctor About Vaccines
Click to discover more
Month 12
Month 6
Month 4
Month 2
At Birth
Month 1
Hep B: This is the first of three shots.
Hep B: Second of three doses.
RV: First of three doses. DTaP: First of five doses, with the last dose given between 4 and 6 years. Hib: First of four doses. PCV: First of four doses. IPV: First of four doses, with the last dose given between 4 and 6 years. (Hep B: If not already given at one month, this second dose can be given now.)
RV: Second of three doses. DTaP: Second of five doses. Hib: Second of four doses. PCV: Second of four doses. IPV: Second of four doses.
Hep B: Final dose. (That's the typical schedule, but according to CDC guidelines, the final dose could be given as late as 12 or even 18 months.) RV: Third of three doses. DTaP: Third of five doses. Hib: Third of four doses. PCV: Third of four doses. IPV: Third of four doses (it can be given between 6 and 18 months, per the CDC). Influenza: Given yearly as early as 6 months old. (Children 6 months to 8 years old receiving the vaccine for first time will receive two doses four weeks apart, which means you’ll need two separate appointments.)
Hib: Fourth of four doses. (It can be given at 15 months instead if you prefer, per the CDC.) PCV: Fourth of four doses. (It can be given at 15 months instead if you prefer, per the CDC.) (IPV: If not already given at 6 months) (Hep B: If not already given at 6 months) MMR: First of two doses, with the last dose given at 4 to 6 years. It can be given at 15 months if desired. Varicella: First of two doses, with the last dose given at 4 to 6 years. It can be given at 15 months if desired. Hep A: First of two doses should be given between 12 months and 23 months of age, with the second dose given 6 to 18 months later.
Protects against Hepatitis B, which can cause liver infection or failure.
Hep B
Protects against Rotavirus, which can cause severe, life-threatening diarrhea.
RV
This combined vaccine protects against three serious diseases: diphtheria, tetanus (lockjaw) and pertussis (whooping cough).
DTaP
Protects against a strain of influenza called Haemophilus influenzae type B, which can cause meningitis.
Hib
Protects baby against the pneumococcus virus, which is easily spread and can become very serious.
PCV
Protects against polio, a crippling and potentially fatal infectious disease.
ipv
Prevents the most common strains of the flu each year.
Influenza
MMR
Protects against measles, mumps and rubella (German measles).
Protects against chickenpox.
Varicella
Protects against Hepatitis A, which can cause liver failure.
Hep a
What the Vaccines Are For:
Check out the CDC-recommended timeline below to see what vaccinations to expect when—and learn more about what these shots are protecting baby against.
When to Get Baby Vaccinated
Average number of vaccinations baby gets over the first 12 to 15 months.
20+
That’s a 15 percent increase from 2013—partly because of people refusing to get vaccinated.
But we get that you may still have concerns about these vaccinations, what they do, what's in them and when baby really needs them. We’re here to help you separate fact from fiction, and share tips and advice that’ll make the process a little easier on both you and baby.
Number of cases of pertussis (whooping cough) reported to the Centers for Disease Control and Prevention (CDC) in 2015.
20,762
And don’t forget, this works both ways. When people choose not to vaccinate, they put their children—and everyone around them—at risk. Case in point: the measles outbreak at Disneyland that began in December 2014. Of the more than 100 cases of measles that stemmed from the theme park, about half occurred in people who were unvaccinated or not fully vaccinated (at least 28 people were intentionally unvaccinated), and at least 12 of the cases were in infants who were too young to be vaccinated. Despite the fact that measles was said to be eliminated in the US in 2000 (meaning the majority of people had been vaccinated against the highly contagious disease), when people stopped vaccinating, it easily resurfaced. In 2014 alone, there were 667 cases of measles reported across the country, which was the greatest number of cases in the US in 14 years. Fortunately, in 2016, the number of cases went down to 70.
Number of measles cases in 2016.
70
You made it through nine months of doctor visits, with seemingly constant tests and screenings—congrats! Now it’s baby’s turn, and a big part of his or her checkups, especially over the first year, will involve immunizations. The recommended vaccination schedule for baby can seem overwhelming: With so many shots in a short amount of time for such a tiny person (ouch!), you might be worried about potential side effects or the scary myths you may have heard. But there’s no reason to be. Countless studies show vaccines are not only completely safe for baby, they remain your best strategy to protect her against future illness and pain.
Beyond your own family's health, getting baby vaccinated also helps the rest of the community by building up what scientists call “herd immunity.” When most of a population is vaccinated against an infectious disease, it’s hard for it to spread. So even those who can't get vaccinated (like very young infants or people with compromised immune systems) are offered some measure of protection.
the new parents' guide to vaccines for baby
Number of hospitalizations vaccinations will prevent among children born in the last 20 years
MILLION
