<ul class="summary-list"><li>Folate deficiency symptoms can include tongue inflammation, mouth sores, and fatigue.  </li><li>You may be at a greater risk of folate deficiency if you are pregnant, or have Chrohn's disease or celiac disease. </li><li>To get more folate, you should eat more leafy greens in your diet and consider taking a <keyword id="144540" type="PERSON" weightage="60" keywordseo="folic-acid">folic acid</keyword> supplement. </li><li>This article <strong>was <a href="https://www.insider.com/insider-medical-review-board" target="_blank" rel="noopener">medically reviewed</a></strong> by <a href="https://www.samanthacassetty.com/" target="_blank" rel="noopener">Samantha Cassetty</a>, MS, RD, <keyword id="52652" type="ORGANIZATION" weightage="60" keywordseo="nutrition">nutrition</keyword> and wellness expert with a private practice based in New York City.</li></ul><p><a href="https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/" target="_blank" rel="nofollow noopener sponsored">Folate</a>, also called B9, is an essential B vitamin that our bodies use to form DNA and produce red blood cells. A folate deficiency can cause symptoms like weakness and headaches to depression and decreased nerve functioning.</p><p>Here's everything you need to know about folate deficiency, from recognizing the signs and symptoms to finding the right treatment plan.</p><h2>What does folate do? </h2><p>Folate helps with a series of tasks across the body. </p><p>According to <a href="https://facultyexperts.jwu.edu/klingbeil-elizabeth.html" target="_blank" rel="noopener">Elizabeth Klingbeil</a>, PhD, RDN, LDN, an assistant professor in the department of nutrition &amp; dietetics at Johnson &amp; Wales University, folate's functions include: </p><ul><li>Formation of DNA </li><li>Breaking down protein so it can be utilized by the body </li><li>Brain functioning and development </li><li>Red blood cell production </li><li>Promoting proper fetal development </li></ul><h2>Signs and symptoms of folate deficiency </h2><p>Understanding the symptoms of a folate deficiency can help you and reach out to a doctor for diagnosis and treatment.  While symptoms may change over time as folate levels fluctuate, according to Klingbeil and <a href="https://www.rebeccarecommendsrd.com/" target="_blank" rel="noopener">Rebecca Guterman</a>, a dietitian in New York City, <a href="https://www.hsph.harvard.edu/nutritionsource/folic-acid/" target="_blank" rel="noopener">mild symptoms of folate deficiency</a> include:</p><ul><li>Tongue inflammation</li><li>Mouth sores</li><li>Fatigue</li><li>Weakness</li><li>Irritability</li><li>Headache</li></ul><p>According to Klingbeil, if a folate deficiency is left untreated, more severe symptoms can develop over time, including: </p><ul><li><a href="http://insider.com/what-is-depression" target="_blank" rel="noopener">Depression</a></li><li>Decreased nerve function </li><li>Developmental issues for a fetus if you are pregnant </li></ul><h2>Causes of folate deficiency </h2><p>Folate deficiency occurs when <a href="https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&amp;contentid=vitamin_b12_folate#:~:text=If%20the%20test%20is%20done,doesn't%20provide%20enough%20folatelate" target="_blank" rel="noopener">folic acid blood levels drop</a> below 2 ng/mL in blood plasma and 140 ng/mL in red blood cells. There are many factors that can cause folate deficiency, but it usually occurs when you do not consume enough folate in your diet. </p><p>Your <a href="https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/" target="_blank" rel="noopener">recommended daily intake</a> of folate depends on your age and other factors:</p><table style="height: 168px; width: 0%; border-collapse: collapse; border-style: ridge;" border="5"><tbody><tr style="height: 21px;"><th style="width: 20%; height: 21px; text-align: center;" scope="col">Age</th><th style="width: 20%; height: 21px; text-align: center;" scope="col">Male</th><th style="width: 20%; height: 21px; text-align: center;" scope="col">Female</th><th style="width: 20%; height: 21px; text-align: center;" scope="col">Pregnancy</th><th style="width: 19.8726%; height: 21px; text-align: center;" scope="col">Lactation</th></tr><tr style="height: 21px;"><td style="width: 20%; height: 21px; text-align: center;" scope="row">Birth to 6 months</td><td style="width: 20%; height: 21px; text-align: center;" align="right">65 mcg</td><td style="width: 20%; height: 21px; text-align: center;" align="right">65 mcg</td><td style="width: 20%; height: 21px; text-align: center;"> </td><td style="width: 19.8726%; height: 21px; text-align: center;"> </td></tr><tr style="height: 21px;"><td style="width: 20%; height: 21px; text-align: center;" scope="row">7–12 months</td><td style="width: 20%; height: 21px; text-align: center;" align="right">80 mcg </td><td style="width: 20%; height: 21px; text-align: center;" align="right">80 mcg</td><td style="width: 20%; height: 21px; text-align: center;"> </td><td style="width: 19.8726%; height: 21px; text-align: center;"> </td></tr><tr style="height: 21px;"><td style="width: 20%; height: 21px; text-align: center;" scope="row">1–3 years</td><td style="width: 20%; height: 21px; text-align: center;" align="right">150 mcg</td><td style="width: 20%; height: 21px; text-align: center;" align="right">150 mcg</td><td style="width: 20%; height: 21px; text-align: center;" align="right"> </td><td style="width: 19.8726%; height: 21px; text-align: center;" align="right"> </td></tr><tr style="height: 21px;"><td style="width: 20%; height: 21px; text-align: center;" scope="row">4–8 years</td><td style="width: 20%; height: 21px; text-align: center;" align="right">200 mcg</td><td style="width: 20%; height: 21px; text-align: center;" align="right">200 mcg</td><td style="width: 20%; height: 21px; text-align: center;" align="right"> </td><td style="width: 19.8726%; height: 21px; text-align: center;"> </td></tr><tr style="height: 21px;"><td style="width: 20%; height: 21px; text-align: center;" scope="row">9–13 years</td><td style="width: 20%; height: 21px; text-align: center;" align="right">300 mcg</td><td style="width: 20%; height: 21px; text-align: center;" align="right">300 mcg</td><td style="width: 20%; height: 21px; text-align: center;"> </td><td style="width: 19.8726%; height: 21px; text-align: center;"> </td></tr><tr style="height: 21px;"><td style="width: 20%; height: 21px; text-align: center;" scope="row">14–18 years</td><td style="width: 20%; height: 21px; text-align: center;" align="right">400 mcg</td><td style="width: 20%; height: 21px; text-align: center;" align="right">400 mcg</td><td style="width: 20%; height: 21px; text-align: center;" align="right">600 mcg</td><td style="width: 19.8726%; height: 21px; text-align: center;" align="right">500 mcg</td></tr><tr style="height: 21px;"><td style="width: 20%; height: 21px; text-align: center;" scope="row">19+ years</td><td style="width: 20%; height: 21px; text-align: center;" align="right">400 mcg</td><td style="width: 20%; height: 21px; text-align: center;" align="right">400 mcg</td><td style="width: 20%; height: 21px; text-align: center;" align="right">600 mcg</td><td style="width: 19.8726%; height: 21px; text-align: center;" align="right">500 mcg</td></tr></tbody></table><p>Some people are at increased risk of developing a folate deficiency. This includes women who are pregnant, as the fetus requires large amounts of folate to develop properly. That's why women who are trying to get pregnant should consider taking a folate-containing prenatal vitamin to prevent a deficiency that could harm their baby. </p><p>"Inadequate folate during pregnancy, especially during the first 28 days of development, is related to neural tube defects — such as <a href="https://www.mayoclinic.org/diseases-conditions/spina-bifida/symptoms-causes/syc-20377860#:~:text=Spina%20bifida%20is%20a%20birth,the%20tissues%20that%20enclose%20them." target="_blank" rel="noopener">spina bifida</a> or other neurological issues — in the developing fetus," says Klingbeil. </p><p>According to Guterman, other conditions that increase your risk of folate deficiency include: </p><ul><li>Alcoholism</li><li>Malnutrition </li><li>Celiac disease </li><li>Crohn's disease </li></ul><h2>Diagnosis</h2><p>If you suspect you have a folate deficiency, it's important to visit your doctor so they can confirm symptoms are not due to another deficiency or underlying <keyword id="6354750" type="UNKNOWN" weightage="100" keywordseo="health">health</keyword> problems. Additionally, Klingbeil strongly recommends speaking to your doctor if you're experiencing:</p><ul><li>Ongoing depression</li><li>Mental confusion</li><li>Fatigue</li><li>Diarrhea</li><li>Nerve problems</li></ul><p>Your doctor will order a blood test to confirm the deficiency. "Folate deficiency will most commonly present itself as megaloblastic anemia," says Klingbeil. A person with <a href="https://rarediseases.org/rare-diseases/anemia-megaloblastic/" target="_blank" rel="noopener">megaloblastic anemia</a> will produce structurally large, irregular, and immature red blood cells, also known as megaloblasts. Through a blood test, your doctor can determine if your red blood cells are megaloblasts or normal.</p><h2>Treatment </h2><p>Folate deficiency is often treated through dietary changes that increase the amount of folate-rich foods you consume. Foods <a href="https://www.hsph.harvard.edu/nutritionsource/folic-acid/" target="_blank" rel="noopener">high</a> in folate include:  </p><ul><li>Broccoli </li><li>Chickpeas</li><li>Brussel sprouts</li><li>Leafy greens, such as cabbage and spinach</li><li>Peas</li><li>Whole grains</li><li>Eggs</li></ul><h3>Supplements </h3><p>Changes to your diet are generally the first step in remedying a folate deficiency. However, people who can not consume enough folate from food alone due to dietary restrictions or absorption issues may use supplements. Supplements contain <a href="https://www.hsph.harvard.edu/nutritionsource/folic-acid/" target="_blank" rel="noopener">folic acid</a> — the man-made version of folate which is more easily absorbed by the body. </p><p>"I advise individuals to not take a supplement that is over 100% of the recommended dietary allowance of folate to avoid vitamin toxicity," says Klingbeil. The <a href="https://www.hsph.harvard.edu/nutritionsource/folic-acid/" target="_blank" rel="noopener">upper limit intake of folate</a> is 1,000 mcg a day for adults. A medical professional can help you determine if you need a supplement, and what dosage you should be taking. </p><h2>Insider's takeaway</h2><p>Folate is a vitamin used for DNA formation, fetal development, and red blood cell production. Folate deficiency occurs when you consume less than your daily recommended intake of 400 mcg, and causes symptoms like headaches, weakness, and mouth sores. It can be treated by increasing your intake of folate-rich foods or taking a supplement.</p><h2>Related articles from <a href="https://www.insider.com/health-reference" target="_blank" rel="noopener">Health Reference</a>:</h2><ul><li><strong><a href="https://www.insider.com/is-spicy-food-good-for-you" target="_blank" rel="noopener">Is spicy food good for you? 5 proven health benefits of eating spicy food regularly</a></strong></li><li><strong><a href="https://www.insider.com/celery-juice-benefits" target="_blank" rel="noopener">Many health claims about celery juice are false — here are 4 proven benefits backed by science</a></strong></li><li><strong><a href="https://www.insider.com/zinc-deficiency" target="_blank" rel="noopener">Zinc deficiency: symptoms, causes, and treatments</a></strong></li><li><strong><a href="https://www.insider.com/saturated-vs-unsaturated-fat" target="_blank" rel="noopener">Saturated vs. unsaturated fat: why nutritionists say unsaturated fat is healthier </a></strong></li><li><strong><a href="https://www.insider.com/magnesium-deficiency" target="_blank" rel="noopener">How to recognize the symptoms of magnesium deficiency and effectively treat it</a></strong></li></ul>

How to recognize the signs and symptoms of folate deficiency and effectively treat it

<ul class="summary-list"><li>The US <keyword id="135040" type="PERSON" weightage="60" keywordseo="birth-rate">birth rate</keyword> decreased 4.4% in one year, per data CBS cited from December 2020.</li><li>Experts say the dwindling births indicate we're struggling financially, physically, and mentally.</li><li>Pregnant people still fear hospitals and families are too tight on money to have <keyword id="6415538" type="UNKNOWN" weightage="60" keywordseo="babies">babies</keyword>.</li></ul><p>Despite a year where most people stayed cooped up at home due to the coronavirus <keyword id="43587" type="ORGANIZATION" weightage="60" keywordseo="pandemic">pandemic</keyword>, a much-anticipated baby boom never happened.</p><p>According to <a href="https://www.cbsnews.com/news/birth-rate-declining-baby-bust-covid-pandemic/">data from 28 state health departments</a> compiled by CBS News, the US birth rate declined 4.4% between December 2019 and December 2020 - the equivalent to 95,000 fewer births.</p><p>Birth rates have been on a <a href="https://www.insider.com/jaw-dropping-decline-global-fertility-rates-lancet-demographic-time-bomb-2020-7">steady decline in recent years</a>, but the latest numbers are a stark comparison to March 2020 predictions that extra time spent at home would result in more baby-making.</p><p>"There's so much video calling going on that the babies conceived during the coronavirus pandemic should be called 'Baby Zoomers,'" one <a href="https://twitter.com/ThatBShar/status/1240701836132155393?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1240701836132155393&amp;ref_url=https%3A%2F%2Fpublish.twitter.com%2F%3Fquery%3Dhttps%253A%252F%252Ftwitter.com%252FThatBShar%252Fstatus%252F1240701836132155393%26widget%3DTweetweet">Twitter user mused</a> at the time.</p><p>The opposite has occurred. Experts say it's likely due to pandemic-related financial, physical <keyword id="6354750" type="UNKNOWN" weightage="100" keywordseo="health">health</keyword>, and mental health stressors.</p><p>As a result, experts say, the US and much of the world could experience a demographic time bomb, where babies aren't being born at a high enough rate to replace the existing population. It's a trend that <a href="https://www.insider.com/us-fertility-rate-dropped-fourth-year-row-demographic-time-bomb-2019-11">public health experts have worried about for years</a> because it could impact countries' economies, resource distribution, and workforce potential.</p><h2>'The birthrate is a barometer of despair'</h2><p>The lack of pandemic babies offers insight into the state of the world right now.</p><p>"The birthrate is a barometer of despair," Dowell Myers, a demographer at the University of Southern California, <a href="https://www.npr.org/2019/05/15/723518379/u-s-births-fell-to-a-32-year-low-in-2018-cdc-says-birthrate-is-at-record-level">told NPR</a> in 2019. "Not a whole lot of things are going good and that's haunting young people in particular, more than old people."</p><p>For the average person, the pandemic has exacerbated existing problems with <a href="https://www.insider.com/coronavirus-baby-boom-rich-famous-celebrity-pregnancy-2020-5">financial stress</a>, fears of falling ill to a deadly virus, and mental health issues like anxiety and depression.</p><p><a href="https://www.businessinsider.com/us-weekly-jobless-claims-labor-market-unemployment-filings-recession-coronavirus-2020-4">Record-breaking rates of unemployment</a> due to the pandemic are only solidifying feelings of financial insecurity for those who might otherwise want children. (Even the ability to hold off on having a child is a privilege: <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835625/">those who have limited or no access to birth control or abortion</a> are often forced into these positions even if they can't afford or want them.)</p><p>In a <a href="https://modernfertility.com/modern-state-fertility-2020-sofi-career-money?clickid=RRowInRqMxyORQRwUx0Mo38VUkiwMZRNI0jeQw0&amp;utm_source=Impact&amp;utm_medium=10079&amp;utm_campaign=Online%20Tracking%20Link&amp;irgwc=1#takeaway-1gwc=1#takeaway-1">survey</a> of more than 1,000 women from personal finance company SoFi and reproductive health company Modern Fertility, one-third said the pandemic influenced their family-planning decisions. 61% said they were more anxious about their ability to support children at this time, with 41% specifically citing financial reasons.</p><p>According to the USDA, its <a href="https://www.usda.gov/media/blog/2017/01/13/cost-raising-child">costs an average of $233,610 to raise one child,</a> and that doesn't include the cost of higher education from a university, which is an extra $20,000 to $40,000 on average.</p><h2>Pregnant people still fear COVID-19 in hospitals</h2><p>Others are concerned about the health risks of a pregnancy during the pandemic.</p><p>27% of respondents from the SoFi survey said they're delaying their pregnancies because they're worried they'll get COVID-19, and 22% are worried their partner will get the disease. Meanwhile, nearly half of respondents said they're worried about access to prenatal care due to the coronavirus.</p><p>Haley Neidich, a 35-year-old therapist from Florida, told Insider that she <a href="https://www.insider.com/should-you-stop-trying-to-get-pregnant-during-coronavirus-2020-3">put her pregnancy plans on hold</a> due to her previous complicated pregnancy and need for careful and regular monitoring at doctor's offices. Neidich experienced a miscarriage in January while trying to conceive a second child. They decided they'd start trying again in March, but the pandemic curtailed that plan.</p><p>She also said the prospect of caring for her two-year-old daughter while carrying a high-risk pregnancy would be too much to handle right now, especially without the help of nearby family and friends she'd normally lean on.</p><p>Experts are unsure if sharp decline in births is a <a href="https://www.cbsnews.com/news/baby-bust-declining-birth-rate-covid-pandemic/">trend that's pandemic-specific</a>, or one that will continue even when the global health crisis ends.</p><p>"We don't know if it's the beginning of a bigger decline over the whole next year or if it's just a shock from March," Phil Cohen, a sociologist at the University of Maryland, told <a href="https://www.cbsnews.com/news/baby-bust-declining-birth-rate-covid-pandemic/">CBS News</a>. "But I'm more inclined based on history to think that all of next year is going to be very much down for births."</p>

US birth rates just plummeted to their lowest since the baby boom era

By Payal Banerjee <p>New Delhi, Apr 13 () The Indian Council of Medical Research on Monday said the emerging evidence suggests that transmission of coronavirus from mother to baby before birth or during delivery is possible although the proportion of pregnancies affected and the significance to the neonate is yet to be determined.</p><p>The apex health research body also said there are no recorded cases of breast milk being tested positive for COVID-19 at present, and no data suggesting an increased risk of miscarriage or early pregnancy loss in relation to the disease.</p><p>"...Emerging evidence now suggests that vertical transmission (from mother to baby antenatally or intrapartum) is probable, although the proportion of pregnancies affected and the significance to the neonate has yet to be determined," it said.</p><p>However, it is unknown whether newborns with COVID-19 are at an increased risk for severe complications and transmission after birth via contact with infectious respiratory secretions is a concern, the ICMR said.</p><p>In a guidance for management of pregnant women during the pandemic, the apex body said hospitals should consider "temporarily separating" (separate rooms) the mother, who has COVID-19 or is a suspected case, from her baby until the mother's transmission-based precautions are discontinued.</p><p>"Also, there is no evidence currently that the virus is teratogenic (causing developmental malformations). Long-term data is awaited," the ICMR said.</p><p>It clarified pregnant women do not appear more likely to contract the infection than the general population. "However, pregnancy itself alters the body's immune system and response to viral infections in general, which can occasionally be related to more severe symptoms and this will be the same for COVID-19".</p><p>In other types of coronavirus infection(SARS, MERS), the risks to the mother appear to increase in particular during the last trimester of pregnancy. There are case reports of preterm birth in women with COVID-19 but it is unclear whether the preterm birth was always iatrogenic, or whether some were spontaneous. </p><p>Pregnant women with heart disease are at highest risk (congenital or acquired), the ICMR said, adding the coronavirus epidemic increases the risk of perinatal anxiety and depression, as well as domestic violence.</p><p>"It is critically important that support for women and families is strengthened as far as possible; that women are asked about mental health at every contact," it said.</p><p>The guidance states that the obstetric units should ensure appropriate isolation of pregnant patients who have confirmed COVID-19 or are under investigation.</p><p>Healthcare providers should create a plan to address the possibility of a decreased workforce, potential shortage of personal protective equipment,limited isolation rooms, and should maximize the use of tele healthfor prenatal care.</p><p>ICMR said the guidance are based on the limited evidence available to date about transmission of the virus that causes COVID-19, and knowledge of other viruses that cause severe respiratory illness including influenza, severe acute respiratory syndrome coronavirus (SARS-CoV),and Middle East Respiratory Syndrome coronavirus (MERSCoV). </p>The recommendations are based on guidelines from international disease control agencies and publications and simplified for Indian context, the document stated.  PLB   NSD ABHABH

Transmission of coronavirus from mother to baby before birth, during delivery possible: ICMR

<ul class="summary-list"><li><keyword id="12062569" type="UNKNOWN" weightage="60" keywordseo="women-of-color" source="Orion">Women of color</keyword> experience racial disparities during <keyword id="6357793" type="UNKNOWN" weightage="60" keywordseo="pregnancy" source="Orion">pregnancy</keyword> and birthing.</li><li>Black women are twice as likely to have a stillbirth, and almost three times as likely to die of maternal causes.</li></ul><p>A nurse placed a purple blanket on Damali Stennette's legs and wheeled her out of the hospital. Stennette's swollen belly and breasts full of milk were indicators that she had just given birth. Yet, there was no baby to take home, just a purple blanket signifying her loss. </p><div type="image" title="Damali Stennette with the purple blanket, a marker of her loss" height="6000" width="3646" msid="92860760" hostid="261" sizebytes="853740"></div><p>Fatima, Stennette's daughter, was stillborn.</p><p>A few hours earlier, Stennette was writing thank you cards when she felt a tightening in her stomach and the baby's legs extending inside her belly. She immediately called her doctor's office. "I asked them if I should come in," Stennette said. "They were like, 'well if you want to.'"</p><p>Since the hospital staff didn't think it was a matter of urgent concern, she went about her day. But later that night, Stennette began to feel uneasy. She realized she hadn't felt her baby move since earlier that afternoon. </p><p>"I drank cold water, I ate a green apple and lay on my side, but I still didn't feel anything," she said. "My husband said, 'Let's go see the doctor.'"</p><p>At the hospital, staff still did not seem to be worried. "Everything's probably fine," Stennette recalled a nurse saying. </p><p>Stennette was taken to a triage room where a nurse probed for her baby's heartbeat. There was none.</p><p>Fatima was one of nearly<a href="https://www.cdc.gov/ncbddd/stillbirth/facts.html"> 24,000 stillbirths</a> that occur every year in the United States. Of that number, around 7,000 stillborn babies are born to Black mothers. Black women, like Stennette, are <a href="https://www.cdc.gov/ncbddd/stillbirth/features/kf-black-mothers-stillbirth.html">twice as likely</a> to have a stillbirth than white women. The COVID-19 pandemic further<a href="https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/maternal-mortality-rates-2020.htm"> exacerbated</a> the racial disparities women of color face in birthing. <a href="https://www.nytimes.com/2022/02/23/health/maternal-deaths-pandemic.html">Maternal deaths increased by 14 percent from 2019 to 2020</a>, disproportionately affecting Black and Hispanic women.</p><p>These disparities have forced many women of color to seek alternative models of care, including home-based midwifery and traditional postpartum care. </p><h2><strong>Midwives have historically been discredited</strong></h2><p>This shift is reflected in the deliveries in Stennette's home state of California. From 2007 to 2017, births attended by midwives in the state <a href="https://www.chcf.org/publication/californias-midwives/">rose by 213</a> percent, while the number of births assisted by doctors <a href="https://www.chcf.org/publication/californias-midwives/">decreased by 22.8</a> percent. </p><p>Despite this, many find midwifery to still be inaccessible. This is partially due to a history of undermining traditional forms of birthing care.</p><p>"Before the professionalization of obstetrics and gynecology, much of reproductive health care for women had been done by women," said Michele Goodwin, a professor at the University of California, Irvine. "There weren't men with white lab coats and stethoscopes riding around the plains of Africa or in what is today China or the Middle East."</p><p>In the early 1800s, a male-led movement began to discredit midwifery. At the time, most midwives were primarily Black and Indigenous women. Childbirth became a lucrative business with the development of surgery and tools like forceps that came through "<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727302/">research done</a> on the bodies of non-consenting Black women," Goodwin explained. </p><p>For many white lawmakers and healthcare workers, including physician <a href="https://britannica.com/biography/Walter-Channing">Walter Channing</a>, midwifery was rooted in "<a href="https://collections.nlm.nih.gov/bookviewer?PID=nlm:nlmuid-2545065R-bk">quackery and empiricism</a>." He wrote in 1820 that women could not be educated and had no "active power of mind." Channing was the first professor of obstetrics at Harvard University.</p><p>The movement against midwifery peaked in the early 20th century. "[Doctors] used the force of the legislatures … to craft laws and policies that would ultimately make it very difficult for midwifery to continue," Goodwin said. </p><p>In 1921, the<a href="https://history.house.gov/Historical-Highlights/1901-1950/The-Sheppard%E2%80%93Towner-Maternity-and-Infancy-Act/"> Sheppard-Towner Act</a> passed, which provided federal funds for maternity and childcare and was an important force in the medicalization of pregnancy. The law increased regulations on midwifery, ultimately pushing out Black and Indigenous midwives from their practices. </p><div type="image" title="Stennette's memory box of her stillborn daughter, Fatima" height="4000" width="5333" msid="92860761" hostid="261" sizebytes="678606"></div><h2><strong>The movement against midwifery continues to be felt today</strong></h2><p>This movement against midwifery has generational implications, as Stennette experienced firsthand. </p><p>Three months after her stillbirth, Stennette became pregnant again. She wanted a different birthing experience. However, she found that to be challenging to find in California, particularly in the city of Palmdale, where she lives.</p><p>In 2019, California had a total of<a href="https://www.chcf.org/publication/californias-midwives/"> 386 licensed midwives</a> — barely enough to attend to the approximately <a href="https://www.cdc.gov/nchs/fastats/state-and-territorial-data.htm">420,000</a> babies born in the state annually. Palmdale, a small city north of Los Angeles with a population of just over 150,000, has just one hospital that offers labor and delivery services. It was the same hospital where Stennette had her stillbirth. The city also had no licensed midwives. </p><p>"I didn't have an option out where I live," Stennette said.</p><p>Anxious, she turned to two friends in midwifery school for support. </p><p>"They're both Muslim, they're both Black," Stennette said. "I went to UCLA with them and felt super comfortable with them." </p><p>Her friends helped Stennette reframe questions and requests to her doctor during her second pregnancy. Stennette saw a maternal-fetal medicine specialist who sometimes pushed back on her demands.</p><p>"[My friend] would confirm what the doctors were saying, or say no, I think you should be able to have that if that's what you want," she said. </p><p>They also offered virtual emotional support when she gave birth to her second daughter, Leena, in August 2020. After the delivery, Stennette was wheeled out of the hospital with her baby in her arms. Leena wore a white romper with pink flowers — Fatima's going-home outfit.  </p><p>"It was very healing to breastfeed and wear my baby and do the things that I knew my body was supposed to do and that I wanted to do with my first child but I couldn't," Stennette said.</p><h2><strong>The importance of community</strong></h2><p>Having a support system helped ease Stennette through her second pregnancy. Tema Mercado, a licensed midwife at La Matriz Birth Services in San Diego, saw firsthand the impact support can have on postpartum when she visited a friend who had just given birth.</p><p>"It was the first time I heard somebody speak about their birth experience in a positive, beautiful manner," said Mercado.</p><p>That night, Mercado said she wondered why it was so rare for her to hear about happy birth experiences. That influenced her to enroll in midwifery school. </p><p>The concept of being a midwife was not foreign to Mercado. Her paternal grandmother delivered 13 children at home, sometimes with midwives and sometimes alone. On her maternal side, her nurse-midwife grandmother taught her traditional herbal remedies.</p><p>"When I would think about the enfermera parteras [nurse-midwifes] in my family, that seems so removed, like that wasn't an American thing," Mercado said.</p><p>That changed when she, herself, became a midwife. Today, Mercado said her Mexican culture and her grandmothers' ancestral wisdom informs the personalized prenatal and postpartum plans she offers.  </p><p>"I have had a lot of clients who have experienced postpartum depression with their first hospital deliveries and then go on to have much happier, fulfilling postpartum experiences," said Mercado. </p><p>One of the methods Mercado employs is to encourage clients to observe cuarentena — a 40 day lie-in period — after giving birth. Food is treated as medicine during this time. As the mother's body is in a cold state because of the loss of blood, the baby, and the placenta, Mercado teaches her clients to eat warm foods.</p><div type="image" title="Raeanne Madison breastfeeds her baby she birthed at home" height="877" width="1169" msid="92860762" hostid="261" sizebytes="41456"></div><h2><strong>A postpartum doula explains the purpose of a 40 day rest period</strong></h2><p>Adilah Yelton, a postpartum doula of Malaysian descent based in Texas, agrees with this practice. "Your body's trying to reheat itself and so the belief is to keep your body warm and not to overwork it," said Yelton.</p><p>In Singaporean and Malaysian culture, the mother is celebrated for 40 days postpartum. "People come to take care of the other children for you while you rest, bond and breastfeed your baby," she said</p><p>The new mother also enjoys massages, scalp treatments and body scrubs. Her swollen belly is tightly bound with a bengkung belly bind to help with abdominal support after giving birth. </p><p>Raeanne Madison, an Indigenous mother of the Ojibwe tribe, birth worker and community educator at Postpartum Healing Lodge, also observed the cuarentena period after birthing her daughter at home. </p><p>"Our ceremonies open the doorway between life and death and if we don't act properly in these spaces, people can get sick and even die," she said about the importance of postpartum care. "These first moments after birth begin to teach [newborns] about life here on Earth. Do we wish our babies to witness chaos, neglect, abuse and destruction? Or do we wish them to witness love, tenderness and immense care?"</p><p>Postpartum traditions in Native American culture are designed to honor the physiological as well as emotional needs of a mother, Madison says. Food is the foundation of her work. "Our grandmother says that no ceremony can begin until the kitchen fire is lit, and no ceremony is over until everyone who attended has been properly fed," she said.</p><p>Madison has observed a renewed interest in postpartum nourishment. She attributes the loss of traditions to factors such as boarding schools that targeted Native Americans resulting in the loss of land and languages. While she is keen on sharing her traditional knowledge, she is also cautious.</p><p>"I primarily work with Black, Indigenous, and people of color who are committed to reconnecting to their cultural lineage practices with integrity and honor," she said.</p><p>The 40 days of rest tradition is also reflected in religious belief systems. Drawing on Biblical texts, some Jewish women observe a 'niddah,' or lying-in period, after giving birth. Similarly, some Christians withdraw from daily life after giving birth, and in Islam, a woman is exempt from religious practices during bleeding postpartum.</p><div type="image" title="Damali Stennette with her second-born daughter, Leena" height="3006" width="4000" msid="92860763" hostid="261" sizebytes="457740"></div><h2><strong>Women say a resting period helps heal physically and emotionally</strong></h2><p>After the birth of her fourth child, Nilo Mea, a doula in the Bay Area honored her Islamic faith by observing 40 days of rest. </p><p>"Because I was at home, I didn't have any outside stressors coming in," Mea said. "I felt secure and supported in my needs that it didn't affect me mentally as it has with previous pregnancies."</p><p>On the fortieth day, Mea sought a sealing of the bones ceremony, which culminated with a tightly wound body wrap.</p><p>"It reminded me of how [Muslims] shroud the deceased," Mea said. "The doula leaves the room, and you have to sit in your feelings. This is a time for you to think about any traumas, process and let go."</p><p>Stennette said she also found comfort in her Islamic faith after her stillbirth. "Sometimes Allah [God] does something that gives us so much pain but we don't know the benefits it might have," she said. </p><p>She said she keeps Fatima's memory alive by reminding Leena about her big sister. "Even though her life was only inside me, it mattered," Stennette said. "She's still my daughter. She'll always be my daughter."</p>

In a post-Roe world, women of color continue a return to midwives and traditional forms of postpartum care

<ul class="summary-list"><li>Pregnant women with COVID-19 are more likely to be admitted into the intensive care unit, put on ventilators, need life support, and die than <keyword id="1754604" type="PERSON" weightage="60" keywordseo="coronavirus">coronavirus</keyword> patients who aren't pregnant, a CDC report found.</li><li>Racial disparities existed too, with pregnant Hispanic women more likely to contract COVID-19 and Black women with the illness more likely to experience serious complications, whether or not they were pregnant. </li><li>The findings add to past research showing COVID-19 can increase the risk of <keyword id="6357793" type="UNKNOWN" weightage="60" keywordseo="pregnancy">pregnancy</keyword> complications, though the overall risks are still low. </li></ul><p>Most pregnant women with COVID-19 fare well, but they are still at increased risk for serious complications when compared to nonpregnant women with the disease, a large <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6944e3.htm?s_cid=mm6944e3_w">report</a> out of the Centers for Disease Control and Prevention found. </p><p>The analysis looked at data from about 400,000 15- to 44-year-old women who had symptomatic COVID-19 between late January and early October. They found that pregnant women were more likely to be admitted into the intensive care unit, put on ventilators, need life support, and even die than those who weren't pregnant. </p><p>Specifically, pregnant women with COVID-19 were nearly four times as likely to need ventilation and twice as likely to die than nonpregnant women with COVID-19 of the same age. Still, their overall risks for complications were low: 1.5% of pregnant women went to the ICU, 0.29% needed ventilation, 0.07 required life support, and 0.15% died. </p><p>The findings demonstrate how important it is for pregnant women and their families to take coronavirus transmission measures seriously. They could also inform how healthcare systems treat pregnant COVID-19 patients. </p><h2>Women of color were disproportionately affected by COVID-19 and negative outcomes </h2><p>In 2019, 24% of pregnant women were Hispanic and 51% were white. In the current analysis, 30% of the COVID-19 positive pregnant women were Hispanic and only 24% were white. Like past research, this finding suggests people of color are disproportionately susceptible to contracting COVID-19. </p><p>The report illuminated other racial disparities too, with pregnant Asian and Native Hawaiian/Pacific Islander women seeming to be at disproportionate risk of ICU admission, and non-Hispanic Black women, whether or not they were pregnant, having higher rates of death from COVID-19.  </p><p>Marian Knight, the lead author <a href="https://www.businessinsider.com/half-pregnant-women-in-uk-coronavirus-black-ethnic-minorities-2020-6">of a UK study</a> that found more than half of pregnant women who were admitted to the hospital with COVID-19 were Black or from other minority ethnic groups, previously told Insider more qualitative research involving talking to women about their experiences is "urgently needed."</p><p>That work, she said, will help discern what puts pregnant women of color at such risk for COVID-19, be it household arrangements, jobs that make physical distancing difficult, restricted access to healthcare, something else, or all of the above. </p><h2>In contrast to past research, the findings suggest pregnant women with COVID-19 are more likely to die than nonpregnant women with the illness </h2><p>The current report had some limitations, mostly related to incomplete data. For instance, providers may be more inclined to report more serious outcomes and some serious outcomes may not yet be seen. </p><p>Pregnant people's increased risk for serious outcomes could also be related to how pregnancy affects the body, for example by increasing heart rate and oxygen consumption, decreasing lung capacity, dampening the immune system, and raising the risk for blood clots, the authors write.</p><p>But the large number of women studied adds to <a href="https://www.businessinsider.com/cdc-pregnant-women-increased-risk-for-severe-coronavirus-cases-hospitalization-2020-6">past research finding that pregnant women with COVID-1</a>9 are more likely to end up in the ICU and receive ventilation than nonpregnant women of the same age. It also finds pregnant women with COVID-19 are more likely to need life support and die than nonpregnant women, which past research didn't find. </p><p>pregnant women and their families should take precautions like limiting interactions with people who might have been exposed to the coronavirus, wearing a mask, practicing social distancing, frequently washing their hands, and staying up to date on their prenatal care visits, the authors write. </p><p>Because other research has shown pregnant women, whether or not they have COVID-19, are also <a href="https://www.insider.com/coronavirus-linked-high-rates-depression-anxiety-pregnant-women-new-moms-2020-6">at high risk for depressive and anxiety symptoms</a> during the pandemic, it's also critically important for them to seek support, whether from friends and family, online support groups, or a mental health provider. </p><p>"There are going to be a lot of emotions, some of which are sadness, grief and the unknown," Dr. Jane van Dis, an OB-GYN who serves as medical director at the telemedicine network <a href="https://www.mavenclinic.com/">Maven</a>, previously told Insider. "Just know that connecting with people who are there to support women is essential for mental health." </p>

CDC: COVID-19 is more likely to be serious or deadly in pregnant women than other women of the same age

<ul class="summary-list"><li>London-based YouTube star Nicole Thea died at 8 months pregnant along with her unborn child July 11. </li><li>The family said they believe the cause of death was a "massive heart attack." </li><li>In the UK, Black women are five times more likely than white women to die during <keyword id="6357793" type="UNKNOWN" weightage="60" keywordseo="pregnancy">pregnancy</keyword> and postpartum. </li><li>Many factors likely contribute to the disparities, but one OB-GYN is encouraging doctors to "check [their] implicit bias" and women of color to speak up. </li></ul><p>Nicole Thea, a London-based social media star, died July 11 along with her unborn child at 8 months pregnant.</p><p>Thea, who had more than 230,000 Instagram followers and whose <a href="https://www.youtube.com/watch?v=ipC5MYLMqRY">YouTube videos</a> could garner more than a million views, had been documenting her pregnancy, sharing what she and her partner were packing in their hospital bag June 28, for example, and writing "I can't wait to meet you little man" on June 29. </p><p>The dancer and accessories designer, who had already named the child Reign, was 24. </p><p>While the autopsy report is still pending, Thea's uncle <a href="https://www.dailymail.co.uk/news/article-8522271/Nicole-Thea-24-died-unborn-son-suspected-heart-attack-family-reveal.html">told the Daily Mail</a> the family thinks she died from "a massive heart attack." </p><p>"Nicole was saying that she was struggling to breathe. She was struggling with her chest — she had a pain in her chest," Charles Murray told the Mail. "It is so surreal as she was so young. It is such a shock. It has really, really shaken us all up." </p><p>The tragedy is part of a larger trend: While pregnancy- and childbirth-related deaths are rare, women of color are disproportionately susceptible. </p><h2>Racial disparities persist in maternal mortality rates </h2><p>In the US, Black women are three to four times more likely to die in pregnancy, <keyword id="31250" type="PERSON" weightage="60" keywordseo="childbirth">childbirth</keyword>, or immediately postpartum than white women. In the UK, black women's maternal mortality rates <a href="https://www.bbc.com/news/uk-england-47115305">are five times higher</a> than white women.  </p><p>Doctors and researchers have <a href="https://www.businessinsider.com/half-pregnant-women-in-uk-coronavirus-black-ethnic-minorities-2020-6">pointed to a variety of factors that could help explain the outcomes</a>, including socioeconomic status, access to prenatal treatment, racial bias in the medical system, a culture that doesn't encourage Black women to speak up about their <keyword id="6354750" type="UNKNOWN" weightage="100" keywordseo="health">health</keyword> concerns, and medical complications during pregnancy like pre-eclampsia. </p><p>"To this day, Black people are less likely to get the same treatment in terms of pain medication, they're more likely to wait longer in the ER, they're less likely to be taken seriously — it's a holdover from the days of slavery," Dr. Jennifer Lincoln, an OB-GYN, <a href="https://www.tiktok.com/@drjenniferlincoln/video/6835696093255322886">said on TikTok</a> in response to Thea's death. </p><p>She pointed to a study showing that 50% of doctors and residents surveyed falsely <a href="https://www.statnews.com/2016/04/04/medical-students-beliefs-race-pain/">believe Black people experience pain differently than white people</a>, leading to inappropriate treatment. </p><p><div type="image" title="beyonce pregnant" height="1338" width="1080" msid="76988558" hostid="261"></div></p><p>Celebrities of color have also spoken out about their difficult pregnancy and childbirth experiences. </p><p>Beyonce's preeclampsia, a complication involving high blood pressure and protein in the urine, for one, put her on bed rest for more than a month prior to an emergency C-section. </p><p>Serena Williams also had an emergency C-section, followed by a pulmonary embolism that almost killed her, she <a href="https://www.insider.com/serena-williams-almost-died-during-birth-of-daughter-olympia-2018-2">wrote for CNN</a>. Both women have emphasized that not many black women, and those in poorer countries, aren't so lucky to receive the kind of life-saving treatment they did. </p><p>"Every mother, everywhere, regardless of <keyword id="15024" type="ENTERTAINMENT" weightage="60" keywordseo="Race">race</keyword> or background deserves to have a healthy pregnancy and birth," Williams wrote. </p><p>In her TikTok, Lincoln told healthcare professionals "check your implicit bias" and urged women of color to speak up if they feel they're not getting appropriate care. </p><p>"If this is happening to you, ask to speak to a different nurse, a different doctor, report them, speak up," she said. </p><ul class="read-more-links"><li><strong>Read more:</strong></li><li><a href="https://www.businessinsider.com/what-pregnant-women-should-know-about-the-coronavirus-2020-3">What pregnant women should know about the coronavirus</a></li><li><a href="https://www.insider.com/is-viagra-more-accessible-than-birth-control-supreme-court-ruling-2020-7">People are saying Viagra is now more accessible than birth control because of a Supreme Court ruling — here's the reality</a></li><li><a href="https://www.insider.com/many-us-women-want-fewer-children-because-of-coronavirus-pandemic-2020-6">Many US women say they want fewer children because of the coronavirus pandemic</a></li><li><a href="https://www.insider.com/coronavirus-linked-high-rates-depression-anxiety-pregnant-women-new-moms-2020-6">Pregnant women and new moms are experiencing 'shocking' rates of anxiety and depression during the pandemic</a></li></ul>

The death of pregnant YouTube star Nicole Thea highlights a tragic trend affecting women of color

<ul class="summary-list"><li>After learning my son had a chromosomal abnormality, I experienced the devastating loss of a <keyword id="33680" type="PERSON" weightage="60" keywordseo="miscarriage">miscarriage</keyword>.</li><li>When I saw the news of <keyword id="883113" type="PERSON" weightage="60" keywordseo="Chrissy-Teigen">Chrissy Teigen</keyword>'s <keyword id="1449453" type="PERSON" weightage="60" keywordseo="pregnancy-loss">pregnancy loss</keyword>, memories of my own miscarriage came flooding back.</li><li>The physical pain from the medical procedures in its aftermath were bad, but it was nothing compared to the emotional pain.</li><li>I experienced recurring nightmares, anxiety, and feelings of <keyword id="60307" type="ENTERTAINMENT" weightage="60" keywordseo="grief">grief</keyword> and loss, but my doctors were largely indifferent.</li><li>No one asked me how I was doing emotionally. It was assumed that I was fine. No follow-up appointment was offered. Shame in miscarriage is common, but often silenced.</li></ul><p>I sat in a hospital waiting room staring at the green patterned painting hanging on the wall in front of me. One hand gripped the other while my sneakers traced the old blue carpet. Doctors in scrubs, pregnant women, and hospital employees walked by me, immersed in their morning routine. </p><p>I wanted to leave — to run to the nearest elevator and escape — but I waited for my name to be called.</p><p>Moments later, the surgeon, wearing a purple Patagonia fleece and a low ponytail, greeted me and went over the details of the dilation and curettage procedure. It would be performed following a devastating loss: the miscarriage of my son.</p><p>The vivid memories of that day came rushing back recently, as news broke of Chrissy Teigen's pregnancy loss. As others <a href="https://www.insider.com/people-sharing-miscarriage-stillbirth-experiences-after-chrissy-teigens-pregnancy-loss-2020-10">shared</a> their own stories of loss, I was reminded of my own grief, and of how unfathomable the days and months after it seemed. And I was reminded, too, of just how little it seemed to matter to the doctors around me. </p><h2><strong>Two days before I found myself in that waiting room, I received a phone call from a genetic counselor.</strong></h2><p>Our results indicated that our baby boy had Trisomy 13. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4543265/">Ninety percent</a> of babies with this chromosomal abnormality do not live to be a year old. We scheduled an appointment the following morning for an ultrasound.</p><p>The ultrasound technician was bubbly when we arrived, confirming my name, my age and that I was twelve weeks pregnant. But shortly after she covered my belly in lubricating jelly, she began to move her tool faster, searching, unable to find an angle where our baby did not appear still on the screen.</p><div type="image" title="maternity ward" height="1668" width="2223" msid="78465182" hostid="261"></div><p>The technician left quietly and a doctor I had never met before entered the room minutes later. "I'm sorry. Your baby has passed," she said. Without time to take that information in, she explained I could wait for the baby to exit my body naturally or schedule a D&amp;C to "remove the tissue."</p><p>My husband Peter and I held each other and burst into tears the moment she left. Minutes later, the medical staff re-entered to schedule the D&amp;C, and the doctor returned to ask us to leave. They needed the room for other patients.</p><p>There were two pain management options for the D&amp;C — sedation through an IV, which would leave me with no memory of the procedure, or oral medication, which would leave me aware. I decided on oral medication, which consisted of Ativan and Ibuprofen.</p><p>When it was time to head back into the operating room, my husband was asked to leave. I clung to him until they wheeled me away.</p><p>The procedure started off relatively painlessly. The surgeon dilated my cervix, applied numbing medication, and explained each step aloud. She used suction to remove what she called "particles" from my body. When I first heard the suction, I winced, anticipating a physical blow.</p><p>Because of my positioning, I couldn't see the machine, so my imagination took over. I envisioned our baby being forcibly pulled from my body in pieces. I began to cry. The crying turned into sobs.</p><p>When the suction stopped, the surgeon pushed down on my lower abdomen. "We need to make sure all of the particles are removed," she said. A young nurse came over to hold my hand, but a stranger couldn't provide the comfort I needed.</p><p>The surgeon told me I could return to work in a day and could try for another baby in a month. I felt like a little girl being patted on the head before being shooed off to play. "And you should cancel all your prenatal appointments," she added. The unnecessary reminder felt like a jab.</p><h2><strong>I left the hospital bleeding and experienced painful headaches, cramps, soreness and back pain. </strong></h2><p>The less I understood about what was happening to my body physically, the more anxious I became. But my physical symptoms were incomparable to the emotional pain.</p><div type="image" title="mental health depression grief anxiety stress disorder ADD panic OCD mood trauma sad tired cox 24" height="1665" width="2220" msid="78465190" hostid="261"></div><p>The sadness felt inescapable. With that came anxiety and fear about whether I would get pregnant again, and if I would have to endure another miscarriage. Those thoughts dominated my mind, making it difficult to feel hopeful about my future. </p><p>The loss also triggered prior grief. Nine years before we miscarried, I lost my mother to ALS and five years prior, I lost my father to cancer. Each death eroded my ability to stay positive a little bit more than the prior. I wondered how many more losses I could endure. </p><p>According to a recent study published in the American Journal of Obstetrics and Gynecology, <a href="https://www.sciencedirect.com/science/article/abs/pii/S0002937819313699">one in four women</a> experience post-traumatic stress disorder (PTSD) one month after a pregnancy loss. Although I wasn't officially diagnosed with PTSD, I still experienced the symptoms.  </p><p>I couldn't escape the image of our motionless baby on the ultrasound screen or the sound of the suction, which woke me in the early morning hours the first night after our miscarriage. I cried so hard that I woke my husband. The nightmares continued for weeks.  </p><p>The morning after a nightmare, I would open my eyes, remember what happened, and eagerly wait for the day to end. </p><h2><strong>I felt exhausted, but my mind was wired — I felt alone, but unable to connect with those I love.</strong></h2><p>Through research, I discovered my symptoms were common. <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1741-3729.2011.00647.x">One in two</a> women who miscarry experience depressive symptoms shortly after, and <a href="https://www.ncbi.nlm.nih.gov/pubmed/8123604">two in five</a> experience anxiety immediately following the miscarriage. But at the moment, the American Association of Obstetricians and Gynecologists does not specifically recommend screenings for depression and anxiety symptoms after a miscarriage.</p><p>The impact of miscarriage is understood, but rarely mentioned. Doctors are not mental <keyword id="6354750" type="UNKNOWN" weightage="60" keywordseo="health">health</keyword> care providers, but they are the gatekeepers to information for women who miscarry. The mental health effects of a miscarriage are well established and women deserve care which acknowledges that fact.</p><p>No one asked me how I was doing emotionally. It was assumed that I was fine. No follow-up appointment was offered. Shame in miscarriage is common, but often silenced.</p><h2><strong>Because I had experienced significant grief before, I recognized that my mental health was not well, and I needed help </strong></h2><p>If I was going to get better, I needed to start talking. I began to share my story with family and friends, asking for support. I continued to see a therapist. My husband and I spoke often of our loss and supported each other through the grief we faced together and individually. </p><p>There was never a magic moment when the pain suddenly left. But with time it became more bearable. The more I shared, the less I felt ashamed of my experience, and the more I recognized that despite its commonality, miscarriage is a loss, which can take a significant emotional toll.</p><div type="image" title="medical health pregnancy baby parenting childbirth cox 1" height="1666" width="2222" msid="78465194" hostid="261"></div> <p>Weeks ago, over a year after our miscarriage, I left the hospital after giving birth to a baby girl.  Almost every day since, I have breathed in her newborn scent and stared at her in amazement. </p><p>I understand how lucky we are to have a healthy baby. </p><p>As I breastfed her at 5 o'clock this morning, exhausted from sleeping only two hours at a time during the night, I read Chrissy Teigen's Instagram post. "We are. . . in the kind of deep pain you only hear about," she wrote on Instagram as she bravely shared the news of her pregnancy loss. </p><p>Holding my daughter, my face was covered in tears by the final words of the post. Her words reminded me of the emotional pain we endured not long ago. </p><p>The birth of my daughter does not erase that experience or our loss. Rather, our baby boy who passed is now a part of my story that I am no longer afraid to accept.</p><p><em>Katie C. Reilly is an attorney and writer. Her work primarily focuses on women's health, grief and social justice issues. </em></p><p><strong>Read more: </strong></p><p><a href="https://www.insider.com/people-sharing-miscarriage-stillbirth-experiences-after-chrissy-teigens-pregnancy-loss-2020-10">Chrissy Teigen fans are sharing their heartbreaking experiences with pregnancy loss after she posted about losing her son</a></p><p><a href="https://www.insider.com/having-a-baby-pregnancy-coronavirus-pandemic-2020-3">I'm nine months pregnant, and I'm bringing my baby into a world I no longer understand. I have to remain hopeful anyway.</a></p><p><a href="https://www.insider.com/beyonce-miscarriages-self-care-motherhood-2019-12">Beyonce says having miscarriages taught her to mother herself before she could be a mom to anyone else</a></p>

The unspeakable devastation of losing a pregnancy

<ul class="summary-list"><li>A <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6925a1.htm?s_cid=mm6925a1_w">government analysis</a> has found that pregnant women with COVID-19 are more likely to be hospitalized, admitted to the ICU, and put on ventilators than infected non-pregnant women. </li><li>The report also found that Black and Hispanic pregnant women were more susceptible to the virus than white pregnant women. </li><li>It's unclear how many hospitalized women were admitted for labor and delivery versus <keyword id="1754604" type="PERSON" weightage="60" keywordseo="coronavirus">coronavirus</keyword> complications. </li><li>Much remains unknown about how the coronavirus affects pregnant women and their future children, but the report underscores the importance of taking serious precautions and addressing racial disparities. </li></ul><p>Pregnant women with COVID-19, the disease the coronavirus causes, are more likely to be hospitalized, admitted to the intensive care unit, and put on ventilators than non-pregnant women with the disease, according to a new CDC analysis including over 90,000 US women. </p><p><a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6925a1.htm?s_cid=mm6925a1_w">The report</a>, the largest of its type to date, also found that Black and Hispanic pregnant women may be disproportionately affected by COVID-19. </p><p>While the analysis comes with many caveats — namely, that it's unclear how many of the women were hospitalized due to labor and delivery, or <keyword id="6357793" type="UNKNOWN" weightage="60" keywordseo="pregnancy">pregnancy</keyword> complications unrelated to COVID-19 — it provides important data on a group that scientists have known little about. </p><p>It also underscores <a href="https://www.businessinsider.com/what-pregnant-women-should-know-about-the-coronavirus-2020-3">recommendations for pregnant women and their providers to take COVID-19 infections seriously</a>, and for the healthcare system to address disturbing racial disparities. </p><h2>The report found almost a third of COVID-positive pregnant women were hospitalized </h2><p>For the study, researchers compared 8,207 COVID-positive pregnant teens and women to 83,205 of their infected peers who were not pregnant.</p><p>They found that more than 31% of the pregnant women were hospitalized, 1.5% were admitted to the ICU, and 0.5% needed to be put on ventilators. Of the non-pregnant women, 6% were hospitalized, 0.9% went to the ICU, and 0.3% were ventilated. </p><p>Pregnant women with COVID-19 were not any more likely to die. </p><p>The findings are reminiscent of a <a href="https://pubmed.ncbi.nlm.nih.gov/32386441/">recent study out of Sweden</a> showing that COVID-positive pregnant women were five times more likely to be admitted to the ICU and four times more like to be ventilated than non-pregnant women.</p><p>While the <a href="https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/03/novel-coronavirus-2019">American College of Obstetricians and Gynecologists (ACOG) </a>has considered pregnant women an at-risk population for COVID-19 since they're susceptible to greater morbidity and mortality from other respiratory conditions like the flu, the <a href="https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html">CDC</a> has maintained that the virus doesn't seem to "affect pregnant people differently than others."</p><p>This new data calls that conclusion into question. </p><p>"I think the bottom line is this: These findings suggest that compared to nonpregnant women, pregnant women are more likely to have severe COVID," Dr. Denise Jamieson, head of the COVID-19 task force at ACOG, <a href="https://www.nytimes.com/2020/06/24/health/coronavirus-pregnancy.html">told the New York Times</a>. </p><p>While not addressed in the current study, it still seems that women can't pass the virus to their babies in utero or through breastmilk, and that most newborns who do test positive for COVID-19 have mild or no symptoms, and completely recover.</p><p><div type="image" title="FILE - In this Aug. 7, 2018 file photo, a doctor performs an ultrasound scan on a pregnant woman at a hospital in Chicago.  A new study released Tuesday, Sept. 17, 2019, suggests when a pregnant woman breathes in air pollution, it can travel beyond her lungs to the placenta that guards her fetus. During pregnancy, particle pollution is linked to premature births and low birth weight, but scientists don’t understand why. (AP Photo/Teresa Crawford, File)" height="3840" width="5760" msid="76631645" hostid="261"></div></p><h2>Pregnant women of color seemed to be especially susceptible to COVID-19</h2><p>Among the pregnant women with COVID-19 who reported race/ethnicity, 46% were Hispanic, 22% were Black, and 23% were white.</p><p>Set against data from women who gave birth last year — 24% Hispanic, 15% Black, and 51% were white — the findings suggest women of color are disproportionately susceptible to COVID-19 during pregnancy. </p><p><a href="https://www.businessinsider.com/half-pregnant-women-in-uk-coronavirus-black-ethnic-minorities-2020-6">Earlier research out of the UK</a> found more than half of pregnant women who were admitted to the hospital with COVID-19 were Black or from other minority ethnic groups. </p><p><a href="https://www.businessinsider.com/the-racial-gap-in-coronavirus-deaths-is-driven-by-racism-2020-6?r=US&amp;IR=TIR=T">Other reports have shown</a> that people of color, pregnant or not, are more susceptible to severe COVID-19 infections and deaths due to systemic racism, and <a href="https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2015/12/racial-and-ethnic-disparities-in-obstetrics-and-gynecology">ACOG has long known that serious disparities in women's health care persist</a>, with Black Americans three to four more times likely to die from <keyword id="31250" type="PERSON" weightage="60" keywordseo="childbirth">childbirth</keyword> or pregnancy complications than women. </p><p>Marian Knight, the lead author of UK study, previously told Insider more qualitative research involving talking to women about their experiences is "urgently needed" to help understand what puts pregnant women of color at such risk for COVID-19, be it household arrangements or jobs that make physical distancing difficult, restricted access to healthcare, something else, or all of the above. </p><p>The answers will likely differ between minority groups, making the questions even trickier to answer, Knight, a professor in the University of Oxford's Nuffield Department of Population Health, said. "We have to accept that it's difficult, but that doesn't mean we shouldn't be trying to tackle it." </p><h2>The report comes with important caveats but pregnant women should still take the coronavirus seriously </h2><p>The current report has important limitations, most glaringly that it's unclear why the hospitalized women were admitted — for labor, delivery, or another pregnancy-related issue, or because their COVID was severe? </p><p>Plus, clinicians are more liberal when it comes to admitting and providing care for pregnant women in general, so it would make sense that they'd experience higher rates of hospitalization than non-pregnant women. </p><p>A lot of data was missing, too, forcing the researchers to make assumptions, for example that if a certain negative outcome wasn't reported, it didn't occur. </p><p>The analysis also couldn't answer whether having COVID-19 is linked with adverse pregnancy outcomes, like pregnancy loss or preterm birth, although the CDC has maintained that it is, since that's the case with other respiratory illnesses. </p><p>What the report does do, however, is provide needed data about a population researchers and doctors are still learning a lot about, and emphasize that women and their providers need to take the risk COVID-19 infection seriously. </p><p>"The emerging data on the increased risk of more severe illness among people who are pregnant is something that has become more visible as we have increasing numbers of cases occurring," Dr. Jay Butler, CDC Deputy Director of Infectious Diseases and COVID-19 Response Incident Manager, said during a press briefing Thursday. </p><p>"I would anticipate that we'll get more granularity on our understanding of the degree of risk as we continue on and we have additional data," he continued. </p><p>Meantime, the study authors advise pregnant women to continue with their regular prenatal care appointments, limit interactions with others and take precautions like mask-wearing and social distancing when they do occur, and keep at least a 30-day supply of medicines. </p><p>Because another recent study has shown pregnant women, whether or not they have COVID-19, are also <a href="https://www.insider.com/coronavirus-linked-high-rates-depression-anxiety-pregnant-women-new-moms-2020-6">at high risk for depressive and anxiety symptoms</a> during the pandemic, it's also critically important for them to seek support, whether from friends and family, online support groups, a mental health provider, or all of the above. </p><p>"There are going to be a lot of emotions, some of which are sadness, grief and the unknown," Dr. Jane van Dis, an OB-GYN who serves as medical director at the telemedicine network <a href="https://www.mavenclinic.com/">Maven</a>, previously told Insider. "Just know that connecting with people who are there to support women is essential for mental health." </p>

Pregnant women may be more likely to suffer severe coronavirus infections, according to the largest study of its kind

<ul class="summary-list"><li>Insider spoke to a handful of women who are currently pregnant or who have recently given birth who said they'd advise women to wait to get pregnant.</li><li>There's little data about how COVID-19 could affect an unborn baby — limited studies point to <a href="https://jamanetwork.com/journals/jama/fullarticle/2765616">heightened risks of stillbirth</a> and fetal distress in newborns.</li><li>A New York City-based OB-GYN said she wouldn't advise women to delay <keyword id="6357793" type="UNKNOWN" weightage="60" keywordseo="pregnancy">pregnancy</keyword> due to the pandemic.</li></ul><p>Ten days into developing <a href="https://www.businessinsider.com/coronavirus-live-updates-latest-news">the coronavirus</a> in March, when she was 18 weeks pregnant, Jessica Sigal developed a case of pneumonia so severe that every breath she took felt like she was "inhaling glass." As a physical therapist, Sigal is comfortable using a <a href="https://www.insider.com/what-is-a-pulse-oximeter">pulse oximeter</a>, and she regularly measured her oxygen saturation levels, carefully monitoring if she needed to go to the hospital</p><p>But when her oxygen levels dropped to the low 90s and then the high 80s, Sigal started to panic. Values less than 90 are considered low and a lack of oxygen in utero may <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963133/">contribute to some congenital cardiovascular issues.</a> At that point, Sigal went to the emergency room of a major New York City hospital. </p><p>"It's not just about me," Sigal told Insider. "Because if it was just me, then that's fine. But It's about me and about the life that I'm that I'm creating. That's the most terrifying thing."</p><p>While in the ER, her vitals improved to the point where it was safe for her to go home. She hasn't been able to breathe easy since.</p><p>Due to the many unknowns about how having the coronavirus could affect an unborn baby, Sigal said she would advise women who are considering getting pregnant now to wait if they can afford to. Insider spoke to a handful of other women who are currently pregnant, or who have recently given birth, who have also had challenging experiences. They shared similar sentiments. </p><h2>Some women who were pregnant during the pandemic report feeling isolated and worried about their babies' <keyword id="6354750" type="UNKNOWN" weightage="100" keywordseo="health">health</keyword></h2><p><div type="image" title="pregnant woman mask coronavirus crystal cox" height="900" width="1200" msid="76651311" hostid="261"></div></p><p>Throughout her pregnancy, Sigal has felt isolated. She had to be apart from her parents, who are in their 70s, and had hoped to share the experience with them. She's already grieving the fact that they may not even be able to be a part of her newborn's life.</p><p>She's felt anxious about telehealth appointments, and not being able to hear her baby's heartbeat as frequently as she would have under normal circumstances. But she worries about going to in-person appointments and getting infected again. </p><p>At times, she's felt sad about the milestone moments she hasn't been able to experience — celebrating a baby shower, testing baby gear, and outfitting a nursery. Instead of signing up for prenatal classes, she's enrolled in studies for pregnant women who have had COVID-19, the disease caused by the coronavirus.</p><p>What concerns Sigal most are the unknown factors related to the disease. </p><p>"Wait at least until we have more information and more data on how infection may affect the unborn, because we just don't have that data yet," Sigal said of what she would tell women who are thinking about getting pregnant. "You want [a baby] to be able to have everything that they can possibly get from day one."</p><h2>A study found that 34% of women want to delay pregnancy or have fewer children due to the pandemic</h2><p>Sigal's advice echoes the results of a recent study published by the Guttmacher Institute, a reproductive rights group.  The organization surveyed <a href="https://www.guttmacher.org/report/early-impacts-covid-19-pandemic-findings-2020-guttmacher-survey-reproductive-health">2,000 cisgender, sexually-active women</a> and found that 34% of respondents wanted to delay pregnancy or have fewer children because of the pandemic. </p><p><a href="https://www.insider.com/many-us-women-want-fewer-children-because-of-coronavirus-pandemic-2020-6">Low-income women and women in marginalized communities</a> were especially likely to say they've altered their reproductive plans. </p><p>Dr. Michelle Tham Metz, assistant clinical professor of Obstetrics, Gynecology and Reproductive <keyword id="41551" type="ENTERTAINMENT" weightage="60" keywordseo="science">Science</keyword> at the Mount Sinai Hospital in New York City, said that there's still paltry data available about the effects of COVID-19 on unborn babies and newborns. Right now, it's mostly case reports, not vetted studies. </p><p><div type="image" title="sex health sexual genitals female male anatomy peach crotch orgasm pleasure same sex reproduction penis testicles anal vagina vibrator toy sperm uterus ovaries pregnancy test cox 157" height="1667" width="2500" msid="76651317" hostid="261"></div></p><p>Still, Dr. Metz said she wouldn't advise anyone to put off pregnancy due to the the pandemic. She especially encourages women over 35, who could face a reduction in fertility, to not delay pregnancy.</p><p>But she understands if younger women want to wait to see how the data pans out.</p><p>"If it makes sense to postpone from a logistical standpoint," Dr. Metz said, "I don't think it's generally unreasonable to wait."</p><h2>There may be a heightened risk of stillbirth in women who had the coronavirus in the third trimester</h2><p>Data about how COVID-19 affects pregnant women and their babies is steadily emerging as researchers learn more about the disease. </p><p>A new analysis by the US Centers for Disease Control, the largest of its kind, found that pregnant women with COVID-19 are <a href="https://www.businessinsider.com/cdc-pregnant-women-increased-risk-for-severe-coronavirus-cases-hospitalization-2020-6?r=US&amp;IR=TIR=T">more likely to suffer severe infections </a>than those with the disease who aren't pregnant. </p><p>Pregnant women are more likely to be hospitalized, admitted to the intensive care unit, and put on ventilators, according to a new CDC analysis. (The analysis didn't note why the hospitalized women were admitted, and whether the reasons were labor-related or not). <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6925a1.htm?s_cid=mm6925a1_w">The report</a> also found that Black and Hispanic pregnant women may be disproportionately affected by COVID-19. </p><p>There are also studies to suggest that there may be an increased risk for stillbirth, babies born with fetal distress, or in need of admission to the neonatal intensive care when a mother develops <a href="https://jamanetwork.com/journals/jama/fullarticle/2765616">COVID-19 in the third trimester.</a> There also may be an increased <a href="https://www.insider.com/pregnant-women-with-covid-19-show-placenta-injury-in-small-study-2020-5">risk of injury to the placenta</a> in women who have had the coronavirus.</p><p>But getting pregnant in and of itself is a good health indicator.</p><p><div type="image" title="Screen Shot 2020 06 26 at 7.54.11 AM" height="721" width="961" msid="76651328" hostid="261"></div></p><p>Women in their late 30s and early 40s who have experienced pregnancy loss may not be able to wait to try to get pregnant, and have to weigh that consideration as well. </p><p>Lauren Cosenza, who's 41, had a chemical pregnancy last summer, followed by a miscarriage soon after at around nine weeks. When Cosenza, a mother of one, got pregnant in December, she was elated. </p><p>Like most women who have experienced pregnancy during the pandemic, Cosenza has faced plenty of stressors. </p><p>She goes to her doctors' appointments in Manhattan covered from head to toe, and brings an extra set of clothing to change into before going home. Cosenza had hoped her parents would've been an integral part of her birth plan, but because of their age, she doesn't know when she'll see them. </p><p>She and her husband have been balancing their startup hot sauce business while taking care of their toddler without childcare. </p><p>Even still, Cosenza said she's grateful for this pregnancy and wouldn't have changed anything about it. </p><p>"If you don't feel like you're ready and it's time, then you're not ready," Cosenza said. "But if you feel like me, where age is a consideration, and loss is a consideration — it gave me that clarity that I wouldn't want to miss this opportunity, even if it's a harder window."</p><h2>Women who had COVID-19 while pregnant still don't know how that will affect their babies</h2><p><div type="image" title="Lauren Wellbank" height="541" width="721" msid="76651331" hostid="261"></div></p><p>But the fact that this feels like a lot more than just a "passing window" for some can be particularly disconcerting.</p><p>That was the case for Lauren Wellbank, who <a href="https://www.insider.com/i-gave-birth-during-pandemic-scared-afterwards-5">gave birth to her third child in April</a>. Wellbank said she also would encourage women to wait to get pregnant. She said knowing what she knows now, she would've reconsidered having this baby.</p><p>"I don't think I would have had a third kid. Period," Wellbank told Insider. "Because I am afraid of what the future looks like for humanity." </p><p>Wellbank experienced many of the challenges other pregnant people have reported. </p><p>She got sick in March, and the urgent care she visited wasn't able to test her for the coronavirus. Wellbank isn't sure if she's had COVID-19 or if her baby had been exposed to it. </p><p>"What if I did have COVID? We don't know the effects, or the complications down the line," Wellbanks said. "It's a great big question mark."</p><p>The freelance writer said the labor and delivery process was eerie and isolating. Once Wellbank and her husband were settled in their room, she was left to labor alone for the night, and they weren't permitted to leave. Her OB wasn't called until right before she started pushing, and she said wearing a mask was hard, especially while taking deep, gasping breaths.</p><p>Wellbank's mother met her grandson through a window, able to just make out the blanket she had knitted for him. </p><p>For Wellbank and her husband, many of their new fears are just emerging. </p><p>Writing assignments have been drying up and payments have been slashed. Her husband works in the healthcare field and his hours may get cut too. Wellbank now has to also consider how to keep her other children, who are five and three, busy this summer, while she cares for her newborn and tries to generate work. She doesn't know how she'll manage homeschooling them in the fall if schools stay shut down. </p><p>"It's a scary time," Wellbank said. "I've got three kids that I'm worried about and what kind of world they're going to grow up in."</p><ul class="read-more-links"><li>Read more:</li><li><a href="https://www.insider.com/i-gave-birth-during-pandemic-scared-afterwards-5">I had a high-risk pregnancy, and was terrified to give birth during the pandemic. Everything's even scarier now that my son has been born.</a></li><li><a href="https://www.insider.com/coronavirus-linked-high-rates-depression-anxiety-pregnant-women-new-moms-2020-6">Pregnant women and new moms are experiencing 'shocking' rates of anxiety and depression during the pandemic</a></li><li><a href="https://www.insider.com/mom-gave-birth-alone-hospital-what-it-was-like-2020-3">A New York City mom gave birth in a hospital without her partner because of coronavirus restrictions. Here's what it was like.</a></li><li><a href="https://www.insider.com/mom-covid19-newborn-after-waking-up-from-coma-2020-4">A woman with the coronavirus gave birth while in a coma. She met her newborn when she woke up 11 days later.</a></li><li> </li></ul>

Women who've been pregnant during the pandemic are advising others to wait: 'I don't think I would have had a third kid. Period.'

<p><div class="KonaFilter image-container display-table"><div><div class="image"></div></div></div></p><ul class="summary-list"><li><strong>Endocrine disruptors are chemicals that <a href="https://www.businessinsider.com/category/toxic-chemicals" target="_blank" rel="noopener">mess with the body's normal functioning</a>.</strong></li><li><strong>T</strong><strong>hey can contribute to lowered IQs, raised infertility rates, obesity, and low birth weights, among other things.</strong></li><li><strong>Leo Trasande, a pediatrician who studies the effects of these chemicals on people, warns of their effects in his new book, "Sicker, Fatter, Poorer."</strong></li><li><strong>Trasande says that with a few simple hacks, we can make our lives a little safer by avoiding these chemicals when possible.</strong></li><li><strong>The endocrine-disrupting chemicals he's most worried about are in our carpets, clothes, canned and packaged foods, cosmetics, and even receipts. </strong></li></ul><p>Through the course of a single day, your hands, mouth, and body come in contact with countless pieces of paper, plastic, fabric, and furniture.</p><p>You probably don't think about the chemicals these substances might harbor, or consider that they have a drug-like effect on health. But some do. They can make metabolisms slow down, subtly lower IQs, contribute to ADHD in children, and mess with sperm counts in men.</p><p>They're called "endocrine disruptors," and they're around us all the time. The chemicals change how our bodies work by shifting the way hormones operate, according to Leo Trasande, a pediatrician and public-health researcher at NYU Langone Health.</p><p>"Hormones are the basic signaling molecules in our body that take on so many actions for practically every organ system" Trasande told Business Insider. "And endocrine disruptors are synthetic chemicals that scramble those signals, contributing to disease and disability."</p><p><div class="KonaFilter image-container display-table"><div><div class="image"></div></div></div></p><p>In his <a href="https://www.amazon.com/Sicker-Fatter-Poorer-Hormone-Disrupting-Chemicals/dp/1328553493" target="_blank" rel="noopener">new book</a>, "Sicker, Fatter, Poorer: <span id="productTitle">The Urgent Threat of Hormone-Disrupting Chemicals to Our Health and Future ... and What We Can Do About It," Trasande lays out the four big categories of endocrine disruptors he's most concerned about, based on evidence from scientific studies and observations in his patients.</span></p><p>They are:</p><ul><li><strong>Bisphenols,</strong> like BPA, which are often found in the linings of aluminum-<a href="https://ehp.niehs.nih.gov/doi/10.1289/ehp.5512" target="_blank" rel="noopener">canned food and drinks</a> and on cash-register <a href="https://www.pca.state.mn.us/green-chemistry/bpa-thermal-paper" target="_blank" rel="noopener">receipts</a>.</li><li><strong>Brominated flame retardants</strong> that are in some carpets, furniture, and clothing.</li><li><strong>Synthetic pesticides</strong> on food.</li><li>"Plasticizer chemicals" called <strong>phthalates</strong> that show up in plastic food packaging, lotions, and cosmetics.</li></ul><h2>BPA makes fat cells bigger, contributing to obesity and lower sperm counts</h2><p>The chemical BPA, and <a href="https://www.thelancet.com/pdfs/journals/lanplh/PIIS2542-5196(17)30049-9.pdf" target="_blank" rel="noopener">others like it</a>, could make the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5765817/" target="_blank" rel="noopener">body turn more calories into fat</a> instead of muscle, predisposing people to obesity.</p><p>In the lab, BPA acts like an obesogen. "It makes fat cells bigger," as Trasande writes. This is especially true if human embryos are exposed to the chemicals while still in a mother's womb.</p><p>Trasande said the obesogen effects of BPA are fairly small compared to what diet and exercise can do for health, but <a href="https://www.ncbi.nlm.nih.gov/pubmed/22990270" target="_blank" rel="noopener">they're real</a>.</p><p>"BPA exposure may explain nearly 2% of all obesity in 4-year-olds," Trasande says in his book. That stat is based on his analyses of data on childhood obesity and adult heart issues published in <a href="https://www.ncbi.nlm.nih.gov/pubmed/24452104" target="_blank" rel="noopener">the journal Health Affairs in 2014</a>.<span style="background-color: #ffcc00;"></span></p><p>The chemical is also <a href="https://www.ncbi.nlm.nih.gov/pubmed/24247736" target="_blank" rel="noopener">dangerous for babies and pregnant women;</a> it can up the odds of a premature birth, and mess with placenta function.</p><p><div class="KonaFilter image-container display-table"><div><div class="image"></div></div></div></p><p>Men are not immune to the effects of BPA, either. The chemical can mess with androgens (male sex hormones) like testosterone, contributing to lower sperm counts, and even testicular-cancer rates.</p><p>The vast majority of us are exposed to the chemical. A 2013-14 <a href="https://www.cdc.gov/exposurereport/index.html" target="_blank" rel="noopener">CDC survey</a> suggested 95% of US adults have detectable levels of BPA.</p><p>Counter to the adage that "the dose makes the poison," with hormone-disrupting chemicals there are often nonlinear relationships between the amount of chemical exposure and risk as the body's enzymes duke it out and compete with the hormone disruptors.</p><p>"The notion that everything needs to be linear - in a straight-line relationship - is really our own intellectual construct on a scientific reality that's much more complicated," Trasande says.</p><p>Many manufacturers are switching to BPA-free products. But that doesn't always mean they're safer, Trasande says, because many of the so-called replacements are just BPA relatives and the chemicals have similar effects on our health.</p><p>"To a large extent, when you don't know what's replacing [BPA], it's often BPS, BPF, BPP, BPZ - what I like to joke of as the artist formerly known as Prince," he said.</p><p><div class="KonaFilter image-container display-table"><div><div class="image"></div></div></div></p><h2>Brominated flame retardants found in most furniture we use</h2><p>Brominated flame retardants - flame-stomping chemicals found in furniture, carpeting, clothing, and car-seat foam - can change the way the thyroid functions in a similar way to BPA, shifting how the body processes fats and carbohydrates.</p><p>What's more, a 2012 <a href="https://www.chicagotribune.com/news/watchdog/ct-met-flame-retardants-20120506-story.html" target="_blank" rel="noopener">Chicago Tribune</a> investigation found that the firefighting chemicals, which are standard fare in foam cushions, don't work well to stop flames.</p><p>One <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4123029/" target="_blank" rel="noopener">large study of the flame retardants</a> in houses pinpointed a link between ADHD and exposure to the chemicals. More <a href="https://www.nih.gov/echo" target="_blank" rel="noopener">research</a> is ongoing.</p><p>Concentrations of the chemicals <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5360950/">in human blood, sweat, and breast milk</a> are much higher in the US than in parts of the world, such as Europe, where more brominated flame retardants are banned.</p><p><div class="KonaFilter image-container display-table"><div><div class="image"></div></div></div></p><h2>Chemicals we spray to kill bugs can mess with us too</h2><p>Certain pesticides used on food are also a concern, including bug-killing chlorpyrifos pesticides. These have been shown to impede brain development, making changes to the way a woman's thyroid functions during pregnancy.</p><p>In the 1970s and '80s, before the chemical was banned in homes, doctors started noticing an increase in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5739382/" target="_blank" rel="noopener">tinier and shorter premature babies</a> being born, even in homes with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1247388/" target="_blank" rel="noopener">low levels of the chemicals</a>. After the Environmental Protection Agency banned the use of chlorpyrifos in homes, <a href="https://www.epa.gov/ingredients-used-pesticide-products/chlorpyrifos" target="_blank" rel="noopener">in 2000</a>, birth weights went back up.</p><p>Exposure to chlorpyrifos can have lasting effects on child development. One <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809635/" target="_blank" rel="noopener">2015 study in kids between the ages of 11 and 14</a> found prenatal exposure to the chemical was linked to more arm tremors, which are also common in adults who've been exposed to lead. The chemicals are <a href="https://thehill.com/policy/energy-environment/408173-trump-admin-appeals-ruling-ordering-epa-to-ban-pesticide" target="_blank" rel="noopener">still used</a> in agriculture.</p><h2>Flexible plastics can also contribute to cancer</h2><p>Finally, Trasande is concerned about phthalates, chemicals that help make plastics more flexible and durable. They appear in raincoats, flooring, hair spray, nail polish, plastic food packaging, and toys.</p><p>According to the <a href="https://toxtown.nlm.nih.gov/chemicals-and-contaminants/phthalates" target="_blank" rel="noopener">US government</a>, "one phthalate, Di (2-ethylhexyl) phthalate (DEHP), is an endocrine disruptor and can cause cancer." Additionally, the government says some phthalates can mess with normal reproduction and child-development processes.</p><p>In some studies, <a href="https://www.cdc.gov/biomonitoring/Phthalates_FactSheet.html" target="_blank" rel="noopener">women tended to have more of the chemicals in their bodies than men</a> because of beauty products they use. But anyone who eats packaged food or breathes in household dust probably has phthalates in their system.</p><p>More research on what these chemicals are doing to us is needed, but we do already have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005250/" target="_blank" rel="noopener">some evidence that they're leading to premature births</a>, which can set kids up for a whole <a href="https://ukhealthcare.uky.edu/wellness-community/health-information/short-long-term-effects-preterm-birth" target="_blank" rel="noopener">host of health problems</a> later in life, including <a href="https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm" target="_blank" rel="noopener">vision and hearing</a> issues, chronic diseases like diabetes, <a href="https://www.nichd.nih.gov/newsroom/resources/spotlight/012612-effects-preterm-birth" target="_blank" rel="noopener">anxiety, depression</a>, and learning disabilities.</p><p>The plasticizing chemicals <a href="https://www.ncbi.nlm.nih.gov/pubmed/26385792" target="_blank" rel="noopener">may also be linked</a> to decreases in male testosterone levels. Scientists need to know more about the plastics before they'll say that conclusively, though.</p><p><strong><em>Read more</em></strong>: <em><a href="https://www.businessinsider.com/what-are-pfas-chemicals-2018-8" target="_blank" rel="noopener">Dangerous 'forever chemicals' have been found in US drinking water at alarmingly high rates - here's what to know about PFAS</a></em></p><p>Recently, manufacturers, retailers, and state lawmakers have started to pay more serious attention to the dangers of hormone disruptors, and they're making some changes.</p><p>Since 2013, California <a href="https://www.kqed.org/science/11318/its-official-toxic-flame-retardants-no-longer-required-in-furniture" target="_blank" rel="noopener">no longer requires furniture</a> to contain flame retardants (a previous requirement for 38 years).</p><p><div class="KonaFilter image-container display-table"><div><div class="image"></div></div></div><span style="background-color: #ffcc00;"></span></p><h2>What you can do to reduce your exposure</h2><ul><li>Eat less canned food and more fresh produce. Trasande is a fan of organic farming because it generally excludes synthetic pesticides, but studies suggest that eating <a href="https://www.businessinsider.com/could-eating-organic-prevent-cancer-2018-10" target="_blank" rel="noopener">whatever fresh produce you can afford</a> is the best strategy for your health.</li><li>Say no to paper receipts. This can help receipt-handling cashiers, who often have <a href="https://www.ncbi.nlm.nih.gov/pubmed/21205581" target="_blank" rel="noopener">elevated levels of BPA</a> in their urine.</li><li>Don't microwave plastic containers or put them in a dishwasher as the heat promotes chemical leaching. Throw kitchen plastics away when they become etched or scratched.</li><li>Avoid the recycling Nos. 3, 6, and 7, which are <a href="https://www.dec.ny.gov/docs/materials_minerals_pdf/plasticpam.pdf" target="_blank" rel="noopener">common plastics</a> found in shampoo bottles, Styrofoam trays for ground beef, and coffee-cup lids, among other things.</li><li>Incorporate iodine-rich foods into your diet, including seafood, dairy, and cranberries. Iodine is <a href="https://ods.od.nih.gov/factsheets/Iodine-Consumer/" target="_blank" rel="noopener">a necessary ingredient for thyroid-hormone production,</a> which helps bones and brains develop well.</li><li>Look for cosmetics that are "phthalate-free" and made without parabens, triclosan, or benzophenones.</li><li>Opt for naturally flame-resistant fibers, like wool, instead of chemically treated carpets, furniture, and clothes.</li><li>Circulate fresh air through your home.</li></ul><p>Small steps like these can make a big difference. The <a href="http://web.colby.edu/cleanmakeup/government-regulations/european-union-regulations/" target="_blank" rel="noopener">European Union</a> has <a href="https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32009R1223" target="_blank" rel="noopener">banned</a> 1,328 chemicals from cosmetic use, and under the new bans <a href="https://www.sciencedirect.com/science/article/pii/S1438463916301092?via%3Dihub" target="_blank" rel="noopener">French scientists have noticed a decline in chemical concentrations</a> in people's blood, urine, and hair. In the US, the FDA <a href="https://www.fda.gov/Cosmetics/GuidanceRegulation/LawsRegulations/ucm127406.htm" target="_blank" rel="noopener">forbids just 11 chemicals</a>, and concentrations of the toxic chemicals in American bodies <a href="https://ehp.niehs.nih.gov/doi/10.1289/ehp.1002727" target="_blank" rel="noopener">are elevated</a> when compared to Europeans.</p><p>The US has taken steps to improve public health before. The phase-out of leaded gasoline and paint in the 1970s led to a measurable brainpower boost in kids: as blood lead levels dropped, IQs went up anywhere from 2.2 to 4.7%. The economic benefits of that ban tally up to <a href="https://med.nyu.edu/departments-institutes/pediatrics/divisions/environmental-pediatrics/research/policy-initiatives/economic-costs-childhood-lead-exposure-low-middle-income-countries" target="_blank" rel="noopener">$2.45 trillion every year,</a> and Trasande compares the IQ hike's impact on productivity and the economy to a generous stimulus package:</p><p>As Trasande writes, "Each of us 300 million Americans gets the equivalent of as much as a $1,000 tax refund each year because we did the right thing and got lead out of gasoline in the 1970s."</p><p>Many of the chemicals on Trasande's danger list today stay in the <a href="https://www.hindawi.com/journals/jeph/2012/185731/" target="_blank" rel="noopener">body for hours</a> or days, not months or years, which means it's never too late to reduce your exposure.</p>

A toxic-chemicals expert is sounding the alarm about 4 cancer-linked chemicals that could be making us sicker and fatter

<p><div class="KonaFilter image-container display-table float_right"><div><div class="image on-image"><p class="source"><span>Shutterstock</span></p></div><p></p></div></div></p><p>The change in national attitudes towards cannabis and in legal access to marijuana around the US over the past several years is staggering.</p><p>As of last fall, 57% of adults in the US said that marijuana should be legal, with only 37% taking the opposing view, which is essentially a reversal of the <a href="http://www.pewresearch.org/fact-tank/2016/10/12/support-for-marijuana-legalization-continues-to-rise/">opinions held just a decade ago</a>. And after November's elections, a full <a href="http://www.businessinsider.com/marijuana-legalization-public-health-colorado-traffic-fatalities-2016-11">20% of the US population lives in a state that has voted to legalize recreational use</a> - and far more live in states with some access to medical marijuana.</p><p><strong>But this obscures a crucial fact. From a scientific perspective, there's still a ton we don't know about cannabis.</strong></p><p>A massive <a href="http://nationalacademies.org/CannabisHealthEffects">new report released today</a> by the National Academies of Sciences, Engineering, and Medicine gives among the most comprehensive looks ever (and certainly the most up-to-date) of exactly <a href="http://www.businessinsider.com/mental-physical-effects-of-marijuana-2016-4">what we know about the science of cannabis</a>. The committee behind the report, representing top universities around the country, considered more than 10,000 studies for their analysis, from which they were able to draw nearly 100 conclusions.</p><p>In large part, the report reveals how much we still have to learn - but it's still surprising to see exactly how much we know about certain health effects of cannabis.</p><p>This summation was sorely needed, as is more research on the topic.</p><p>"The policy has outpaced <keyword id="41551" type="ENTERTAINMENT" weightage="100" keywordseo="science">science</keyword>, and it's really too bad," <a href="http://www.mcleanhospital.org/biography/staci-gruber">Staci Gruber</a>, an associate professor of psychiatry at Harvard Medical School and director of the Marijuana Investigations for Neuroscientific Discovery program at McLean Hospital, told Business Insider in an interview last week, several days before we saw the report.</p><p>"As a scientist, I think the goal is always to try very hard to get to the findings and to be able to disseminate those findings, so that we can make good decisions grounded in science," Gruber said. "[Cannabis] has been around for thousands of years; it's not like we just made it in a lab." Having good research is essential so that we know "how best we can use it; what are the safest ways; and what are the real risks," she added.</p><h2>Surprising findings on cancer, mental health, and more</h2><p>Before we dive into the findings, there are two quick things to keep in mind. First, the language in the report is designed to say exactly how much we know - and don't know - about a certain effect. Terms like "conclusive evidence" mean we have enough data to make a firm conclusion; terms like "limited evidence" mean there's still significant uncertainty even if there are good studies supporting an idea; and there are different degrees of certainty falling in between these levels. For many things, there's still insufficient data to really say anything positive or negative about cannabis.</p><p><div class="KonaFilter image-container display-table"><div><div class="image on-image"><p class="source"><span>Thomson Reuters</span></p></div><p></p></div></div></p><p>Second, context is important. Many of these findings are meant summations of fact, not endorsements or condemnations. For example, the report found evidence that driving while high increased the risk of an accident. But the report also notes that certain studies have found lower crash rates after the introduction of medical cannabis to an area. It's possible that cannabis makes driving more dangerous <em>and</em> that crashes could go down after introduction <em>if</em> people take proper precautions. We'll be working on providing context to these findings over the next few days but wanted to share some of the initial findings first.</p><p>With that in mind, here are some of the most striking findings from the report:</p><ul><li>There was conclusive or substantial evidence (the most definitive levels) that cannabis or cannabinoids, found in the marijuana plant, <strong>can be an effective treatment for chronic pain</strong>, which is "by far the most common" reason people request medical marijuana, according to the report. With similar certainty, they found <strong>cannabis can treat muscle spasms related to MS and can help prevent or treat nausea and vomiting associated with chemotherapy</strong>.</li><li>The authors found evidence that suggested that marijuana<strong> increased the risk for a driving crash.</strong></li><li>They also found evidence that <strong>in states with legal access to marijuana, children were more likely to accidentally consume cannabis</strong>. We've <a href="http://www.businessinsider.com/marijuana-legalization-public-health-colorado-traffic-fatalities-2016-11/#more-people-have-sought-treatment-for-marijuana-poisonings-since-legalization-5">looked at these numbers before</a>, and seen that the overall increases in risk are small - one study found that the rate of overall accidental child ingestion went from 1.2 per 100,000 population 2 years prior to legalization to 2.3 per 100,000 population 2 years after legalization. There's still a far higher chance parents call poison control because of kids eating crayons or diaper cream but it's still important to know that some increased risk exists.</li><li>Perhaps surprisingly, the authors found moderate evidence (a pretty decent level of certainty and an indication that good data exists) that <strong>cannabis was not connected to any increased risk of the lung cancers or head and neck cancers associated with smoking</strong>. However, they did find some limited evidence suggesting that chronic or frequent users may have higher rates of a certain type of testicular cancer.</li><li>Connections to heart conditions were less clear. There's <strong>no evidence to support or refute the idea that cannabis might increase the risk of a heart attack, </strong>though there was some limited evidence that<strong> cannabis smoking might be a trigger for a heart attack</strong>.</li><li>There was substantial evidence that<strong> regular marijuana smokers are more likely to experience chronic bronchitis </strong>and that stopping smoking was likely to improve these conditions. There's no real evidence to say that that cannabis does or doesn't increase risk for respiratory conditions like COPD or asthma.</li><li>There was limited evidence that <strong>smoking marijuana could have some anti-inflammatory activity</strong>.</li><li>Substantial evidence suggests <strong>a link between prenatal cannabis exposure (when a pregnant woman uses marijuana) and lower birth weight</strong>, and there was limited evidence suggesting that this <strong>use could increase pregnancy complications and increase the risk a baby would have to spend time in the neonatal intensive care unit</strong>.</li><li>In terms of mental health, substantial evidence shows<strong> an increased risk for developing schizophrenia among frequent users</strong>, something that studies have shown is a particular concern for people at risk for schizophrenia in the first place. There was also moderate evidence that<strong> cannabis use was connected to a small increased risk for depression and an increased risk for social anxiety disorder</strong>.</li><li>Limited evidence showed a<strong> connection between cannabis use and impaired academic achievement</strong>, something that has been shown to be especially true for people who begin smoking regularly during adolescence (which is also shown to increase the risk for problematic use).</li><li>One of the most interesting and perhaps most important conclusions of the report is that far more research on cannabis is needed. <strong style="color: #222222;">Importantly, in most cases, saying cannabis was connected to an increased risk doesn't mean marijuana use <em>caused</em> that risk. </strong></li></ul><p>And it's hard to conduct research on marijuana right now. The report says that's largely because of regulatory barriers, including the Schedule 1 DEA status of marijuana and the fact that researchers often can't access the same sorts of marijuana that people actually use. Even in states where it's legal to buy marijuana, federal regulations prevent researchers from using that same product.</p><p>Without the research, it's hard to say how policy makers should best support legalization efforts - to say how educational programs or mental health institutions should adapt to support any changes, for example.</p><p>"If I had one wish it would be that the policy makers really sat down with scientists and mental health practitioners" as they enact any of these new policies, <a href="http://uwm.edu/psychology/people/lisdahl-krista-m/">Krista Lisdahl</a>, an associate professor of psychology and director of the University of Wisconsin-Milwaukee's Brain Imaging and Neuropsychology lab, told Business Insider in an interview shortly before we were able to review this report.</p><p>It's important to know what works and what doesn't and what needs to studied more. This report does a lot to show what we've learned in recent years, but it also shows just how much more we need to learn.</p><p>In studying cannabis, "we're not really after the good or the bad, we're after the truth," says Gruber.</p>    <div class="margin-top">        <h3>NOW WATCH: <a href="http://www.businessinsider.com/exercise-workout-shape-routine-2016-12">An exercise scientist reveals exactly how long you need to work out to get in great shape</a></h3>        <div>            <div>        <div class="ooyala-video-player" data-video-autoplay="false" data-video-id="hzamwyNDE6XH_rIq5Z2V-8yxA0I6rbAN" data-player-variable="ooyalapopvideo" id="ooyalaplayer_popvideo" style="width:1280px;height:720px"></div>        </div>        </div>            </div>

11 key findings from one of the most comprehensive studies on the health effects of marijuana

<p>These days, anyone with a smartphone can download a variety of games designed to make them healthier, whether that means helping them stick to an exercise routine, lose weight or manage a chronic illness. The games, invented by health insurers and a host of technology startups, are marketed directly to consumers, who use them to track their progress and record key health metrics such as blood sugar and pounds shed. Players of these games can win rewards, perhaps even cash, if they hit their health goals.</p>
<p>Experts have dubbed this trend "the gamification of health care." It means "applying elements and design concepts from games to other contexts that are not themselves games," says <a href="https://lgst.wharton.upenn.edu/profile/1159/">Kevin Werbach</a>, Wharton professor of legal studies and business ethics. "Using motivational techniques from games is part of it, as is creating engaging experiences for people." Werbach is co-author of <em>For the Win: How Game Thinking Can Revolutionize Your Business</em>, which argues that companies should think like game designers when they are devising new ways to motivate employees and customers.</p>
<p>In health care, however, gamification presents a distinctive set of challenges. Health care providers that want to offer games to their customers must do so without violating federal patient privacy regulations -- a requirement that can make it difficult to target games to the patients who will benefit most from them. Even companies that are not subject to those regulations are finding themselves under pressure to protect players' most personal data.</p>
<p>Then there is the problem of the games themselves: How can companies make them engaging enough to keep customers interested? "It's sometimes hard to build a game that's sufficiently serious and on topic, but also fun," Werbach says.</p>
<p>Health insurance providers were among the first to dip their toes into gamification. Minnetonka, Minn.-based UnitedHealth Group, for example, launched OptumizeMe, an <keyword id="235499" type="ORGANIZATION" weightage="60" keywordseo="APP">app</keyword> that allows people to participate in fitness-related contests with their friends, and the company is pilot testing Join For Me, a program that encourages adolescents who are obese and at risk of developing diabetes to play videogames that require dancing or other physical activities. Healthways has a Boston subsidiary called MeYou Health, which has developed a rewards program for people who complete one health-related task per day.</p>
<p>Several technology startups have burst onto the scene as well, many of them focused on fitness. Boston-based GymPact uses GPS to track its users to the gym. Members who meet their workout goals win cash, much of it from GymPact members who pay penalties for failing to exercise as promised. Fitbit, based in San Francisco, markets wireless tracking devices that sync to smartphones and computers so that users can track their fitness activities. Then there is New York's Fitocracy, which is more of a Facebook-like social network, where people can track their workouts, challenge friends to exercise contests and earn recognition for meeting goals. </p>
<p>Werbach notes that there has also been a plethora of smaller companies inventing games for people with challenging health issues, such as SuperBetter Labs, a San Francisco company that is beta testing an online social game designed to help people coping with illnesses, injuries or depression. The company collaborated with scientists and doctors to develop the game.</p>
<p><strong>Encouraging Patient Activation</strong></p>
<p>Bonnie Henry is CEO of GameMetrix Solutions, which draws inspiration from classic games like Jeopardy and Solitaire to invent fun platforms for managing chronic illnesses, particularly diabetes. "We're primarily based on a belief system that games and game mechanics are really going to be the motivating factor for chronic conditions that people struggle with on a daily basis," Henry says. "In the health care arena, there's a lot of discussion around patient activation, meaning getting people going [with games] and looking at the change in their engagement levels." GameMetrix provides platforms for companies, such as insurers, to create games for their customers tailored to specific health parameters.</p>
<p>GameMetrix's developers knew that pulling patients into the games would be a challenge, Henry says, which is why they decided to model their products on known properties. "One of the challenges companies face is they're trying to build new kinds of games and game mechanics. We focus on classic games where customers already know the game mechanics. They are games that have already been proven and tested."</p>
<p>When GameMetrix started in 2007, its founders tested their model by developing a game for people with diabetes that was based on classic trivia games like Trivial Pursuit. The company was stunned, Henry says, when 3,200 people started playing the game regularly, with very little marketing. "It's still live, and people are still playing. We recognize the motivations going on with these patients: They have a difficult time living with their condition. We are giving them a relaxed and therefore receptive environment for dealing with it."</p>
<p>According to Henry, one of the most valuable warnings in Werbach's book is to be wary of "pointification," or the awarding of points and badges to people who play games. She sees the health care community "rapidly embracing what I would say are simply loyalty programs, where if you participate, you get points or rewards.But it's really the deep elements of games and what makes them motivating that I think is missing. You may get a spike in participation, but it's not sustaining."</p>
<p>Werbach echoes that sentiment, adding that most of the unsuccessful games that have been tried in the business world failed because they relied too heavily on pointification. "The points aren't going to be effective unless they're embedded in a well-designed structure that uses them in a way people will find engaging," he says.</p>
<p>Keeping customers engaged, referred to in the gamification realm as "stickiness," is one of the biggest challenges for companies that are trying to encourage healthy behaviors, says <a href="https://opimweb.wharton.upenn.edu/profile/389/">Katherine Milkman</a>, professor of operations and information management at Wharton. Milkman recently co-authored a study designed to test whether allowing people to listen to exciting books-on-tape when they are at the gym -- and only at the gym -- would cause them to become addicted to exercise.</p>
<p>The researchers found that the tactic worked well at first, but then weakened over time. "We were able to increase exercise frequency because we tied something to the gym that was instantly gratifying and attractive," Milkman says. "It worked quite well for seven weeks, but then the kids in our study went home for Thanksgiving break. They came back, and they had forgotten about it. What I think that means is we have to be constantly evolving. You can't build one Super Mario game that people can only play while exercising and expect it to do the trick forever."</p>
<p>UnitedHealth is experimenting with several gamification models, including one that uses financial incentives to keep its members engaged over the long run. The game, called Baby Blocks, is offered to 50,000 pregnant members in seven states and is designed to encourage women on Medicaid to attend all their prenatal checkups. The women can unlock "blocks" in the game by going to those appointments. After they attend key checkups, they can receive rewards, such as gift cards for maternity and baby clothing. In 2012, the company says, 2,296 members actively used Baby Blocks pilot, logging 7,098 prenatal appointments and unlocking an average of 3.1 prenatal blocks per member. "We do think financial incentives are important," says Arrianne Hoyland, game producer for innovation and R&amp;D at United. "We felt using extrinsic rewards could increase engagement."</p>
<p>Werbach says that paying people to get healthy may be effective -- but only to a point. "Tangible rewards are potentially very effective, but also potentially very dangerous," he says. "If it signals that this is really not about improving your life, but this is about getting some financial payment, then people will tend to only do the thing to the extent that they get the payment. The totality of the game experience must be sufficiently engaging."</p>
<p><strong>Protecting Patient Privacy</strong></p>
<p>Any company that applies gamification to health care faces the added challenge of protecting patient privacy. Insurers, hospitals and other health providers are bound by the Health Insurance Portability and Accountability Act (HIPAA), which requires them to conceal personal health information related to all patients in their care.</p>
<p>But the rules for technology startups and other companies that don't provide direct patient care are considerably fuzzier, says <a href="https://lgst.wharton.upenn.edu/profile/1132/">Andrea Matwyshyn</a>, professor of legal studies and business ethics at Wharton. "These kinds of innovative health gamification ventures are primarily governed by contract law and not existing privacy law," Matwyshyn says. "So a host of problems arise because of the way that digital contracts in particular have developed."</p>
<p>For example, when consumers sign up for most <keyword id="1662298" type="UNKNOWN" weightage="60" keywordseo="health-apps">health apps</keyword> or web programs, they are generally asked to agree to a lengthy contract, which they may not bother to read, particularly if it is written in a very small font and they are viewing it on a cell phone. "We know that the reality is the consumers don't read these contracts, or they do, but they have tremendous difficulty understanding them because they're written by lawyers for lawyers," Matwyshyn says.</p>
<p>Some consumers have complained that health-app companies release too much information about their personal habits. For example, Fitbit came under fire in 2011 when the sexual habits of several hundred of its customers started showing up in Google search results. The company had been making all of the physical activities of its members public to encourage exercise and competitive interactions. After the outcry, Fitbit flipped the default setting for its members activities from public to private.</p>
<p>Matwyshyn suggests that most technology startups working in health care need to place more emphasis on privacy concerns. "The legal consequences of losing consumer data are not aggressive enough to encourage companies to plan optimal levels of data security budgeting into their bottom lines," she says. "In that sense, you have internal culture wars between the data security champions and the bean counters, who are more concerned with quickly visible profits quarter to quarter. Yet it does have real ramifications when a company is perceived by its consumers to have behaved in a way that violates their trust. The risk is that consumers will leave you." Matwyshyn says there's an "active debate" in the legal community about how best to tighten up the laws governing tech startups working in the health arena.</p>
<p>In the meantime, startups and established health care players alike continue to add elements to their games that will improve their stickiness. Most recently, health-related games have taken on more of a social feel, with features that allow users to challenge other users to fitness or weight-loss contests, for example, and to announce their results on Facebook and Twitter. "Community and social experiences are very commonly connected to games. We want to play with and against others, and to share that experience with others," Werbach says. "So having a social dimension is typically a significant and valuable part of gamification."</p>
<p>But adding that social element isn't enough, Werbach warns. "As with everything else, it has to be done effectively. It's not enough to say, 'Do you want to announce to your Facebook friends that you hit this milestone in a game?' It has to be a real community."</p>
<p>This post originally appeared <a href="http://knowledge.wharton.upenn.edu/article.cfm?articleid=3168">at Knowledge@Wharton</a></p>
<p><strong>NOW READ: <a href="http://www.businessinsider.com/colombias-entrepreneurial-economy-2013-1">How Colombia Became A Great Country For Entrepreneurs</a></strong></p><p class="tagline">This story was originally published by <a href="http://knowledge.wharton.upenn.edu/" target="_blank">Knowledge@Wharton</a>.</p>

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