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Much attention is paid to the physical health of pregnant women, but new research suggests that a woman's emotional health also can affect her fetus. In a study led by Dr. Catherine Monk, assistant professor of clinical psychiatry at P&S, researchers at P&S and the New York State Psychiatric Institute asked 32 pregnant women in the third trimester of pregnancy to fill out a questionnaire rating their anxiety levels.

The women subsequently took a standard computer test designed to elicit feelings of stress. Monitors measured the maternal and fetal heart rates and the women's breathing rates and blood pressure during and after the test.

While taking the stress test, the women's blood pressure and heart rates rose but on average, the researchers did not observe an increase or decrease in fetal heart rates. However, when Dr. Monk and her colleagues looked at the results according to women's reported levels of anxiety, they found that during the stress test, the heart rates in fetuses in highly anxious women were higher than those of fetuses whose mothers reported a lower level of anxiety on the questionnaire.

The researchers also noted that during the five-minute recovery period after the stress test, changes in maternal heart rate and blood pressure were associated with fetal heart rate changes.

"Our research indicates that women's mood-based physiological changes may affect the fetus and play a role in shaping fetal development," Dr. Monk says. The findings appeared in the February issue of Developmental and Behavioral Pediatrics.

She and her fellow researchers now are studying pregnant women who have psychiatric disorders such as depression to see if fetuses have heart rate changes similar to those of psychiatrically healthy women with more anxious personality styles. They also will track the babies as newborns and at four months of age to observe their development.

—Matthew Dougherty

Women prescribed birth control pills are usually told by their doctors to begin taking them when their next menstrual period begins. The conventional start time is thought to minimize irregular "breakthrough" bleeding that is common during the first few months of pill use, but women may become pregnant while waiting to start the pill.

Now, P&S researchers have found no difference in breakthrough bleeding patterns between women who delay their start time until menstruation and women who start taking the pill on the day it is prescribed. The results of the randomized, controlled trial—the first study to examine bleeding patterns of regimens with different starting times—were published in the February issue of Fertility and Sterility.

"Concern about breakthrough bleeding should not be used as a justification for delaying the start of birth control pills," says lead author Dr. Carolyn Westhoff, professor of obstetrics and gynecology at P&S and two Mailman departments, Epidemiology, and Population and Family Health.

Dr. Westhoff and her colleagues randomly assigned a conventional start time or an immediate start time to 113 women who were prescribed birth control pills. From the first day of pill use, the women kept a 90-day diary to record bleeding and spotting days.

The researchers found no differences in the number of breakthrough bleeding days or the duration of bleeding between the two start times. Dr. Westhoff says immediate pill starts will not provide immediate protection, so women should complete a week of pills before abandoning other birth control methods.

—Susan Conova

Last year, Dr. Kevan Herold, associate professor of clinical medicine in the Naomi Berrie Diabetes Center, and his colleagues found that an experimental diabetes drug stopped the progression of Type 1 diabetes in newly diagnosed patients for one year or more.

New research now has given them a better idea how the drug works and how the drug's effectiveness could be increased. The study is published in the February issue of the Journal of Clinical Investigation.

In Type 1 diabetes, the immune system attacks and destroys all insulin-producing beta cells within several months of diagnosis. The experimental drug is an antibody designed to block the activation of T cells, including those that carry out the attack on beta cells. However, in the clinical trial, many patients experienced a mild rash that indicated some T cells were activated.

Further analysis of the patient's response to the drug shows that the antibody activates a set of T cells that produce IL-10. The researchers believe that the IL-10 T cells are regulatory cells that then inactivate the T cells responsible for the disease. The mechanism differs from similar types of antibody drugs that directly inactivate the attacking T cells.

The discovery of the mechanism of the drug action has led Dr. Herold to develop new protocols to see if he can sustain the drug's effectiveness. The proposed protocols test whether a combination of the drug with a diabetes-specific antigen, GAD-65, will skew the immune responses to this diabetes autoantigen and thereby turn off T cells that cause the disease while promoting the development of specific regulatory cells. This approach may lead to a drug with very specific effects on diabetes without affecting the rest of the immune system.

—Susan Conova