The first U.S. experiments of creating genetically-modified human embryos happened earlier this year in Portland, Oregon.  Sound like science fiction or something from “The Matrix”?  Not anymore.  Researchers used a technology called CRISPR to insert and replace defective genetic code in human embryos.  None of these embryos were allowed to develop past a few days, nor were any of them intended to be implanted into a uterus via IVF, but this type of experiment has potential for both profoundly good and profoundly bad avenues of use.

First, the potential for good.  With regard to hereditary human disease, such as thalassemia, cystic fibrosis, or even color-blindness, this technique can be used to find and replace defective genetic mutations in the eggs at the same time as fertilization with sperm occurs.  Following correction, the new DNA sequence would then be passed to any offspring of a genetically modified child.  In this “germline engineering” process, the DNA replacement would only have to happen in one generation for the changes to be inherited by his/her children, grandchildren, great-grandchildren, etc.  Could this be the end of hereditary blood disease or even hereditary cancer, preventing disease before the baby even begins to develop?

Unfortunately, we’re not quite there yet.  Although this has been the first successful human experiment in the U.S., China has been performing similar research for several years, and they’ve noticed a few drawbacks.  The editing process still made a number of errors while trying to change the genetic code.  Not only did CRISPR sometimes modify cells that weren’t meant to be changed, but it didn’t always change all of the cells in the embryo that it was supposed to.

Also, the morality of changing DNA in humans is still up for debate.  While the U.S. Academy of Science approved the process for elimination of dangerous diseases, CRISPR is not approved for enhancement of abilities, at least in the U.S.  So, if you were hoping to build the world’s most beautiful baby who not only had an IQ of 200 but also could dunk a basketball like Lebron James or throw a football like Tom Brady, you’re going to have to wait awhile.  In fact, that’s one of the big moral concerns for many religious groups:  is use of this technology to design the perfect baby like trying to usurp God?

For now, the debate continues about the amazing treatment potential and also the scary potential for abuse of germline engineering, so babies will have to continue to be made the old-fashioned way.  That being said, isn’t your child the perfect little angel anyway 😊

​Dr. Nick

So, I understand why women want birth plans.  There are so many horror stories online of poor birth experiences and an overall sense of lack of control over the birth process.   I truly wish there was a way to ensure that everyone had an uneventful pregnancy and childbirth experience.  However, there are some things that we just can’t control.  Despite being an obstetrician myself (and being married to one), I went into preterm labor at 32 weeks and could do very little to stop it.  I had planned every detail of my pregnancy and maternity leave and suddenly all those plans were wiped out as I lay in a hospital bed contracting away.  So, I guess it begs the question- is formulating a birth plan really worth it and what should it include?  Here are some do’s and dont’s. 

1. Please don’t copy and paste an online birth plan and present it to your provider without reading it- there may be a lot of crazy stuff on there.  There are some birth plans that involve giving birth in a pool of dolphins and using an African birth swing (I don’t even know what that is or where you would find one and I guarantee your there won’t be one on labor and delivery).  Do some research and type out your own birth plan, making sure you review the details with your delivering provider and your labor and delivery nurse.   
2. Pain Control: if you are a first-time mom, wait and see how painful contractions are before you decide about an epidural.  Everyone has a different level of pain that they can manage comfortably.  Embrace the pain management technique that works for you and make sure you talk to your provider about all your options.  
3. The most common thing we hear is- “I don’t want to be hooked to a bunch of wires and monitors and have unnecessary exams and interventions and not be allowed to eat or drink while I am in labor.”  We don’t want that for you either.  We want you to go into labor naturally and deliver without any interventions.  But we also want you to have a heathy baby and an uneventful recovery.  Sometimes medications to help your labor progress if you are not progressing or antibiotics to prevent infection are necessary to get your little one here safely.  Talk to your provider and find out what their philosophy on interventions are from the beginning.  
4. Discuss all plans about the baby after delivery with your pediatrician.  Your delivering provider is not likely the person taking care of your baby.  If you don’t want your baby to receive vaccinations or Vitamin K, this is something you should discuss with your pediatrician before delivery and decide together what is best for your family.  
5. Research the hospital or facility that you plan to have your baby at.  If you want to labor in a tub, make sure that hospital has one.  If you want to labor in a hospital with a level 3 NICU, again, make sure it has one.  Plan a tour and ask the support staff lots of questions.  Nothing can prepare you for something you haven’t experienced yet, but at least you will feel more comfortable.

​I think the most important take home here is that you don’t let your birth plans encourage unrealistic expectations.  While you can plan all you want, there is very little that can be planned about the birth process: You can’t plan how long labor will last, how much pain you will have, how big your baby will be or how your baby will tolerate labor.  You should, however, discuss what your preferences are with your delivering provider and labor and delivery team beforehand so that way we can all achieve the same goal together- healthy baby, healthy pregnancy, and quick recovery. 

Dr. Pam

As you prepare for pregnancy, many moms probably wonder why get in shape before pregnancy if I'm just going to gain all of that pregnancy weight anyway?  Why not just indulge now and figure it out after the little one gets here.  The problem is that some are a little better at indulging than others, and it turns out, elevated BMI can have negative effects on not only moms during pregnancy but also their babies.  As the obesity epidemic has grown in the United States, researchers have begun to look at the implications this can have on a growing baby.  Obesity has increased substantially, especially among young adults.  In 1950, only 10% of adults were obese; today, that number has grown to over 35%.  Obesity in pregnancy has caused all sorts of issues: An increase in diabetes, hypertensive disorders and cesarean sections.  However, these are all risks that are posed to mom.  Other than large babies (and who doesn't love those little roly-poly babies and loving on all of those baby rolls :) , what effect does maternal obesity have on the baby?​

It turns out, there is concern about an increased risk of congenital malformations, aka birth defects.  A recent study of 1.2 million pregnant women showed that the risk for specific congenital malformations increased substantially based on how obese the mother was.  In this study, they assessed congenital malformations of the heart, limbs, genital organs, urinary system, digestive system, cleft lips and palates, eye, nervous system and other malformations.  This was true even for women without diabetes (We'll get back to the effects of diabetes on pregnancy later).  So, what did they find?  The baseline risk of birth defects in normal weight mothers is 1 in 29, but this number increases to 1 in 21 for morbidly obese mothers. While the most common type of malformation noted was heart malformations, there was an increased risk of genital, urinary and nervous system malformations in obese mothers.  We are not exactly sure what causes this, however, we do know that fat cells produce estrogen.  There is some thought that all this extra estrogen may disrupt the signals for normal development, which in turn may contribute to an increase in congenital malformations in babies of obese moms. 

Another problem for many obese moms is that increased BMI is also associated with diabetes.  So, what is diabetes?  THe type associated with obesity, type 2, means that your body can't process sugar well.  Essentially, your body may be able to process a gummy bear, but the whole extended family of sour patch kids?  Not so much.  Poor control of diabetes can be teratogenic, especially in the first trimester, and can contribute to severe fetal malformation as well.  This may increase the chance of having a baby with a birth defect even higher than the obesity alone.  Lastly, babies born to mothers with higher BMIs have an increased chance of being obese themselves or developing diabetes later in life.  Even for potentially normal babies, maternal obesity and diabetes is associated with increased chance of early pregnancy loss and stillbirth.    

What it comes down to: Yes, your pre-pregnancy weight, the amount of weight that you gain during pregnancy, and the way your sugars are controlled (if you have diabetes) can have lifelong implications for your baby.  Please discuss this with your provider, and let's work together to help you have your healthiest pregnancy :)

Dr. Pam