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With National Folic Acid Awareness Month taking place January 12 through 18, 2009, brides-to-be should start thinking about saying "I do" to taking a daily multivitamin with 400 micrograms (mcg) of folic acid daily – to protect their own health and the health of their children-to-be.

Folate is a water-soluble B vitamin that occurs naturally in foods, such as leafy green vegetables, whereas folic acid is the synthetic form of folate that is found in supplements and added to fortified foods. This essential B-vitamin helps build and maintain healthy cells, which is especially critical for the developing fetus. Studies have shown that if taken before and during early pregnancy, folic acid can significantly reduce the number of birth defects of the brain and spine called neural tube defects (NTDs) by up to 70 percent.

Despite the food fortification program that began in 1998, which has enriched breads, cereals, flours, corn meals, pastas, rice and other grain products with folic acid, the average non-pregnant Caucasian woman gets only 128 mcg per day of folic acid from fortified food, according to a study published in the May 2007 issue of the American Journal of Clinical Nutrition – African American and Hispanic women get even less folic acid in their daily diet.

"There are nearly 60 million women in the U.S. who are of childbearing age," says Elizabeth T. Jordan, a perinatal clinical nurse specialist and member of the National Healthy Mothers, Healthy Babies Coalition Board of Directors. "We know that nearly half of all pregnancies in the U.S. are unplanned and that the average woman is getting less than one-third of the recommended amount of folic acid. We also know that the odds of having a baby born with an NTD could be greatly reduced by women of childbearing age getting the recommended amount of folic acid." The easiest way to reduce the risk of having a baby born with an NTD is for women to begin taking a multivitamin with 400 mcg of folic acid today – not after they become pregnant, says Dr. Jordan.

According to the recent Healthcare Professionals (HCP) Impact Study, conducted by the "Life...supplemented" consumer wellness campaign, almost three quarters of physicians (72 percent) and more than three quarters of nurses (88 percent) say it is a good idea for patients to take a multivitamin – many of which contain 400 mcg of folic acid. According to the same survey, 86 percent of nurses and 87 percent of physicians personally take a multivitamin.

"Evidence suggests that the incidence of neural tube defects could be decreased as much as 70 percent if all women had an adequate folate intake during the periconceptual period," says Dr. Jordan. "The neural tube begins to close within the first month of gestation, often before a woman realizes she is pregnant."

To help remind brides-to-be of the importance of taking a daily multivitamin with folic acid, two organizations, the Council for Responsible Nutrition and the Healthy Mothers, Healthy Babies Coalition, have teamed up to develop a series of free e-postcards that can be sent to brides-to-be, reminding them to take care of their health.

To wish a bride-to-be a lifetime of happiness and health, visit www.crnusa.org/commitment or www.hmhb.org.

The Garbose Family Special Delivery Unit (SDU) at The Children's Hospital of Philadelphia is the world's first comprehensive obstetrical unit within a pediatric hospital for mothers carrying a fetus with a known birth defect. It is an innovative new labor and delivery unit for expectant mothers whose babies require highly specialized, sophisticated neonatal, surgical or cardiac care at birth. Unlike centers where mothers give birth and recover in one hospital while their critically ill newborns are transferred to a specialized pediatric facility, the SDU allows the mother and baby to stay in the same hospital with a multidisciplinary team of experts caring for both the mother and the baby.

The uniqueness of the SDU goes far beyond the geography of having the mother and baby together in a pediatric hospital. The unit staff strives to optimize and individualize the birth experience for mothers and normalize their delivery experience as much as possible during a difficult and technically challenging time for the baby. After the birth, the SDU team immediately fosters bringing the family together, encouraging parents to be with their new babies as soon as possible and will even provide some of Mom's postpartum care in the intensive care units where these babies are being cared for. This helps to make an overwhelming time a little bit easier because families aren't divided.

The SDU teams also works to help families achieve the best experience even at a time of uncertainty. Families start from the baby's birth, not from the time of discharge, and are supported by other families on the unit because everyone is experiencing a similar type of life-changing event.

"This state-of-the-art, one-of-a-kind Special Delivery Unit provides the most personalized, comprehensive care for these families before, during and after birth," says Dr. N. Scott Adzick, surgeon-in-chief at The Children's Hospital of Philadelphia and medical director of the Center for Fetal Diagnosis and Treatment (CFDT). "Babies are delivered and treated immediately in the Harriet and Ronald Lassin Newborn/Infant Intensive Care Unit (N/IICU) or the Evelyn and Daniel M. Tabas Cardiac Intensive Care Unit (CICU) while the mother recovers in the same hospital."

The first baby born in the Special Delivery Unit, Caoimhghin Williams, arrived on Tuesday, June 10 at 9:43 a.m. During their 18-week ultrasound, Courtney and Martin Williams of Albany, N.Y., learned that their fourth son had spina bifida.

Courtney's younger sister had been born with spina bifida and she was surprised but not completely shocked with the diagnosis. Their obstetrician referred the Williamses to the Center for Fetal Diagnosis and Treatment at Children's Hospital. After a one-day evaluation process with the CFDT team, they knew for certain that the baby had spina bifida and that they would need to deliver their baby at CHOP.

Courtney and Martin welcomed Caoimhghin into the world and were able to spend time with him before he went into surgery – which was necessary to close the opening on his spine. They were by his side immediately after the procedure. Courtney and Martin were thrilled to be able to go down the hall to the Newborn/Infant Intensive Care Unit to see their son the same night that he was born. The SDU team focused on keeping the family together as much as possible.

Courtney's mother tells a truly compelling story about how Courtney's experience delivering Caoimhghin in the Special Delivery Unit is light years away from the care she received when she delivered a baby with spina bifida more than 20 years ago. The grandmother poignantly notes that she remained in her community hospital, unable to visit the hospital where her baby daughter was receiving care, which was hours away from home, until after her discharge from the hospital five days later. She needed to search to find a neurosurgeon for her daughter's surgical repair and just wanted to feel like a normal mom. The SDU is exactly the experience she hoped that Courtney would have – the ability to be with Caoimhghin immediately, to know his neurosurgeon and to feel like her delivery experience was normal.

For more information, visit www.chop.edu.

Researchers examined breastfeeding duration in new mothers – age 18 or older, who gave birth to a single child (all in southern California) without abnormalities – between July 2002 and December 2003. The study found that women with maternity leaves ending within six weeks of giving birth are three times more likely to stop breastfeeding, compared to women who do not return to work. Women working in inflexible or non-managerial jobs, and those with high psychosocial distress, are at greatest risk of breastfeeding cessation.

Maternity leave after delivery but not prior to delivery influences breastfeeding success. The AAP recommends that babies be breastfed during the first year of life, and for as long as is mutually desired. The study authors recommend that pediatricians encourage women to take maternity leave, and advocate for extended, paid postpartum leave and more flexibility in working conditions for breastfeeding women.

A new study links in-home smoking bans with parental understanding of the negative effects of thirdhand smoke – the residual tobacco contamination that remains after a cigarette is extinguished, according to a study in the journal Pediatrics.

For the study, researchers conducted phone surveys of more than 1,500 households to assess the level of agreement with the statements that breathing air in a room today where people smoked yesterday could harm the health of children.

Overall, 95.4 percent of nonsmokers versus 84.1 percent of smokers agreed that secondhand smoke harms the health of children, and 65.2 percent of nonsmokers versus 43.3 percent of smokers, that thirdhand smoke harms children. Strict rules prohibiting smoking in the home were more prevalent among nonsmokers – 88.4 percent versus 26.7 percent. Belief that thirdhand smoke harms the health of children was independently associated with rules prohibiting smoking in the home. Health messages about thirdhand smoke contamination should be incorporated into tobacco control campaigns, programs and routine clinical practice.

Read more about vitamin D and pregnancy here.

The U.S. Consumer Product Safety Commission (CPSC) recently joined Target, of Minneapolis, Minn., in announcing a new notification system for communicating product recalls in Target stores nationwide. Target's innovative safety and recall notification program involves posting signs throughout its stores that direct guests to gift registry kiosks near the Guest Service desk to learn about recalled products.

Through the kiosk system, guests in Target stores will have easy access to notices of new or past recalls for all product categories and can print copies of safety and recall notices to take with them.

Target will continue to post safety and recall information at Target.com, provide links to the CPSC and related Web sites and send e-mails to guests who have purchased recalled products online. To further increase awareness of recalls, Target has introduced a new process for eligible Target REDcard account holders, which provides recorded phone messages for guests who purchase an item that has been recalled.

CPSC would also like to urge consumers to sign up to receive automatic e-mail updates on recalls. "We have several subscription lists so consumers have more choices in the types of messages they can receive to ensure their families are safe," says Acting Chairman Nancy Nord.

By logging on to www.cpsc.gov/cpsclist.aspx consumers can tailor the type of e-mail notification they prefer, based on product type. Subscription lists include the following:

• All CPSC press releases, including recalls
• All recalls only
• Only those recalls involving infant/child products
• Only those recalls involving products used for sports and recreation
• Only those recalls involving products used outdoors
• Only those recalls involving household products
• Only those recalls involving specialty products

At the gift registry kiosk or at www.target.com, Target guests can also search for recall information based on specific product categories.

The research, "Increased Risk of Adverse Neurological Development for Late Preterm Infants," by Petrini et. al. was published online by the Journal of Pediatrics. The authors also found that late preterm infants, (those born 34 to 36 weeks gestation), had a higher risk of developmental delays than babies born full-term.

The team of researchers from the March of Dimes, Kaiser Permanente Division of Research, Columbia University and the Harvard School of Public Health analyzed the medical records of more than 140,000 children born in California between January 2000 and June 2004 who had at least one follow-up doctor visit. These children had health insurance coverage through the Kaiser system and as a result had access to preventive care, diagnostic tests and treatments.

The earlier an infant is born, the higher the risk of some neuro-developmental problems, the researchers have found. For example, infants born between 30 and 33 weeks gestation are nearly eight times as likely as full-term infants to have cerebral palsy.

"The significantly higher rates of cerebral palsy and developmental delays for late preterm babies were surprising," says Dr. Joann Petrini, director of the March of Dimes Perinatal Data Center and lead author of the study. "Our research adds to the growing body of evidence showing that being born just a few weeks too soon can have lasting consequences that can no longer be described as temporary or benign. These findings reinforce the March of Dimes message that a few extra weeks of pregnancy can have a beneficial effect on an infant's health."

"Since brain development continues through the first year, these findings suggest that some late preterm infants may benefit from neurological assessments by their pediatricians to determine whether there is a need for specialized services," says Dr. Gabriel Escobar of the Kaiser Permanente Division of Research in Oakland, Calif., and a co-author of the study. "Future research should focus on how at-risk late preterm infants can be identified sooner, as neurological screening of all late preterm infants is not feasible."

More than half a million babies are born too soon each year in the United States, and the rate of premature birth has increased almost 20 percent since 1990. Late preterm babies account for more than 70 percent of all preterm births and for the majority of the increase in preterm birth rates during the past two decades.

Late preterm infants have a greater risk of breathing problems, feeding difficulties, temperature instability (hypothermia), jaundice, delayed brain development and death than babies born at term. This new analysis shows that these late preterm infants also have three times the risk of cerebral palsy and a slightly higher risk of mental retardation.

Exactly what causes the increased risk of cerebral palsy and neuro-developmental delays in late preterm infants cannot be determined from this study, and should be the subject of future research, the investigators say. However, there are several theories, including risk factors during the pregnancy that may contribute to damage in utero, or complications related to the preterm birth.

For more information, visit www.marchofdimes.com.

Nearly half of all children in the United States are still exposed to secondhand smoke (SHS) each week, according to a new survey from the American Legacy Foundation®, the American Academy of Pediatrics (AAP) Julius B. Richmond Center of Excellence and researchers from Mississippi State University.

The groups say that while America has come a long way in changing the social perception of smoking in the past 10 years, children are still exposed to secondhand smoke at alarming rates, and they are encouraging parents who smoke to quit for good.

The Social Climate Survey of Tobacco has found that 42 percent of children are exposed to SHS each week, and there are public settings where children could be exposed that are still not smoke-free.

"Children especially deserve smoke-free environments, and all public places where children eat and play should be protected from secondhand smoke," says Dr. Jonathan Klein, director of the American Academy of Pediatrics Julius B. Richmond Center for Excellence. "Adults have the power to make healthier decisions for their children, and there needs to be more done to protect children in homes and cars from the dangers of secondhand smoke."

Other key findings include the following:

• While 75 percent of U.S households prohibit smoking in the home and car, that leaves 25 percent of American homes and cars unprotected.
• More non-smokers prohibit smoking in the home than smokers.
• More than one quarter of smokers report that their child had been exposed to secondhand smoke in their home.
• Among parents who smoke, only 53.5 percent prohibit smoking in the home and even fewer (22.5 percent) prohibit smoking in the family vehicle.
• 8.1 percent of U.S. parents report that their child was exposed to SHS in an indoor public place in the past seven days.

Over the years, studies have concluded that SHS can be just as harmful as cigarette smoking. It is estimated that SHS exposure causes approximately 3,400 lung cancer deaths annually among adult nonsmokers in the United States. Even more disturbing is the fact that young children who are exposed to SHS are at a higher risk of developing asthma, ear infections and cavities. Infants are at a higher risk of SIDS (sudden infant death syndrome).

"The effects of secondhand smoke are serious and should not be minimized," says Cheryl G. Healton, president and CEO of the American Legacy Foundation, the only national public health foundation solely dedicated to reducing tobacco use in the United States. "Addressing this issue starts with helping adult smokers and parents quit. Most know they are dealing with a tough addiction, so pediatricians and others can provide the tools and resources for parents to re-learn their life without cigarettes."

Today's research coincides with the launch of a new partnership between Parents® magazine and the American Legacy Foundation, Parents Quit for Good. The program provides a free quit plan for moms and dads powered by the foundation's online cessation program, Become an Ex. The program launches just in time to help parents plan their New Year's resolutions to quit smoking.

This new collaborative will be featured in three upcoming issues of Parents starting in January, and includes a new Web site, www.ParentsQuitForGood.com where moms and dads can receive step-by-step assistance in identifying their own smoking triggers, in finding new ways to get through the day without cigarettes, and avoiding weight gain along the way.

In order to educate women, the Twin-to-Twin Transfusion Syndrome Foundation has declared December 7 World TTTS Awareness Day, an international mobilization effort to increase awareness of TTTS, a leading problem facing twins and higher multiple pregnancies.

On December 7, participants across the world marched in the first-ever Matthew and Steven TTTS Walk for the Babies to raise awareness and funds to fight TTTS. In honor of the babies affected by TTTS, a candlelight vigil and prayer took place at 5:10 p.m. and 5:15 p.m. in all time zones. In Bay Village, Ohio, home of the TTTS Foundation founder, Mary Slaman-Forsythe will be walking to honor her twins, Matthew and Steven.

"The goal of the TTTS Foundation is to educate pregnant women about the importance of getting an ultrasound in the first trimester to identify multiples, and then to determine whether there is one placenta or two," says Slaman-Forsythe. "TTTS can only occur when there is one placenta; therefore, women must learn the warning signs of TTTS, the 15 questions to ask during each ultrasound, and the available treatment options. Even the worst cases of TTTS can be reversed with treatments. My son Steven passed away from TTTS. I made a promise to him and Matthew to raise awareness about this potentially fatal disease, which is why I worked to establish World TTTS Awareness Day. I hope to empower parents and provide them with hope, help and encouragement."

TTTS is a disease of the placenta that affects identical twins (or higher multiple gestations) who share a common monochorionic placenta at any time during the pregnancy. The shared placenta contains abnormal blood vessels that connect the umbilical cords and circulations of the twins. As a result, one baby, the recipient, receives more than normal amounts of blood and his cardiovascular system becomes overloaded. The recipient then produces too much amniotic fluid, the first sign of TTTS, and is at risk for heart failure. The other baby, the donor, receives less then normal amounts of blood and becomes anemic. The donor baby produces little to no amniotic fluid and becomes at risk for heart failure. While there is a range of severity to TTTS, it is always life-threatening.

"It is critical that women become aware of the options available to treat TTTS in order to take precaution during pregnancy," says Slaman-Forsythe. "As the mother of a child that was lost to TTTS, I know firsthand the importance of awareness and am dedicated to fighting TTTS. It's a promise I made to my sons and my life's conviction."

For more information about World TTTS Awareness Day or TTTS, please visit www.worldtttsawarenessday.org or www.tttsfoundation.org.

Read more about Twin-to-Twin Transfusion Syndrome here.