As COVID-19 vaccines began to roll-out following Emergency Use Authorization by the FDA in December 2020, our MotherToBaby Pregnancy Studies program and our Mommy’s Milk program rapidly opened studies to evaluate the use of these vaccines during pregnancy and lactation.
Center for Better Beginnings Website Privacy Policy & Terms of Use
Welcome to the Center for Better Beginnings website. This website is operated and managed by the Division of Dysmorphology and Teratology in the Department of Pediatrics at the University of California San Diego (UCSD).
PLEASE READ THESE TERMS AND CONDITIONS OF USE CAREFULLY BEFORE USING THIS SITE. By using this site, you agree to these terms of use. If you do not agree to these terms of use, please do not use this site. This site is owned and operated by the UCSD Division of Dysmorphology and Teratology (referred to as “we,” “us,” or “our” herein). We reserve the right, at our discretion, to change, modify, add, or remove portions of these terms at any time. Please check these terms periodically for changes. Your continued use of this site following the posting of changes to these terms will mean you accept those changes.
Health Information
All health and health-related information contained within this website is intended to be general in nature and should not be used as a substitute for medical treatment by a health care professional. Your health care provider should be consulted regarding matters concerning the medical condition, treatment, and needs of you and your family.
Every effort is made to ensure that the material within this website is accurate and timely; however, this should not be considered official and should be confirmed with other reliable sources. This information is provided without warranty for quality or accuracy. We are not responsible for any errors or omissions in any information provided or the results obtained from the use of such information.
Privacy
We respect the privacy of our users.
Our goal is to provide you with a personalized Internet experience that delivers the information, resources, and services that are most relevant and helpful to you. In order to achieve this goal, we sometimes collect information during your visits to understand what differentiates you from each of our other users.
To demonstrate our commitment to your privacy, we have prepared this statement disclosing our website privacy practices.
Here, you will learn what personally identifiable information of yours is collected, how and when we might use your information, how we protect your information, who has access to your information, and how you can correct any inaccuracies in the information.
Collection of Data
We collect certain information from and about our website users in two ways: directly from the user and from our Web server logs.
Use of Data
The UCSD Division of Dysmorphology and Teratology does not sell, rent, or exchange any personal information collected or gathered online about visitors to this site unless (i) provided for otherwise in this Privacy Policy; (ii) we obtain your consent, such as when you choose to opt-in or opt-out to the sharing of information; (iii) a service provided on our site requires the interaction with or is provided by a third party; (iv) pursuant to legal process or law enforcement; or (v) we find that your use of this site violates this Policy or other usage guidelines or as deemed reasonably necessary by us to protect our legal rights and/or property.
Security: How We Protect Your Information
This site has security measures in place to protect the loss, misuse, and alteration of the information under our control. We work to protect the security of your information during transmission by using Secure Sockets Layer (SSL) software, which encrypts information you input.
No Guarantees
While this Privacy Policy states our standards for maintenance of personal information and we will make efforts to meet them, we are not in a position to guarantee these standards. There may be factors beyond our control that may result in disclosure of data. As a consequence, we disclaim any warranties or representations relating to maintenance or nondisclosure of Data.
Updating Your Information
If you would like to update your personal information or stop receiving communication from the Center for Better Beginnings, please call 858-246-2140.
If you have any questions about this privacy statement, you can contact the Web Operations Team at BetterBeginnings@health.ucsd.edu.
Relationship of This Site to University of California
The Center for Better Beginnings website is an unofficial website that is operated and managed by the UCSD Division of Dysmorphology and Teratology. Any content contained or accessible from this site is solely the view of the UCSD Division of Dysmorphology and Teratology. Any content contained or accessible from this site does not reflect the views of the Regents of the University of California, the University of California San Diego as a whole, nor UC San Diego Health, and these entities do not endorse, warrant, or otherwise take responsibility for the contents of this site or of any material accessible from this site.
Endorsements
Links from this website to the website of any external entity do not imply endorsement of the external entity’s products or services. References to non-Center for Better Beginnings products, services, or organizations do not imply endorsement of such products, services, or organizations.
Restrictions of Use of Material
All trademarks, service marks, and trade names are proprietary to the UCSD Division of Dysmorphology and Teratology, unless noted otherwise. No material may be copied, reproduced, republished, uploaded, posted, transmitted, or distributed in any way, without explicit permission, except that you may download one copy of the materials on any single computer for your personal, non-commercial home use only, provided you keep intact all copyright and other proprietary notices. Modification of the materials or use of the materials for any other purpose is a violation of our copyright and other proprietary rights. The use of any such material on any other website or networked computer environment or in any other medium is prohibited.
Are you pregnant or parent to a 0-6 month-old child and living in San Diego County? If so, our colleagues may be interested in learning about your experience as a caregiver during the COVID-19 pandemic!
Researchers from across 5 institutions are looking for female caregivers either currently pregnant or with children up to age 6 months. We want to better understand the effect of COVID-19 on your experience as a caregiver as well as a variety of aspects of family functioning. Earn $50 by participating in an individual interview.
As SARS-CoV-2, the novel coronavirus that causes COVID-19, continues to spread around the world, so do the concerns of breastfeeding mothers. Although there have been no documented cases to date of an infant contracting COVID-19 as a result of consuming infected breast milk, the critical question of whether there is potential for this form of mother-to-infant transmission remains. Our latest study, published August 19, 2020 in the online edition of JAMA, sought to answer this question.
What did we do?
Since March 2020, our Mommy’s Milk: Human Milk Biorepository has been collecting breast milk samples by mail from breastfeeding women throughout the U.S. who reported being symptomatic for COVID-19, having been exposed to an infected person, or having a confirmed SARS-CoV-2 infection. In preparation for analyzing these samples, in collaboration with colleagues at the University of California Los Angeles we developed and validated an RT-PCR test (a laboratory technique) for detecting SARS-CoV-2 in breast milk. We also developed a test to determine if any virus found in milk would be able to replicate; the ability of the virus to replicate is a key component of determining whether an infant could be infected by consuming milk that contains the virus. Last, we developed techniques to mimic the type of pasteurization that human milk banks use to screen donor milk for infection; we did this so we could determine if these techniques are able to eliminate any virus in milk. The study was partly supported by Emergency COVID-19 Research Seed Funding provided by the University of California Office of the President.
What did we find?
Between March 27 and May 6, we enrolled 18 women who had a confirmed SARS-CoV-2 positive test; these 18 women provided a total of 64 breast milk samples that were collected at different time points before and after their positive test result. Of the 64 milk samples that were collected, we only detected virus in one sample; however, subsequent tests found that the virus was unable to replicate. In addition, infectious virus could not be detected in milk samples following pasteurization.
So what’s the take-away?
According to the lead investigator on this study, director of Mommy’s Milk, and our Center co-Director Dr. Tina Chambers, PhD, MPH: “Detection of virus does not equate to infection. It has to grow and multiply in order to be infectious and we did not find that in any of our samples. Our findings suggest breast milk itself is not likely a source of infection for the infant.” She also added that our pasteurization findings are “a very positive finding for donor milk, which so many infants – especially those born premature – rely on.”
However, she also cautioned that more research is needed: “Our findings fill in some important gaps but more studies are needed with larger sample sizes to confirm these findings.” To that end, our future work will not only look at whether breast milk is free of the virus, but also if it contains active antiviral components, such as antibodies to SARS-CoV-2 that women may produce after exposure to the virus and that they can then give to their infants through breast milk, protecting the infant from COVID-19.
Child health is impacted by a combination of factors – from environmental to biological to social – that often intersect in complex ways. But attempting to collect all of this information from a given research participant could be overwhelming or take a long time to gather. That’s why our researchers are capitalizing on the wealth of different data sets that already exist for San Diego County families and are combining them in unique and powerful ways to answer crucial questions about child health.
The Center launches an Employee Excellence Award program to recognize exceptional staff.
At the UC San Diego Center for Better Beginnings, we strive to ensure that our services and resources are accessible to people with disabilities. We have made changes to our website, BetterBeginnings.org, to ensure it is easier to use and more accessible for people with disabilities, with the strong belief that every person has the right to live with dignity, equality, comfort and independence.
Accessibility. BetterBeginnings.org makes available the UserWay Website Accessibility Widget that is powered by a dedicated accessibility server. The software allows BetterBeginnings.org to improve its compliance with the Web Content Accessibility Guidelines (WCAG 2.1).
Enabling the Accessibility Menu. The BetterBeginnings.org accessibility menu can be enabled by clicking the accessibility menu icon that appears on the bottom left corner of the page. After triggering the accessibility menu, please wait a moment for the accessibility menu to load in its entirety.
Disclaimer. The UC San Diego Center for Better Beginnings continues its efforts to constantly improve the accessibility of its site and services in the belief that it is our collective moral obligation to allow seamless, accessible and unhindered use for those of us with disabilities.
Despite our efforts to make all pages and content on BetterBeginnings.org fully accessible, some content may not have yet been fully adapted to the strictest accessibility standards. This may be a result of not having found or identified the most appropriate technological solution
We’re Here For You. If you are experiencing difficulty with any content on BetterBeginnings.org or require assistance with any part of our site, please contact us during normal business hours as detailed below and we will be happy to assist.
Contact Us. Please contact us if you wish to report an accessibility issue, have any questions, or need assistance.
Jennifer Zellner
Director of Research Operations & Development
jazellner@health.ucsd.edu
UC San Diego Center for Better Beginnings
9500 Gilman Dr., MC 0828
La Jolla, California 92093-0828
858.822.3682
Updated June 2020
Major depression affects approximately 8% of pregnant women in the United States, and 7-13% of pregnant women use antidepressants during pregnancy. Because untreated depression in pregnancy is associated with poorer outcomes for both mom and baby, medication and/or non-medication treatment is encouraged. However, more information is needed about whether and how antidepressant medications could impact a pregnancy and the baby. The study we just published in Pediatrics sought to evaluate the risk for certain pregnancy and newborn complications, namely pre-term birth, heart defects in the newborn, and respiratory distress in the newborn.
What did we do? We obtained data for nearly 227,000 singleton births between 2012-2016 from the OptumLabs Data Warehouse, a database that contains de-identified medical and pharmacy claims, lab results, and enrollment records for over 200 million privately insured or Medicare enrollees across a mix of ages, ethnicities and geographical regions in the US. We then looked at whether and when the women filled a prescription for an antidepressant during their pregnancy and the dosage that was prescribed. We then categorized the women based on their patterns of antidepressant use, resulting in 5 groups: (1) women with low dosages who reduced or stopped taking their antidepressant during their first trimester of pregnancy; (2) women with low dosages who continued taking their antidepressant throughout pregnancy; (3) women with moderate dosages who reduced or stopped taking their antidepressant during their first trimester of pregnancy; (4) women with moderate dosages who continued taking their antidepressant throughout pregnancy; and (5) women with high dosages who continued taking their antidepressant throughout pregnancy. We then compared the groups to see if there were differences in the rates of pre-term birth, newborn heart defects, and newborn respiratory distress. Funding for the study was partly provided by the National Institutes of Health (NIH), and we received access to the OptumLabs data from a University of California–OptumLabs research credit.
What did we find? We found that 15,041 (6.6%) of the pregnancies were exposed to an antidepressant. In comparing our 5 groups, we found that continued use of moderate (~40 mg/day of fluoxetine) or high dosages (~80 or more milligrams per day) of antidepressants increased the chance of preterm birth. We also found that compared to Group 1 (the women on low doses who reduced or stopped take their antidepressant during their 1st trimester), the other four groups had an increased chance of newborn respiratory distress, with those taking the highest dosages at the highest risk. Finally, we found that taking moderate dosages of antidepressants throughout pregnancy increased the chance of infant heart defects, but this finding was no longer significant when we compared them to women with depression or anxiety who did not take antidepressants, suggesting that the underlying depression or anxiety may play a role in risk for heart defects.
So what’s the take-away? Our study largely confirmed the findings of previous research suggesting there may be some increased infant risks when taking antidepressants during pregnancy, particularly if the mother is taking moderate-to-high dosages over the course of her pregnancy. The lead investigator on this study and our Center faculty member Dr. Gretchen Bandoli, PhD, MPH, stressed that “We cannot emphasize enough the importance of treating underlying depression or anxiety during pregnancy, as both conditions are linked to poorer outcomes for both mom and baby. What our findings suggest is that when the method of treatment is an antidepressant, health providers should consider treating the mom with the lowest effective dose that will benefit both mom and baby and they should also monitor mom and baby for these outcomes.
Over 28 million women in the US suffer from migraines, and when they happen in pregnancy previous research has suggested that this can increase the risk of maternal stroke. The study we just published in JAMA Neurology sought to determine the extent to which pre-existing blood pressure-related disorders increase this risk.
What did we do? We obtained data from the State of California for birth certifications and hospital discharge summaries for 3 million singleton, live births between 2007-2012. We examined these records for medical codes associated with migraines, strokes, and hypertensive disorders including high blood pressure and preeclampsia, a pregnancy complication characterized by high blood pressure, swelling, and protein in maternal urine. In our analysis, we adjusted for other factors that are commonly associated with stroke, such as age, maternal body mass index, race/ethnicity, maternal smoking, drug, and alcohol use, and maternal diabetes. Funding for the study was partly provided by the California Preterm Birth Initiative at the University of California San Francisco.
What did we find? We found that in 914 out of every 100,000 deliveries women suffered from migraines; in addition, strokes occurred in 29 out of every 100,000 deliveries. Compared to women without migraines, women with migraines during pregnancy were more likely to have a hypertensive disorder and to have a stroke during pregnancy or postpartum. In our analyses, hypertensive disorders explained 21% of the risk for stroke among women with migraines during pregnancy and delivery, and 27% of the risk for a postpartum stroke among women with migraines.
So what’s the take-away? Accordingly to the lead investigator on this study and our Center faculty member Dr. Gretchen Bandoli, PhD, MPH: “The findings suggest that by managing hypertension and preeclampsia in pregnancy, approximately one-quarter of the cases of stroke that can be attributed to migraines could potentially be prevented. Cardiologists should thus continue to counsel their pregnant patients on the importance of well-controlled blood pressure, particularly before and during pregnancy.”
However, she also cautioned that more research is needed: “Hypertension only accounted for one-quarter of the excess risk of maternal stroke associated with migraine, which indicates there are other risk factors that we have not yet quantified. Although maternal stroke is rare during pregnancy, delivery, and in the postpartum period, it can be deadly. We need more research to identify other factors contributing to stroke risk among women with migraines that can be modified to reduce the risk of a mom having a stroke.”
In response to the COVID-19 pandemic, our Mommy’s Milk program launched a study to confirm early findings that the virus is not present in milk, and to determine if and when maternal antibodies to the virus can be found in breast milk. “We’re collecting and analyzing a larger number of samples than have been reported in the scientific literature to date. Hopefully, the results of our study can be used to provide reassurance to women that breastfeeding with COVID-19 infection doesn’t pose a risk to the infant, and will also help us learn whether antibodies may be passed along that could protect the infant from infection,” said lead investigator and Mommy’s Milk director Dr. Tina Chambers.
Recognizing the urgent need for research in this area, Medela, a company best known for the advancement of breast milk technology, has announced that they will be donating breast milk pumps and milk storage bags to support our study efforts. “Since the beginning of this crisis, moms around the world have reached out to us for guidance and answers around COVID-19 and breastfeeding,” said Annette Brüls, CEO of Medela. “We fully agree with UNICEF that breast milk is the best nutrition for infants, especially in times like these. It is well known that breast milk provides dynamic immunologic protection. Therefore, we are excited to support such research projects to gain in-depth understanding of the natural defense mechanisms through breast milk and the presence of antibodies in it.”
The supplies will be used to capture milk samples from breastfeeding women across the U.S and Canada with known or suspected COVID-19 infection. “The pandemic came on so quickly that we had to launch the study without an identified funding source to support all of the research activities. Thanks to the generosity of Medela, the supplies that we need to obtain the breast milk samples are one less expense that we’ll have to worry about,” added Chambers.
Read more about Medela
About Mommy’s Milk: Mommy’s Milk is a human milk biorepository that is dedicated to research, with the goal of establishing a clinical database of breast milk samples that can be used to help us better understand the relationship between human milk and infant and child health and development. The Mommy’s Milk COVID-19 Breastfeeding Study is collaborating with other UC San Diego School of Medicine research partners, including the Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence (led by Dr. Lars Bode).
