The first evidence of a biological explanation for newborns dying suddenly in their sleep may have been found by a group of researchers investigating the brain.
Researchers at the Royal Alexandra hospital for children at Westmead say they have discovered babies who die from sudden infant death syndrome (Sids) have greatly decreased levels of a certain brain protein-like neuropeptide, known as orexin, responsible for regulating sleep arousal.
It is hoped the research could eventually lead to babies being screened for low levels of orexin.
Such a test would not be available for at least another decade, however, and parents still need to follow the Sids prevention guidelines, experts caution.
There are many well known and evidence-based environmental risk factors related to Sids, such as smoking, excessive bedding and stomach sleeping.
Dr Rita Machaalani, the sleep unit manager at Westmead, said there was now evidence that Sids was caused by a biological condition in an area of the brain responsible for sleep regulation.
A cohort study of more than 27 Sids cases and 19 controls found the level of orexin was 20% lower in the brains of those babies who had died from Sids.
“That seems to indicate that these babies may have had some defect in the message that says this baby should arouse during their sleep time but it didn’t get through to do so,” Machaalani said.
Machaalani said her team was now conducting research to find the mechanism responsible for this reduction in orexin, which has previously been implicated in sleep disorders in adults.
Medical researcher and associate professor Alexandra Martiniuk from the George institute for global health at the University of Sydney, said the potential to screen was huge.
But orexin could be just “one of many” causes of Sids, Martiniuk added.
“I have read a lot of coroner reports of children who have died of SIDS and there are these other risk factors,” she said. “They do often state that they found the child lying face down or face embedded between mattress and something else.”
Martiniuk said Sids could be the result of a combination of biological and environmental factors, such low levels of orexin and bad sleeping habits.
“It will remain to be seen whether you need a loading of risk factors to have a bad outcome of death.
“But certainly it’s a huge breakthrough because in my knowledge of Sids there hasn’t been anything biological like that before, it has always been environmental risk,” she said.
The astute woman of child-bearing age develops a facility to tune out of alarmist headlines about the biological clock. But every now and again an expert comes along and offers the kind of soundbite that cuts through. The latest came courtesy of Gillian Lockwood, medical director of Midland Fertility Clinic, who last month said: “It may not be true that women should be having babies at the time of GCSEs, but they shouldn’t leave it much later than graduation. Age 25 is exactly the time when today’s young women have left university, are trying to get off on a good career, trying to find someone who wants to have babies with them, and trying to get on the housing ladder.”
Twenty-five? In a supportive society, women keen to conceive in their mid-twenties might find it realistic to do so. But not in the current climate, where the financial crisis, spiralling property prices, unstable employment, austerity and low pay have combined to trap many members of Generation Y in perpetual financial adolescence.
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Last year I interviewed people in their twenties up and down the UK who desperately wanted children but felt their situation was too precarious. Many were living in rented accommodation or with their parents, faced low pay, unemployment or insecure work, and felt they had no chance of getting on the property ladder anytime soon. They are, essentially, priced out of parenthood.
It’s a depressing state of affairs that has left some wondering whether reproductive technologies might be the answer. What if you could freeze your eggs and put having a baby literally on ice until things were looking a tad more grown up?
In the US, the marketing of egg freezing as a kind of insurance policy for millennials is already in full swing. Facebook, Apple, and the US military now offer egg freezing as an employee benefit. Fertility company EggBanxx estimates that by 2018, 76,000 women will have frozen their eggs. EggBanxx, which describes itself as “Uber, but for egg freezing”, has slogans including “Smart women freeze” and “Lean in, but freeze first!” and throws “Let’s chill” events aimed at young women. Could the UK soon follow suit, as more and more women put off the decision to have children? Inquiries into egg freezing at private clinics in Britain reportedly surged by 400% between 2014 and 2015, and more than half of these came from women under-35.
In the US, the marketing of egg freezing is in full swing. Facebook and Apple now offer it as an employee benefit
Mehrunissa, 23, plans to freeze her eggs in the next two years. “Ambitious, career-driven women often find it difficult to settle down – in terms of finding suitable partners,” she says. “Other women, who feel more of a time pressure to have kids, feel like they’re in a desperate situation where they need to find a man and settle as soon as possible, so freezing your eggs makes you immune to that sort of pressure, and also puts you in absolute control of your life. I envisage that when I do decide to have kids it’ll be for the right reasons rather than a feeling of desperation or losing a battle against time.”
She seems far too young to be thinking about such an extreme course of action but then again, the younger a woman is when she freezes her eggs, the better the chances are of conception. Not that there are any guarantees, and it can very costly – at least £5,000 in some London clinics; the more cycles you invest in, the better is your chance of conceiving. As for Mehrunissa’s aim of being in “absolute control”, when it comes to fertility, there is no such thing. But in a world in which young people lack stability it isn’t hard to understand why the illusion of it can be seductive.
“Social circumstances have delayed a lot of things. It’s not just about not having children younger but about not having a job, or a stable career younger, or not having a home,” explains Angel Petropanagos, a research associate in impact ethics at Dalhousie University in Canada, who spoke at a recent debate in the UK organised by the Progress Educational Trust, asking “Can you put motherhood on ice?”
“There is all this financial and social instability that has contributed to delayed parenting,” Petropanagos continues, but “one of the challenges is that in the US, egg freezing is really targeting a particular demographic with their advertising … upper middle-class women who are already privileged. These are the kind of women whose parents and grandparents are paying for egg freezing as a graduation present.”
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And this is one of the major problems with egg freezing: that it is being portrayed as an option available for all women to delay motherhood, regardless of their income, when in reality, the costs are prohibitive to many, especially younger women. But because the clinics are arguing that your twenties are what Petropanagos calls the reproductive “sweet spot” when your eggs are more likely to yield results, young women are buying into the dream.
Sarah Martins Da Silva, a consultant gynaecologist based in Dundee, points out that “social egg freezing is a personal choice, but you could argue that it actually discriminates against this [younger] demographic as egg freezing needs to be self-funded, and costs several thousand pounds.” She refers to a report by the Centre for Population Change which details how womenwho remain childless largely do so because they have never wanted children, or because they simply haven’t met the right person yet. “On that basis, I would say the target market is the 30 to 35-year-old career woman who has not met Mr Right, who recognises that they are at risk of fertility problems as they get older, and who wants to preserve better quality eggs and an option to use them in future fertility treatment.”
At 34, Natalie (not her real name) could be said to fit into that category. “I’m still very much living that ‘young professional in London’ lifestyle,” she says. “Although I am in my thirties I don’t feel stable enough in myself [to have children]. I part-own a house and earn a decent wage, but freezing my eggs just seems like it could potentially buy me some time. It’s pricey, though, which is why it’s still only a consideration.”
In the UK, young women are not yet being aggressively targeted by clinics offering egg freezing. But as it takes longer for them to get on the career and housing ladders, you do wonder how many others will soon be faced with the same choice, and how companies will take advantage of that anxiety. If egg freezing is hawked as a sort of “wonder solution”, it is surely only a matter of time.
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The danger is that the overwhelming focus of this will be on the individual reproductive choices of wealthier women, when instead we should be addressing the social structures preventing young women on lower incomes settling down sooner and having children earlier. Lack of affordable housing and maternity and paternity pay, along with (in)flexible or unreliable employment and prohibitively expensive childcare are all factors in our reproductive choices. It would do all women an injustice to neglect to challenge these barriers because of egg-freezing technology’s seemingly miraculous allure.
Study leader Professor Ian Goodyer, of Cambridge University, explained: “Depression is a terrible sickness that will have an effect on as several as 10 million men and women in the Uk at some level in their lives.
“By way of our research, we now have a quite genuine way of identifying individuals teenage boys most likely to create clinical depression. This will help us strategically target preventions and interventions at these individuals and hopefully support decrease their risk of significant episodes of depression and their consequences in grownup lifestyle.”
The study’s first writer Dr Matthew Owens added: “This new biomarker suggests that we may possibly be able to supply a much more personalised approach to tackling boys at threat for depression.
“This could be a considerably required way of reducing the quantity of folks suffering from depression, and in certain stemming a threat at a time when there has been an rising rate of suicide amid teenage boys and youthful guys.”
The researchers measured amounts of cortisol in saliva from two separate massive groups of teens. The initial consisted of 660 youngsters, who offered 4 early morning samples on schooldays inside of a week and then once more 12 months later. The researchers have been in a position to display inside this group that cortisol levels were secure above 1 year in the population at massive in both boys and girls.
A 2nd group, consisting of 1,198 teens, provided early morning samples in excess of 3 school days.
Using self-reports about recent signs and symptoms of depression collected more than the 12 months and combining these with the cortisol findings, Professor Goodyer and colleagues had been able to divide the youngsters in the 1st group into four distinct sub-groups.
They ranged from people with typical ranges of morning cortisol and reduced signs and symptoms of depression in excess of time (Group one) through to individuals youngsters with elevated ranges of morning cortisol and substantial signs and symptoms of depression over time (Group four) – this latter group created up one particular in six of all topics (17 per cent).
Since the two groups gave identical benefits, Professor Goodyer and his colleagues have been capable to combine them and examine the total sample of 1,858 youngsters for the probability of creating clinical key depression and other psychiatric problems when followed up twelve to 36 months later on.
The subjects in Group 4 had been on regular 7 times a lot more probably than individuals in Group 1, and two to three occasions more most likely than in the other two groups, to develop clinical depression.
More evaluation uncovered that boys in Group 4 had been 14 instances much more most likely to endure from major depression than these in Group one and two to 4 times more likely to develop the problem than either of the other two groups.
Women in Group 4, on the other the other hand, had been only four occasions much more likely than people in Group one to produce major depression, but were no more probably to create the issue than individuals with both elevated morning cortisol or signs and symptoms of depression alone. The findings recommend gender distinctions in how depression develops.
The researchers hope that having an very easily measurable signpost will allow medical professionals to identify boys at substantial risk and think about new public mental overall health methods.
The research has been welcomed by the Wellcome Believe in which funded the examine.
Dr John Williams, Head of Neuroscience and Psychological Health, said: “Progress in identifying biological markers for depression has been frustratingly slow, but now we finally have a biomarker for clinical depression.
“The technique taken by Professor Goodyer’s crew may possibly yet yield additional biomarkers. It also gives tantalising clues about the gender differences in the triggers and onset of depression.”
The examine was published in the journal Proceedings of the Nationwide Academy of Sciences.
