Personal Health - Gain in Pregnancy Is Linked to Weight Problems in Children

Increasing evidence indicates that the trouble often starts in the womb, when women gain more weight than is needed to produce a healthy, full-size baby. Excessive weight gain inpregnancy, recent findings show, can result in bigger-than-average babies who are prenatally programmed to become overweight children— who, in turn, are more likely to developdiabetes, heart disease andcancerlater in life.

TheInstitute of Medicine, the health arm of theNational Academy of Sciences, reported last year that more than a third of normal-weight women and more than half of overweight and obese women gain more weight than is recommended during pregnancy. Over all,“fewer than 40 percent of pregnant women gain only the recommended amount of weight during their pregnancy,” Dr. Sylvia R. Karasu and Dr. T. Byram Karasu report in their new book“The Gravity of Weight.”

Not‘In the Genes’

While genes play a role in weight issues for some people, recent studies indicate thatgeneticsis not the main reason babies are born too fat. Rather, the new evidence suggests that in addition to gaining significantly more weight than is recommended during pregnancy, more women now start out fatter before they become pregnant.

The latest studycontrolled for the effects of genetics by studying consecutive pregnancies among more than half a million women. The analysis, by Janet Currie, a health economist atColumbia University, and Dr. David S. Ludwig of Children’s Hospital Boston, found a consistent association between the amount of weight a woman gained during pregnancy and the birth weight of her babies.

Women who gained more than 53 pounds during a full-term pregnancy with one baby were more than twice as likely to have babies who weighed 9 or more pounds at birth than were women who gained only 18 to 22 pounds. For each kilogram (2.2 pounds) of weight gained by the pregnant mother, the baby’s birth weight increased by 7.35 grams (one-fourth of an ounce).

Because birth weight tends to predictbody mass indexlater in life,“these findings suggest that excessive weight gain during pregnancy could raise the long-term risk of obesity-related disease in offspring,” the authors concluded in their report, published online in The Lancet on Aug. 5.

The analysis sought to rule out the effects of genetics on birth weight by comparing each married woman’s pregnancy weight gain and birth weight of her babies in successive pregnancies that occurred within a few years of each other (and thus were most likely to involve the same father). Although the authors did not know how much the women weighed before becoming pregnant each time, other studies have found that many women fail to lose all their pregnancy weight before they become pregnant again. Thus, they are likely to start out fatter and gain more during the next pregnancy.

Inan accompanying editorial, Dr. Neal Halfon and Dr. Michael C. Lu of the Center for Healthier Children, Families and Communities at theUniversity of California, Los Angeles, citedstill another study, this one based ondata gathered from parents and children in Britain. It found that at age 9, the children of women who had gained more weight than recommended by the Institute of Medicine were fatter than other children, more likely to become overweight, and had several risk factors for heart disease— including higherblood pressureand lower levels of protectiveHDLcholesterol— as well as poorer immune function.

This study, published in Circulation in June, found that a woman’s weight before pregnancy was even more important than excessive weight gain during pregnancy in predicting a number of risks for the baby: birth complications, excessive baby fat and“metabolic abnormalities associated with poor health outcomes, including childhood obesity,” as the editorial put it.

Dr. Halfon, a pediatrician, said in an interview,“The little changes in children’s metabolism tend to be compounded over time and become big changes in adults.”

The Recommendations

The latest recommendations from the Institute of Medicine, revised last year, suggest these pregnancy weight gains, as determined by a woman’s prepregnancy weight:

¶28 to 40 pounds for thin women, with a B.M.I. of 18.5 or lower.

¶25 to 35 pounds for normal-weight women, with a body mass index of 18.6 to 24.9.

¶15 to 25 pounds for overweight women, with a body mass index of 25 to 29.9.

¶11 to 20 pounds for obese women, with a body mass index of 30 or higher.

Dr. Lu, an obstetrician, said prepregnancy weights in nine states revealed significant increases in overweight and obesity between the periods 1993-94 and 2002-3. Even normal-weight women are now more likely to gain excessive amounts during pregnancy than were women who became pregnant in the 1990s, according to data from the nationalCenters for Disease Control and Prevention.

According to data from the National Center for Health Statistics, since 1990 proportionately more women have gained more than 40 pounds in a singleton pregnancy.

Higher Birth Weights

The new findings suggest that Americans are now caught in a vicious cycle of increasing fatness, with prospective mothers starting out fatter, gaining more weight during pregnancy and giving birth to babies who are destined to become overweight adults.

“There are a lot more high-birth-weight babies being born,” Dr. Currie said in an interview,“and this may have something to do with the increase in overweight we’re now seeing in the population over all.”

When I was pregnant 40-odd years ago, a normal-weight woman was expected to keep her pregnancy weight gain to within 24 pounds. But, Dr. Currie said, about 20 years ago the concern about too many babies with low birth weights may have prompted many doctors to be less restrictive about how much weight women gained while pregnant.

“We still see a lot of low-birth-weight babies, but the number of high-birth-weight babies has increased quite dramatically,” Dr. Currie said.“There’s no reason for a woman to gain more than 40 pounds with a single baby. We used to think babies in the womb were well protected, but we now know they are influenced by lots of things that will affect them later in life.”

She added,“The next frontier has to be the prepregnancy period. If we really want to improve the health of children, we have to get to mothers before they get pregnant.”

As Dr. Halfon said,“You can’t turn around in the nine months of pregnancy what’s been going on for many years of life. The preconception period is critical to placing pregnancy on a healthier trajectory.”

This is the second of two columns about weight. Last week’s wason the body mass index.

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Feast of Data on BPA Plastic Yields Few Answers

Concerns about BPA stem from studies in lab animals and cell cultures showing it can mimic the hormoneestrogen. It is considered an“endocrine disruptor,” a term applied to chemicals that can act like hormones. But whether it does any harm in people is unclear.

Where science has left a void, politics and marketing have rushed in. A fierce debate has resulted, with one side dismissing the whole idea of endocrine disruptors as junk science and the other regarding BPA as part of a chemical stew that threatens public health.

About half a dozen states have banned BPA in children’s products, and SenatorDianne Feinsteinhopes to accomplish the same nationwide, with an amendment tothe food safety billscheduled for a vote in the Senate next week.

This year, apresidential panel on cancer and the environmentsaid there was a“growing link” between BPA and several diseases, includingcancer, and recommended ways to avoid BPA, like storing water in bottles free of it and not microwaving food in plastic containers. Some cancer experts said the report overstated the case against chemicals, but the concerns it raised seemed to reflect growing public worries.

Consumer fears have made the words“BPA-free” a marketing tool. Wal-Mart, Whole Foods, Sears, CVS and other retailers have said they will stop selling baby bottles made with BPA, and major formula and baby-bottle manufacturers have also scrapped it. Worried people have purged their homes of plastics labeled 7. (Products are numbered for recycling; those with BPA carry a 7, but not everything with a 7 contains BPA). Nalgene, which makes popular water bottles, quit using BPA when customers began complaining about it. Sunoco, one of the companies that makes BPA, said it would sell the chemical only to buyers who guaranteed that they would not use it in food or drink containers meant for children.

In May, aWhite House task force on childhood obesityissued a report suggesting that BPA and certain other chemicals might be acting as“obesogens” in children— promoters ofobesity— by increasing fat cells in the body and altering metabolism and feelings of hunger and fullness.

Perhaps not surprisingly, the issue of whether BPA is safe has become highly partisan.

Environmental groupsand many Democrats want BPA banned, blaming it for an array of ills that includes cancer, obesity, infertility and behavior problems. Environmentalists think the United States should adopt the“precautionary principle,” a better-safe-than-sorry approach favored in theEuropean Union. The principle says, in essence, that if there are plausible health concerns about a chemical, even if they are not proved, people should not be exposed to it until studies show it is safe. The United States takes the opposite approach: chemicals are not banned unless there is proof of harm.

Many Republicans, anti-regulation activists and thefood-packagingandchemical industriesinsist that BPA is harmless and all but indispensable to keeping canned food safe by sealing the cans and preventing corrosion, and to producing many other products at reasonable prices. They argue that the chemical has been demonized, and that adopting the precautionary principle would lead to needless and ruinously expensive bans on safe and useful products. Both sides are closely watching the issue unfold, because BPA is widely seen as a test case in an era of mounting worry about household chemicals, pollution and the possible links between illness and environmental exposures, especially in fetuses and young children.

“This isn’t the only endocrine-disrupting chemical on the block,” said Patricia Hunt, a biologist atWashington State University, in Pullman.“It’s just the one that’s captured the attention, because researchers like me have gotten into the field and gone,‘Holy cats! We’re all exposed to this.’ There’s been a heavy industry response, and we’ve gathered our forces together a little more strongly to shine a light on it. This is the poster child for this group of chemicals. Academic scientists are saying we need to do something, and we need to do it fast.”

Linda S. Birnbaum, director of the National Institute of Environmental Health Sciences (part of theNational Institutes of Health), said that a new round of government-financed studies with uniform methods, now under way with animal subjects, should help to resolve unanswered questions. In the meantime, Mrs. Feinstein’s ambitious plan to ban BPA from baby bottles, sippy cups, baby food and formula was blocked by partisan battling. She had hoped that the ban would be included in thefood safetybill, not merely in an amendment to be considered separately.

But after months of wrangling, she gave up. The food industry, mostly supportive of the food bill, threatened to oppose it if the BPA provision got in. So did many Republican senators. In August, Mrs. Feinstein’s Democratic colleague RepresentativeJohn D. Dingellof Michigan made public a letter in which he urged her to back off on BPA for the sake of the bill, which will broaden the authority of theFood and Drug Administrationover the food supply— a measure widely seen as essential to reducing food-borne illnesses like the recentsalmonellaoutbreak from eggs.

In a statement released in August, Mrs. Feinstein said,“TheFood SafetyBill was the logical place for this legislation, and I have been working hard to reach a compromise, but unfortunately BPA language is not included.”

As an amendment instead of being part of the bill itself, the ban is far less likely to pass the Senate and become law. Last week, the legislature in Mrs. Feinstein’s state, California, rejected a BPA ban like the one she is proposing.

Buried in an Avalanche of Data

The mountains of data produced so far show conflicting results as to whether BPA is dangerous, in part because different laboratories have studied the chemical in different ways. Animal strains, doses, methods of exposure and the results being measured— as crude as body weight or as delicate as gene expression in the brain— have all varied, making it difficult or impossible to reconcile the findings. In science, no experiment is taken seriously unless other researchers can reproduce it, and difficulties in matching BPA studies have led to fireworks.

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Money Missing to Confirm Trial of Microbicide Against H.I.V.

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Modified Salmon Is Safe to Eat, F.D.A. Says

The assessment makes it more likely that the fish will become the first genetically modified animal to enter the American food supply.

Food from the salmon“is as safe as food from conventional Atlantic salmon,” the F.D.A. said inits analysis, which was posted on its Web site Friday.“There is a reasonable certainty of no harm from consumption of food from this animal.”

The salmon can grow to market size in 16 to 18 months instead of the 30 required for a regular farmed Atlantic salmon, according to its developer, AquaBounty Technologies of Waltham, Mass.

AquaBounty has been trying for years to win approval for the salmon, a goal that now appears within reach. The analysis by the F.D.A. staff was in preparation for three days of public meetings on the salmon that will start on Sept. 19.

The F.D.A. is expected to make a final decision on approval in the weeks after the meetings. The company has said it will take two to three years after approval for the fish to reach American supermarkets.

A coalition of 31 consumer, animal welfare, environmental and fisheries groups announced opposition to the approval last week, citing, in particular, concerns that the salmon could escape and possibly outcompete wild salmon for food or mates.

But AquaBounty said the fish would be grown only inland. And only sterile females will be sold, limiting any ability to reproduce. The F.D.A., in its analysis, basically agreed that the chance of escape or ecological disruption was small. The salmon“are not expected to have a significant impact on the quality of the human environment,” it concluded.

But the analysis is not likely to satisfy critics, in part because much of thedataupon which the F.D.A. based its conclusions was submitted by AquaBounty.

Jaydee Hanson, a policy analyst at the Center forFood Safety, a Washington advocacy group, said that only a handful to a few dozen fish were used for some of the studies on the safety of the fish flesh or its potential to causeallergic reactions.

“We’re actually pretty amazed at how small their samples were,” he said. He also pointed to information in the documents suggesting that up to 5 percent of the fish might not be sterile because the process is not perfect.

The AquAdvantage Atlantic salmon contains agrowth hormonegene from the Chinook salmon that is kept active all year round by a genetic on-switch from a different fish, the ocean pout. Normally, salmon produce growth hormone only in warm weather. So with the hormone produced year round, the AquAdvantage salmon grow faster.

One issue that might attract some discussion at the public meetings is that the engineered salmon have slightly higher levels of insulinlike growth factor 1, a hormone related to growth hormone. Some studies suggest that high levels of the insulinlike hormone in the bloodstream are associated with greatercancerrisk, though it is not clear how much food contributes to hormone levels in the blood.

However, the F.D.A. did an analysis that concluded that even if people ate a lot of the salmon, it would not make a significant difference in the amount of the hormone they would consume.

Genetically engineered animals are regulated by the F.D.A. under rules covering animal drugs. The agency’s Veterinary Medicine Advisory Committee will discuss the application on Sept. 19 and 20 in Rockville, Md. The next day the agency will hold a public meeting to discuss whether or how food from the salmon should be labeled.

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Child’s Ordeal Shows Dangers of Antipsychotic Drugs

Thus began a troubled toddler’s journey from one doctor to another, from one diagnosis to another, involving even more drugs.Autism,bipolar disorder,hyperactivity,insomnia,oppositional defiant disorder. The boy’s daily pill regimen multiplied: the antipsychotic Risperdal, the antidepressantProzac, two sleeping medicines and one for attention-deficit disorder. All by the time he was 3.

He was sedated,droolingand overweight fromthe side effectsof the antipsychotic medicine. Although his mother, Brandy Warren, had been at her“wit’s end” when she resorted to the drug treatment, she began to worry about Kyle’s altered personality.“All I had was a medicated little boy,” Ms. Warren said.“I didn’t have my son. It’s like, you’d look into his eyes and you would just see just blankness.”

Today, 6-year-old Kyle is in his fourth week of first grade, scoring high marks on his first tests. He is rambunctious and much thinner. Weaned off the drugs through a program affiliated withTulane Universitythat is aimed at helping low-income families whose children havemental healthproblems, Kyle now laughs easily and teases his family.

Ms. Warren and Kyle’s new doctors point to his remarkable progress— and a more common diagnosis for children of attention-deficit hyperactivity disorder— as proof that he should have never been prescribed such powerful drugs in the first place.

Kyle now takes one drug, Vyvanse, for his attention deficit. His mother shared his medical records to help document a public glimpse into a trend that some psychiatric experts say they are finding increasingly worrisome: ready prescription-writing by doctors of more potent drugs to treat extremely young children, even infants, whose conditions rarely require such measures.

More than 500,000 children and adolescents in America are now taking antipsychotic drugs, according to a September 2009 report by theFood and Drug Administration. Their use is growing not only among older teenagers, whenschizophreniais believed to emerge, but also among tens of thousands of preschoolers.

AColumbia University studyrecently found a doubling of the rate of prescribing antipsychotic drugs for privately insured 2- to 5-year-olds from 2000 to 2007. Only 40 percent of them had received a proper mental health assessment, violating practice standards from the American Academy of Child and Adolescent Psychiatry.

“There are too many children getting on too many of these drugs too soon,” Dr. Mark Olfson, professor of clinicalpsychiatryand lead researcher in the government-financed study, said.

Such radical treatments are indeed needed, some doctors and experts say, to help young children with severe problems stay safe and in school or day care. In 2006, the F.D.A. did approve treating children as young as 5 with Risperdal if they had autistic disorder and aggressive behavior, self-injury tendencies, tantrums or severe mood swings. Two other drugs, Seroquel fromAstraZenecaand Abilify fromBristol-Myers Squibb, are permitted for youths 10 or older with bipolar disorder.

But many doctors say prescribing them for younger and younger children may pose grave risks to development of both their fast-growing brains and their bodies. Doctors can legally prescribe them for off-label use, including in preschoolers, even though research has not shown them to be safe or effective for children. Boys are far more likely to be medicated than girls.

Dr. Ben Vitiello, chief of child and adolescent treatment and preventive research at the National Institute of Mental Health, says conditions in young children are extremely difficult to diagnose properly because of their emotional variability.“This is a recent phenomenon, in large part driven by the misperception that these agents are safe and well tolerated,” he said.

Even the most reluctant prescribers encounter a marketing juggernaut that has made antipsychotics the nation’s top-selling class of drugs by revenue, $14.6 billion last year, with prominent promotions aimed at treating children. In the waiting room of Kyle’s original child psychiatrist, children played with Legos stamped with the word Risperdal, made byJohnson&Johnson. It has since lost its patent on the drug and stopped handing out the toys.

Greg Panico, a company spokesman, said the Legos were not intended for children to play with— only as a promotional item.

Cheaper to Medicate

Dr. Lawrence L. Greenhill, president of the American Academy of Child and Adolescent Psychiatry, concerned about the lack of research, has recommended a national registry to track preschoolers on antipsychotic drugs for the next 10 years.“Psychotherapy is the key to the treatment ofpreschoolchildren with severe mental disorders, and antipsychotics are adjunctive therapy— not the other way around,” he said.

But it is cheaper to medicate children than to pay for family counseling, a fact highlighted by aRutgers University studylast year that found children from low-income families, like Kyle, were four times as likely as the privately insured to receive antipsychotic medicines.

TexasMedicaiddata obtained by The New York Times showed a record $96 million was spent last year on antipsychotic drugs for teenagers and children— including three unidentified infants who were given the drugs before their first birthdays.

In addition,foster carechildren seem to be medicated more often, prompting a Senate panel in June to ask theGovernment Accountability Officeto investigate such practices.

In the last few years, doctors’ concerns have led some states, like Florida and California, to put in place restrictions on doctors who want to prescribe antipsychotics for young children, requiring a second opinion or prior approval, especially for those on Medicaid. Some states now report thatprescriptionsare declining as a result.

A study released in July by 16 state Medicaid medical directors, which once had the working title“Too Many, Too Much, Too Young,” recommended that more states require second opinions, outside consultation or other methods to assure proper prescriptions. The F.D.A. has also strengthened warnings about using some of these drugs in treating children.

No Medical Reason

Kyle was rescued from his medicated state through a therapy program calledEarly Childhood Supports and Services, established in Louisiana through a confluence of like-minded childpsychiatristsat Tulane, Louisiana State University and the state. It surrounds troubled children and their parents with social and mental health support services.

Dr. Mary Margaret Gleason, a professor ofpediatricsand child psychiatry at Tulane who treated Kyle from ages 3 to 5 as he was weaned off the heavy medications, said there was no valid medical reason to give antipsychotic drugs to the boy, or virtually any other 2-year-old.“It’s disturbing,” she said.

Dr. Gleason says Kyle’s current status proves he probably never had bipolar disorder, autism orpsychosis. His doctors now say Kyle’s tantrums arose from family turmoil and language delays, not any of the diagnoses used to justify antipsychotics.

“I will never, ever let my children be put on these drugs again,” said Ms. Warren, 28,chokingback tears.“I didn’t realize what I was doing.”

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Doctor and Patient - A Medical Team Bonded as Hurricane Katrina Hit - Question

But in the week of August 28,Hurricane Katrinawould test that relationship and the clinicians’ limits of compassion, patient advocacy and professionalism. Trapped within the confines of their hospital with 18 seriously ill patients, Dr. Berggren and the two teams of nurses and support personnel who stayed behind first lost power, then food and very nearly their hope. In the overbearing humidity, the darkened central stairwell, the only passage to other parts of the hospital, quickly became a treacherous obstacle course, slippery from human sweat. Vending machines, smashed open with bare hands, stood empty in small puddles of blood. The air grew increasingly rank as people, lost in dark hallways, began defecating and urinating wherever they could.

Dr. Berggren and her team were finally rescued six days later, but only after every one of their patients on 9 West had been evacuated first.“Not a single patient died, and nobody on our team left until our patients were safely out of Charity,” Dr. Berggren said in a recent interview.“We got every single one of our patients out.”

Below are excerpts from my interview with Dr. Berggren, now an associate professor of medicine and the director of the Center for Medical Humanities and Ethics at theUniversity of TexasHealth Science Center in San Antonio.

Q.How did you end up at the hospital during Katrina?

A. As the assigned physician, I was expected to be there. Normally we would have also had a team of doctors-in-training and an entire support staff. But no one else showed up that Sunday morning other than the nurses and support personnel who had been trained in disaster response.

This happened all over New Orleans. Sometimes it was the senior physician who didn’t show up, and the doctors-in-training were left to care for patients without supervisors; sometimes the senior physicians were left without the support of doctors-in-training.

Q.Why do you think the other doctors didn’t show up for work?

A. I had to ask myself at first why people who had been so passionate about patient advocacy had not bothered to show up. But with disaster preparedness, people have to evaluate their own suitability for being a first responder— and not necessarily in terms of medical or technical skills. If you have a conflict of interest that relates to what is most dear to you, you are not necessarily going to be your best self as a responder.

Some people who stayed behind were the sole caregiver for an elderly person; some had children left with a baby sitter. They broke down after four or five days. Their loved ones were lost, and that created such hugeanxietythey couldn’t function. I was lucky because I knew my husband and children were safe. I think if I didn’t know where my family was, my ability to be reasonable, empathic and compassionate would have gone out the window.

Q.Did you ever fear for your own life?

A. We had heard on the news that if theleveesbroke, the water could be 20 feet deep and filled with toxic chemicals, so I did feel that something serious could happen. But none of us felt deeply frightened the first day. We felt safe in Charity. We had a nice team of people. And there was more patient interaction than usual.

When the storm hit, things changed rapidly. Water came through the seams of closed windows, and we had an inch of water on the floor. We heard an eerie screeching— almost like human screaming— that was, I think, the sound of metal scraping against metal. Then the lights went out.

For a day, we were able to keep the patients’ treatments going using the hospital’s emergency backup power. But as time went on, we lost that power and all the machines switched over to batteries. Eventually, those batteries went out.

At first I was busy switching patients over to treatment plans that wouldn’t require power, but most of patient management the rest of the week had to do with constant communication with the nursing staff, keeping people calm and trying to keep to some kind of routine.

In the end, I didn’t spend a lot of time worrying about the 20 feet of water with toxic chemicals because there was so much to be done. As a physician who could do something good for people, I felt it was time for me to step up to the plate. That sense of purpose propelled me for the next six days.

Q.The Superdome, only four blocks away from Charity, was racked with chaos and violence that week. Did the same happen on 9 West?

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Bedbugs a Worry for Scouring Shoppers at Secondhand Stores

And they are scared thatbedbugsfrom the home of a former owner still call that $20 designer jacket or that fabulous $65 chair their castle.

That explains why a puzzled-looking Elizabeth Borné was standing on East 23rd Street one afternoon last week. Should she risk the $325 sofa with the paisley fabric that she had just seen in theHousing Works thrift shopnear Third Avenue? Was it worth feeling jittery and jumpy about something whose history she could not know? Would she fret every time she invited someone over or curled up for a nap?

“I like and I want it,” she said.“It looks sort of reproductiony. It’s quirky, it’s eclectic, it’s rustic-slash-retro. But my first thought is bedbugs— and bedbugs are freaky.”

Ms. Borné is hardly the only secondhand-store shopper whose first thought has beenCimex lectularius, the speck-size common bedbug. In the spring, the first question from a student at aFashion Institute of Technologycourse called“Is Vintage for You?” was,“Have you ever experienced any issues with bedbugs?”

“One girl in particular in the class had an issue,” said the instructor,Bridgett Artise, a fashion designer and an author of“25 Ways to Deconstruct, Reinvent and Recycle Your Wardrobe.”“She said,‘I had a problem with a jacket.’ She said they were in the lining, so it was hard to know they were even there.”

“They” might find a funky 1950s housedress as appetizing as a so-last-year strapless number.“Obviously, these bugs do not respect economic level or social status or neighborhood— they found them in Abercrombie&Fitch,” said Jose Medellin, a spokesman forGoodwill Industries of Greater New York and Northern New Jersey.

And so secondhand-store buyers worry about something the size of a lentil that could have been on a pipe near the ceiling or in a book on a shelf before it made the jump to clothing or furniture that was consigned or given away. Ms. Borné, a nursing student, said she had looked at pictures of bedbug bites online to see how they differed from spider bites and mosquito bites, just in case she ever needed to know.

Ms. Artise said:“I only worry about newbies, new vintage shoppers. People like myself already know the telltale signs, and what to do.

“The first thing I always tell people who buy vintage clothing is if they see any type of anything that looks like it might have remnants of bedbugs, put it in a plastic bag and freeze it. You keep it in there, I would say, for at least three days. It can’t survive freezing. And after it thaws out, I would take it to a dry cleaner.”

Lisa Slocum, a lawyer who bought a velvet coat for $33 at theCity Opera Thrift Shop—“I just can’t resist a bargain,” she said— lived through bedbugs a couple of years ago.

“I swore if I ever bought anything in a thrift shop again, I’d wrap it in plastic and take it right to the dry cleaner,” Ms. Slocum said.“You really do believe you’ll never get rid of them.”

The infestation was enough for her to stop making the rounds of vintage shops“for a while,” even though she had no evidence they came from the stores she had frequented.“I’m a hard person to stop from secondhand shopping,” she said as she left the City Opera shop on East 23rd Street.

Managers and clerks at vintage stores said that they were getting a lot of questions from customers but that the bedbug epidemic did not seem to be putting a dent in their business.

“I’ve never seen a bedbug,” said Tiffany Collings, the manager atBeacon’s Closet, on Fifth Avenue in Park Slope, Brooklyn, where party dresses sell for as little as $10.“We’ve never— knock on wood— had a problem with bedbugs, but it’s absolute and utter sheer luck.”

Ms. Collings said some customers asked what precautions the store took.“I tell them,‘If you’re worried about bedbugs, I’ve read about bedbugs. If you put clothes in a dryer under high, high heat, it’s supposed to kill the bugs and eggs,’ ” she said.“We’re looking, physically looking at clothes” when a customer brings in clothing to sell, and if she saw a bedbug, she said, she would hand the item back.

Housing Works said it fumigated its stores and its processing and distribution center in Long Island City. For furniture, said Matthew Bernardo, the senior vice president for business service, Housing Works has a screening policy: someone from Housing Works inspects it at the prospective donor’s apartment first.

“We always say when people set up for us to pick up furniture that we have the right to refuse,” Mr. Bernardo said.

Mr. Medellin, the Goodwill spokesman, said Goodwill Industries sprayed all its 39 stores and its processing center.

“We do not take home pickups, and we have not received any reports of bedbugs,” he said.“We have an ongoing contract with an exterminator. We asked them,‘Please, make sure that we’re covered for bedbugs as well.’ ”Mattresses are a particular concern, because many consider them the passport for bedbugs through the city.Gale A. Brewer, a city councilwoman who represents the Upper West Side, pressed for a ban on used and reconditioned mattresses. It turned out used mattresses were already covered under a state law passed years ago requiring that they be sanitized, thus killing any bedbugs, before they can be resold. But state regulators have yet to publish standards for accomplishing that.

“I tell people— given the fact that the Centers for Disease Control has declared bedbugs a pretty big menace, an epidemic, actually, and when you have an epidemic you take precautions— that I don’t shop in secondhand stores,” Ms. Brewer said.“That’s everything from the Salvation Army stores to fancy vintage-clothing stores.”

And Ms. Borné and the sofa at the Housing Works shop?“I’m not sold on it,” she said.

But she did buy a $20 Zara dress.

“A dress,” she said,“you can wash.”

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