So…are you planning to become pregnant? For the last decade, pregnancy has been in a 50/50 situation. That is, about half the pregnancies occurring in the U.S. are planned. The rest? Well, not necessarily unwelcome, but definitely unplanned.
Will this change in the current recession (or as a friend said today, Let us just call it a depression and move on)? So far, it is clear that pregnancy rates are not dropping, despite an unwillingness to spend money on many other things. What does this say?
Once again, despite living in a high tech world, having babies is a primal experience. It does not diminish when resources are scarce.
So, plan to or not, if you have a baby during this depression, do not waste your money. Figure out how to have a healthy pregnancy.
Next on the Pregnancy Pathway: the act of conception.
Small Rant — Women, their pregnancies, births and mothering styles are all unique. The big issue in childbearing these days is control. Fear of losing control, who controls birth (do YOU give birth or are you delivered by others?), having the self confidence and skills to know when to let go of control yet be okay. It’s interesting to hear what happened to someone else, but (here’s the rant part) this can often be frightening because — let’s face it — catastrophe gets our attention. Whatever you’ve heard, you still have to do it yourself. Pregnancy, birth and parenting create a steep learning curve.
Review — Our job at the DTP Blog is to help with the learning curve through evidence-based information. We are moving along a pathway. Here it is, in a small version (see Feb. 5 for full version):
So far, we have dealt with Preconditions (the Green items). If you understand what you can and cannot control along your Pregnancy Pathway it can help prevent you from spinning your wheels or wasting money. Some things are worth doing (self care, good food, exercise) and some are not (self-indulgence, toxins, stress). Preconditions to pregnancy — genetics, environment and behavior — are worth paying attention to if you are of childbearing age and think or know you are moving along this pathway.
References - We have used hundreds so far and will use many, many more, but only some of you will find the science something you want to pursue, so please go to our DTP website (use the Blogroll) for more information on research in this field. Here are some texts that explain much more: “Women and Exercise” in Varney’s Midwifery (editions 3, 4 & 5), Jones & Bartlett Pub.; Women’s Fitness Program Development by Ann Cowlin, Human Kinetics Pub.; and Immunology of Pregnancy by Gil Mor, Springer Pub.
Coming Attractions — next, we talk about conception. Yes, this is an exciting part, though not perhaps why you think (!). It turns out conception is fraught with many twists and turns.
Q: Why does it take a million sperm to fertilize just one egg?
A: Because none of them will stop and ask directions.
[Sorry, couldn’t resist.]
After that we will likely rant and review again, have more humorous incursions, proceed on to the pregnancy and birth experiences, then discuss health outcomes for mom and baby in the short and long term.
Why do we spend our time on this? From a biological perspective, humans can do nothing more important than create healthy offspring. Wars may be fought, the banks fail or cars become a thing of the past; we might even become post-racial; but, having babies doesn’t really change. It remains a primal experience. It’s nestled in a high tech world, but its still primal. Women have always had guides; we take this role seriously.
Please refer to February 5 entry for entire graphic. Today: Behavioral Preconditions to Pregnancy.
Why do you suppose the American College of Nurse Midwives and the American College of Obstetricians and Gynecologists recommend the minimum time between pregnancies to be two years? Why is it critical to eat foods high in B vitamins (including folic acid) and calcium during the childbearing years? How does your exercise regimen in the six months prior to conception affect your risk for some disorders of pregnancy, such as preeclampsia?
Answer: Your preconception or interconception behavior affects the course and outcome of your pregnancy. As it turns out, it takes about two years for a mother’s body to replenish her stores between pregnancies. Prior to a first pregnancy, behavior in the six months leading up to conception has been shown to affect outcome.
During pregnancy, nutritional and functional resources must support two beings in one body, one of whom is growing at a very fast speed by biological standards (think cell time NOT computer time). Essential vitamins and minerals (such as B vitamins and calcium) are taken from the mother’s body — already in metabolic stress due to demands on the kidneys and liver to clear toxins and filter metabolic waste from the fetus as well as the mother.
Insuring that maternal stores of valuable nutrients are adequate to provide for both fetus and mother is a job that only the potential mother can do. By eating a balanced and colorful diet of proteins, fruits and vegetables, whole grains and essential fatty acids (omega 3’s and 6’s — fish, walnuts, olive oil, avacado, eggs), as well as adequate aerobic exercise leading up to and during pregnancy, a woman improves her odds for a healthy infant. Smart behavior reduces her risk for conditions that cause immune system and cardiovascular disorders that disturb implantation, blood pressure and blood flow to essential organs.
Further, avoiding risky behaviors that may lead to systemic infections, metabolic syndromes or malnutrition leading up to conception is an aspect of behavior known as “risk-aversion” — the ability to avoid behaviors that have negative consequences. Infection at the time of conception (to be discussed in a future post), an extreme lifestyle (either sedentary or anorexic), toxic food choices, drugs, tobacco and alcohol are all behaviors that incur risk for poor pregnancy outcomes, including prematurity and low birth weight — outcomes on the rise in the U.S.
As discussed in the previous two posts, behavior is intertwined with genetics and environmental influences. Having a certain gene mutation or an environmental risk may predispose a woman to possible problems in pregnancy or the development of certain cancers, but some behaviors — especially exercise — may mitigate this potential or reduce the severity or course of disease. Behavior is the area in which we have the greatest control. Exercise, healthy nutrition and risk aversion are the three areas in which women can exert control over their destiny as moms-to-be. It’s a difficult set-up. We live in a time of instant gratification of personal acts. But, motherhood is a long-term commitment to the biological and psychic wellbeing of a new human who is — and is not — us.
Please refer to February 5 entry for entire graphic. Today: Environmental Preconditions to Pregnancy.
Our environment is with us all the time. Even if we think we are preventing or controlling environmental factors that impinge on our bodies and minds, they are lurking here, there, everywhere, and they are myriad. Our environmental influences are everything from the air we breathe to the persons who raise or teach us, from the food available to our housing, from our job stresses to cultural forces or even the weather in our part of the world. These things help shape who we are physically and mentally, over the long term and from moment to moment.
Are you prepared to become a parent? One way to tell is to look at your environment…is it healthy? Are you living in a situation that you can count on? What about clean air, safe paint or safe food? What about water? What about people around you? Are they supportive? Does your environment help you stay healthy?
What about your body? Factors in the environment that affect fertility (or lack of it) may determine if you can even become pregnant, or when you can become pregnant. Think about this: Women who work together often cycle together. What if you work alone, say at home…does this affect your ovulation? One factor identified in the lowering age of menstruation in girls is the increasing number of hormones in various meats. Another factor is the presence of non-biologically related older males in the household. If these things are known, imagine what is not known about situations, chemicals or people in our environment that affect our reproduction!
There is not an absolute separation of genetics, environment and behavior. If we are genetically predisposed to certain disorders, for example, we may or may not develop them, depending on environment. Some persons are inclined toward autoimmune disorders, but they may do well or poorly depending on the air pollution where they live. Some individuals may develop immune disorders. And, this situation may adversely impact inflammatory responses during implantation.
People who strive to take care of themselves even if they live in horrible conditions can use their behavior to improve their chances for success in everything from a healthy pregnancy to a meaningful existence. Even if genetics and the environment are against the process, behavior can sometimes overcome the odds. Granted, it’s not likely you can produce 6′5″ offspring (see last post on genetics!) if the egg person is 5′2″ and the sperm person is 5′7″, but much is possible beyond that.
So, what do you do about your environment if you are thinking about becoming pregnant? Take stock. Ask yourself what, if anything, might have to change. Ask what you can or can’t accept for your offspring, if you know there are environmental factors that aren’t perfect. Fetuses are amazing creatures; the placentas that supply and defend them are ruthless and will protect a fetus at all costs. But, you can give your body and potential baby a good chance to do well by providing a six month span of a healthy environment leading up to conception. And, healthy for mind as well as body.
When your baby comes into the world, a door opens in your heart to a room you didn’t even know was there. In that room is a certain kind of love and caring that cannot be described. It is love for this being who is and isn’t you. As a mother, you have been her/his environment for nine months or however long you have shared. The womb is a small, protected, organized environment, one that reflects your larger environment. So, take stock now, ahead of time.
Please refer to February 5 entry for complete graphic. The Precondition we will discuss today is Genetics.
There are genetic factors totally outside your control that determine things as simple as your offspring’s hair or eye color, how the earlobe attaches to the side of the head and whether or not s/he can roll the tongue. More complex things, such as a predisposition to types of cancers, bleeding disorders or various other diseases, also have a genetic basis.
Because the male contributes the sex of the offspring, once conception happens, the sex off the fetus is determined — at least genetically. But, it turns out not everything genetic is set in stone. In utero, hormone exposures may affect how male and female characteristics develop, so that some girls will be very girlie, some will be tomboys, and some may be gay. A similar effect will influence how boys develop.
Genetic, environmental and behavioral preconditions can be intertwined. Environmental factors can alter genes, causing them to express proteins that would otherwise be dormant. Likewise, our behavior affects some of our genes. If we have a family propensity for heart disease, but we eat a healthy diet, exercise and avoid risky behaviors, we alter the impact of our genetic code.
Keep in mind that some things will be completely determined by genes. It is not reasonable to hope, for example, that our offspring will be 6′5″ if both parents are short (or vice versa). If the mother has “thrifty genes” — that is, genes that make it easy for her to gain weight — she may well do so during pregnancy, even if she follows a reasonably healthy lifestyle. If the immune systems of both parents have some similarities, it may affect the maternal immune response to the implanting trophoblast cells, thus affecting the placenta and, indeed, the entire pregnancy.
So, how do we advise people who are thinking of pregnancy to prepare themselves for a healthy pregnancy genetically? Surely, to determine all the potential genetic possibilities is not feasible or affordable at this point. Maybe in another century! But, we can know some factors: Is there sickle cell anemia in both families? Is there a Mediterranean type of sickle cell disorder? What about clotting factors or differences in Rh? What about diseases or disorders that are not common, like ALS? These are things that potential parents may want to discuss.
Like so much of life, we can’t know everything. There are no guarantees. There is a lot to be learned still about human genes and how they work.
This blog has at its heart the notion that physical activity has tremendous benefits for mother and offspring…and for partners, too. How does the genetic component affect this? First, preconception fitness lowers some risk factors for mothers and babies. Second, each mother’s genes will make it easier or more difficult for her to enjoy or benefit from the activity of exercise. We appreciate this and encourage young moms-to-be to find something enjoyable that you like doing and find people or situations that support you in being active now before you become pregnant.
If you need assistance or advice, please go to www.dancingthrupregnancy.com (use the BlogRoll)
Find Ask the Expert under the Consumer menu. Let us know how we can help!
Please refer to February 5 entry for complete graphic. Today we turn to the question of preconditions to pregnancy and how they might affect maternal and offspring health.
Pre-existing factors that can influence health outcomes include genetic factors (family risk for heart disease, for example), environmental factors (living in a building with mold, for example), and behavior (eating well and exercising, for example). In each category, factors will contribute to the health of the mother and eventually to offspring health.
It is important to understand what major genetic factors may affect your offspring and whether the environment or behavior can help offset negative factors. For example, there may be a history of preeclampsia during pregnancy in your family, but vigorous aerobic exercise in the six months prior to pregnancy provides a high degree of protection from this risk. Preeclampsia puts both mother and offspring at risk for complications.
Other genetic factors that may be of consequence include autoimmune disorders, allergies, and metabolic syndromes. For example, so-called “thrifty genes” may predispose you to a high weight gain in pregnancy. But, you may be able to offset health problems associated with this by staying active and eating well.
Please refer to the Pregnancy Pathway chart in the February 5, 2009 entry. During pregnancy, there are some factors within our control and some that are not. The Pregnancy Pathway, designed by Dancing Thru Pregnancy® founder and Yale University Movement Specialist Ann Cowlin, and Certified Nurse Midwife Robyn Brancato, is intended to describe the flow of factors that influence pregnancy and its outcome.
In the weeks to come, we will focus on individual areas. Our goal is to help women understand how they can optimize their pregnancy by focusing on what they can control that results in beneficial outcomes.
Ann and Robyn are also founding members of the Women’s Health Fitness Institute, a non-profit organization whose mission is research and public education outreach in women’s health fitness. Our comments for this blog are based on scientific evidence and 30 years of tracking individual pregnancy outcomes from women throughout the world. Some entries will include references to the relevant studies.
By helping women understand what endeavors are effective in producing benefits for mothers and their offspring, we hope to aid moms-to-be and those considering pregnancy to be fully present and active in the empowering process of becoming a mother.