Pregnancy — 50% planned; 50% unplanned

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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, Review, References & Coming Attractions

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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):
pregnancy_pathway

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.

Humor­ous incur­sion:
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.

Stay tuned!!

Pregnancy Pathway, Preconditions — Behavior

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Please refer to Feb­ru­ary 5 entry for entire graph­ic. Today:  Behav­ioral Pre­con­di­tions to Preg­nan­cy.
bubblus_preconditions-behavior

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.

dtp_mover22As 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.

Pregnancy Pathway, Preconditions — Environment

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Please refer to Feb­ru­ary 5 entry for entire graph­ic. Today: Envi­ron­men­tal Pre­con­di­tions to Preg­nan­cy.
bubblus_preconditions-environment
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.

08-4Are 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.

Pregnancy Pathway, Preconditions — Genetics

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Please refer to Feb­ru­ary 5 entry for com­plete graph­ic. The Pre­con­di­tion we will dis­cuss today is Genet­ics.

bubblus_preconditions_-_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!

Pregnancy Pathway, Preconditions

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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.

Preconditions

Pre­con­di­tions

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.

Pregnancy Pathway, introduction

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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.