Women’s Health & Fitness Programs
Many important health issues for girls and women involve matters of reproductive
health, childbearing, fertility and aging. Research informs us that an active, healthy
lifestyle provides a number of benefits throughout a woman’s life span:
reduced discomforts from pregnancy, labor, birth, recovery & menopause
reduced risk of hypertensive disorders of pregnancy and premature birth
potentially shorter active labor and reduced risk of cesarean delivery
more rapid return to joyful activities, less excess weight following birth
mother-infant interaction, leading to infant psychomotor enhancement
reduced rates of obesity, cardiovascular disease, and type 2 diabetes
reduction of some cancers, osteoporosis, falls and loss of muscle mass
improved social support, networking and stress management skills
greater belief in one’s ability to be strong and capable (self-efficacy)
This is the time of year many of us consider where to make our charitable contributions. We have assembled a list of groups to which you might want to consider giving this year. By donating to these organizations you can help improve the lives of mothers, newborns,children and families around the world. Most will also send a card or email message to a mom in whose honor you give the gift.
UNICEF Inspired Gifts. You can choose gifts that improve education, water, health, nutrition, emergency care and other factors that affect the well-being of women and children.
The Fistula Foundation. This group exists to raise awareness of and funding for fistula treatment, prevention and educational programs worldwide. Fistula is the devastating injury cause by untreated obstructed labor.
The Preeclampsia Foundation. This organization supports research to prevent and treat one of the most dangerous disorders of pregnancy, one that accounts for a large percentage of premature births and low birth weight infants. Having preeclampsia is also a risk factor for later heart disease for the mother.
Clean Birth. Clean Birth Kits are designed to provide birth attendants and/or expecting moms with the tools they need to ensure a clean birthing environment. The Kits ensure the WHO’s “6 Cleans”: clean hands, clean perineum, clean delivery surface, clean cord cutting implement, clean cord tying, and clean cord care.
March of Dimes. The “mother” of all charities for helping prevent and treat disorders and diseases that affect children.
While public awareness of low birth weight and premature infants is becoming – at long last – interesting to the mainstream culture and media, another phenomenon is beginning to shake the professional birthing world: high birth weight. Because it is occurring in a more affluent element of society, it is alarming. This tells us that you cannot buy your way out of pregnancy risks that are created by a sedentary, toxic food life-style.
Here is the dilemma:
Normal weight and some overweight women who eat too much in pregnancy tend to have babies who are, basically, already obese at birth. Therefore, these infants already have metabolic and cardiovascular dysfunction. Babies born over 8 lbs. 14 oz. are at increased risk for Type 2 Diabetes and heart disease.
Interestingly, the Institute of Medicine recently issued new guidelines on pregnancy weight gain. After nearly 20 years of adhering to the “normal” weight gain being 25 to 35 pounds, the Institute recognized that prenatal BMI plays a role in how much weight gain is necessary for a healthy pregnancy.
The evidence that underlies this change demonstrates that gains greater than 22 pounds – for all classifications of prenatal BMI – is the demarkation point for increased health problems. More information on this is available at: New IOM Guidelines.
We have known for a while now that obesity in pregnancy puts mother and infant at risk for a number of problems from cardiovascular, metabolic and immune disorders to prematurity, low birth weight, increased need for cesarean birth and slow recovery. Add another one: Obese newborns with increased risk for heart and metabolism problems.
Reference on weight gain and high birth weight:
Ludwig DS, Currie J. The association between pregnancy weight gain and birthweight: a within-family comparison. Lancet. 2010 Sep 18;376(9745):984-90. Epub 2010 Aug 4.
A good reference for issues surrounding obese pregnancy:
Leddy MA et al. The Impact of Maternal Obesity on Maternal and Fetal Health. Rev Obstet Gynecol 2008;1(4):170-178.
We have long known that vaginal birth and breastfeeding are key factors in the development of a healthy immune system in infants. Passing through the vagina exposes the baby to an array of bacteria that help stimulate its unchallenged immune system. Breast-fed babies receive anti-bodies, proteins and other molecules that protect it from infection and teach the immune system to defend the infant.
Breastfeeding is key for long-term health.
Recent research at UC Davis has shown that a strain of the bifido bacteria – acquired from the mother – thrives on complex sugars (largely lactose) that were previously thought to be indigestible. The bacterium coats the lining of the immature digestive tract and protects it from noxious bacteria.
This combination of interactions affects the composition of bacteria in the infant gut as it matures. Another example of how evolution has “invented” the perfect nutrition for infants, this research contributes to the notion that evolution has selected for many genes that serve normal birth and breastfeeding by protecting the newborn. Intervening with the normal progression of birth and breastfeeding – while occasionally necessary – interrupts these beneficial adaptations and contributes to allergies and autoimmune disorders.
What is fetal programming? Every person living on earth was first exposed to a uterine environment that helped determine their lifetime health and development. The term for this phenomenon is fetal programming. It is a hot topic and deserves attention.
Accepting the importance of fetal programming places responsibility on the mother-to-be to do all she can to insure her body provides nutrients and oxygen to her growing infant while avoiding possible risks and toxins. At the same time, genetic and environmental factors contribute greatly to the potential for some disorders and problems that arise. Thus, we must be careful in assigning guidelines for acceptable behavior or blame for poor outcomes to pregnant women.
On the one hand, we can all see the negative consequences of something like fetal alcohol syndrome…clearly the result of maternal behavior. Is a pregnant woman whose baby has been damaged in this way guilty of abuse?
But, what if a mother is obese, eats poorly and ends up with an infant with a disturbed metabolism. Is this abuse? What if the mother has an infection that results in cerebral palsy? Or what if she lives near a highway and involuntarily inhales fumes that negatively affect the placenta?
How do you get a healthy baby? Of course, there are no guarantees. There remain many unknown factors that can affect the course and outcome of a pregnancy. Some factors we are aware of, such as avoiding certain fumes or chemicals. There are some behaviors we know can maximize the potential for a good outcome, such as eating adequate protein, aerobic conditioning and strength training. [Note for new readers…lots of these factors have been covered in our previous posts.]
But, what about all the things we don’t know about?
If these goats eat the wrong grass, will they go into labor?
Here is a cautionary tale: There is a species of goat that, if they eat a certain type of skunk grass on day 14 (and only day 14) of pregnancy, will not go into labor. Why? Plant toxins in this grass interfere with the development of a small portion of fetal brain, the paraventricular nucleus. This nucleus is involved in the signaling cycle of labor. Without it, the mother will not go into labor!
What are the take-home messages here?
Probably no one is ever a perfect fetus…too many possible threats.
There are some threats we can avoid…being lazy, over-eating, smoking.
There are some threats we cannot avoid, so we do the best we can.
Do the best you can by your baby…aerobic fitness, good nourishment, sleep, good hygiene and de-stressing your life.
Rachael Blum of Santa Monica, CA, has alerted us to an excellent article in the New England Journal of Medicine concerning the evidence for the role of exercise in pregnancy in helping prevent childhood obesity: http://healthcarereform.nejm.org/?p=3321&query=home. Rachael, our newest DTP family member, has also alerted us to an LA Times article on this subject: LA Times article.
With the recent emphasis on the importance of movement in the fight against childhood obesity, there is recognition that beneficial fetal programming through maternal exercise can make a big contribution to this effort. A combination of proper maternal nutrition and maternal fitness may well prove to be most efficient and potentially effective way to help children develop an appetite for motion!
In May 2009, the Institute of Medicine (IOM) issued new guidelines on weight gain in pregnancy. You can find this report at the URL listed below. As you may be aware, they are recommending lower weight gains than previously.
A detour: We received a question about nutrition and exercise for multiples. So, here is some information for those with twins and triplets. Add a comment if you have a question or experience to share on this topic! Next comes birth, we promise!!
If one is a girl and one is a boy, they're fraternal!
Nutrition for Multiples:
The primary thing we tell people with twins or more is that the protein needs rise about 30 grams/baby/day above the 70 – 90 grams/day needed for a singleton. Water intake also needs to rise. Avoid thirst and as much as possible, drink until urine runs clear rather than yellow (as best as you can).
Multiples is considered a risk factor, and for each risk factor (multiples, underweight, teenage mom, inter-pregnancy period less than a year) an additional 200 calories is often recommended, with 400 extra calories the upper limit.
Exercise with Multiples:
A critical factor in successful implantation and growth of the placenta appears to be aerobic fitness in the six months prior to and the first half of pregnancy. Once biomechanics become difficult in mid-pregnancy, women with multiples can continue activity safely as long as monitoring show the babies are growing appropriately. A belly support can be extremely helpful when exercising.
Contraindications for exercise include the discovery that one fetus is growing at a significantly slower rate than the other(s), that both/all are too small, that the placenta(s) is/are malfunctioning, or some other condition occurs, such as an incompetent cervix or placenta previa, that would be a factor in any case.
Absolute size difference does not necessarily mean that one baby is growing more slowly, as some fetuses may be a couple weeks younger than their uterus-mate(s) if the mother ovulated twice in the fertility cycle. Or, s/he might be smaller if genetically destined to be a smaller infant at birth. Thus, growth rate is the measurable factor that helps determine if a fetus is at risk of not receiving adequate energy. This can happen when there are two placentas and one placenta is working more poorly than the other, or for some reason there is a flaw in the umbilical cord of an identical. The competition for energy places a slower growing baby at risk.
Protecting Mom and Baby:
The placenta is designed to nourish the baby and will do so at a cost to the mother first if there is inadequate nutrition. Thus, activity to the level the mother can tolerate and following nutritional guidelines above – in the absence of medical complications – produces healthy offspring. Multiples will garner all the same benefits a singleton does.
Note about images: we strive to use images we own or that are advertised as free on the internet. We want to thank google, bing and yahoo for making free images available.
How many extra calories do you need in each trimester to offset the metabolic cost of pregnancy?
First trimester – 0; Second trimester – 300; Third trimester – 500 (source: Institute of Medicine).
Keep in mind that you may also need calories for any fitness program you are doing. If you are continuing a program, the only change is due to the pregnancy.
If you begin or increase your activity, you need to take that into account. One yoga class = 100 – 150 calories. One aerobics class = 200-400 calories. Walk one mile = 100 calories.
1 slice whole grain bread = 50-100 calories
Be sure you read food labels so that you can balance your food intake and your calorie output. A small woman (under 5’3″ & 130 lbs.) probably needs about 1200 calories per day as a base. A medium sized woman needs about 1400, and a large woman (over 5’9″ & 160 lbs.) probably needs 1600 to 1800 calories. Add your activity and pregnancy needs to your base amount.
What foods are necessary for a healthy pregnancy?
Answer, part A:
PROTEIN. Lean proteins like turkey and those with omega 3 fats like ocean fish and eggs….yes! EGGS!
Turkey is a good protein
Ocean fish 1 or 2 times/wk = good protein & omega 3 fat
Eggs are a perfect pregnancy food!
70-90 grams of protein are necessary each day, along with adequate water. These are needed to make an extra 40% blood volume required to support the placenta.
Answer, part B:
WATER. Two (2) quarts of water…more if you are very active…are needed to make extra blood and to prevent dehydration.
Question: What else?
Fresh vegetables also provide fiber
Answer: CARBS. Fresh, colorful fruits & veggies provide necessary vitamins and minerals, as well as fiber. Eat 5 servings a day from all the colors: yellow, orange, red, purple and green, and you will get live vitamins all day long that help your baby develop properly! Fruits, vegetables and whole grains are low glycemic index carbohydrates – the good ones!
Dairy provides calcium
Do I need dairy products and red meat? Can I get the needed minerals in other ways?
Calcium is needed in adequate amounts for bones and teeth. It is most easily obtained by drinking milk or eating cheese, yogurt or cottage cheese. Soy, dark green leafy vegetables and calcium fortified juice are alternatives.
Iron is necessary for red blood cells to take up oxygen. It is found in high amounts in beef, and lesser amounts in raisins, spinach, and prune juice. Prenatal vitamins are your insurance against deficiencies of these essential minerals.
Anything else that’s essential?
Yes! Healthy FAT!!
Avocado is an excellent source of omega 6 fat
In addition to omega 3 fats found in fish, walnuts and flax seeds, you need also need omega 6 fats, which are found in avocados, olive oil and other vegetable oils. Healthy fats help balance cardiovascular constriction and dilation, reducing the risk for hypertension.
What is a healthy weight gain?
In 2009, the National Academy of Sciences revised its recommendations. It now bases desirable weight gain on pre-pregnancy BMI (Body Mass Index…google this!).
BMI less than 18.5 (low) – 28 to 40 lbs.; BMI between 18.5-24.9 (normal) – 25 to 35 lbs.; BMI 25.0 to 29.9 (high) – 15 to 25 lbs.; obese women (BMI over 30.0) – 11 to 20 lbs.