risk-aversion

Pregnancy Pathway, Pregnancy — Behavior: Avoiding Risks

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Some­times it seems like preg­nan­cy is a time of restric­tions. Avoid­ing risks can be one thing that makes it seem that way. But, bear with us here in an inter­est­ing trip through dan­ger and find­ing you find ways of enhanc­ing your preg­nan­cy!

Risk Fac­tor #1:

Lack of pre­na­tal care. More than any­thing else, be sure you have care. Hav­ing some­one mon­i­tor your health and that of your baby dur­ing preg­nan­cy is vital to a good out­come.

Risk Fac­tor #2:

Not exer­cis­ing. Seden­tary behav­ior increas­es the risk for meta­bol­ic, car­dio­vas­cu­lar and immune dis­or­ders.

I know, I know, you don’t have time to exer­cise. Well, pay now or pay lat­er, as they say. Make time to go to a class (make sure it includes 20 -30 min­utes of aer­o­bics) a cou­ple times a week. A class will also pro­vide social sup­port, anoth­er fac­tor that enhances your preg­nan­cy. Take a walk at lunch time. Prac­tice relax­ation tech­niques.

Risk Fac­tor #3:

Breath­ing dan­ger­ous fumes. Yes, this includes smok­ing and sec­ond-hand smoke. But, it also means avoid­ing envi­ron­ments where there is a lot smog (near high­ways), liv­ing with mold or dust, and fan­cy cleansers that may have dan­ger­ous chem­i­cals in them. Stick with vine­gar, ammo­nia or bleach as cleansers.

Smog can endanger your fetus!

Smog can endan­ger your fetus!

We are learn­ing that com­bus­tion exhaust from cars and trucks can neg­a­tive­ly affect birth weight and pre­ma­tu­ri­ty. If you live or work near a high­way or in an area where smog is preva­lent, what are your options? Can you trans­fer or move? Can you wear a mask? Talk to your care provider and fig­ure out the best pro­tec­tion for you and your fetus.

Risk Fac­tor #4:

Poor Nutri­tion. Yup, just go back one entry and find out how food affects preg­nan­cy. If you don’t eat enough pro­tein and drink enough water, you don’t make suf­fi­cient blood vol­ume to nour­ish your pla­cen­ta and thus your fetus.

Read labels!

Read labels!

Eat whole foods and learn to read labels when you buy processed foods. What is a “processed” food? Any­thing with more than one ingre­di­ent!

Some pro­cess­ing (ex: home­made soup) takes lit­tle nutri­tion away, but some pro­cess­ing (ex: pota­to chips) takes every­thing good away and replaces it with unsafe sub­stances. Look for low sodi­um, low sug­ar, high vit­a­min and min­er­al con­tent items with no sat­u­rat­ed or trans fats.

Read the ingre­di­ents; if you don’t know what the words mean, maybe you want to pass it up.

Risk Fac­tor #5:

Alco­hol and Drugs. Com­mon items can be as dan­ger­ous as street drugs, which

There is plenty of time in life for a glass of wine...later.

There is plen­ty of time in life for a glass of wine…later.

No. No. No. Only meds from your prenatal care provider are okay.

No. No. No. Only meds from your pre­na­tal care provider are okay.

Caffeine? Only one cup & only if you must.

Caf­feine? Only one cup & only if you must.

can severe­ly com­pro­mise you baby’s future. If you have a drug or alco­hol habit, get help.

Risk Fac­tor #6:

Genet­ics. You can have genet­ic pre­dis­po­si­tions for many preg­nan­cy issues. How­ev­er, that does not nec­es­sar­i­ly mean you will devel­op a giv­en dis­or­der. For exam­ple, nutri­tion and exer­cise great­ly reduce the risk and sever­i­ty of meta­bol­ic issues. Some genet­ic issues are unavoid­able how­ev­er, and your care provider will alert you to these, if they are rel­e­vant.

Risk Fac­tor #7:

Social issues — iso­la­tion, lack of sup­port, abuse, pover­ty. All of these fac­tors can have neg­a­tive effects.

If iso­la­tion is a sim­ple mat­ter of need­ing to meet oth­er moms-to-be, join an exer­cise pro­gram. That way, you get both sup­port and exer­cise; just be sure it includes aer­o­bics, along with cen­ter­ing, relax­ation and appro­pri­ate strength.

If your sit­u­a­tion is more dire, seek the help of a care provider or social work­er at your local hos­pi­tal or clin­ic. Safe­ty and sup­port are crit­i­cal for you at this time. Get the help you need. There are peo­ple who care. And, if you know of some­one who needs help, help them.

If you have oth­er risk fac­tors to offer, please post them in the com­ments. Thanks!

What’s next?  BIRTH!!

Pregnancy Pathway — Exercise

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How lucky is this? Just a few days ago, yet anoth­er study was released and has been cir­cu­lat­ing on Med­scape and oth­er med­ical sites that indi­cates exer­cise is ben­e­fi­cial in preg­nan­cy, whether the moth­er is a pre­vi­ous exer­cis­er or not. Just in time for this entry!

Behavior Affects Pregnancy Outcome

Behav­ior Affects Preg­nan­cy Out­come

Phys­i­cal exer­tion (we call it “exer­cise” nowa­days) is a nor­mal state for healthy humans. Only in the last cen­tu­ry has the desire to rest or the need to store extra calo­ries as fat become more pos­si­ble to achieve than our need to move about to sur­vive.

Preg­nan­cy is a state in which both of these fac­tors (rest­ing and stor­ing calo­ries) are enhanced through organ­ic changes in body chem­istry, adap­ta­tions that favor fetal sur­vival. The cur­rent seden­tary lifestyle exag­ger­ates these meta­bol­ic changes and results in syn­dromes that increase the risk for a num­ber of meta­bol­ic, car­dio­vas­cu­lar and immuno­log­i­cal dis­or­ders of preg­nan­cy.

When con­front­ed by the idea that it is coun­ter­in­tu­itive to think exer­cise in preg­nan­cy might be safe (let alone ben­e­fi­cial) I am dumb­found­ed. To me, it is coun­ter­in­tu­itive to think that a seden­tary lifestyle in preg­nan­cy might be safe!

Burning Calories in Pregnancy Improves Outcomes!

Burn­ing Calo­ries in Preg­nan­cy Improves Out­comes!

What is the evi­dence that exer­cise in preg­nan­cy is ben­e­fi­cial? Keep in mind that some stud­ies have been exe­cut­ed more expert­ly than oth­ers. But, what is com­pelling is that numer­ous well-respect­ed researchers have sought to test the hypoth­e­sis that exer­cise is not safe, but come away with results that indi­cate the oppo­site!

Here are some of the major find­ings:

• The pla­cen­ta is larg­er and has more trans­port sur­face in exer­cis­ers than seden­tary women

• The fetus­es of (aer­o­bic) exer­cis­ing moth­ers make ben­e­fi­cial car­dio­vas­cu­lar adap­ta­tions

• Women who do aer­o­bic exer­cise are less like­ly to devel­op severe preeclamp­sia or ges­ta­tion­al dia­betes, and the long term health prob­lems that accom­pa­ny these dis­or­ders

• Women who are aer­o­bi­cal­ly fit recov­er from birth 10 times faster than seden­tary women (as mea­sured by time need­ed to metab­o­lize free rad­i­cals pro­duced in labor)

• Women who exer­cise in preg­nan­cy are more like­ly to be phys­i­cal­ly fit in midlife

• Babies of aer­o­bi­cal­ly fit women are at reduced risk for pre­ma­tu­ri­ty and low birth weight
DTP_mover2
So, we have arrived at the take-home mes­sage: MOVE!! Preg­nan­cy works best when you move and burn calo­ries in a mod­er­ate to vig­or­ous fash­ion. But, alter­nate this activ­i­ty with rest and good nutri­tion, and be sure to stay well hydrat­ed.
If you want more specifics and resources on this top­ic, try these:
“Women and Exer­cise” in Varney’s Mid­wifery.

Pregnancy Pathway, Pregnancy – Exposure to Toxins and Infection

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Hot top­ic for today: Tox­ins and infec­tions in preg­nan­cy.

Pregnancy Exposure to Toxins and Infections

Preg­nan­cy Expo­sure to Tox­ins and Infec­tions

A moth­er-to-be needs to be aware of items that can have adverse effects on the health and devel­op­ment of her fetus, as well as her own health. Two of these fac­tors are tox­ins and infec­tions.

1. Tox­ins can be food, envi­ron­men­tal fac­tors, and med­ica­tions, alco­hol or drugs. Let’s start with food. Inter­est­ing­ly, many plants have slight tox­ins in them that can have a small neg­a­tive impact dur­ing ear­ly fetal devel­op­ment. One the­o­ry of nau­sea and vom­it­ing in ear­ly preg­nan­cy is that this helps the mother’s body pre­vent these tox­ins from inter­fer­ing with nor­mal devel­op­ment. Pica — espe­cial­ly eat­ing dirt that is large­ly clay — may be anoth­er man­i­fes­ta­tion of how the body strives to counter plant tox­ins, as clay can coun­ter­act some of the effects of these tox­ins. So, plant tox­ins can be one food source in ear­ly preg­nan­cy.

Anoth­er source is food addi­tives (things you can­not pro­nounce, so read the ingre­di­ents!). We have no idea how many chem­i­cals and hor­mones added to foods affect fetal devel­op­ment.

NIH illustration of reading food label

NIH illus­tra­tion of read­ing food label

Risk-aver­sion involves avoid­ing items that are risky. If you are not sure, don’t eat it. For up to date infor­ma­tion, look at the FDA site on food safe­ty or the NIH site on read­ing food labels.

Envi­ron­men­tal fac­tors that may affect fetal devel­op­ment can include air pol­lu­tion, house­hold cleansers, mold and oth­er items encoun­tered any­where one goes. Things we breathe can be par­tic­u­lar­ly dan­ger­ous, so be sure to keep cleanser use to sim­ple items such as vine­gar, ammo­nia or chlo­rine bleach. Wear­ing a mask while clean­ing is also a good idea.

Med­ica­tions, drugs or alco­hol that might nor­mal­ly be con­sid­ered safe for a non-preg­nant per­son — some­thing as sim­ple as aspirin — can be dan­ger­ous as they affect blood clot­ting fac­tors and threat­en the pla­cen­ta. Or, because they cross the pla­cen­tal bar­ri­er but can­not be metab­o­lized by the imma­ture fetal liv­er, they are tox­ic and induce dam­age to the fetus.

2. Infec­tions are of con­cern, as well. It is pos­si­ble that an active infec­tion at the time of fer­til­iza­tion and implan­ta­tion can con­tribute to dys­func­tion in preg­nan­cy because it inter­feres with the nor­mal immune respons­es of ear­ly preg­nan­cy. Hyper­ten­sion in preg­nan­cy may be relat­ed to infec­tion in the ear­ly days of preg­nan­cy. Some infec­tions — par­tic­u­lary sex­u­al­ly trans­mit­ted infec­tions — are known to have detri­men­tal effects on the baby’s health. Preterm pre­ma­ture rup­ture of mem­branes (P-PROM) almost always reflects active infec­tion.

Tak­ing Pre­cau­tions: First, be sure to let your health care provider know about any ill­ness or infec­tion. Sec­ond, take care of your­self. Fol­low rec­om­men­da­tions for fre­quent hand­wash­ing and car­ry ster­ile hand gel in your purse or back­pack. Avoid places where hygiene might be com­pro­mised. Prac­tice safe sex.

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.