August 30, 2009

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!

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!

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.

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

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!!

August 14, 2009

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

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!

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

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:

Cowlin, AF. Women’s Fitness Program Development.

Clapp, JF 3rd. Moving Through Your Pregnancy.

“Women and Exercise” in Varney’s Midwifery.

And, the American College of Obstetricians and Gynecologists recommendations regarding exercise in pregnancy.

August 10, 2009

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

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

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 FD A 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.

February 23, 2009

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_mover22 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.