10 Healthy Pregnancy Tips

By Debby Amis, RN, BSN, CD(DONA), LCCE, FACCE

  1. Learn as much as possible about the wonderful ways that your body is changing and about how your baby is growing. Talk to your mother, your friends, and other women about pregnancy, labor, and birth. Attend an early pregnancy childbirth class, read books, and watch videos about normal pregnancy and childbirth.
  2. Think about whether you want to give birth at a hospital, at a birthing center, or at home. Choose a health care provider who will be able to assist you in your chosen location and who helps build your confidence for pregnancy and childbirth.
  3. Eat a well balanced diet, paying attention to the recommendations by the U.S. Department of Agriculture (www.choosemyplate.com). Drink more milk, or foods that substitute for milk, and eat a little extra protein. If you don’t eat several servings of fresh fruits and vegetables every day, take a prenatal vitamin that contains folic acid. Drink lots of water—six to ten glasses a day—and choose (real) fruit juices instead of sodas.
  4. Avoid substances that may be dangerous for you and your baby, such as cigarettes, alcohol, and street drugs. Do not take any medications, even over-the-counter medications, unless you have discussed them with your health care provider.
  5. Stay active! Continue exercise programs that you were doing before you became pregnant according to the recommendations of your health care provider. If you were not exercising before becoming pregnant, consider yoga, walking, or swimming. Start with short periods of exercise, and gradually increase the amount of time you are exercising.
  6. Get plenty of rest. Listen to your body to determine if you need short breaks during the day and to determine how many hours of sleep you need at night.
  7. Talk to your baby and enjoy your growing bond with him. Research now shows that babies react to the sense of touch as early as ten weeks of pregnancy. A little later, she can react to light, your voice, music, and other sounds.
  8. Try to minimize the stress in your life and practice stress management techniques such as slow, deep breathing and relaxing various muscle groups when you feel under stress. You can learn these techniques and other strategies for relaxation in childbirth education classes.
  9. Plan your baby’s birth. For most women, birth is normal, natural, and healthy. Learn as much as possible about what birth is like in the location you have chosen. Ask questions about the six care practices that are known to promote normal birth. Lamaze classes will help you understand what happens during childbirth and will help you and your partner learn positions and movements which will aid labor and ways to cope with the stress and pain.
  10. Enjoy this special time in your life! Your partner, your family and friends can help make the most of this wonderful transition. Have confidence in your body’s ability to grow, nourish, and give birth to this baby as women have done for centuries.

Understanding the Effects of Alcohol on Your Body & Your Baby

By Sonia Alvarado, Senior Teratogen Information Specialist, MotherToBaby CA

Spring break 2014, which, for some, actually fell at the end of winter this year, is in full swing. Many students are back to school working diligently toward their degree. For some students, Spring break means a trip back home, a trip abroad for cultural education and for others, it’s a time to let loose on a warm beach, usually with one (or many) alcoholic beverages. One young woman went on holiday to the Caribbean after a particularly stressful semester at college. After returning to school and missing her period, she called the MotherToBaby service. She was frantic after recalling the amount of alcohol she had consumed during her seven days in the sun.

In the last two decades, a change in social conventions, increased disposable income, and marketing, media, and other societal influences have encouraged women to drink more alcohol than in years past. These various factors have contributed to a higher number of women drinking alcohol during college, binge drinking during college and risking alcoholism. According to the Centers for Disease Control (CDC), the issue of women and alcohol drinking is an under-recognized problem. The CDC reports that approximately 24% of women 18-24 and 20% of women 25 to 34 report binge drinking.  Binge drinking is classified as four or more drinks in one occasion. Studies suggest that college-age women may be binge-drinking in higher numbers than men. This may be due in part to the fact that many women do not know that the recommendations for alcohol drinking for men are different  – and higher – than for women. These issues are very concerning because most pregnancies are unplanned and binge drinking is a threat to the healthy development of a pregnancy.

Fortunately, in the now worried “Spring Breaker” we spoke with, our counselor was able to reassure her after identifying her exposure as having occurred very early in pregnancy, prior to placental communication being established. However, the amount of exposure she had reported, four or more drinks daily, may have been a risk had it occurred later in the first trimester.

The U.S. Department of Health and Human Services recommendation for alcohol use by non-pregnant women is one drink per day (maximum of seven per week). Men have a recommendation of maximum two drinks per day. The reason that women have a lower dose recommendation is that women are more sensitive to the effects of alcohol. Specifically, the average woman that takes two drinks will have more alcohol in her system compared to a man drinking the same amount. This is due to a size difference, genes, and maybe, hormones too. Women are generally smaller than men and that means having less blood. Having less blood means less water. A woman’s body is made up of about 52% water and a man’s about 61%. Water dilutes alcohol, both in a glass and in the body. More dilution means less impact. Also, women have more fat and unfortunately, alcohol in fat can’t be metabolized as quickly and it ends up concentrating in blood.

There is an important enzyme(s) called alcohol dehydrogenase that breaks down alcohol. These enzymes are primarily stored in the liver and the stomach. These enzymes are found in greater abundance in men than women. The lower number of enzymes means that more alcohol gets into the blood and stays there longer.

Hormones may also play an important role in breaking down alcohol. Studies suggest that the premenstrual phase slows down alcohol and results in higher blood alcohol levels. There is some evidence that birth control pills that contain estrogen also slow the breakdown of alcohol.

So what does this all mean? Should Spring break mean all work and no play? Not necessarily. However, part of feeling empowered and making responsible decisions is learning the facts about how alcohol can affect us all differently. During April’s Alcohol Awareness Month, I encourage everyone to take a moment to think about those differences – It could make the difference in your future baby’s life.

 

References:

http://www.cdc.gov/vitalsigns/bingedrinkingfemale/infographic.html

http://pubs.niaaa.nih.gov/publications/brochurewomen/women.htm

Jones, MK,,& Jones BM. (1984). Ethanol metabolism in women taking oral contraceptives. Alcohol Clin Exp Res, Jan-Feb;8(1):24-8

 

Sonia Alvarado is a bilingual (Spanish/English) Senior Teratogen Information Specialist with MotherToBaby California, a non-profit that aims to educate women about medications and more during pregnancy and breastfeeding. Along with answering women’s and health professionals’ questions regarding exposures during pregnancy/breastfeeding via MotherToBaby’s toll-free hotline, email and private chat counseling service, she’s provided educational talks regarding pregnancy health in community clinics and high schools over the past decade.

MotherToBaby is a service of the international Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about alcohol, medications or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or visit MotherToBaby.org to browse a library of fact sheets and find your nearest affiliate.
photo credit: opacity via photopin cc

Choose Wisely: Studies Show Increased Risk of Cesarean Linked to Choice of Doctor

By Jacqueline Levine

The cesarean rate in the United States has leveled off, as reported last year by the Center for Disease Control and Prevention (CDC). The information came from the National Center for Health Statistics, and it says, in sum: “After 12 years of consecutive increases [1998 to 2009], the preliminary cesarean delivery rate among singleton births was unchanged from 2009 to 2011”;  the report cites the current rate as 31.3%.  That the rate has stopped rising is good news. And that the rate is too high is not in dispute. The World Health Organization and other organizations that promote and support optimal maternity care have been making that case for a long time.

Most recently, the American Congress of Obstetricians and Gynecologists (ACOG) has come out with a report entitled “Safe Prevention of the Primary Cesarean Delivery,” with guidelines meant to prevent a first-time c-section. The study calls for revisiting the list of the common indications for cesarean. The various rationales for cesarean have held sway in maternity care for years.  These new guidelines can be seen as an admission that the rate of surgical birth is indeed far too high, and that current practices do not promote the ideal health of women and babies.

Added to this news are two studies that reveal additional factors that can affect a woman’s chance of having a cesarean. News from the American College of Obstetricians and Gynecologists’ (ACOG) 57th Annual Clinical Meeting, as reported in Medscape Today (Medscape Medical News, May 12, 2009), discussed an article entitled “Liability Fears May Be Linked to Rise in Cesarean Rates.”  The following is a direct quote (bold emphasis is mine):

“It has been suggested that medical-legal pressures are a factor in the high number of cesarean deliveries. A number of studies have borne this out.  Localio and colleagues (JAMA. 1993; 269:366-673) found a positive association between medical malpractice claims risk and the rate of cesarean delivery.   Murthy and colleagues (Obstetrics & Gynecology 2007; 110:1264-1269) found an association between professional liability premiums and rate of cesarean delivery — for every $10,000 increase in insurance premium there was a 15% increase in the rate of cesarean(s) delivery.  Dr. Barnhart said “First of all, I applaud the abstract, in that it quantifies a perceived problem,” ”We all anticipated that defensive medicine might be a reaction to litigation, and this paper demonstrates that that is indeed the case,”  ”So don’t just blame the doctor for doing a C-section, recognize that there’s probably a reason that [he or she is] doing it. And that fear of litigation is the reason,” Dr. Barnhart concluded.”

The study implies that what’s being done in the way of care might indeed be for the welfare of obstetricians who practice defensive medicine, and may not be for the best welfare of the woman in his care. The results of this study are not addressed in the recently released ACOG guidelines to eliminate the overuse of c-section, but it’s helpful to acknowledge the possible affect of malpractice insurance on women’s birth options.

We assume that the most fundamental tenet of care is that what a doctor does is for our benefit, and not for her or his well-being, convenience or safety. A doctor who picks up a scalpel and performs surgery for defensive reasons is behaving in a way that is the antithesis of ethical behavior, a betrayal of our trust in the doctor-patient relationship.

The other study addresses how an obstetrician’s personality affects your risk of having a cesarean. The article, “Women’s Risk of Having C-section May Depend on Her Obstetrician’s Personality,” discusses a study published in the Journal of Obstetrics and Gynecology in 2008. (Allcock, C., Griffiths, A., & Penketh, R., The effects of the attending obstetrician’s anxiety trait and the corresponding obstetric intervention rates. Journal of Obstetrics and Gynecology, 28(4), 390-393. [Abstract]). “Trait anxiety” is an integral and unchanging part of the human personality and is very different from “‘state anxiety’” which happens in response to a particular situation.

The results of the study are very concise (emphasis mine):

“Obstetricians were asked to complete a validated survey that measures ‘trait anxiety’ which is stable and enduring… The obstetricians with the least anxiety had the lowest emergency cesarean rates.  The obstetricians with the most anxiety had the highest rates.”

Statistical analysis revealed that the doctor’s trait anxiety levels were highly correlated with cesarean rates. 

These studies document just two of the many factors that affect a birthing mother’s chances of having a cesarean — factors that have nothing  to do with a mother’s or baby’s actual health status. The more we know about what influences doctors in the decisions they make about our care, the better our ability to recognize and request best-evidence care for ourselves and our babies. And so the question becomes, how can a birthing woman understand and avoid the influence of lesser-known factors on her chances of avoiding cesarean?

As our own best advocates, we must seek out the ethical caregivers who do not rely on routine interventions and who use surgery only to save the lives or health of babies and mothers. Before deciding  on a caregiver , it’s of critical importance to become familiar with best-evidence, optimal maternity care, so that you’re able to
question her/him about all the health care practices that will affect labor and birth. Knowing the facts about normal, healthy birth and conservative reasons for c-section based on our genuine health status help you make informed choices about your care.

Recommendations for OBs, hospitals and midwifery care from women across the United States can be found at the non-profit, all volunteer website www.thebirthsurvey.com. Question your prospective OB or midwife about his/her c-section rate, induction rate, episiotomy rate, and other routine and common practices that may not confer best-evidence care. If you perceive a defensive posture about his stats, or an air of reluctance to tell you what you want to know, consider it a red flag warning and seek a new caregiver for optimal care.

 

Looking for more information and resources surrounding cesarean and VBAC? Check out this list of online resources and test-your-knowledge quiz from Science & Sensibility.

 

About the Author

Jacqueline Levine, BA, LCCE, FACCE, CD(DONA), CLC has been a DONA doula and  lactation counselor  for 10 years, a Lamaze educator for twelve years, and a WIC educator.  She teaches Lamaze childbirth education at Planned Parenthood of Nassau County, where she volunteers birth doula services to the clients of Planned Parenthood, an underserved population.  She won the Lamaze Community Outreach Award for these services to the community, and she has taught and supported pregnant teens in local high schools.

She’s been a contributor to Science and Sensibility, the Lamaze research blog, since 2009, and writes for BreastfeedingUSA, the online peer-to-peer breastfeeding site as well.  Some of her articles for breastfeeding teens have been on the US Breastfeeding Committee site, and she is a guest lecturer in the Sociology Department of CW Post College of LIU, teaching a class in the History of Childbirth in the United States, as well as breastfeeding classes for DONA doula certification that stresses best-evidence care for mothers and newborns.

She is mother of three and grandmother of five, and came to the world of birth after she retired from a career as artist and designer in the Garment Center in NYC.

Travel During Pregnancy – What to Bring Along

With the onset of spring — and summer just around the corner — many of us will spend time traveling on vacation, likely to warmer climates. When you travel during pregnancy, you’ll want to add a few additional items to your packing list for optimal comfort and health. Consider adding the following to your carry on bag.

 

Pertinent medical information – You never know when you may need your medical information while traveling. It’s a good idea to have a paper copy (yes, paper) of your medical history for your pregnancy. This is especially true if you’re traveling outside the country as it may prove more difficult to obtain your records electronically or by fax.

Insurance card – In case you need to go to the doctor while traveling.

Vitamins and any medication related to your pregnancy – A must-have!

Water – Staying hydrated during pregnancy is so important, since dehydration can cause preterm labor. If you’re flying, be sure to pick up a bottle after the security checkpoint to take on the plane, and then pick up a good supply once you’re at your destination. Depending on where you go, tap water may be a no-no for health reasons — be sure to check with your hotel.

Comfy shoes – Never has wearing comfortable shoes been more important than in pregnancy. Of course you can pack your cute heels, too, but for any amount of extended walking, you’ll want something more comfortable.

Snacks – High protein and easy-to-transport snacks are so important to take with you as you travel during your pregnancy, since you don’t know how long it may be between meals, depending on the availability of food.

Pregnancy pillow – This may be hard to pack on a flight, but if you’re traveling by car and there’s room, it’s can be so nice to have the same comforts of home while traveling. If you can’t pack your favorite pillow, extra pillows at your destination can go a long way to making your sleep more comfortable.

Camera – Whether it’s with your smart phone or a regular camera, snap at least a few pics of yourself during your trip to document your adventures during pregnancy.

Journal – Often, travel is a time when you can de-stress and take time out to reflect. Take a journal with you to write down thoughts and feelings about your life at the moment, including your pregnancy. Even if you never write in the journal again, you’ll cherish the snippet of history in your life.

Reading material — not pregnancy related – When you’re pregnant, so many of your thoughts and conversations center around pregnancy. When you pack reading material for your trip, it may be nice to take a break from all the belly talk and pack books and magazines on other interests.

 

 

Marijuana & Pregnancy – Is it Safe?

By Sonia Alvarado, Senior Teratogen Information Specialist, MotherToBaby CA

Marijuana has been in the news a lot lately and for marijuana users who have had to smoke in illegally, it appears societal attitudes about pot smoking may be changing.  Twenty states have laws legalizing some form of marijuana use. Two states, Colorado and Washington, have legalized its recreational use. In an interview, the NFL Commissioner seemed to leave open the possibility that medicinal use could be considered for NFL players if there was scientific evidence that it was helpful to treat injuries and pain. Even President Obama has said that he doesn’t believe marijuana is any more dangerous than alcohol. Marijuana is currently listed as a Schedule I drug. Other Schedule I drugs include heroin, lysergic acid diethylamide (LSD), 3,4-methylenedioxymethamphetamine (ecstasy).

 

What The Research Shows Us

According to studies, pregnant women who use illicit substances are more likely to use marijuana compared to other drugs. This is often due to the belief that marijuana is less harmful to the developing embryo and fetus, compared to other drugs such as cocaine or heroin.

Marijuana is Cannabis. The delta-9-tetrahydrocannabinol (THC) in the Cannabis plant produces the psychoactive effect or “high.” Marijuana can be smoked in a joint, inhaled through a bong or vaporizer, eaten in food and teas/beverages, used in tinctures, and topical balms.  Smoking and ingestion exposes the user to THC, producing the high. When smoked in a joint, the user is exposed to carbon monoxide from the burning of the leaf as well as tar, which can stay behind in the lungs.

Marijuana use during pregnancy has been studied since the 1960’s. Like all studies, there are weaknesses that have been pointed out. For example, asking women about past drug use may not be the most accurate way to make a connection between the dose of the drug and the adverse effects because the women may have forgotten. Also asking women to volunteer information about drug use, which they may fear disclosing even in a confidential setting, may make it difficult to know how frequently pregnant women use drugs overall. Still, a number of experts have reviewed hundreds of reports in humans and animals. At least to this point, the studies do not support an association between marijuana smoking and birth defects. One large study of 12,825 interviews done after delivery, did not find a statistical association between marijuana use and birth defects.

However, the studies also show that marijuana is not risk free. Studies have reported associations between marijuana smoking and growth restriction and lower birth weight, particularly in women who keep smoking through delivery or late in pregnancy. An Australian study of almost 420,000 live births reported a higher risk for neonatal intensive care admission for newborns exposed prenatally to pot. Also, there are reports of abnormal responses or behaviors in the newborn period and this suggests a toxicity or withdrawal. The symptoms include exaggerated and prolonged startle reflexes (sleep cycle disturbances with high-pitched crying.) In a Brazilian study, exposed newborns were “more irritable and less responsive to calming, cried more during the examination, and exhibited more jitteriness and startles than the non-exposed neonates.” Pregnant women who smoke daily and/or through delivery, have a higher risk for complications in their pregnancy compared to women who quit in the first trimester.

Researchers have attempted to assess the long-term effects of prenatal marijuana exposure. Studies of 3, 10 and 14-year old prenatally exposed children suggest that the prenatal exposure to high doses of marijuana may make it harder for children to learn and may affect their emotions (increased aggression) and increase depression symptoms. Studies are needed to assess which prenatally exposed children are most at risk. Its important to note that the children in these studies often have had prenatal exposure to other drugs as well, struggles with poverty and other life challenges, making it difficult to know that the findings are due to a single drug exposure.

 

So Where Does Marijuana Rank Compared To Other Drugs?

Alcohol: Specific to use during pregnancy, marijuana is not alcohol. Alcohol is still the drug with the highest risk and the widest range of birth defects, including physical, mental and behavioral. Alcohol is a drug with the highest use throughout the world, easy legal access, and social acceptance.

Cocaine: Cocaine, by comparison, is associated with a small risk for birth defects, and a higher risk for admission to newborn intensive care for withdrawal and toxicity. Additionally, cocaine is associated with prenatal growth retardation, lower birth weight, shorter length, and smaller head circumference. Studies suggest the effects on height extend into childhood.

Heroin: Heroin has not been associated with an increased risk for birth defects, however, is associated with a higher risk for withdrawal and admission to newborn intensive care and sudden infant death syndrome.

 

Bottomline: Snuff Out Smoking It

Clearly, marijuana use in pregnancy is not preferable, nor less risky, compared to most other drugs when a side-by-side comparison is made. Changing societal attitudes doesn’t change the fact that the developing embryo (and fetus) is dependent on the mother for oxygen, nutrients and a balance of hormones, chemicals and other substances to grow normally. Disrupting the normal fetal environment, through the introduction of marijuana or other recreational drugs, puts the pregnancy at risk in the short-term and possibly the long term as well.

 

Sonia Alvarado is a bilingual (Spanish/English) Senior Teratogen Information Specialist with MotherToBaby California, a non-profit that aims to educate women about medications and more during pregnancy and breastfeeding. Along with answering women’s and health professionals’ questions regarding exposures during pregnancy/breastfeeding via MotherToBaby’s toll-free hotline, email and private chat counseling service, she’s provided educational talks regarding pregnancy health in community clinics and high schools over the past decade.

 

MotherToBaby is a service of the international Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about beauty products, medications or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or visit MotherToBaby.org to browse a library of fact sheets and find your nearest affiliate.
photo credit: MendezEnrique via photopin cc
 

 

Positive Pregnancy Test! Now What?

The flood of emotions that comes with a positive pregnancy test is quickly followed by pressing questions.  How do I manage the symptoms I’m feeling?  Should I change my diet and exercise, or the medications I take?  When should I tell my family, friends and co-workers?

But sometimes it’s easy to overlook other issues that can impact your pregnancy and “The Big Day.” Lamaze’s latest webinar will address one of the most important questions any newly pregnant woman can consider.

“What can I do now to increase the chances I’ll have a safe and healthy birth for my baby and me?”

The following webinar discussion (embedded below) will provide resources and perspectives on what newly pregnant women can be thinking about and doing in early pregnancy, and how they can take charge in pushing for the best possible care. The “Positive Pregnancy Test? The Top 5 Things You Should Do Next” webinar will help you to:

  • Consider options for care you might be overlooking
  • Avoid “due date” mistakes
  • Get savvy on real-world childbirth challenges
  • Equip your childbirth partner to be rock-solid support
  • Think about healthy choices in a new light

The presenter of this webinar is Jessica Deeb, MS, WHNP, CLC, LCCE.  Two years ago, she shared her first childbirth experience with fellow moms in Lamaze’s Push for Your Baby video.  Since then, she has applied her professional training in labor and delivery and her passion for better birth to become a Lamaze Certified Childbirth Educator.  She is expecting Baby #2 in December!

Red Light, Green Light – A Quiz on Getting the Best Care

Are you getting the best prenatal care from your provider (midwife, OB, or family doctor)? Take this “red light, green light” quiz to find out. Red light indicates care that is not evidence based or respectful of your choices. Yellow light indicates care that should make you question your provider further to see if she is the best fit. Green light indicates great care!

Pregnant with Disabilities: Multiple Sclerosis

By Neda Ebrahimi , Teratogen Information Specialist, Motherisk

As a counselor with Motherisk, the Canadian partner of MotherToBaby and a service of the Organization of Teratology Information Specialists (OTIS), I hear many stories from women about pregnancy. Some of those stories strike cords with me. Their urgency and desire to make the healthiest decisions possible for their future children is both understandable and admirable. In honor of National Multiple Sclerosis Awareness Month, I give you Nina’s story.

 

Nina’s Story

“I’m 31 years old, and I was diagnosed with Relapsing Remitting Multiple Sclerosis (RRMS), when I was only 22. My first relapse was scary. I was writing my finals, and 2 days before my last final, I lost sight completely in one eye, and my legs felt so week and wobbly that I couldn’t stand even for a second. After going to the hospital and receiving several courses of steroids over 10 days, I started to improve but it took 2 months for my symptoms to fully resolve. And then, everything went back to normal, as if nothing had ever happened. I received my diagnosis several months after, and it felt like a death sentence. I had 2 more relapses before my doctor put me on disease modifying drug (DMD), and I started with Infterferon-B1a. Over the last 8 years, I only experienced 5 more relapses. The last relapse I had was only a few months ago; I lost sight in my left eye, and numbness that ran from my face to my toes on just the right side of my body. I have always been able to work full-time except when I’m experiencing a relapse, for which I’ve had to take a month off. I am a dentist, so not surprisingly I can’t carry out my job when I’m experiencing numbness in my hand. I met John 5 years ago at the MS clinic I used to visit. He was a nurse there. We fell in love, and despite of my illness he proposed to me last year, and we talked about having a family, with two children, hopefully one boy and one girl, and living happily ever after. It didn’t initially worry me that one day I may want children. John is crazy about kids, and I feel my maternal instincts kick in every time I hold a baby. Since we got married, my anxiety has been increasing proportionally to my yearning for having a child.  I know my MS can’t be cured, at least not now, I know it can get worst over time, and eventually I may need support to carry out even simple tasks. Or Maybe I won’t, and I would be one of the few who never enter the progressive state. I don’t know if I’ll be able to care for a baby and meet his or her demands. What will happen after my pregnancy? I really don’t want to experience another relapse after I deliver. How am I going to manage my illness, and what will happen if I need to came off my DMD when I’m pregnant or breastfeeding? There are so many questions, and I don’t know who to turn to.”

Nina is not alone in her thirst for answers. MS is an autoimmune neurological disease with very different presentation. No two MS patients are exactly the same and symptoms can vary from just the occasional mild tingling in the finger tips to more severe symptoms that render the patient unable to walk or stand for several weeks. With Relapsing Remitting MS accounting for 85% of all MS cases, most patients will undergo a remissive state after an attack, and will resume their daily life with little or no hindrance. Some patients will continue to have modest symptoms during the remissive state which they learn to adapt to and manage by different medications and or lifestyle changes.  As there are no current cures for MS, many MS patients live for decades with this disease, and must find the means to maintain a high quality of life as the disease progresses, which can be challenging in the later stages of the disease.

MS impacts many more women than men with a 3:1 ratio in North America.  As the disease onset occurs during the reproductive ages, many women with MS face the dilemma of pregnancy at some point during their lives. Young women, like Nina, with MS planning pregnancies, have many questions. Because the disease presentation and progression varies from person to person, there is no exact answer and treatment and management must be tailored to the specific person’s need. However, I’d like to address some of the most common questions to help all of the “Ninas” out there:

1. “Would the disease adversely impact the pregnancy and my developing baby”?

Up until the late 1950s, women with MS were advised to terminate their pregnancies. With our advancement in the field, we know that this is almost never necessary. Many women with MS continue to have healthy babies, and research shows that there is no increased risk for having a baby with a structural malformation or developmental delay and many deliver healthy babies with no major complications. Although there is a trend toward lighter weight babies, the birth weight percentile remains in the normal range for most. Another observation has been the higher rate of miscarriage in the MS population with mixed results from different studies. The reason for this is not well understood, but the majority of miscarriages are in early pregnancy. While miscarriage rates in the general population are around 10-15%, in women with MS the rates are closer to 20%-30%. With successful conception, the chance of delivering a healthy baby at term is high, and women with MS should be assured that their disease is unlikely to cause harm to the developing baby.

2. “Would my baby also have MS”?

There is a complex interplay between genetics and environment leading to MS. While the risk of getting MS in the general population is 0.3%, having a parent with MS will increase this risk by almost 15 times. So children of women with MS may have a 3% to 6% chance of developing MS later in life, but the environmental and lifestyle factors may play the ultimate role in disease manifestation. Hence despite the genetic contribution, the risk for your baby developing MS remains small and can potentially be modified.

 3. “If I stop my DMD when planning, what are the risks of having a relapse while I try to conceive?”

Depending on how long it takes to conceive, the drug free period prior to pregnancy may be a risky period for experiencing a relapse. While some women conceive after just one cycle, many will conceive after several months of actively trying to become pregnant. It will take 1 to 3 months (depending on the drug) to fully clear the system, and during this time, some may experience disease activity. If prior to starting the DMD you had very active disease, there is a risk that you’ll experience a relapse when you stop the medication, especially if it takes more than 3 months for you to conceive. The decision to continue DMDs is highly individualized and is determined on a case-by-case basis.  You and your neurologist will determine the best mode of action.

4. Would having a pregnancy make my MS progress faster?

Pregnancy has not been shown to speed the disease process. In fact, pregnancy is a state of remission for many women with MS, and a time for optimal wellbeing. It is well established that relapse rates reduce by 70% by the third trimester of pregnancy compared to the year prior to pregnancy. However after delivery the relapse rate increases, with 60% of women experiencing a relapse in the first 3 to 6 months postpartum. While the risk is increased in the postpartum period, the course of MS tends to return to its baseline, and no worse than what it was in the year prior to pregnancy. Some studies have found a protective effect with pregnancy, with a delay in the long-term disease progression; however, more studies are needed to confirm this finding.

5.      Would I be able to continue my DMD through the pregnancy?

Although many women with MS go through remission in the pregnancy, some will continue to experience disease activity especially in the first two trimesters. The decision to continue DMDs is dependent on several factors, including the type of medication, disease activity in the year prior to pregnancy, and the type of control achieved with the given DMD. The use of glatiramer, Interferon Beta 1a/1b, in pregnancy have not been associated with an increased risk for malformations and if you achieved great control with these drugs, and are at a high risk of relapsing, your physician may consider continuing your therapy through the pregnancy. The newer drugs, especially the oral DMDs, have not been well studied, therefore it is recommended that you discuss with your neurologist the best plan for the course of your pregnancy. There are ongoing research studies looking at the outcome of pregnancies following exposure to these medications. MotherToBaby and its affiliates are engaged in such studies. For study information or for the most up-to-date information about newer medications used to treat MS during pregnancy, call from anywhere in North America toll-FREE 866-626-6847.

6. What if I have a relapse during pregnancy?

While relapses during pregnancy are uncommon, they may happen, and can be quite severe for some women. Steroids are usually used to treat those relapses, although some success has been shown with IVIg therapy as well. A woman that experiences a severe debilitating relapse during her pregnancy, may require the standard steroid therapy, while a woman that experiences a mild flare-up may choose, in collaboration with her physician, to abstain from treatment. Systemic steroid use in the first trimester has been associated with a very small risk for cleft lip and palate, and use in the second half of pregnancy may increase the risk for having a smaller baby and for delivering prematurely (before 37 weeks gestation). However, it is recommended that you speak with your health care provider before you stop or change any medication. The benefits of taking a steroid and treating your condition should be weighed against these small possible risks. For more information, check out this fact sheet online: http://www.mothertobaby.org/files/Prednisone_6_13_1.pdf or call anywhere in North America toll-FREE 866-626-6847.

7. Should I breastfeed or start my DMD right after delivery?

The postpartum period is a period with a high risk of experiencing relapses. Data on whether breastfeeding has protective effect has conflicting results. Some studies suggest a protective effect, possibly due to the delay of menses returning, while others show no impact. Information on safety of DMDs in the breastfeeding period are scarce, however given the large molecule size of glatiramer acetate, and Interferons, it is unlikely any will transfer into milk. If they do, they are likely not to be absorbed from the baby’s gastrointestinal tract. There is no information regarding other DMD usages during lactation. The benefits of breastfeeding baby are numerous, but, ultimately, your functionality and ability to care for your child take priority. The decision to breastfeed or not may depend on your ability to breastfeed, especially since the demands of a newborn and the hormonal changes in the postpartum period can be very taxing on your energy levels and if you experience chronic fatigue due to your condition.  Thus, if a woman (while consulting her physician) decides to breastfeed she may do so. However, if she needs to restart her DMD, currently she may be advised to stop breastfeeding.


Bottom line: While having MS poses physical and emotional challenges, it does not jeopardize a woman’s capacity to mother. With careful planning and close collaboration with your doctors and healthcare providers, and especially with some support from family and friends, you will be able to have successful pregnancies, healthy children, and out of control teenagers, just like any other woman. So if becoming a mother is something you have always wanted and looked forward to, having MS is more of a bump in the road rather than a life sentence, and with some maneuvering you can achieve your dreams. Happy parenthood!                                                           

 


Neda Ebrahimi is a research associate and counselor at the Canadian Motherisk program, a non-profit MotherToBaby/OTIS affiliate that aims to educate the public about medications and more during pregnancy and breastfeeding. The Motherisk program is also a center for teaching and clinical research in the area of exposures in pregnancy and breastfeeding. Neda is pursuing her PhD in the field of Multiple Sclerosis in Pregnancy. To learn more about her work and about her study, email her at neda.ebrahimi@sickkids.ca or call 416-813-7654 ext. 204928. You can also call the Motherisk Helpline at 1-877-439-2744 and ask to be referred to the MS study.

 

MotherToBaby and its affiliates are services of the international Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about MS, medications or other exposures during pregnancy or breastfeeding, call toll-FREE 866-626-6847 or visit www.MotherToBaby.org.

Weight Loss During Pregnancy

There are many times during the year that many of us think about losing weight or getting in shape: New Year’s, before summer beach season, or when a big social event is coming up.

But what if you’re pregnant?

Pregnancy is different. We still want to look our best, but that baby growing inside us needs to get all of the nutrients needed to grow well. Yet, there is pressure on pregnant women to diet. Obstetricians recommend only gaining a limited amount of weight during pregnancy, and some doctors and midwives will put pressure on women to stop gaining weight at a certain point if they have gained “too much” weight too quickly. Additionally, some women may worry about gaining too much weight during pregnancy. Will it increase my risk? Will I look fat instead of pregnant? What if I can’t get the weight off again after I have my baby?

Yes, there are risks to gaining too much weight during pregnancy. However, there are also considerable risks to trying to lose weight during pregnancy, or not gaining enough. Some of those risks include a higher chance of baby being born prematurely, being too small (small for gestational age or low birthweight), having heart or lung problems,1 and even an increased risk that baby could die within the first year.2  ACOG (The American Council of Obstetricians and Gynecologists) recommends that ALL women gain weight during pregnancy. Even obese women should gain at least 11 pounds during pregnancy.3 To make this perfectly clear: a woman should never try to lose weight while pregnant.

Safe ways to look and feel better during pregnancy without dieting

Fortunately, there are things you can do to look and feel better, while also helping your baby be healthier. The ideas below may affect your appearance by improving muscle tone or by reducing the amount of weight gained during pregnancy. Using the ideas should help ensure that you gain the right amount of weight for you and your baby, without needing to count calories or watch the scale like a hawk. In addition, starting these healthy weight-influencing habits during pregnancy will help you feel better, help your baby to be healthier, and may help you reach a more ideal body composition more quickly after your baby is born.

Please understand that these are general suggestions for healthy, low-risk pregnant women. Please discuss any changes to your nutrition, exercise or other lifestyle habits with your doctor or midwife before making any changes.

  • Do aerobic exercise. Regular aerobic exercise, 30 minutes or more a day, helps condition your heart, train your body to burn sugar efficiently, use calories, and move toxins out of the body. Try walking, stationary bicycle, swimming, or another activity you enjoy.
  • Do strength training or toning exercises. Doing strength training and toning exercises, even for a few minutes most days of the week, will help your body to burn more calories overall in addition to toning your muscles. Try prenatal yoga or Pilates.
  • Eat more fruits and vegetables. Yes, I know. Who wants to eat more fruits and vegetables? They can be an acquired taste, and it is harder for some of us to acquire that taste than others. The benefits are well worth it, though. Not only are fruits and vegetables power-packed with nutrition for their calorie content, but their fiber helps you feel full for longer.
  • Swap some foods for healthier alternatives. Substituting healthier foods for some snacks and meals can make a big difference. These can be small changes, like eating low-fat or baked potato chips instead of conventional potato chips, or they can be big changes, like eating an apple, a handful of blueberries, or some carrots instead of potato chips. Start with just swapping one snack or food item a day for a healthier option.
  • Eat low glycemic. This basically means eating in a way to keep your blood sugar more stable. When we eat certain foods that digest quickly, it raises blood sugar quickly, but falls just as quickly. This can result in feeling tired or disoriented, getting moody, or feeling hungry even when our bellies feel stuffed. Low glycemic foods raise blood sugar more slowly, and will tend to keep blood sugar more stable longer, as well. So what makes a food low glycemic? Essentially, the more protein, fiber and fat that a food has compared to carbohydrates, the lower it is on the glycemic index and the slower it will digest. Some examples of low glycemic carbohydrates include berries, whole grain breads, sweet potatoes and brown basmati rice. We will explore low glycemic eating in more depth in a future post.
  • Watch what you drink. Many beverages contain a lot of calories, and our bodies do not really register those calories as filling us up. That means that it is possible for us to drink an extra meal or more’s worth of calories every day and not even realize it. Switching some or all of our beverages to water or healthy low- or no-calorie drinks can save a lot of unhealthy weight gain over time. Just try to avoid artificial sweeteners.
  • Learn to listen to your body. Our bodies know what we need, and how much we need, to be healthy. The voice of our bodies is usually quiet, though, and many of us are not used to paying attention to it. If we create opportunities, we can learn how to understand our body’s signals. Start by taking smaller portions of food, chewing well, and eating slowly. Before going back for seconds, sit and chat, read, or just relax for 10 minutes or so to let the signals for continued hunger or being satisfied become clearer. Often, we just do not give our body the time or focus to let us know what it needs. If you are not sure whether or not you are still hungry, wait. You can always snack later. It is ok to leave food on your plate. If you don’t want to throw it away, pack it up in a container and eat it later for a snack.
    On the other hand, if you do feel hungry, eat! As you would expect, eating when you are hungry help ensure that baby is getting what he or she needs. Also, depriving ourselves of food when we are hungry makes us more likely to overeat when we do finally get food. It can also wreak havoc with the way our bodies decide whether to burn sugar or store fat.

Pick one of the tips above to start with, and find a friend or two who is willing to make the shift with you. It helps to have other people to commiserate with – I mean support each other – while making lifestyle changes. Change does not happen right away. They say that it takes at least 21 days to create a new habit, so be patient with yourself. Also take it slowly. Choosing one or two changes at a time is easier for most of us to stick with than trying to revamp our entire lives. Add another habit each week if you want to make a number of changes.

While it is not safe to diet or try to lose weight during pregnancy, there are still ways to help keep your weight gain healthy. Focus on these healthy ways, taking any changes slowly, and trust your body! Our bodies are a lot smarter than we give them credit for being. We are able to see more of that innate intelligence as we learn better how to listen, and how to support those needs. During pregnancy, this helps women put on the right amount of weight for themselves and their babies. Postpartum, this helps us to eventually each reach our body’s ideal weight.

 

Melinda Delisle, LCCE, is a mom of two, a natural health researcher and advocate, and a Lamaze-certified childbirth educator. Melinda started teaching childbirth classes in 2000. She found that her students had much more comfortable and healthier pregnancies and births with fewer complications when they decided to follow healthy lifestyle principles. This led Melinda to develop the Pocket Pregnancy Guide ebook series, including “What to Eat When Pregnant” (learn more at www.pocketpregnancyplanner.com ). Melinda believes in the ability of women to make our own choices, and the strength of our bodies when we learn how to support them.

 

  1. Siega-Riz AM, Viswanathan M, Moos MK, Deierlein A, Mumford S, Knaack J, et al. A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention. Am J Obstet Gynecol 2009;201:339.e1–14.
  2. Regina R. Davis, Sandra L. Hofferth, Edmond D. Shenassa. Gestational Weight Gain and Risk of Infant Death in the United States. American Journal of Public Health, 2013; : e1 DOI: 10.2105/AJPH.2013.301425
  3. Weight gain during pregnancy. Committee Opinion No. 548. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;121:210–2.

The Attachment Pregnancy – A Book Review

By Valerie Rohde

Have you ever flipped through the pages of a book to dig in more deeply and as you’re reading you felt it was written specifically for you?  That is exactly how I felt when reading The Attachment Pregnancy by Laurel Wilson and Tracy Wilson Peters.  I found myself underlining, starring, and annotating right along just about every page, it is that resourceful.  As a biologist by education and a researcher by trade, as well as a semi-new mom to a 17 month old son, and trying to conceive our next child, this book came along at just the right time in my quest to gain more knowledge about attachment and our attitudes toward life and others in general.

The Attachment Pregnancy is laid out in such a way that is easy to read for any mom, yet very informative with many scientific processes that occur in the brain and body explained in detail and broken down so you can easily understand and make sense of the information as it applies to you.  Throughout the book, the authors emphasize and explain the importance of the motherbaby bond: “as you meet your baby’s needs for connection, pleasure, love, and affection, you literally change his or her brain chemistry and neurobiology, preparing your child for a lifetime of security, success, and psychological wellness.  This idea is no longer the stuff of sentimentality; it is underpinned by modern brain science and mother-infant attachment research” (p 10).  The book is divided into four parts – Be-ing, Observing, Nourishing, and Deciding – that each focus on a different part of your journey to motherhood and attachment.

In Part 1, the authors define Positive Mental Attitude (PMA), and how you can consciously make the decision every day by using the Three R’s to practice and find the positivity in any circumstance.  Chapters 4 and 5 discuss Conscious Agreement and Conscious Attachment, and how to build supportive relationships with those who come in contact with you during your pregnancy.  Anyone can benefit from understanding how external influences can have such an effect on us when we are acting unconsciously, and “because people often make decisions based on the expectations of others and their own subconscious reactions to others,” it is important to follow the four steps to practice Conscious Agreement and experience the freedom of tuning in to your intuition and to your “source” (“your reason for being, God, etc.,” p 54).

Part 2 of The Attachment Pregnancy focuses on the importance of observing your surroundings and circumstances during the first trimester of pregnancy, how to reduce stress using the four As, your physical bond with your baby, nutrition, and seeking out relationships grounded in “trust, security, and love [to teach] your child that the world is a safe and secure place” (p 130).

Part 3 hones in on the role that your partner plays in supporting your attachment to your baby.  The authors explain your partner’s experience of pregnancy and help demystify some of the differences between hormones in males and females.  Understanding these differences can help make the process into parenthood smoother when you can recognize the reasoning behind why your partner might be reacting in a way differently than you would.  It isn’t that he doesn’t want to be involved or supportive; he is just doing it in a different way.  I was also enlightened by chapter 12’s explanation of napping and the necessity of listening to our body’s cues for rest, rather than giving in to caffeine or sugar.

Part 4 is a wonderful conclusion to the book that discusses bonding through labor and birth, and just begins to scratch the surface of some of the decisions you may make for your family and gives some excellent resources to consider. I particularly loved the idea of creating a birth vision board as opposed to, or in conjunction with, a traditional birth plan to unleash your creativity and really focus on what speaks to your innermost being.

I encourage you to read this book now, even before you conceive, if possible!  Begin your conscious agreement journey right away with the practical tips and activities in each chapter to strengthen your positive mental attitude and set the stage for a joyful, healthy, attachment pregnancy from the start.  The more prepared you are now, the more natural your attachment will be when you get that positive pregnancy test.  For moms who are already pregnant, this is one book you will want to read as soon as possible to become knowledgeable about all the ways you can positively impact your growing baby and nourish your mind and spirit in the process.  No matter where you are on your parenting journey The Attachment Pregnancy is chock full of wisdom and you will be grateful for the chance to read it thoroughly.  I love the inspirational quotes throughout, and the chapter summaries make it easy to reference and remember specific key points.  This book is more than just a sentimental read about having a positive attitude for you and your baby; it is a resource you will return to again and again.  Thank you, Laurel Wilson and Tracy Wilson Peters, for the exceptional job on this resourceful guide!

 

Valerie lives in metro-Atlanta with her husband, son, and 3 pups. She is a biologist by education but is most passionate about her family and in supporting other women and their families during their own journeys to parenthood as a childbirth doula, educator, and lactation consultant. With her own journey to parenthood facing miscarriage and infertility, she has become very interested in nutrition and has experience preparing meals for those following the paleo lifestyle. She has an intrinsic love for writing and you can find her thoughts as a contributing blogger on several sites and on her own atwww.brilliantbeginningsbirth.com