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.

National Birth Defects Prevention Awareness Month

National Birth Defects Prevention NetworkJanuary is National Birth Defects Prevention Awareness Month. As a woman who is pregnant, trying to get pregnant, or will one day get pregnant, it’s important to know what current research says about preventing birth defects. According to the National Birth Defects Prevention Network (NBDPN), birth defects are the leading cause of infant mortality. The good news, however, is that you can take steps before and during your pregnancy to prevent birth defects. NBDPN advises women who are pregnant or who are planning to become pregnant to take the following steps to prevent birth defects:

  • Consume 400 micrograms of folic acid daily
  • Manage chronic maternal illnesses such as diabetes, seizure disorders, or phenylketonuria (PKU)
  • Reach and maintain a healthy weight
  • Talk to a health care provider about taking any medications, both prescription and over-the-counter
  • Avoid alcohol, smoking, and illicit drugs
  • See a health care provider regularly
  • Avoid toxic substances at work or at home
  • Ensure protection against domestic violence
  • Know their family history and seek reproductive genetic counseling, if appropriate

Patricia Olney, MS, a certified genetic counselor and pregnancy risk specialist at MotherToBaby (the pregnancy and breastfeeding medications and toxins exposure specialist organization)  informs parents about the importance of taking folic acid:

Since one-half of U.S. pregnancies are unplanned and because birth defects occur very early in pregnancy (3-4 weeks after conception), the United States Centers for Disease Control recommends all women of childbearing age consume folic acid daily.  CDC estimates that most of these birth defects could be prevented if this recommendation were followed before and during early pregnancy.

Folic acid can be found naturally in dark leafy greens (spinach, kale, collard greens, romaine lettuce), asparagus, broccoli, brussels sprouts, cauliflower, celery, carrots, squash, beets, oranges, papayas, grapefruit, strawberries,  fruits (bananas, melons, and lemons), beans (with lentils yielding the highest amount), seeds and nuts, avocado, yeast, mushrooms, and beef. To ensure that you are receiving sufficient folic acid on a daily basis, CDC advises taking a synthetic supplement (vitamin) of folic acid that delivers at least 400 micrograms of folic acid.

To learn more about prevention or find a support group, NBDPN has created a comprehensive list of birth defect internet resources for parents and families.

Enjoy the Holidays, Safe, Sane & Sound During Pregnancy

By Dr. Kecia Gaither

Deck the halls and hark the herald! Well ladies, the holiday season is upon us again.  Time for family and friends, shopping and travel, New Year’s resolutions and my personal favorite—cooking and eating.  So let’s  discuss a few things, from a medical  perspective, that will keep you and your precious cargo well and whole for the holiday season.

Travel: Recommendations for travel will vary depending on your destination, mode of transportation and the length of time spent traveling. Basic rules: being pregnant increases your risk of blood clots in the legs; long hours of sedentary travel further increases that risk—it’s important during your excursions to wear comfortable clothes, support stockings and to get up and stretch at least every two hours to get that blood pumping.  If you are going to an exotic destination, try to avoid those locales where vaccinations are needed; if you must go, consult your physician to verify which vaccinations are safe during pregnancy.  Be extra cautious about consuming the water in foreign countries to avoid stomach upset/traveler’s diarrhea—err on the side of drinking bottled water in these circumstances.

Flying during pregnancy, pending your medical status, is considered safe in the first and second trimesters.  Prior to making your reservation, it would be prudent to contact your airline carrier for their travel policies concerning  pregnant women as restrictions may vary.  Due to a lack of oxygen, it may be wise to avoid flying in small, unpressurized planes while pregnant.

Food: Food is the mainstay of any holiday celebration — however, there are some foods pregnant women should avoid due to the bacteria, viruses or parasites which may be present.  These critters can cross the placenta and not only affect mom, but baby as well.  Listeria, a bacteria, is top on the list of germs that can cause severe food borne illness, miscarriage, and stillbirth.  Foods such as unpasteurized cheese/milk, and poorly cooked hot dogs may contain this bacteria, so be vigilant in their consumption.  Foods with raw eggs,  (like eggnog), or  uncooked vegetables (particularly sprouts), or under-cooked poultry may contain E.coli and Salmonella, both of which can cause sickness for mom. Undercooked pork products  may contain a parasite which can cause trichinosis — this one can also cross the placenta and affect the fetus, causing stillbirth, so be sure that all pork is thoroughly cooked. Proper refrigeration of cooked food also is important. The USDA recommends pregnant women avoid foods which have been left out for more than 2 hours.

New Years’ Resolutions

When you’re pregnant, there are a few resolutions that are certainly worth thinking about, and that are attainable and maintainable.

  1.  Cut the mama drama – decrease the stress in your life.  Stress for anyone, but particularly pregnant women, affects both mother and fetus—presents with an increased risk of preterm labor/delivery, low birth weight infants.  Stress also contributes to the development of hypertension.  Anecdotally, mothers who are under immense stress tend to have crankier babies.  Stress busters—meditation, yoga, aromatherapy, professional counseling and therapy—all are safe, natural ways to de-stress.
  2. Open wide and say AAH! – pay attention to your dental health.  Infection is thought to play a major role, among other things, in the genesis of preterm labor and heart disease. Periodontal disease, is, in effect, a lingering oral infection.  A trip to the dentist for cleaning of plaque/attention to any gum disease decreases your incidence of preterm labor and delivery.  Make sure to schedule routine visits for maintenance of your oral health throughout the year.
  3. An apple a day keeps the doctor away– the old adage is true; nutrition contributes to great health. Pay attention to your nutritional choices with the new year—focus on increasing your fruit, vegetable, beans, and whole grains intake—cut down on fatty high cholesterol containing foods/processed foods. Lean meats like chicken and turkey are great. Increase your water consumption and eliminate drinks containing high fructose corn syrup.  Good nutrition contributes to a healthy growing fetus, and post delivery, helps with good milk production and keeping mom in a positive nutritional balance.

With those thoughts in mind, enjoy your holiday season, ladies!

 

Dr. Kecia Gaither serves as the Vice Chairman and the Director of Maternal Fetal Medicine in the Department of Obstetrics &
Gynecology at Brookdale University Hospital and Medical Center located in Brooklyn, N.Y. – one of the region’s largest and busiest nonprofit teaching hospitals. In her current position, Dr. Gaither oversees the hospital’s OB/GYN’s Ultrasound Unit and the Maternal Fetal Medicine Division. With more than 20 years of professional experience, Gaither’s expertise is grounded in the
research and care for women with diabetes, HIV and obesity in pregnancy.

A New York City native, Gaither’s mission as a medical professional is to offer exemplary prenatal care to those often
underserved and overlooked. The women who enter Dr. Gaither’s office are typically without the financial means nor the emotional support needed to receive the proper care needed while carrying a high-risk pregnancy.

photo credit: richiebits via photopin cc

Real Complications, Real Voices: HELLP Syndrome

In this new series, Giving Birth with Confidence will address well known and lesser known pregnancy and birth complications by sharing practical information and voices from real women who have experienced them. While most birth complications happen infrequently, they do happen. If you or someone you know is pregnant, it’s important to be aware of the signs and symptoms of complications. We encourage you to join in the conversation in the comments section. The following information is not meant to replace diagnosis or information from your care provider.

HELLP Syndrome 

HELLP syndrome is defined by the Preeclampsia Foundation as: ”A life-threatening pregnancy complication usually considered to be a variant of preeclampsia. Both conditions usually occur during the later stages of pregnancy, or sometimes after childbirth. HELLP syndrome was named by Dr. Louis Weinstein in 1982 after its characteristics:

H (hemolysis, which is the breaking down of red blood cells),
EL (elevated liver enzymes) and
LP (low platelet count).”

It is estimated that 0.2 to 0.6 percent of all pregnancies will be affected by HELLP syndrome.

Warning Signs of HELLP Syndrome

  • High blood pressure
  • Protein in urine (proteinuria)

Symptoms of HELLP Syndrome

Most common:

  • Headaches
  • Nausea and vomiting that continue to worsen and that may occur after eating
  • Upper right abdominal pain or tenderness
  • Fatigue or general feeling of being unwell
The following symptoms vary and may also appear in conjunction with the above more common symptoms:
  • Visual disturbances
  • High blood pressure
  • Protein in urine
  • Edema (swelling)
  • Shoulder pain or pain when breathing deeply
  • Severe headaches
  • Bleeding

Diagnosis of HELLP Syndrome

Diagnosis of HELLP syndrome can be difficult as its symptoms can mimic other common pregnancy ailments or flu-like illness. Early diagnosis, however, is critical to the health of mother and baby. If one or more of the above symptoms are happening during your third trimester, tell your doctor or midwife immediately. She will most likely run a series of blood tests, including liver function. Your care provider will look at your red blood cells, at your liver enzyme levels, and at your platelet count to make an accurate diagnosis.

Treatment of HELLP Syndrome

The best way to treat HELLP is to give birth to your baby. If you have not yet hit 34 weeks of pregnancy, your doctor will try to elevate  your baby’s lung function with the injection of corticosteroids to give him a better chance of survival as a preterm baby.

Risks of HELLP Syndrome

The following are possible complications in mothers and babies if HELLP is left undiagnosed and untreated (from the American Pregnancy Association):

  • Placental Abruption
  • Pulmonary edema ( fluid buildup in the lungs)
  • Diseminated intravascular coagulation (DIC—blood clotting problems that result in hemorrhage)
  • Adult respiratory distress syndrome (lung failure)
  • Ruptured liver hematoma
  • Acute renal failure
  • Intrauterine growth restriction (IUGR)
  • Infant respiratory distress syndrome (lung failure)
  • Blood transfusion

Cause of HELLP Syndrome

Currently, there is no defined cause of HELLP. It is more common in women who have preeclampsia or pregnancy induced hypertension, but it also occurs when neither of these complications are present.

Prevention of HELLP Syndrome

Because the cause of HELLP is unknown there is also no known prevention. Early diagnosis and management is critical.

Real Voices of Mothers who Experienced HELLP 

In her fifth pregnancy, Karen was diagnosed with HELLP and sent for an emergency cesarean after a string of complications. She had a prior history of preeclampsia with her second pregnancy.

I was told I had magnesium toxicity and was beginning to develop HELLP syndrome.  On Monday morning my urine came back with a protein of over 800 and I was scheduled for a c-section later that afternoon.  Here we were again in the same OR having an emergency c-section.  I delivered a six pound boy.  He was admitted to the NICU with a Cpap, which was removed later that day. Josh had a 19- day NICU stay mostly due to lethargy and feeding issues.  They called him a “mag” baby as they felt his issues were related to the magnesium I was given.  He is now nearly 5 months and doing wonderfully.  I again find myself in a love hate relationship with my Medela, and am exclusively pumping breast milk for him. He has absolutely no issues at this time. I feel that this was my most difficult recovery, and every day I feel a little better, making me realize how sick I really was. I still have issues with blood pressure, visual disturbance, headaches, and bruise fairly easily. I have been told that these are still probably all related to the preeclampsia and can take months to completely resolve. I have been told no more babies for us.

It is difficult to share with others who have not experienced difficult births and NICU stays. To those on the outside, “all’s well that ends well” should apply, and it is difficult to express the emotional difficulty of these experiences when I should just be grateful for my beautiful babies. Believe me, no one appreciates and loves these miracles more than I do.

Stephanie, a mother of two, experienced serious complications and premature delivery by cesarean of her first baby while she was under general anesthesia, all due to a late diagnosis of eclampsia and HELLP syndrome. Her son was born at 33 weeks weighing 3 lbs. 7 oz. and spent 21 days in the NICU. He is now a happy, vibrant 7 year old.

It is hard to describe what an experience like this can do to a mother.  For one, I was very determined to breastfeed but given the trauma my body experienced and a delay of two days in getting my son to breast, I failed to produce any real quantity of breast milk.  I will never forget my husband sitting on the end of my hospital bed, encouraging me to pump, even helping me because I was so weak, all because he understood just how important it was to me.  At 21 days old, my son came home.  I was so happy and grateful yet those feelings were overshadowed by the feeling that I had failed him.  My body gave out on him in pregnancy.  He was born early and had to fight extra hard because of me.  I was unable to provide him with what I believe is the best nutrition because my body had failed.  It was very easy to blame myself, to hate myself.  At one time I even thought it might have been better for him if I had died from all the complications. Surely another mother would be better for him than me since it was my body’s fault he came early.  Those thoughts drove me back to the doctor where, with some medication and some therapy, I was able to overcome those feelings.   Even now that Lucas is a healthy, happy, vibrant, 7 year old, I blame myself for his struggles.  Like so many preemies similar to him, he has had some challenges, fine motor delays, and some social and emotional issues that we continue to work through every day.  He has to work harder than other kids because of my body’s failure and that scar is always with me.

Leah only found out after she gave birth to her baby that it was HELLP that caused her swelling, high blood pressure, vomiting, excruciating rib/chest pain, and seizures. At 40 weeks 2 days, she gave birth vaginally (escaping cesarean only due to the risk of  bleeding) to a healthy baby boy.

It wasn’t until after I was home and started to research HELLP Syndrome that I began to understand what had REALLY happened to me. There was really no explanation in the hospital. I even asked my husband afterwards if they took him aside and explained anything to him to make him aware of the severity of the situation and he said no. He was just as in the dark as I was. It was a very scary time for both of us.

Once I realized how close I came to dying I was overwhelmed with emotions – sad, angry, shocked and devastated. I do not relate being “sick” to “dying”. Sick to me is having a cold not dying, yet this is the choice of wording the doctors and nurses used the entire time I was there. Maybe it’s to not send patients in that kind of a state into more shock but I really had no idea that I was dying or there was even a possibility of that.

After some counseling and working through all of my emotions, today I can say that I am just grateful that my son and I are healthy and alive! Today I have a totally new perspective on life and pregnancy/birth. I have made it part of my life mission to help educate women especially first time moms on the signs/symptoms of pre-eclampsia and hellp syndrome.

At 34 and-a-half weeks, Melissa was diagnosed with HELLP and told that her daughter had died. After an attempted vaginal birth, her liver ruptured and she was eventually rushed into an emergency, life-saving surgery. After 3 days in a coma and 6 days in intensive care, Melissa was finally released to go home after a 10-day hospital stay.

Emotionally the recovery from HELLP was impossible. I hated my body. I felt betrayed by it. My daughter died because of my body.    It was the unnatural order of things, she died and I had lived because of my disease. I was a shadow of my former self, incapacitated by grief and left in the ruins of every hope and dream I had ever had. I despised the fact that my daughter was synonymous with a horrific disease, I raged and crumbled under the crushing burden of loss. I did not trust my body to continue working, knowing how quickly life can change. I was left raw, emotionally burned consumed with feeling of powerlessness and completely jaded.

It would take time, counselling, PTSD treatment and grief to allow me to compartmentalize what happened to us. It would be a year before I could look at my scars without hatred. Now it has been 2 years and 4 months since HELLP slammed into us, took my daughter and almost killed me and I can honestly say I will never accept it. I will not accept HELLP as a label in my life. I will not accept this horrid disease. I have incorporated it into our life’s story. I have allowed myself to have faith enough to try again.  Our second daughter was born 1 year and 8 months after our first pregnancy’s end. A perfect, healthy baby girl who looks so much like her big sister, was born after a 38 week perfect, healthy pregnancy.  Though we forever walk with a hole in life somehow, unimaginably she has has returned the joy to our lives. We feel alive once more and for her we are the most grateful.

 

 

How to Soothe Common Pregnancy Discomforts: Heartburn

In this new series on Giving Birth with Confidence, we’re going to cover some of the most common discomforts that can happen during pregnancy and share tried-and-true ways to help soothe or eliminate them. Pregnancy can be an amazing time in a woman’s life, but it can also be challenging. The reality is that some women’s bodies accept and cope well with pregnancy and some don’t. In any case, having extra tools in your coping toolbox can go along way toward increasing your quality of life during the 4o-ish weeks of pregnancy.

Five Ways to Extinguish the Fire of Heartburn During Pregnancy

By Hillari Dowdle, freelance writer for FitPregnancy

It was heartburn that got me in the end. I could take the swelling, the back pain, the constant trips to the bathroom, the itchy skin, the fatigue, the sweating, the sleeplessness and even the psychological shock of seeing the scale tip 200 pounds. But the constant, searing pain of heartburn made the miracle of pregnancy seem more like a curse—by the middle of my third trimester, my mantra had changed from Please, let him be healthy! to Just get him OUT!

That fiery sensation known as heartburn happens when the lower esophageal sphincter (LES), a muscle responsible for keeping stomach contents in their place, begins to relax or leak. this allows stomach acids to flow upward into the esophagus, explains Suzanne Trupin, M.D., CEO of Women’s Health Practice of Champaign, Ill. Pregnant women are prime candidates for two reasons: First, the hormone relaxin—busy limbering up your joints and connective tissue for an easier birth—slows your digestion, meaning food stays in your stomach longer and triggers more acid production. Second, your growing baby exerts pressure on both the stomach and the LES, increasing the chance that acids will be pushed up into the esophagus.

So what’s an expectant mother to do? Follow these five tips to relieve the pain:

1. Eat less, more often
Overeating exacerbates heartburn, says rachel Brandeis, M.S., a registered dietitian in Atlanta who specializes in prenatal nutrition. “When you’re pregnant, there’s less room for your stomach to expand,” she explains. Maintaining a sensible diet will not only stave off heartburn in the short term, but throughout your pregnancy as well, because gaining more than the recommended weight puts more pressure on your abdomen, which can trigger the condition. Instead of three meals a day, aim for six mini-meals (See “Mini-Size Me” below) of no more than 1 1⁄2 cups of food each, Brandeis recommends. Smaller meals are easier for your body to digest.

2. Eliminate trigger foods
Identify the foods that intensify your heartburn and banish them from your diet. While there are no universally “banned” foods, common heartburn triggers include acidic foods, such as citrus fruits and tomatoes, greasy or fried foods, spicy foods, chocolate, coffee, carbonated beverages, and alcohol (which, as you well know, you should eliminate anyway!).

3. Focus on fluids
“Liquid-y foods are less likely to cause problems than solids, since they move through the stomach more quickly,” Brandeis says. Soups, smoothies, yogurt, milkshakes, protein shakes and puddings are good choices. Look for liquids that offer plenty of protein, such as milk and drinkable yogurt, and aim to make solids a little less so: “chew solid foods slowly and extremely well, until they’re almost liquefied,” Brandeis adds.

4. Sleep smart
To avoid nighttime heartburn, don’t eat anything for at least three hours before bedtime. Elevate the head of your bed by placing books under the legs, and if you’re not already sleeping on your left side, start now; stomach acids will have to travel uphill to reach the esophagus—no easy feat!

5. Time for Tums
It’s fine to find relief in a bottle of tums or rolaids or other calcium- containing antacids. However, “too much calcium can block iron absorption, so don’t take tums at the same time you take your prenatal vitamin,” Brandeis advises. By the time I gave birth, I estimate I’d ingested my own considerable body weight in tums. This overuse created calcium overload, which may have exacerbated my anemia. If you’re taking antacids 10 times a day (or more—as I was), talk to your doctor: she may want to check for ulcers or a hiatal hernia (where part of the stomach protrudes into the chest cavity), or prescribe medication.

Also, avoid antacids that list aluminum (such as aluminum hydroxide or aluminum carbonate) as an ingredient; it can cause constipation and can even be toxic in large doses. Remedies containing aspirin (such as alka-seltzer) should also be avoided during pregnancy; look for salicylate or acetylsalicylic acid in ingredients lists. You don’t want an antacid containing sodium bicarbonate (baking soda) or sodium citrate, either. Both are high in sodium, which causes water retention.

Mini-Size Me

Here’s a sample of what a day’s worth of small, healthful meals looks like:

1 cup of oatmeal with milk and 1 apple

1 cup of yogurt with fruit

1 ⁄2 peanut butter and jelly sandwich and 1 cup of vegetable soup

1 handful of whole-grain crackers and 1 ounce of your favorite hard cheese

2 ounces of chicken, 1 ⁄2 cup of mashed sweet potatoes and 1⁄2 cup of cottage cheese with fruit

Find eight more small snacks that are easy to make, packed with pregnancy nutrients and delicious at fitpregnancy.com/snackideas.

 

Did you experience heartburn during pregnancy? What helped you get rid of it? Share in the comments — women want to know!

 

How to Screen Yourself for Postpartum Depression

May is Mental Health Month. As childbirth education advocates, Lamaze believes that mental health during and after pregnancy is critical to the health and safety of moms and their babies. If you are experiencing depression, anxiety, psychosis, or any other mental health issues, contact your care provider and seek support and resources from Postpartum Progress and Postpartum Support International. You don’t have to suffer alone — and you don’t have to suffer. There is support and treatment available for mental health disorders. Also know that you are not alone — it has been found that 1 in 7 women will experience postpartum depression, though that rate is thought to be higher for all postpartum disorders.

So how do you know if you are experiencing a postpartum disorder? Many moms downplay or dismiss their feelings, chalking them up to “hormones,” but it’s important to take notice and check in with yourself. A postpartum disorder is more than just a “bad day,” and even if you feel as though you are coping, a postpartum disorder ultimately affects your quality of life. If you feel as though something is “off” or if your partner expresses concern about your state of well-being, you can take a free, quick, confidential, online screening quiz to determine whether you may be suffering from postpartum depression.

The Edinburgh Postnatal Depression Scale (EDPS) was developed in 1987 to help doctors determine whether a mother may be suffering from postpartum depression. The scale has since been validated, and evidence from a number of research studies has confirmed the tool to be both reliable and sensitive in detecting depression. The EPDS Score is designed to assist — not replace — clinical judgment. If you feel you may be at risk or suffering from post natal depression, please share the results with your care provider.

Pregnancy, Birth & Postpartum Resolutions

New Year’s resolutions may take on more meaning if you’re preparing for the birth of a child in 2013. This year, perhaps for the first time, “join the gym and lose 10 pounds” isn’t on the list. At the same time, many of the resolutions you make for a healthy pregnancy look a lot like those you would make for a healthy lifestyle, pregnant or not. For example:

  • eat fruit and vegetables daily
  • get 8 hours of sleep
  • exercise 30 minutes a day
  • carve out time for yourself
  • ask for help when you need it

For a healthy pregnancy, birth, and postpartum period, we’ve compiled a few significant resolutions for you to consider adding to your list this year.

 

Pregnancy

Listen to your body. If it’s telling you to slow down, do all that you can to make it happen. Cereal for dinner? Why not. Nap at 6 p.m.? Yep. On the other hand, if you’re feeling great, don’t let pregnancy slow you down — continue your exercise regimen, meet up with friends for dinner, enjoy life!

Learn about evidence-based maternity care. You can’t always count on your care provider to give you the best, most up-t0-date care. How will you know if you’re not receiving the best care? Learn how to navigate the maternity care system and how you can get the best care.

 

Labor & Birth

Plan for the best support. Who will attend your birth? Do they support your wishes? Will they provide positive energy? Think carefully about your birth support team. Look into hiring a doula. Share your birth plan with everyone well before labor begins.

Take labor one step at a time. Humans seem to be hardwired to think about what’s going to happen next. With labor, it helps to only think about what’s happening now. If you can take each contraction, each stage, each moment as it’s happening, you’ll be better able to put complete focus on the task at hand instead of worrying about what’s to come.

 

Postpartum

Speak up. It’s wonderful to have friends and family ooo and ahh at your new little joy. But a house full of visitors can be overwhelming during a time when you’re trying to understand a brand new world. Feel free to ask for some time and space alone with your baby. Post visiting hours on your front door or update your Facebook status to let friends know when you’re accepting visitors.

Know the signs of postpartum depression/disorders. Postpartum mood disorders (anxiety, depression, OCD, psychosis) affect hundreds of thousands of women every year. With knowledge of the warning signs and access to resources, women who suffer from postpartum mood disorders can and do recover.

Maternal Mental Health: Pre-Existing Risk Factors for PTSD and Childbirth

In light of the horrific and tragic events that took place at Sandy Hook Elementary School last Friday, Giving Birth with Confidence will be dedicating our posts this week to providing resources relating to mental health and wellness. Approximately 1.3 million women annually suffer from mental health disorders that occur during pregnancy and in the postpartum period. Perinatal and postpartum anxiety and mood disorders far outweigh the annual occurrence of several other major diseases combined. The key to finding help and treating mental health disorders is awareness; the more people who know how to spot warning signs and what to do to find help, the greater our possibility for better health.

 

 

This article is part of the Traumatic Birth Prevention & Resource Guide by PATTCh. Access the complete guide to learn more about traumatic birth and find resources for women and families.

By Heidi Koss, MA, LMHC

Health care providers aren’t exactly sure why some people get post-traumatic stress disorder (PTSD) when exposed to a traumatic event while others do not. Post-traumatic stress disorder can develop when you go through, see or learn about an event that causes intense fear, helplessness or horror. Any trauma, including birth trauma, lies in the eye of the beholder. What one may perceive as traumatic might not be traumatic to others.

As with most mental health problems, PTSD is probably caused by a complex mix of:

  • Your inherited mental health risks, such as an increased risk of anxiety and depression
  • Your life experiences, including the amount and severity of trauma you’ve gone through since early childhood. PTSD can result from a cumulative effect of multiple traumas over a lifetime.
  • The inherited aspects of your personality — often called your temperament
  • The way your brain regulates the chemicals and hormones your body releases in response to stress

General Risk factors for Post-Traumatic Stress Disorder
People of all ages can have post-traumatic stress disorder. However, some factors increase risk of developing PTSD after a traumatic event, including:

  • Being female — women may be at increased risk of PTSD because they are more likely to experience the kinds of trauma that can trigger the condition.
  • Experiencing intense or long-lasting trauma
  • Having experienced other trauma earlier in life
  • Having other mental health problems, such as anxiety or depression
  • Lacking a good support system of family and friends
  • Having first-degree relatives with mental health problems, including PTSD and depression
  • History of abuse (such as childhood abuse, sexual abuse, rape)
  • Combat exposure
  • Physical attack
  • Being threatened with a weapon
  • Car accident, plane or train crash
  • Life threatening experience (such as natural disaster, critical injury, medical crisis, attack, mugging)

These symptoms should alert you to possible PTSD:

  • Flashbacks of the event — vivid and sudden memories
  • Nightmares
  • Insomnia
  • Fears of recurrence
  • Emotional numbing
  • Panic attacks
  • Inability to recall important aspects of the event — psychogenic amnesia
  • Exaggerated startle response, hyper-arousal, always on guard
  • Hyper-vigilance, constantly looking around for trouble or stressors
  • Avoidance of reminders of the traumatic event
  • Intense psychological stress at exposure to events that resemble the traumatic event

How is PTSD different than other Pregnancy and Postpartum Mood Disorders?
Sometimes perinatal mood disorders overlap and it’s hard to tell where one ends and the other begins. PTSD is caused by an event in which you feel threatened, violated, and feel as if you could die. By the way our brain has processed the memory of the event, is causes heightened anxiety, hypervigilance, flashbacks, nightmares, etc. Therefore PTSD is an anxiety or stress reaction and it is different from other postpartum mood disorders such as depression and anxiety. However, other postpartum mood disorders can occur at the same time PTSD.

Resources
Recommended Books:

  • Postpartum Mood and Anxiety Disorders, A Clinician’s Guide, by Cheryl Tatano Beck and Jeanne Watson Driscoll
  • Beyond the Birth, A Family’s Guide to Postpartum Mood Disorders, by Juliana Nason, Patricia Spach and Anna Gruen. Published by Postpartum Support International of WA
  • When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women, by Penny Simkin and Phyllis Klaus

Useful Organizations & Websites:

Heidi Koss, MA, LMHCA is a psychotherapist in private practice in Redmond, WA specializing in pregnancy and postpartum mood disorders (PPMD), birth trauma, and parent adjustment issues. She has been the Executive Director of Postpartum Support International of Washington (PSI of WA), WA State Coordinator for Postpartum Support International as well as co-founder of the Northwest Association for Postpartum Support (NAPS). She offers consultant services and PPMD trainings. Heidi has also been a postpartum doula and certified lactation educator. Heidi is the proud mother of two beautiful daughters.

 

 

 

PATTCh is a not-for-profit, multidisciplinary organization dedicated to the prevention and treatment of traumatic childbirth. Our mission is to develop cross-disciplinary relationships, research, and programs that:

  • prevent PTSD following childbirth through education, interdisciplinary collaboration, and multidisciplinary research;
  • educate perinatal care providers and paraprofessionals in the prevention and treatment of birth and reproduction related trauma;
  • encourage the development of culturally appropriate therapeutic approaches to post-traumatic stress symptoms following childbirth;
  • promote healthy birth practices for all women and families;
  • promote evidence-based research regarding PTSD secondary to childbirth;
  • increase global awareness of the prevalence, risk factors, and effects of PTSD secondary to childbirth; and
  • support collaboration and understanding among all stake-holders, including: researchers, policy makers, medical and mental health care providers, educators, community members, volunteers, women, and families.

 

Maternal Mental Health: Daily Support Service for Mothers Who Suffer from Postpartum Disorders

In light of the horrific and tragic events that took place at Sandy Hook Elementary School last Friday, Giving Birth with Confidence will be dedicating our posts this week to providing resources relating to mental health and wellness. Approximately 1.3 million women annually suffer from mental health disorders that occur during pregnancy and in the postpartum period. Perinatal and postpartum anxiety and mood disorders far outweigh the annual occurrence of several other major diseases combined. The key to finding help and treating mental health disorders is awareness; the more people who know how to spot warning signs and what to do to find help, the greater our possibility for better health.

Postpartum Progress (www.postpartumprogress.com), the most widely-read blog in the United States on postpartum depression, hosts a service to help pregnant and new mothers get through the difficulty of perinatal mood and anxiety disorders.

Daily Hope is the nation’s first support service featuring once-daily e-mails to mothers with postpartum depression, postpartum anxiety, postpartum OCD and antenatal depression or anxiety. This free service provides encouragement from survivors, the country’s top perinatal mental health specialists and authors of the leading books on perinatal mood and anxiety disorders and parenting.

Many of the nearly one million women who suffer each year do not have access to perinatal mental health specialists or PPD support groups where they live. “I hear from thousands of mothers across the country and around the world who say that having someone to lean on who deeply understands can contribute a great deal to their recovery process,” said Katherine Stone, founder of Postpartum Progress and survivor of postpartum OCD. “I felt Daily Hope would be a great way to use technology to offer mothers encouragement from the nation’s most trusted experts on their illnesses, regardless of where they live or what type of health insurance they have. The more support we can provide to women with postpartum depression, the better, because the quicker the recovery, the less likely the illness will have a long-term impact on mom and baby.”

Contributors to Daily Hope include, among many:

  • Karen Kleiman, MSW, author of “This Isn’t What I Expected: Overcoming Postpartum Depression”
  • Ann Dunnewold, PhD, author of “Life Will Never Be the Same: The Real Mom’s Postpartum Survival Guide” and “Even June Cleaver Would Forget the Juice Box”
  • Marlene Freeman, MD, MGH Center for Women’s Mental Health and Harvard University
  • Pamela Weigartz, author of “The Pregnancy & Postpartum Anxiety Workbook”
  • Susan Stone, LCSW, former president of Postpartum Support International
  • Janice Croze, co-founder of 5MinutesforMom.com and survivor of PPD
  • “Aunt Becky,” author of the blog Mommy Wants Vodka, founder of Band Back Together and survivor of antenatal depression
  • Adrienne Griffen, founder of Postpartum Support Virginia

To sign up (for free) and subscribe to Daily Hope, click here.

Postpartum Progress, founded in 2004, provides the most comprehensive, in-depth and accessible information available on perinatal mental illness for pregnant women and new mothers. Having already helped more than 350,000 women and healthcare providers, Postpartum Progress offers an unflinching look at getting through postpartum depression, postpartum anxiety, postpartum OCD, postpartum psychosis, and antenatal depression & anxiety. Postpartum Progress has been named one of the top 10 depression blogs on the web by Psych Central, the winner of Fit Pregnancy’s Best of the Web Awards in the Advice category, and was a runner-up in Parenting’s Must-Read Moms and Scholastic Parent & Child’s Best Parenting Blogs Awards. It has been featured on Babble, ParentDish, Café Mom, Health.com and many other parenting websites. Postpartum Progress was founded by Katherine Stone, who was named a WebMD Health Hero in 2008 and won the Bloganthropy Award in 2010 for her advocacy work for pregnant and new mothers with maternal mental illness.

Postpartum Progress the blog and Daily Hope are both offered by Postpartum Progress Inc., a non-profit organization dedicated to vastly improving the amount of services and support available to women with perinatal mood and anxiety disorders.

Maternal Mental Health: Anxiety Disorders in Pregnancy

In light of the horrific and tragic events that took place at Sandy Hook Elementary School last Friday, Giving Birth with Confidence will be dedicating our posts this week to providing resources relating to mental health and wellness. Approximately 1.3 million women annually suffer from mental health disorders that occur during pregnancy and in the postpartum period. Perinatal and postpartum anxiety and mood disorders far outweigh the annual occurrence of several other major diseases combined. The key to finding help and treating mental health disorders is awareness; the more people who know how to spot warning signs and what to do to find help, the greater our possibility for better health.

 

This World is Not Flat: Anxiety Disorders in Pregnancy

Imagine you are sitting in your care provider’s office, and next to the scary “universal pain chart” with the not-so-happy faces getting progressively more distressed and discolored, is this chart:

1 in 8 pregnant women will develop an illness that poses these risks:

  • preterm birth (the leading cause of infant mortality and disability in US)1,2,3
  • low birth weight4
  • low APGAR scores5
  • a more difficult labor and delivery with increase of PTSD symptoms related to birth6,7,8,9
  • increased chance of Postpartum Depression/Anxiety Disorders after birth10,11
  • newborn may have increased agitation12,13
  • jittery infants up to 6 months after delivery14
  • breastfeeding difficulties15
  • child may develop learning and attention disorders later in childhood16,17,18

Genetic Disorder? Pre-ecamplsia? STD?

Nope. Perinatal Anxiety Disorder.

Current estimates are that anywhere from 5% to nearly 25% of pregnant women (1 in 8 ) will have a mood or anxiety disorder.19,20,21 And for pregnant women with anxiety disorders, high levels of cortisol cross the placenta and have long-term effects noted long after birth.22

With my first pregnancy, I began developing symptoms of depression and anxiety shortly after my second trimester. I knew something was wrong, and had both physical and emotional symptoms that were getting progressively worse. At the time (10 years ago), my providers didn’t know to ask about depression and anxiety during pregnancy—and I did a darned good job covering it up. My illness went untreated, and I ended up suffering Post-Traumatic Stress Disorder (PTSD) in labor and developing severe postpartum depression and anxiety after the birth. I was three months postpartum before my illness got severe enough, and life threatening, to the point where any of us knew I needed immediate medical treatment.

Anxiety in pregnancy and birth is universal and normal. It is a normal reaction to a physically and emotionally stressful, life-altering event. Secondly, an anxiety disorder in pregnancy is a medical illness, not a character flaw or personality trait. Its etiology is currently traced to an interplay of hormonal, genetic, environmental and immunological systems of the body23,24 – not the half shot of espresso in your latte, your character, or your inability to relax in your [irritating] prenatal yoga class. Newer research is looking at the role of increased oxytocin around the time of birth in influencing the onset of Perinatal Anxiety Disorders (PAD).25 Bottom line: It is not your fault.

 

Symptoms of Anxiety Disorders
Anxiety in pregnancy is normal. But when anxiety in pregnancy is significant enough to cause physical, emotional, and cognitive distress — a perinatal anxiety disorder may be occurring and you need help.26

Pec Indman, EdD, MFT and co-author of the award winning book, Beyond the Blues: Understanding and Treating Prenatal and Postpartum Mood/Anxiety Disorders offered this in a recent interview for this post:

While it’s normal to have some worries during pregnancy (for example, “Will my baby be healthy? or, “ Will I be a good mom”?)–women with anxiety find the worry gets in the way of enjoying the pregnancy and other aspects of life. Women with anxiety may also have appetite changes (often difficulty eating), and find that the worry makes it difficult to fall asleep. Some women experience panic episodes during pregnancy. These are times of extreme anxiety where there may be hot or cold feelings, difficulty breathing or a smothering sensation, numbness or tingling in the fingers or around the mouth, a racing heart, and a feeling of loss of control.

There are several types of anxiety disorders that occur in pregnancy and postpartum, including Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Panic Disorder, and PTSD. You can learn more about each type at www.postpartum.net under “Get the Facts.” But generally, symptoms27 of an anxiety disorder include:

  • Excessive, ongoing worry that impacts your day to day activities
  • Thoughts of worry regarding the future, or catastrophic events occurring
  • Insomnia
  • Poor appetite
  • Physical restlessness, inability to sit still
  • Dizziness, hot flashes, nausea
  • Panic attacks

 

Risk Factors
Research shows that there are some risk factors that may predispose some of us to anxiety disorders in pregnancy, and can be discussed with your care provider, partner, family or trained professional. Risk factors28,29 include:

  • Family history of anxiety disorders
  • Personal history of depression or anxiety
  • Thyroid imbalance

 

What do you do if you have symptoms or risk factors for an anxiety disorder in pregnancy?

1. Get help. Talk to a care provider. If you can’t talk yourself, find someone you trust to do so with you. The risks are too great. Pec Indman, EdD, MFT, shares:
If a woman is struggling during pregnancy it is essential to get help. Talk to a trained (many providers have not been trained in this area) and understanding professional. There are lots of kinds of effective treatments including counseling (in particular Cognitive-Behavioral Therapy and Interpersonal Therapy), social support, exercise, Omega-3 fatty acids, acupuncture, and medication.

Regarding women currently on medication, Pec continues:
Women who are on medication for depression, bipolar disorder, or anxiety, should consult with a prenatal (or perinatal) mental health expert before stopping medication. We know that over 50% of women who stop their medication before, or when they are find out they are pregnant, become ill again. Many medications can be taken during pregnancy and will help prevent a relapse.30

2. Ask your care providers (OB/GYN, Midwife, Nurse Practitioner, Family Practitioner) if they are trained in depression and anxiety in pregnancy. One tip I give women is to phrase it this way: “If I develop depression or anxiety during pregnancy or after, how will you be able to help me?” or “How do you help women who develop anxiety or depression in pregnancy?” If it is too difficult to do that, ask a trusted friend, partner, or family member to go with you to your next appointment and help you approach your care provider. Write a list of questions and concerns before you go. Calling ahead to let the front office know you need extra time in your appointment is also a good idea.

What if? If your only option is a care provider who is not trained in this area, go to Postpartum Support International (PSI) for excellent resources to take with you to your appointment, or to find local support systems, or call the warm-line for volunteer support on getting help in your area (1-800-944-4773). If making that call or going online is anxiety producing, ask a trusted friend, partner, or family member to go online for you or with you, to PSI and get the information you need.

3. GET A TRAINED DOULA!!! Birth and postpartum doulas can help you get through birth and postpartum adjustment. I strongly suggest you hire a doula who has training in this area (birth doulas are not required to know this information and postpartum doulas often receive little and/or outdated training on anxiety and depression disorders in pregnancy). Some good questions when interviewing doulas are:

  • What training do you have in anxiety and depression disorders in pregnancy?
  • If I get depressed or anxious, how will you know and how will you help?
  • What local resources do you give to clients?
  • How do you feel about anti-depressant medication during pregnancy and breastfeeding? Any doula who is completely “anti-medication” for any medical illness needs to turn in their birth ball and get with the program (it’s a blog, I can say things like that!). They do not have the skills to help you. Go to PSI and ask therapists in your area for referrals to doulas with experience.

 

Nothing Flat About this World of Anxiety Disorders
Pec Indman notes, “Healthcare professionals used to think pregnant women didn’t experience depression or anxiety. We also used to think the world was flat! Thinking has changed about a lot of things.”

Just as thinking and care regarding birth has changed, health care providers are starting to get it regarding mood and anxiety disorders in pregnancy. But much like our births, women have to raise our voices to raise awareness, and in turn get the care we so desperately deserve and need, for our brains and our reproductive systems.

With my second pregnancy, I knew before I peed on the stick — based on my first pregnancy — I had significant risks for depression and anxiety, that it was a physical illness, and that the risks to me and my baby were real and needed to be avoided. I was extremely fortunate to have the financial access to good, trained providers — they are forever in my heart. And I went through a mine field of providers who didn’t know current research and made me feel like a bad mother until I found the ones who “got it.” I firmly believe that when given the right information regarding our bodies, and particularly our pregnant bodies, we do a damn good job to learn more, discuss with those who could help us with treatment, and make the best informed choices for our lives. Once we remind ourselves and our care providers that our brain and uterus inhabit the same body and need the same kind of care, we will be part of the move to see that the world is not flat.
.

A special thanks to Pec Indman, EdD, MFT for her contribution to this article, humor, and support.

Pec Indman EdD, MFT, is a mom with over 20 years experience as a perinatal mental health psychotherapist and educator. She is the chair of education and training for Postpartum Support International, and co-author of the award-winning book, Beyond the Blues. An updated edition will be available the end of Oct. 2010. Beyond the Blues, Understanding and Treating Prenatal and Postpartum Depression & Anxiety.

 

References

 

  1. Perkin, M.R., Bland J.M. et al. 1993. The effect of anxiety and depression during pregnancy on obstetrical complications. BrJournal of Obstet Gynaecol 100:629-34.
  2. Wadwa, P.D., Sandman, C.A. et al. 1993. The association between prenatal stress and infant birth weight and gestational age at birth: a prospective investigation. Am J Obstet Gynecol 169:858-64.
  3. Orr, S. T., J. P. Reiter, D. G. Blazer, and S. A. James. 2007. Maternal prenatal pregnancy-related anxiety and spontaneous preterm birth in Baltimore, Maryland. Psychosomatic Medicine 69 (6):566-70.
  4. Ibid.
  5. Ibid.
  6. Beck, C. T., 2004a. Birth trauma: In the eye of the beholder. Nursing Research 53, 28-35.
  7. Beck, C. T., 2004b. Post-traumatic stress disorder due to childbirth: The aftermath. Nursing Research 53, 216-224.
  8. Keogh, E., S. Ayers, and H. Francis. 2002. Does anxiety sensitivity predict post-traumatic stress symptoms following childbirth? A preliminary report. Cognitive Behavioral Therapy 31 (4): 145-55.
  9. Kelly, R. H., J. Russo, and W. Katon. 2001. Somatic complaints among pregnant women cared for in obstetrics: Normal pregnancy or depressive and anxiety symptoms amplification revisited? General Hospital Psychiatry 23 (3):107-113.
  10. Lee A.M., Lam S.K. et al. 2007. Prevalence, course and risk factors for antenatal anxiety and depression. Obstet Gynecol 110:1102-1112.
  11. Rambelli, C., Montagnani, M.S. et al. 2010. Panic disorder as a risk factor for post-partum depression: results from the perinatal depression-research and screening unit study. Journal of Affect Disord,122(1-2):139-143.
  12. Coplan, R. J., K. O”Neil, and K. A. Arbeau. 2005. Maternal anxiety during and after pregnancy and infant temperament at three months of age. Journal of Prenatal and Perinatal Psychology and Health 19 (3):199-215.
  13. Tagle, N., Neal, C., Glover, V. 2007. Antenatal maternal stress and long term effects on child neurodevelopment: How and why? Journal of Child Psychology and Psychiatry, 48, 245-261.
  14. Ibid.
  15. Britton, J.R. 2007. Postpartum anxiety and breastfeeding. Journal of Reproductive Medicine, 52:689-695.
  16. Weinberg, M. Tronic, E.Z. 1998. The impact of maternal illness on infant development. J Clinc. Psychiatry 59(suppl 2):53-61
  17. O’Connor, T. G., J. Heron, and V. Glover. 2002. Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. Journal of the American Academy of Child and Adolescent Psychiatry 41 (12): 1470-77.
  18. Ibid.
  19. Onunaku, N. 2005. Improving maternal and infant mental health: Focus on maternal depression. National Center for Infant and Early Childhood Health Policy at UCLA.
  20. Knitzer, J., Theberge, S., Johnson, K. 2008. Reducing maternal depression and its impact on young children: Toward a responsive early childhood policy framework. National Center for Children in Poverty, Project Five Issue Brief 2.
  21. Gaynes B., Gavin, N., Melter-Brody, S., Lhor, K., Swinson, T., Gartlehner, G., et al. 2005. Perinatal depression prevalence, screening accuracy, and screening outcomes: Summary, evidence report and technology assessment, No 119. AHRQ Publication No. 05-E006-1.
  22. Ibid.
  23. Altemus, M. 2001. Obsessive-compulsive disorder during pregnancy and postpartum. In: Yonkers, K., Little., B. (eds) Management of psychiatric disorder in pregnancy. Oxford University Press, NY, pp 149-163.
  24. Stein, D.J., Hollander, E., Simeon, D., et al. 1993. Pregnancy and obsessive-compulsive disorder. Am J Psychiatry 150:1131-1132.
  25. Bartz, J.A., Hollander, E. 2008. Oxytocin and experimental therapeutics in autism spectrum disorders. Progressive Brain Research, 170:451-462.
  26. American Psychiatric Association. 2000. Diagnostic and statistical manual of mental disorders (4th ed, text revision). Author, Washington, DC.
  27. Ibid.
  28. Lee A.M., Lam S.K. et al. 2007. Prevalence, course and risk factors for antenatal anxiety and depression. Obstet Gynecol 110:1102-1112.
  29. Ibid.
  30. Cohen, L.S., Altshuler, L.L. 2006. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA, 295:499-507