With the recent emphasis on the importance of movement in the fight against childhood obesity, there is recognition that beneficial fetal programming through maternal exercise can make a big contribution to this effort. A combination of proper maternal nutrition and maternal fitness may well prove to be most efficient and potentially effective way to help children develop an appetite for motion!

One factor in this is the finding that regular, moderate-intensity exercise helps prevent obesity in the newborn: http://www.nlm.nih.gov/medlineplus/news/fullstory_97212.htmlt. This, may in turn, help prevent childhood obesity.

Recess for everyone!!!

If one is a girl and one is a boy, they’re fraternal!

Nutrition for Multiples:

The primary thing we tell people with twins or more is that the protein needs rise about 30 grams/baby/day above the 70 — 90 grams/day needed for a singleton. Water intake also needs to rise. Avoid thirst and as much as possible, drink until urine runs clear rather than yellow (as best as you can).

Multiples is considered a risk factor, and for each risk factor (multiples, underweight, teenage mom, inter-pregnancy period less than a year) an additional 200 calories is often recommended, with 400 extra calories the upper limit.

Exercise with Multiples:

A critical factor in successful implantation and growth of the placenta appears to be aerobic fitness in the six months prior to and the first half of pregnancy. Once biomechanics become difficult in mid-pregnancy, women with multiples can continue activity safely as long as monitoring show the babies are growing appropriately. A belly support can be extremely helpful when exercising.

Contraindications for exercise include the discovery that one fetus is growing at a significantly slower rate than the other(s), that both/all are too small, that the placenta(s) is/are malfunctioning, or some other condition occurs, such as an incompetent cervix or placenta previa, that would be a factor in any case.

Absolute size difference does not necessarily mean that one baby is growing more slowly, as some fetuses may be a couple weeks younger than their uterus-mate(s) if the mother ovulated twice in the fertility cycle. Or, s/he might be smaller if genetically destined to be a smaller infant at birth. Thus, growth rate is the measurable factor that helps determine if a fetus is at risk of not receiving adequate energy. This can happen when there are two placentas and one placenta is working more poorly than the other, or for some reason there is a flaw in the umbilical cord of an identical. The competition for energy places a slower growing baby at risk.

Protecting Mom and Baby:

The placenta is designed to nourish the baby and will do so at a cost to the mother first if there is inadequate nutrition. Thus, activity to the level the mother can tolerate and following nutritional guidelines above — in the absence of medical complications — produces healthy offspring. Multiples will garner all the same benefits a singleton does.

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

Risk Factor #1:

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

Exercise! Avoiding it is a risk factor for diabetes and preeclampsia.

Risk Factor #2:

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

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

Risk Factor #3:

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

Smog can endanger your fetus!

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

Risk Factor #4:

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

Read labels!

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

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

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

Risk Factor #5:

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

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

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

Caffeine? Only one cup & only if you must.

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

Risk Factor #6:

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

Risk Factor #7:

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

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

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

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

What’s next?  BIRTH!!

Behavior Affects Pregnancy Outcome

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

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

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

Burning Calories in Pregnancy Improves Outcomes!

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

Here are some of the major findings:

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

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

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

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

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

Pregnancy Exposure to Toxins and Infections

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

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

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

NIH illustration of reading food label

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

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

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

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

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

Maternal Immune Response During Pregnancy

Back to work! Thank you for your forebearance while we wrote a chapter for a nursing textbook!

During the course of pregnancy, the mother/fetus dance is ongoing. The maternal immune system and the trophoblast cells continue to influence each other even beyond the implantation.

Because the mother’s immune response modulates near the start of each trimester, the fetus is affected to some degree and mounts a response, as well. For a long time it was thought that maternal and fetal DNA material was not exchanged across the placental membrane, however recent findings indicate that there is some exchange of material. Thus, we all carry some portion of our mother’s DNA and our mother carries some of ours.

What is the impact of this chimeric effect? It depends on how well our DNA gets along!

How does this affect the fetus in utero? The fetus may be affected by clotting issues. Depending on maternal health status s/he may be subject to a stronger or weaker immune system.

How does this affect the mother? Women are more likely than men to develop autoimmune disorders (pregnancy playing a role here), and those who bear male offspring are more likely than those who only have girls to have these disorders.

The maternal/fetal dance goes on.…

Be Prepared for Birth!

Up for discussion…

Health Influences in Pregnancy

Let’s start at the beginning…in the first trimester you feel sick and tired, right? Three things:

1) your immune system is pro-inflammatory (causing nausea and fatigue), 2) your body is protecting your fetus from some toxins (if you eat something not so great for the fetus, you throw up), and 3) you have extreme swings in blood sugar levels so that after you eat, the level soars and you feel sick.

Number 3 can be fixed with behavior, but you may have to wait out 1 & 2. To fix number 3 eat very small meals frequently (6 or 8 times a day) and be sure to eat protein, that is, eggs, meat, fish, fowl, cheese, nuts, rice & beans, soy, etc. with each small meal. This stabilizes blood sugar and prevents dramatic elevations that can cause nausea.

In most healthy pregnancies, the immune system will rebound in the second trimester so that you feel good; it is protecting you again!  But, those wicked toxins and infections are still out there in the environment, so the message is beware bad air (smog, smoking, industrial air pollution), highly processed foods (lunchmeats, things with names you can’t pronounce), any drugs or meds not prescribed or okayed by your ob or midwife, alcohol, and dangerous bacteria, viruses and other microbes!

Exercise wisely…no sky-diving or scuba diving! Eat healthy food and get enough sleep. De-stress through relaxation and meditative techniques. Don’t take risks with your health, but do stay active and start to prepare for birth and bringing home a baby (or two?).

Third trimester & the immune system goes on the fritz again — can’t keep this baby in here forever; must expel! You may feel sick and tired again. BUT, keep your prenatal care appointments, keep moving, get good nutrition, rest and stay focused. Before you know it the real work begins, not to mention the 18 years of sleep deprivation.

Getting from here…

Being Fully Present in Your Pregnancy…

…to here..

Being Fully Present as Mom.

…is a journey like no other. The adaptations of your body to the demands of pregnancy are amazing. If you pay attention, you will learn more about the meaning of existence from this than from anything else.

BE HERE NOW!!

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Why do you suppose the American College of Nurse Midwives and the American College of Obstetricians and Gynecologists recommend the minimum time between pregnancies to be two years? Why is it critical to eat foods high in B vitamins (including folic acid) and calcium during the childbearing years? How does your exercise regimen in the six months prior to conception affect your risk for some disorders of pregnancy, such as preeclampsia?

Answer:  Your preconception or interconception behavior affects the course and outcome of your pregnancy. As it turns out, it takes about two years for a mother’s body to replenish her stores between pregnancies. Prior to a first pregnancy, behavior in the six months leading up to conception has been shown to affect outcome.

During pregnancy, nutritional and functional resources must support two beings in one body, one of whom is growing at a very fast speed by biological standards (think cell time NOT computer time). Essential vitamins and minerals (such as B vitamins and calcium) are taken from the mother’s body — already in metabolic stress due to demands on the kidneys and liver to clear toxins and filter metabolic waste from the fetus as well as the mother.

Insuring that maternal stores of valuable nutrients are adequate to provide for both fetus and mother is a job that only the potential mother can do. By eating a balanced and colorful diet of proteins, fruits and vegetables, whole grains and essential fatty acids (omega 3’s and 6’s — fish, walnuts, olive oil, avacado, eggs), as well as adequate aerobic exercise leading up to and during pregnancy, a woman improves her odds for a healthy infant. Smart behavior reduces her risk for conditions that cause immune system and cardiovascular disorders that disturb implantation, blood pressure and blood flow to essential organs.

Further, avoiding risky behaviors that may lead to systemic infections, metabolic syndromes or malnutrition leading up to conception is an aspect of behavior known as “risk-aversion” -  the ability to avoid behaviors that have negative consequences. Infection at the time of conception (to be discussed in a future post), an extreme lifestyle (either sedentary or anorexic), toxic food choices, drugs, tobacco and alcohol are all behaviors that incur risk for poor pregnancy outcomes, including prematurity and low birth weight — outcomes  on the rise in the U.S.

As discussed in the previous two posts, behavior is intertwined with genetics and environmental influences. Having a certain gene mutation or an environmental risk may predispose a woman to possible problems in pregnancy or the development of certain cancers, but some behaviors — especially exercise — may mitigate this potential or reduce the severity or course of disease. Behavior is the area in which we have the greatest control. Exercise, healthy nutrition and risk aversion are the three areas in which women can exert control over their destiny as moms-to-be. It’s a difficult set-up. We live in a time of instant gratification of personal acts. But, motherhood is a long-term commitment to the biological and psychic wellbeing of a new human who is — and is not — us.

Are you prepared to become a parent? One way to tell is to look at your environment…is it healthy? Are you living in a situation that you can count on? What about clean air, safe paint or safe food? What about water? What about people around you? Are they supportive? Does your environment help you stay healthy?

What about your body? Factors in the environment that affect fertility (or lack of it) may determine if  you can even become pregnant, or when you can become pregnant. Think about this:  Women who work together often cycle together. What if you work alone, say at home…does this affect your ovulation? One factor identified in the lowering age of menstruation in girls is the increasing number of hormones in various meats. Another factor is the presence of non-biologically related older males in the household. If these things are known, imagine what is not known about situations, chemicals or people in our environment that affect our reproduction!

There is not an absolute separation of genetics, environment and behavior. If we are genetically predisposed to certain disorders, for example, we may or may not develop them, depending on environment. Some persons are inclined toward autoimmune disorders, but they may do well or poorly depending on the air pollution where they live. Some individuals may develop immune disorders. And, this situation may adversely impact inflammatory responses during implantation.

People who strive to take care of themselves even if they live in horrible conditions can use their behavior to improve their chances for success in everything from a healthy pregnancy to a meaningful existence. Even if genetics and the environment are against the process, behavior can sometimes overcome the odds. Granted, it’s not likely you can produce 6’5″ offspring (see last post on genetics!) if the egg person is 5’2″ and the sperm person is 5’7″, but much is possible beyond that.

So, what do you do about your environment if you are thinking about becoming pregnant? Take stock. Ask yourself what, if anything, might have to change. Ask what you can or can’t accept for your offspring, if you know there are environmental factors that aren’t perfect. Fetuses are amazing creatures; the placentas that supply and defend them are ruthless and will protect a fetus at all costs. But, you can give your body and potential baby a good chance to do well by providing a six month span of a healthy environment leading up to conception. And, healthy for mind as well as body.

When your baby comes into the world, a door opens in your heart to a room you didn’t even know was there. In that room is a certain kind of love and caring that cannot be described. It is love for this being who is and isn’t you. As a mother, you have been her/his environment for nine months or however long you have shared. The womb is a small, protected, organized environment, one that reflects your larger environment. So, take stock now, ahead of time.