Barb's Daily Dose

Omega-3's Reducing Depression

A recent study on a small group of pregnat women found that those who took DHA, Omega-3 supplements during their pregnancy had a decreased risk of postpartum depression.  According to the lead author, Dr. Michelle Price Judge, it's thought that as pregnancy progresses into the 3rd trimester, more of the mother's stores of DHA are transferred to the baby, which causes a depletion in the mother.

Rocket Fuel & Perchlorates: How to Protect Yourself

When you do a Google search for Rocket fuel, you find lots of interesting information and a few unexpected little gems. Apparently there are recipes for Rocket fuel chicken that can be spiced up to be Mexican or Thai.  In case you’re wondering, they don’t add Rocket fuel, that’s just the catchy and fun name for the culinary masterpieces out there.

Some of my friends call Red Bull, Rocket fuel, and one of them is an engineer who works for the Department of Defense on missiles and rockets. No, we’re not talking about Red Bull, but coincidently, we are talking about real rocket fuel.

Perchlorate, aka Rocket Fuel, is a component of fireworks, munitions and yes, rocket fuel.  It can also be found in certain fertilizers from Chile. Back in 2004, and 2005, researchers began to develop more sensitive tests to detect minute amounts of Perchlorate in drinking water and guess what, this stuff is everywhere.  Holy, guacamole!  Read on, because it’s an interesting reminder of how interconnected everything is.

Drinking water, milk and lettuce were tested, as was human breast milk.  What was surprising was that in some cases the levels of Perchlorates in breast milk was 5 times that seen in the milk you could by off the shelf in the dairy section. 

I need a Latte!

Grabbing a coffee while Pregnant?  Is it ok?  Does it harm the baby?

When I work with pregnant moms, they all want to know, and many feel tremendous guilt if they had a diet soda with lunch 1 week ago.  Here's the deal, and it may just surprise you.

If pregnant moms can limit themselves to just 1 each day, then it's considered safe. So move on over to the Guilt Free Zone, and enjoy that cup of coffee, tea, or diet cola. If you can limit it to 3 times/week even better. 

What's too much?

A recent study confirmed that drinking too much coffee while pregnant isn’t a good idea. Drinking more than 3 cups of coffee or tea, or other fully leaded drinks was associated with lower birth weight in babies. Moderation seems to be the key here. What about the latte's?  Unfortunately, each shot of espresso = 3 cups of coffee.

Previous studies from England and the UK showed a slightly higher risk of miscarriage with more than 3 servings of caffeine each day. 

Is de-caffienated ok?

Decaf espresso and coffee still has some caffeine, about 1/3 the normal amount. Likewise De-caf sodas also contain some caffiene, but much less.  

What's a serving?

• One cup of coffee or tea = 1 serving
• 1 shot of espresso = 3 servings
• 2 shots of espresso = 6 servings  
• 1 shot of decaf espresso = 1 serving 

Why? 

It’s not known why this occurs, but researchers think that caffeine constricts blood vessels, which may include the vessels in the placenta, which is the organ that ensures blood flow, nutrients and oxygen flows easily to the umbilical cord and ultimately the baby. Any constriction in those tiny, yet enormously important vessels could decrease the placenta's efficiency and it's ability to provide necessary nutrients to the baby.

What about chocolate in pregnancy?

Chocolate has much less caffeine than coffee and tea, so it’s ok to have chocolate in moderate amounts. A cup of hot chocolate or a bowl of chocolate ice cream is a great way to get more calcium. Try to limit yourself to 1-2 delicious servings of chocolate/day, mostly so you don't gain too much weight.

If you love your coffee, try half caf and half de-caf, or make it a de-caf latte with lots of milk. Milk, helps your baby grow in so many ways and is a terrific source of protein and calcium.

So if you have a cup now and then, it's probably ok for the baby. If you've got to have your leaded espressos and sodas, now's a good time to try to cut back and switch to decaf.

Stopping all caffeine

If you need to go cold turkey on caffeine, be prepared for a headache for about 3 days.  In pregnancy, tylenol is considered safe, and as always if you have questions, check with your health care provider.  

Cheers.   

Pregnancy Brain

I was just asked why this happens.

The pregnancy fog.....ah I knew it well myself and see it in patients. When patients are forgetful, we say, "It's ok, you have pregnancy brain" or "You're in the pregnancy fog." 

Tunnel Vision

Also, in terms of psychological effects, most women are completely absorbed with their pregnancy and have little space left in their brains for other details. I see this mostly with new moms. They have a laser like focus on their tummies, their baby, how their lives will change and what the future will be like. At times, they may not be interested in conversations around them, and have difficulty dividing their attention.

Sleeping on your left side?

Many women ask me if it's true that they are supposed to sleep on their left side during pregnancy? 

I love this question because when moms ask, it means that they are doing absolutely everything they can to have the healthiest baby possible. Here’s a secret, it’s OK to sleep on your right or your left side. 

It really doesn’t matter which side you choose, as long as you don’t spend too much time on your back toward the 2nd half of pregnancy. Here’s why we recommend that you sleep on your side. When pregnant moms lie down on their backs, the weight of their tummy and their baby can compress the large blood vessels along her spinal cord. This can result in less blood flow to both mom and baby. Many moms feel lightheaded when they’re on their back, a sure sign that it’s time to roll over. 

If you do find that you’re waking up on your back, please don’t lose any sleep over this and don’t worry. If blood flow is decreased, the body will send signals to the brain that it’s time to wake up and roll over.

Heartburn in Pregnancy

Yikes, I hate heartburn! My Italian grandmother and all the Sopranos calls this “Agita”, or indigestion. As in, “You’re driving me crazy, stop giving Agita.” No matter what you call it, it makes life very unpleasant.

As people get older, the sphincter that separates the stomach from the esophagus relaxes a bit, leading to more GERD, Gastro Esophageal Reflux Disease. This also occurs as we gain wait and the stomach gets pushed up toward the lung cavity.  Heartburn can also occur in pregnancy.

In pregnancy, most women experience a surge in their progesterone levels. This hormone helps the pregnancy stay healthy, but has other less welcome side effects. Progesterone relaxes the sphincter , causing stomach acid to migrate upwards toward the throat. Combine this with a bigger tummy that pushes the stomach up closer to the lungs, and you get terrible heartburn. 

Some women experience heartburn in the first trimester and others have to deal with this throughout their pregnancy. This is just one of the many experiences that no one talks about, but we moms endure. Hang in there. The good news, is that heartburn disappears when you deliver. 

Here are some quick tips to help: 

Try sipping drinkable yogurt or milk. This coats the throat and esophagus and provides a little barrier to the acid. 

Eat smaller meals more frequently. 

Avoid carbonated drinks, the bubbles make the heartburn much worse.

Try chewing some Tums. You and the baby can always use more calcium.

Ask your provider about over the counter remedies.

When you sleep, lie on your right side. Your stomach empties on the right side, so less acid will be around to irritate you.

Good luck

Gestational Diabetes Part 2

3 hour Glucose Tolerance Test (3 hr GTT) 

When a pregnant woman's 1 hour glucose test result is greater than 140, it means that she needs further testing.  It does NOT mean that she definitely has gestational diabetes, it just means that she may be at increased risk and further testing is necessary. So try not to panic yet. 

The next test that should be done, to be safe is known as a 3hr Glucose Tolerance Test. 

• First, she'll be asked not to eat or drink anything for 8 hours before the test.
• Next she'll have a fasting blood sugar test. 
• Then she’ll be given a bottle of sweet liquid to drink, with 100 grams of glucose in it. 
• Then her blood will be tested every hour for the next 3 hours. 

Tips

Many women schedule this test for the morning, because it’s easier to fast overnight. 

Gestational Diabetes

Many women ask me what is Gestational Diabetes? 

Briefly, when diabetes occurs during a woman’s pregnancy, it’s known as Gestational Diabetes. 

We think that it caused by the change in hormone levels, but also by the additional weight gain that occurs. This combination of factors affects the woman's blood sugar and her body's ability to use insulin. The blood glucose levels increase and the amount of insulin available is not sufficient.

Insulin Resistance

We think that for some pregnant women, insulin resistance occurs also plays a role. In that scenario, the food that a woman eats is metabolized into blood sugar. Insulin's job is to help transport blood sugar from the circulation into the cells. When there is an insulin resistance, it's much harder for the insulin to move the glucose into the cells. 

Higher levels of blood sugar, also known as blood glucose, can have harmful effects on both mom and baby. 

Codeine After Birth

Careful with Pain Relief

Recently, there have been disturbing reports of new moms who were prescribed codeine to help reduce their pain after giving birth. Sadly, some moms have a genetic variance that causes them to be rapid metabolizers of codeine. When codeine is rapidly metabolized it produces high levels of morphine in the blood and breastmilk which can leave babies very drowsy and difficult to wake. In 2007, in Toronto, one baby whose mom had taken her prescribed codeine for pain relief died after breastfeeding.

Rare

Thankfully the genetic variance that causes rapid codeine metabolism is rare. So taking codeine is not risky for most women and is worrisome for a few.

• The US FDA found that 1% to 10% of Caucasians and about 3% of Asian and African Americans are rapid metabolizers.

• Women from North Africa, the Middle East and Africa have much higher rates of this genetic variance, and it’s estimated as high as 28%.

Don’t stop Breastfeeding

The most important thing that we all have learned from this terrible tragedy is to ask women if they’ve ever used these medications in the past and whether they felt drowsy of more of the effects than expected. These moms should try non-narcotic pain relief first.

SIDS, Back to Sleep & Tummy Time

In 1992, the Back to Sleep campaign was started to educate parents about the importance of placing babies on their backs to sleep. It was long suspected that babies who slept on their tummies had a higher incidence of SIDS, or Sudden Infant Death Syndrome.

The Back To Sleep campaign significantly reduced the numbers of babies who died of SIDS. It's a medical breakthrough that has prevented countless families from facing the tragedy of SIDS.

Tummy Time

When babies are placed on their backs to sleep and don't have an opportunity to be on their tummies, some will have misshaped heads and poorly developed neck muscles. So when your baby is awake and happy, roll them over for some Tummy Time.

What to do
• During a diaper change, place your baby on their tummy on a waterproof pad. This also gives their bottoms some air time, which helps prevent diaper rash.
• Be sure to make lots of eye contact, talk and play with your baby.
• Encourage them to look up and use those neck muscles to look around.
• This also helps them figure out how to get their elbows underneath them to push up.
• Be sure to stay with your baby and don't let them fall asleep on their tummies.
• 10-30 minutes is a good goal for each day.
• Change positions if they're not having fun or become cranky
• When you sit on a chair, you can also try placing your baby on their tummy across your legs above your knee and gently pat their backs.

Have fun and let me know what works for you.