New Research Study Goes Against Popular Belief On “39-week” Pregnancy Rule

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pregnantThis article is courtesy of the Baylor College of Medicine, please share your comments below. Questions or concerns about the article should be addressed directly to the Baylor College of Medicine.

Women who are managing low-risk pregnancies are advised to follow the “39-week rule” – waiting until they are 39 weeks to deliver. This rule is intended to eliminate elective inductions and cesarean deliveries at 37 and 38 weeks, when outcomes for the newborns are believed to be worse than those born at full term.

But new research by a Baylor College of Medicine epidemiologist suggests that babies delivered after elective induction at 37 to 38 weeks may not have an increased risk of adverse neonatal outcomes, compared to those infants who are expectantly managed (i.e., medical observation or “watchful waiting”) and delivered at 39 to 40 weeks. The findings appear in the current issue of Obstetrics and Gynecology.

“Our findings caution against a general avoidance of all elective early-term inductions and call for continued research, based on better data, in what is still a relatively new arena,” said Dr. Jason Salemi, assistant professor of family and community medicine at Baylor and lead author of the study.

The national initiative to eliminate all elective deliveries before 39 weeks began to gain momentum around 2008, Salemi said, and was supported by professional organizations and adopted by healthcare institutions.

“Until then, I had never observed a campaign so enthusiastically embraced and that resulted in such widespread implementation of practice improvement efforts,” Salemi said.

But he saw limitations in many studies used to justify the 39-week rule. Most notably, he recognized what he believed to be an inappropriate choice of comparison group for elective early-term deliveries.

“A number of studies reporting worse outcomes for elective early-term deliveries compared them with later term spontaneous deliveries, a low-risk group. However, the clinical decision that must be made is not between elective early-term delivery and later spontaneous delivery, but between elective early-term delivery and expectant management, in which the outcome remains unknown,” Salemi said.

Salemi and his colleagues conducted a retrospective cohort study that used data on more than 675,000 infants from a statewide database. All live births were classified on the basis of the timing and reason for delivery. The research study compared elective inductions and cesarean deliveries at 37 to 38 weeks to expectantly managed pregnancies delivered at 39 to 40 weeks.

“We focused on serious conditions in early life. Our outcomes included neonatal respiratory morbidity, sepsis, feeding difficulties, admission to the neonatal intensive care unit and infant mortality,” Salemi said.

Salemi cautions that the research findings do not lend support for elective deliveries before 39 weeks and, in fact, provide evidence that supports the avoidance of elective early-term cesarean deliveries. The study found that infants delivered after cesarean delivery at 37 to 38 weeks had a 13 to 66 percent increase in the odds of damaging outcomes.

However, infants delivered after elective early-term induction experienced odds of adverse neonatal outcomes that were largely the same as infants who were expectantly managed and delivered at 39 to 40 weeks. Through the research findings, Salemi hopes to increase awareness on the many issues that surround the timing and reasons for delivery.

“Each pregnancy is unique,” He said. “I cannot overstate the importance of open and ongoing communication between pregnant women and their healthcare providers so that the potential risks and benefits of any pregnancy-related decision are understood fully.”

Other authors that contributed to this research study and article are Dr. Elizabeth Pathak, during her time as an associate professor of epidemiology at the University of South Florida Morsani College of Medicine, and Dr. Hamisu Salihu, professor and vice chair for research in family and community medicine at Baylor.

This research was funded by the Agency for Healthcare Research and Quality (grant number R01HS019997).

Understanding Nutrition During Pregnancy

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This article was submitted by the Baylor College of Medicine, please share your comments below…..

PregnantFor everyone, a nutritious and well-balanced diet is essential to maintaining a healthy lifestyle. But for pregnant women, nutrition is doubly important – it’s a key factor for their own health and that of their baby.

“Pregnant women should eat three meals a day and between-meal snacks,” said Dr. Nina Ali, assistant professor of obstetrics and gynecology at Baylor College of Medicine. “Meals should include foods from all five food groups: grains, fruits, vegetables, proteins and dairy.”

Ali advises women to be mindful of their diet choices and to drink plenty of water to help curb the out-of-control cravings.

“Try to choose food with nutritional value and allow yourself to indulge in small quantities,” said Ali.

Cravings are hard to avoid while pregnant. However, Ali recommends that pregnant woman avoid specific foods altogether.

Women should not consume unpasteurized milk, hot dogs, lunch meats and cold cuts (unless they are heated to steaming hot), raw or undercooked seafood, eggs and meat, fish with high mercury content such as swordfish, king mackerel or tilefish, said Ali.

Nutrition choices also can play a role in minimizing morning sickness that many women experience during pregnancy, she said.

“Ginger candy and ginger tea can be soothing for nausea,” Ali said. “Eat small snacks throughout the day rather than large meals, and avoid heavy or spicy foods. When these measures do not help, talk to your ob-gyn doctor about nausea medications.”

In addition to maintaining a healthy diet while pregnant, Ali recommends women continue to manage a balanced diet after giving birth.

“A healthy, well-balanced diet is an essential part of the mother’s recovery after giving birth,” said Ali. “Also for moms who are breast-feeding, caloric demands and nutrition needs are even higher than while pregnant. I recommend moms continue prenatal vitamins for 6 weeks or as long as they continue breastfeeding.”

During and after pregnancy it is essential to eat nutritious meals and be mindful of good dietary choices.

“A well balanced diet will give your body the building blocks it needs to maintain good health for you and for your baby,” said Ali.

Pregnancy Safety While Traveling

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Submitted by the Baylor College of Medicine

pregnantIf a woman is experiencing an uncomplicated pregnancy it is safe for her to travel over the holidays, but there are some best practices patients should abide by, said a Baylor College of Medicine obstetrician and gynecologist expert.

“The best time for pregnant patients to travel is between 14 and 30 weeks because that is when complications are less likely to occur. After 30 weeks, comfort and the ability to sit for long periods of time may become difficult,” said Dr. Kelly Hodges, assistant professor of obstetrics and gynecology at Baylor,

Bringing snacks and drinks on a trip are always a good idea, but there are more specific traveling guidelines depending on the mode of transportation.

Airplane

Airplane travel, both domestic and international, is safe during pregnancy. Most domestic airlines restrict travel after 36 weeks and international travel can be even earlier.

Hodges recommended that pregnant women stretch and do the leg and ankle exercises recommended by the airline (instructions are usually found in the seat pocket) while flying because, although rare, pregnancy increases the chance of developing blood clots. Support hose can help minimize the risk as well.

In addition, pregnant women should take more care while moving around the cabin because balance can be off while mid-flight.

It also is important to stay hydrated, but Hodges said soft drinks can cause problems.

“I recommend my patients avoid carbonated beverages while flying because the carbonation can expand in the intestines and feel uncomfortable,” she said.

Boat

Same as with air travel, walking while on a boat can be difficult, and Hodges urges patients to take extra care as to not fall or bump their belly.

If women are worried about experiencing sea sickness they should contact their doctor about acceptable medication.

Car

Traveling by car also is doable while pregnant. It is best to keep a day’s travel between five and six hours, taking bathroom and exercise breaks along the way.

Hodges said all travelers should adhere to industry safety guidelines, including wearing seatbelts and, if applicable, life vests, while traveling.

In addition, it is best to find a reputable hospital at your vacation destination in the event that an emergency were to arise.

While it is safe to travel during an uncomplicated pregnancy, Hodges said she always tells her patients to use their best judgment.

“If you’re not feeling well or having contractions, assess the situation and consider not going because your health is most important,” she explained.

Pregnancy & Nutrition: What To Do

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By Dr. Michael Wald

pregnantThe amount of each nutrient should be based on a thorough food log of no less than 5 days long that records the time of consumption of foods and fluids, approximate amounts in ounces and time of day of consumption. The amount of proteins, carbohydrates and fats should always be based on the woman’s body weight in kilograms, related to her total caloric needs (medical charts exist that estimate the total caloric requirements of a pregnant woman). Other health issues might change the food recommendations for proteins, carbohydrates and fats. Foods should be emphasized and nutritional supplements given only if needed. However, a prenatal is a basic and is always recommended. The amount of folic acid, an important B-vitamin, helps to prevent birth defects (80% of BD are from deficiency of folic acid), but this vitamin must be supplement before pregnancy occurs to have this preventative effect.

We measure folic acid levels by using a test that tells us if a woman has a genetic problem with folic acid called homocysteine. We then supplement exactly what a woman needs to normalize testing. Iron is given in the miligram dose range unless anemia exists, at which point the dosage is increased based on the woman’s hemoglobin, hematocrit and red blood cell count. Dietary intake does not guarantee that nutritional needs will be met. Calcium is given usually at around the 1000-1500 mg range daily, but needs to increase during lactation. Vitamin D is only given if found deficient; as important as it is, too much (relative to the woman’s needs) can be teratogrnic (can cause birth defects just like too much vitamin A). Zinc is only given if blood levels are low or if the woman displays signs of deficiency such as dry skin, hair loss, splitting nails, chronic infections, etc – but other issues can cause these symptoms as well. Overall, additional zinc is not recommended unless absolutely needed; the red blood cell zinc test is the best test, not the serum zinc. Vitamin E is not given as it can cause issues such as increased bleeding time; if the woman has a deficiency it is supplemented at a minimum dose of 400 IUs per day. A B-complex is always given as the prenatal, but the levels of B-vitamins in prenatal are too low to be optimally useful and I like to give a better multivitamin that also has reasonable, and not too high (often true of prenatal vitamin).

The overall diet for a pregnant woman should be continuously monitored for issues such as constipation, heart burn (reflux) diarrhea, back pain, fatigue, nausea, depression, headache and other issues common to pregnancy.

– Dr. Michael Wald, aka The Blood Detective, is the director of nutritional services at Integrated Medicine of Mount Kisco, located in Westchester New York. He has appeared on ABC World News Tonight with Diane Sawyer, Channel 11 PIX, Channel 12 News, CNN, The Food Network and other media outlets. Dr. Wald earned the name Blood Detective for his reputation to find problems that are often missed by other doctors. He earned an MD degree, is a doctor of chiropractic and a certified dietician-nutritionist. He is also double-board certified in nutrition. He has published over a dozen books with three additional titles due for release late 2013 including: Frankenfoods – Genetically Modified Foods: Controversies, Lies & Your Health and Gluten-A-Holic: How to Live Gluten Free and the Blood Detective’s Longevity Secrets. Dr. Wald can be reached at: www.intmedny.com or www.blooddetective.com or by calling: 914-242-8844.

Pregnancy, What All Women Should Know

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qaQ & A With Dr. Michael Wald and Dr. Nilay Shah

1. Headaches during pregnancy can be induced from:

A. Hypertension (high blood pressure)
B. Upper cervical (neck) dysfunction
C. Folic acid deficiency
D. Magnesium deficiency
E. All of the above

ANSWER: E — All of the above – All of these can induce mild to sever migraines in women during pregnancy. To possibly prevent this occurrence, women should periodically check their blood pressure, lab work, posture, etc. and correct with the proper guidance. Blood sugar, dehydration, electrolyte imbalances and other nutritional deficiencies and hormonal issues and inadequate calories can also cause headaches.

2. True or False: Lower back pain or hip pains during pregnancy may be an indicator of osteoporosis of pregnancy.

ANSWER: True – Osteoporosis (disease of the bones) during pregnancy can lead to increase lower back and hip pains. Women at risk for osteoporosis, if applicable should undergo preventative measures that include: adequate calcium intake, active vitamin D intake and performing the proper weight bearing exercises. We use sonogram bone testing that does not involve radiation as the DEXA Scan does.

3. Urinary incontinence (the loss of bladder control) can be caused by:

A. Urinary tract infection
B. Pelvic floor muscle dysfunction
C. Vitamin D deficiency
D. All of the above

ANSWER: D — All of the above – Urinary incontinence may be an early sign of a urinary tract infection. Pelvic floor exercises are an effective way to strengthen the muscles and possibly minimize urinary incontinence. Vitamin D intake may prevent the risk of urinary incontinence in women through its relation in supporting the integrity of the pelvic floor muscles. In addition, low vitamin D is associated with increase bacterial infections in women during pregnancy. Blood testing is necessary, along with other synergistic nutrients, for best assessment of optimal dose and absorption.

4. True or False: The intake of high dose folic acid is the only way to prevent neural-tube birth defects in newborns.

Answer: False – Folic acid is helpful in the prevention of neural-tube defects in newborns; however it appears that a multivitamin containing the appropriate doses of vitamins and minerals, including folic acid is more effective at preventing neural tube defects than folic acid alone. There are lab tests that can tell us if an individual is using the folic acid normally as well as other synergists of folic acid including B12 and B6.

5. Nutritional deficiencies in pregnant women can exhibit which of the following signs and symptoms:

A. Food cravings
B. Alzheimer’s disease like symptoms
C. Pale skin
D. Fatigue, shortness of breath
E. All of the above

ANSWER: All of the above – Nutritional deficiency is pregnant women can be early signs of anemia (the decrease in red blood cells). Low iron, B12, B6, folic acid and/or other nutrients are necessary for the production of adequate red blood cells within the body. Women who are deficient in such nutrients may exhibit physical signs and symptoms of light headiness, dizziness, heart palpitations, food cravings and the inability to focus and concentrate. Pregnant women are at an increase risk of nutritional deficiency, paying close attention to early signs and symptoms are essential. We are experienced working with pre-pregnancy and pregnancy safely and effectively.

– Dr. Michael Wald, Brain-Energy Blast

For more information about this or other topics please go to: www.intmedny.com

Healthy Pregnancy Diet That Should Be Maintained During Pregnancy

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By Tina Antony

pregbellyDuring pregnancy every action of the would-be mother directly or indirectly adds to you and your infant’s health. A pregnancy diet should comprise of all the important food and nutrition to be in taken during pregnancy period which would beneficial for the health of both mother and child. The healthy diet that is advisable is crucial for the growth of the fetal in an appropriate way. A balanced diet should necessarily be taken with the beneficial nutrition constituents and quantity of meals should be reduced at the same time the number of meals should be increased. If you choose the proper food with correct nutrient you may have a healthy pregnancy period with minimal level of complexity.

Importance of protein at pregnancy period

Protein is a requisite that should be included as a healthy pregnancy diet. Protein comprises of chicken, lamb, beef and pork. Awareness should be there while having seafood chiefly the fish containing mercury may be harmful during pregnancy. Fish such as swordfish, Kingfish and shark have the highest mercury content. For a vegetarian healthy pregnancy diet beans and cheese are considered to be a chief source of protein. Other high protein content may be in taken in the form of almonds or peanut butter. Ample amount of fresh and pure water and healthy fruit juices is recommended by experts. Conceiving women should surely carry with her a bottle of fresh and filtered water when moving out from home.

Take plenty of fruits

strawberriesFruit intake is very essential to be included in the healthy pregnancy diet as it contains vitamin C which is highly advisable for the conceiving women. Fruit items such as orange, grapes or tomato should be served to the pregnant women. Fruits contain fiber and nutrients which actually serve the beneficial aspect for the pregnant women. Almost on a regular basis you should take yellow or orange colored fruits or vegetable to your pregnancy diet. Eggs are brilliant sources enriched with protein, vitamins and minerals advantageous during pregnancy containing cholesterol which would aid your infant’s brain to develop. Green leaf salad enriched with fruits can be taken several times a day. Banana contains high fiber and iron which would assist in keeping the blood pressure of the would-be mother stable.

Be conscious to avoid unhealthy foods

Healthy fat content is considered as an indispensable diet during pregnancy which may include nut oils or olive oils. Trans-fats should be avoided to a great degree. Caffeine is considered to be safe when consumed in minimal quantity. The consumption of soda, tea or coffee per day should be switched to a cookiedecaffeinated drink such as green tea. Folic acid, iron tablets should be recommended as per doctor’s vigilance. Fasting should be entirely eliminated as it would be harmful for the mother and child. A very high fat saturated product should be totally eliminated from your pregnancy diet. Junk food may also be prevented and in spite of its healthy nutrition based food should be in taken. Poor habits such as smoking and consuming alcohol or drugs should be strictly prohibited as it would directly hamper your baby. By following the healthy pregnancy diet you would be able to deliver a fit and healthy baby which may provide you an immense feeling of fulfillment.

Tina Antony is a freelance writer who writes on different topics such as traveling, beaches and social media. Her famous articles includes article on During pregnancy. She loves to travel and make new friends.

Guest Post – Dr. Jeremy Korman, Pregnancy After Weight Loss Surgery

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PregnantKeeping Fit While Pregnant[/caption]As unfortunately obesity is not uncommon among U.S. citizens, weight loss surgeries are becoming a more attractive option, even among young women who are planning on becoming pregnant at a later date. There are two basic types of weight loss surgery, but in order to be eligible for such a procedure patients have to fulfill several criteria, basically because the procedure can have long term consequences, like for example affecting a future pregnancy.

What can I expect?

First of all patients need to understand that after gastric bypass surgery their body will suffer major changes, including rapid weight loss and nutritional instability. Getting pregnant in such a period can cause several complications. For instance if the mother is unable to absorb enough calories from food, the baby is likely to suffer from malnutrition. Things will become even worse if the woman is suffering from post-surgery nausea or severe morning sickness.

On the other hand getting pregnant soon after weight loss surgery is more likely especially if the woman has been suffering from obesity related fertility problems.

On the other hand getting pregnant soon after weight loss surgery is more likely especially if the woman has been suffering from obesity related fertility problems. Once with the weight loss, her fertility will increase and pregnancy is likely to occur, considering she hasn’t been using any birth control methods. The situation is quite frequent as many surgeons advice their patients to discontinue oral contraception before the surgery.

During the pregnancy there are also different issues to consider. For example many of these women are still at risk of developing hypertension of gestational diabetes even if they lost considerable weight. Other more serious complications can also occur affecting the mother’s health such as internal hernias or small bowel obstruction. Besides that pregnancy involves gaining weight soon after a stressful surgery and recovery period. In many cases the situation can cause emotional distress which is under no circumstances benefic for the baby.

Once the gestational period completed, future moms might face another difficulty. According to a study published in 2004 in the American Journal of Obstetrics and Gynecology, women who underwent weight loss surgery are more likely to have a c-section delivery.

What should I do?

In order to avoid any potential complications in pregnancies following weight loss surgery here is some useful advice any woman can follow:

• Do not perform weight loss surgery unless it is absolutely necessary, if you suffer from clinical obesity and no other methods are efficient

• Avoid getting pregnant in the first 18 months after surgery until your weight is stabilized and you resolved nutrient deficiencies

• If you do get pregnant make sure to tell your obstetrician about the surgery

• During pregnancy make sure to take enough vitamins and minerals especially iron, vitamin B12, calcium and vitamin D

• Perform light physical exercises like swimming and walking during pregnancy to prevent gaining excessive weight

• Make sure to gain enough weight for normal fetal development

As shown above weight loss surgery can be benefic for pregnancy but it also involves several issues. Therefore all women who underwent the surgery and are or intend to become pregnant are advised to openly discuss with their surgeon, health care provider and gynecologist about all their concerns and to closely follow their instructions.

drkorman– Dr. Jeremy Korman, is a board certified bariatric surgeon and the medical director of L.A. Bariatrics, a surgical weight loss clinic offering bariatric solutions for people struggling with extreme cases of obesity and associated health conditions. Located at Marina Del Rey Hospital in California L.A. Bariatrics serves multiple location across greater Los Angeles.