Don't Put That in Your Mouth!

A new study was released earlier this month addressing too much weight gain during pregnancy. The study, done in Britain, addresses women who gain too much in the first trimester, and/or throughout the remainder of the pregnancy. I sometimes am asked why weight is so important during pregnancy, or a mom makes a flippant remark about losing it all with breastfeeding. There can be ramifications to inadequate weight gain as well as gaining too much.



It seems there are some links between risk factors in the offspring when momma gains too much weight. Having been there and done that x3, I certainly was guilty of gaining too much (40, 30, 25 pounds). I wish someone had told me why less weight gain was important. I wonder if providers sometimes avoid the weight issue altogether. Perhaps like taking a sexual history, it can make one uncomfortable to delve into a private personal area. Maybe providers are afraid of offending women. But the reality is that we do not do justice by the women we provide care for by avoiding this topic.



The subject matter requires more research before changes in weight gain guidelines are changed. If you would like to see the abstract, click here.

Nutrition Corner: Omega-3s

Omega-3s rock. That's all there is to it. They are fantastic for you whether you are pregnant or not, and at any stage of your life!

Omega-3s are found largely in fatty fishes such as tuna, mackerel, and salmon. They also can be found in walnuts, flaxseed, and full-fat salad dressings (but use in moderation!). You can also purchase supplements at any store selling vitamins, etc.

Why should you? Here's some of the benefits...

• A recent study published by Human Reproduction showed that women with ample omega-3 consumption may have a lower risk of endometriosis. The study involved 70,000+ american nurses followed over a 12 year period. Of these women, those that consumed plenty of omega-3s had a 22% lower risk for endometriosis!
• Omega-3s lower inflammation and can decrease your risk for cancer, heart disease, and arthritis.
• Omega-3s seem to be highly concentrated in the brain and it is felt that they are important for cognitive and behavioral function. Infants of mothers who did not consume enough omega-3s during pregnancy, were found to have more risk for developing nerve and vision problems.

Symptoms of omega-3 defiency include fatigue, poor memory, dry skin, heart problems, mood swings or depression, and poor circulation.

Another type of fatty acid necessary in the diet is the Omega-6s. This fatty acid promotes inflammation. Having a careful balance between the omega-3s and the omega-6s can lead to optimal health. Most Americans have 14-25 times the omega-6s then the omega-3s....this isn't good. Using a mediterranean diet tends to lead to a healthier balance of these fatty acids. The Mediterranean diet does not include much meat (which is high in omega-6 fatty acids) and emphasizes foods rich in omega-3 fatty acids, including whole grains, fresh fruits and vegetables, fish, olive oil, garlic, as well as moderate wine consumption (unless pregnant of course).

Have I convinced you? I hope so. I recommend omega-3 supplements to all my patients....running out to go pick up some more for myself :)

Guest Post: Pregnancy and Chiropractic Care

Pregnancy and Chiropractic Care

Yay... You're Pregnant! This is an amazing time in your life, one that will never be experienced again because each pregnancy is different, be excited. You have, or are working on creating an amazing supporting team for this adventure, and along with your OG/BYN and/or Midwife, Chiropractic Care is essential.

A large percent of pregnant women experience back discomfort or pain during pregnancy due to previously unnoticed imbalances of the spine and pelvis that are accentuated during pregnancy. During this time women undergo many structural and hormonal changes that affect the spine, nerves, joints, ligaments, connective tissues, center of gravity and stability. Specific, GENTLE adjustments elimintate the stresses in your spine and pelvis restoring balance and resulting in greater comfort, health, and vitality.

Chiropractic care is a drugless alternative to pain management. Since nearly all drugs and medications can cause fetal damage or malformations it is important for pregnant women to avoid them as much as possible.

Along with pain management, optimum nerve function is extremely important for mom and baby during pregnancy. Just as mom needs to pay closer attention to good and nutritious foods in order to grow and nurture her new baby, she needs to pay closer attention to the functioning of her nervous system. All life functions come from the nervous system, if the spinal cord is cut, there is no life. Chiropractic care removes all nerve interference from misalignments of the spine and allows life to flow freely... Baby needs 100% of moms life to be flowing freely in order to create 100% of life flow to the baby.

Baby's Position:
Prenatal chiropractic techniques release stress on the pelvis and uterus, helping the unborn child to turn and position itself properly for a healthy birth presentation. If a woman's uterus is constrained as birth approaches, the baby can be prevented from getting into the best possible position for birth. Even if the baby is in the desirable head down position, often times constraint to the uterus affects the babys head from moving to the ideal position for delivery. Any baby position even slightly off during labor can slow down labor, and add pain to both mother and baby.


Frequently Asked Questions

1. Is chiropractic safe during pregnancy?
Of course! A safe alternative to drugs is wonderful for both mother and baby.

2. Is there a time in pregnancy when chiropractic adjustments should stop?
No! Some women even receive chiropractic care during labor to aid in reducing pain with delivery.

3. Should I see a chiropactor only if I have a painful pregnancy?
No! Regular spinal check ups should be as common as weigh ins. Remember that your body is changing i nmany ways and can place a great deal of stress on your spine and nervous system. So rather than wait for problems to arise, prevent them by frequent visits to your chiropractor.

4. What about after pregnancy?
Spinal care can help the postpartum woman return to pre-pregnancy fitness by balancing her spinal column, realigning her pelvic bones and removing vertebral subluxations.


If you have any questions please call me anytime,

Dr. Ashley Waggoner


Ashley Chiropractic

480-259-0064

3006 S Rural Rd

Tempe 85282

Consistent lactation lowers maternal vascular risk

I recently read that women who have more than 3 children are at increased risk for cardiovascular events such as heart attack and strokes later in life. The research study postulates that this may be related to the changes in the circulatory system brought on by repeated pregnancies. If there ends up being some founding to this then breastfeeding may be a counteractive measure that moms can take...


March 1, 2010

Contemporary OB/GYN

Consistent lactation lowers maternal vascular risk


Breastfeeding may protect mothers against the development of vascular disease, according to a recent study. The new data add to existing data for the long-term health benefits of lactation.

The new finding comes from 297 women, 45 to 58 years old, who were enrolled in an ancillary study to the Study of Women Across the Nation (SWAN), called SWAN-Heart. SWAN is a community-based cohort study of racially diverse women conducted at 7 sites across the United States; SWAN-Heart participants were enrolled only at the Pittsburgh and Chicago sites. Women in SWAN reported at least 1 live birth at enrollment and were free of cardiovascular disease at entry.

Lactation history was assessed at enrollment and was self-reported. It was classified as no lactation, inconsistent lactation (breastfeeding at least 1 child for less than 3 months), and consistent lactation (breastfeeding each child for 3 months or more).

SWAN-Heart participants had subclinical cardiovascular disease measured at baseline by 2 screening tools: electron beam tomography with an ultrafast computed tomography (CT) scanner and B-mode ultrasonography (carotid duplex scanning).

Ultrafast CT provides a measure of calcification; in SWAN-Heart, calcification of the aorta and coronary arteries was assessed. B-mode ultrasonography was used to assess carotid adventitial diameter, carotid intima-media thickness, and carotid plaque.

After adjusting for age, parity, measures of socioeconomic status, and lifestyle and family history, a significant association was observed between aortic and coronary calcification and consistent lactation for 3 months postpartum, reported Eleanor Bimla Schwarz, MD, MS, assistant professor, medicine, and obstetrics, gynecology, and reproductive sciences, University of Pittsburgh, and colleagues.

The odds of aortic calcification was increased by a factor of 3.85, and the odds of coronary artery calcification by 2.78 in the mothers who did not breastfeed compared to the mothers who consistently breastfed. The association between lactation and less aortic calcification persisted after adjusting for body mass index and traditional cardiovascular risk factors. In fact, after adjusting for all potential confounders, the risk of aortic calcification increased by more than 5-fold in the mothers who did not breastfeed compared to those who consistently breastfed.

The authors wrote: "These findings build on previous work that has shown that women who do not breastfeed are at greater risk of clinical cardiovascular disease, by providing insight in to the early effects of lactation on a mother's body."

They speculate that the effects of lactation on prolactin and oxytocin may have positive long-term effects on cardiovascular risk profiles because these hormones have been shown to be associated with blood pressure, preclinical atherosclerosis, and vascular resistance.

Schwarz EB, McClure CK, Tepper PG, et al. Lactation and maternal measures of subclinical cardiovascular disease. Obstet Gynecol. 2010;115(1):41-48.

Herbal Use in Pregnancy Part II

Continuation of herbal remedies (listed by problem)

• Perineal Care - postpartum use, calendula or comfrey - make a tea, strain and add to a sitz bath. Vitamin E oil or calndula, comfrey, pilewort, St John's wort, symphytum, hydrastis, and achillea creams or ointments can be topically applied to the perineum. Make comfrey tea and soak sanitary pads in the teat, then freeze and use on perineum.
• Postpartum Depression - teas of chasteberry, motherwort, nettle, or raspberry leaf. (Encapsulated placenta is supposed to be wonderful in preventing depression - will get an article up at some point about that!)
• Sleep Problems - take a small bed pillow, open one end, add cloves, mint, and rosemary, and sew up open end.
• Sore Nipples - wash the nipples with infusions of marigold or comfrey and expose to the air or sunlight. Ointments from calendula, comfrey, plantain, St. John's wort, or yarrow are particulary effective in healing cracked nipples and relieving pain. Wipe breasts prior to feeding baby.
• Threatened miscarriage - crampbark or black haw bark taken in the form of a cup of the decoction or drops, or a tincture of chasteberry, or raspberry leaf tea
• Varicose veins and hemorrhoids - tea, capsule, or tonic of blessed thistle. Lotions, compresses, or creams made from comfrey, marshmallow, marigold, plantin, yarow, or hawthorn berries. For hemorrhoids, try pilewort cream combined with an equal quantity of comfrey cream or try echinacea an comfrey teas put into a sitz bath, soak 15-30 minutes.
• Water retention - dandelion leaf, corn silk, or both used in tea form.

I can't stress enough that seeing a well trained herbalist is the best option for trying herbal remedies. There is an extensive list of herbs that are to be avoided during pregnancy and childbirth so be sure to check with your provider or a skilled herbalist prior to trying ANY herbal remedy.

There are numerous books and websites on herbal medicine, which can be found doing a search on the internet.

Information on herbs in this post and Part I are from Childbirth Education: Practice, Research, and Theory 2nd Edition by Nichols and Humenick.

Dark Chocolate Is Good For You?!?!

I was sent a suggestion for a blog topic - a yummy one at that - dark chocolate and the health benefits associated. I am a huge chocolate lover - I'm all about anything in support of it being healthy :) So here are some resources I checked out and think you will find helpful and interesting!

This first one is actually from WebMD - it has a lovely slideslow with yummy pictures and some interesting history as well. It discusses chocolate's history as an aphrodisiac and more recently the health benefits.

This article, also from WebMD, discusses how dark chocolate seems to help prevent heart disease. It works by keeping c-reactive protein (CRP) at lower levels. This chemical marker is associated with inflammation which contributes to heart problems.

This article, Health By Chocolate, actually delves more into the type of chocolate you need to get to reap the health benefits.

This article, on chocolate during pregnancy, discusses how dark chocolate used sparingly may help avoid pre-eclampsia!

This is only the beginning of research on dark chocolate. So feel free to head out and grab some chocolate BUT you gotta buy the right kind and it has to be in moderation. No chocolate for every meal of the day ok! Cuz then you will be hearing us lecturing about weight gain!

Group B Strep Testing in Pregnancy

I was browsing around on the computer, accumulating a little energy prior to starting the Easter dinner, and found this blog post on Group B Strep (GBS) testing at the Arizona Birth Network blog.

I felt like the info offered was very accurate and appropriate. Check it out and feel free to ask any questions you might have! I have on occasion had women decline testing or treatment in the event of a positive result. That's really ok as long as a woman understands the benefits AND the risks of her decision. We each have to determine what our own acceptable risk is for every decision you make in life. This is no different!

Herbal Use During Pregnancy Part I

Many women are interested in a more natural approach to pregnancy, labor, and birth. This can include the use of herbal remedies to treat common problems, enhancing one's health and well being, or a desire to avoid man-made medications if possible. There are many herbs available to women, with many being safe during pregnancy. The following is NOT an all-inclusive guide to herbal use. There are so many out there that enitire books are written about herbs! I will discuss some of the more common herbs used during pregnancy as well as what to avoid. As always, you should discuss herbal use with your provider before using. Speaking with an herbalist is also a great way to get safe advice.



Herbs are made from one or more plants. It's important to remember that just because it's 'natural', doesn't mean it's safe!



The most common methods for preparing herbs are capsules, teas or infusions, tinctures or extracts, and infused oils. The standard measure for tea is 1 ounce of dried herb or 2 ounces of fresh herb with 1 pint of water. Pour the boiling water over the herb, cover, and steep for 15 minutes, strain and drink! For roots, seeds, or the hard, woody parts measure out the same proportion as the infusions, but boil in the water for 20 minutes. Then strain and drink.



Herbal Remedies (listed by problem)

• Cystitis - corn silk thread, horsetail, or marshmallow in tea form


• Engorgement - the leaves of a green or white cabbage leaf as a lining in the bra - change when they are limp, or grate a potato and add it to the cabbage leaf along with a small amount of hot water. Mash together and apply as a paste to the breasts. Only for engorgement as cabbage leaves are commonly used to dry up milk as well.


• Exhaustion in Labor - infusions of fresh ginger root, alone or added to raspberry leaf tea (don't use the ginger if birth is imminent or in the first postpartum hour. Other options include an infusion of rosemary tea, or a tincture of blue cohosh root.


• Headaches - fill a clean white sock with white rice, and add lavendar, rosemary, cloves, or combination thereof. Sew up the open end of sock and warm in the microwave or chill in the freezer. Apply to the forehead (being careful not to burn yourself!).


• Heartburn - Teas of ginger, Iceland moss, lemon balm, chamomile, marshmallow, meadowsweet, peppermint, or spearmint. Alfalfa tablets can also be helpful and are a good source of iron as well.


• High Blood Pressure - hawthorn and cramp bark combined in tea form.


• Insomnia - nervine tea at bedtime.


• Lactation - teas of comfrey, dill, milk thistle, red clover alfalfa, nettles, fenugreek, hops, and vervain. Borage, blessed thistle, and wood betony as teas act as an antidepressant and increase milk supply. fennel seeds sipped in a tea throughout the day, then chewed and swallowed, improve milk flow and are thought to decrease infant colic.


• Mood Changes - herb baths using the flowers of roses, lavendar, borage, daisies, or chamomile. Teas of raspberry leaf alone or in combo with equal amounts of either spearmint or peppermint teas. St John's wort in capsule or tincture form. Teas of vervainherb, lemon balm, lavendar flower, borage flower, lemon verbena leaf. Fish oil or other sources of omega 3's.


• Morning Sickness - anise, black horehound, chamomile, cinnamon bark, cloves, fennel, gentian, ginger root, hops, Iceland moss, lavendar, meadowsweet, red raspberry leaf, rosemary, spearmint or peppermint teas. Chewing or sucking slippery elm tablets or candied ginger. red raspberry capsules or tonic.


• Muscle Aches - fill a clean white tube sock with natural buckwheat; add clove, chamomile, and lavendar herbs. Sew up the sock and warm or chill the sock. Placed on affected area.


• Pain in Labor - motherwort in tincture form (5-10 drops mixed in a small glass of water every hour), scullcap drunk as an infusion or sipped from a glass of water to which had been added one teaspoon of the tincture, or St John's wort in an infusion, or add 23-30 drops to a glass of water. Black cohosh root in tincture form in half-teaspoon doses.Pasque flower in tea, tincture, or capsule. Basil and gotu kola teas and sage compresses.

To be continued...

Guest Post: Planning a Pregnancy

Jeanene Traynor, WHNP-BC submitted this guest post on planning a pregnancy. Jeanene works in our office, providing obstetrical care, gynecology services including preconceptional counseling, and minor procedures. Preconceptional counseling is simply a way of optimizing your chances of getting pregnant as well as improving the liklihood of a healthy pregnancy.

Tiffany

PLANNING A PREGNANCY by Jeanene

For a woman to become pregnant, one of her eggs must unite with a man's sperm at just the right time. The egg will be released from the ovary and travel through the fallopian tube. The man's sperm should join the egg during this journey. This means that during intercourse, he will ejaculate and his sperm will travel up through the vagina, cervix, uterus to the fallopian tube, where the egg and sperm unite. The fertilized egg continues to travel, attaching itself to the inside of the uterus. Here the fertilized egg will embed, and continue to grow.

Lifestyle changes for women that will improve pregnancy outcomes include a healthy diet, some form of exercise and eliminating unhealthy lifestyle habits, such as tobacco, alcohol, illegal drugs and some prescribed medications.

Each month, a woman having regular intercourse has a 20 - 25% chance of pregnancy. Most couples conceive within one year of unprotected, regular intercourse.

If you are planning to become pregnant, it is good to be up to date on your gynecologic exams and immunizations. A pre-conception appointment is always a good idea; lifestyle changes, medications and nutrition can be discussed at this appointment. Prenatal vitamins can be started three months or so before a pregnancy is planned.

Nutrition Corner: Minerals

We've covered vitamins so let's move on to minerals now. During pregnancy, minerals are typically obtained in adequate numbers between dietary intake and your prenatal vitamin. Let's look at the minerals in detail...

Iron

During pregnancy, iron is needed for the manufacture of hemoglobin in both mom and baby's red blood cells (RBCs). The baby will draw iron from momma, so mom needs to keep her iron levels up. Iron is better absorbed from dietary sources than from supplements. The RDA is 30mg. Most prenatal vitamins contain around 27-35mg. But again, iron is better absorbed by the body if it comes from dietary sources. So, try eating foods such as lean or organ meats, enriched grains, green leafy veggies or dried fruits, and egg yolks.


Calcium

This mineral is important for bones, muscles, and regulatory functions in cells and blood. Again, the baby will draw calcium from momma to help with skeletal growth. Pregnant women need about 1200mg of calcium a day. Good food sources for calcium include milk, cheese, whole grains, leafy veggies, and egg yolks. Tip: if you find yourself having frequent 'charley horses', or leg cramps, try getting more calcium in the form of a supplement or dietary. This usually takes care of those pesky leg cramps!


Phosphorus

Phosphorus works closely with calcium, with the body maintaining a careful ratio in the blood. Our diets in the US are typically very high in this mineral. Typically foods that are high in phosphorus contain only small amounts of calcium. The RDA is 1200mg during pregnancy. Foods high in phorphorus include lean meats, milk, cheese, processed meats, snack foods, and carbonated beverages. No supplementation is needed on this one!


Magnesium

Much of this mineral is stored in the bones, similar to calcium and phosphorus. Active magnesium is found in the nerve and muscular cells. This mineral can also be taken as a supplement to decrease leg cramps, however does not cause any change in blood levels of the mineral. The RDA is 320mg. Dietary sources include green veggies, nuts, wheat bran, soybeans, and wheat germ.


Iodine

Iodine is important for preventing many mental deficiencies in the developing baby's brain. The RDA is 22o micrograms. The source is idodized salt and seafood. It is rare to have a deficiency in this mineral in the US.



Zinc

This mineral is a component of insulin so has an active role in metabolism. The zinc RDA is 15mg. Zinc supplements are not recommended at this time due to lack of evidence that shows a benefit. Foods rich in zinc include oysters, shellfish, Brewer's yeast, wheat germ, wheat bran, pine nuts, bran cereals, and pecan nuts. Other sources that also have zinc include liver, cashew nuts, fish, eggs, and parmesan cheese.



Manganese

This trace mineral is typically ingested in adequate amounts from food sources so supplementatation is not necessary. The mineral plays a role in the formation of bones and cells. The RDA is 2.6mg. Food sources include:

1 cup raisin bran cereal: 1.9 mg
1 cup cooked brown rice: 1.8 mg
1 cup cooked oatmeal: 1.3 mg
1 ounce (19 halves) pecans: 1.3 mg
1 ounce English walnuts (14 halves): 1.0 mg
1/2 cup pineapple chunks: 0.9 mg
1/2 cup boiled spinach: 0.9 mg
1/2 cup black beans: 0.4 mg
1 ounce (23 whole kernels) almonds: 0.6 mg
1 slice whole wheat bread: 0.6 mg1 cup black tea: 0.5 mg
1/2 cup raspberries: 0.4 mg
1/2 cup sliced strawberries: 0.3 mg

Nutrition Corner: Vitamins

I was recently emailed by a patient of ours. She is pregnant with her third baby and wants to really make every effort to be healthy. She was wondering what minerals, vitamins, herbs, and spices were safe during pregnancy and in what amounts. I decided to break this down a bit and will talk about vitamins first. A couple posts will follow in the near future with more information about minerals and herbal use during pregnancy. Great questions Amy!

I've always felt that it's a struggle to get everything we need in our daily foods when it comes to minerals and vitamins. Or maybe I'm the one who struggles with that! Anyway, during pregnancy, healthy eating becomes even more critical due to eating 'for two'. Typically a prenatal vitamin (and it doesn't have to be a fancypants one at that!) is adequate for most women coupled with a healthy sensible diet. What follows are the most common minerals and vitamins we need (and why) and the amounts recommended for pregnancy. Keep in mind this is a general overview and that some women may have special needs. Also important to remember - it's better to get most minerals and vitamins from dietary sources as opposed to pill form.

First, a few definitions...

• Protein - provides the structural base for all new cells and tissues in the mother and baby.


• Carbs - Source of energy


• Lipids - Fat....enuff said?


• RDA - Recommended Daily Allowance

Vitamins

• Thiamin, riboflavin, and niacin contribute to the production of energy. They are found in almost all foods but exceptionally good sources include whole grains, legumes (beans, etc), organ meats, pork, milk, cheese, lean meats, and leafy green veggies. RDAs respectively are 0.5, 0.6, and 6.6mg per 1000 calories eaten. So if you eat a 2000 calorie a day diet, then you should be getting 1mg a day of thiamin to maintain optimal health.
• Folic acid is involved in DNA and RNA synthesis so very important for cell growth and division. It was found that having enough folic acid in the diet significantly reduced the liklihood of neural tube defects (NTD) such as spina bifida. It is recommended that women be taking folic acid prior to pregnancy or as soon as pregnancy is known to gain maximal effect. The recommended amount is 0.4mg per day. If a woman has previously had a child with a NTD, then she should be taking 4mg. Orange juice is the largest contributor of folate in America.It can also be found in many foods, however does not absorb as well as the synthetic (pill) form. Go figure!
• Vitamin B12 is important for the nervous system. Deficiency in this vitamin is rare as it is present in all foods of animal origin (i.e. milk, eggs, meat, liver, cheese) as well as being manufactured by bacteria in the gut. The RDA is 2.2 mcg.
• Vitamin B6 is another important vitamin involved in protein formation and can affect the nervous system as well. the RDA is 2.2mg per day. Some benefit may be gained in taking this vitamin in high doses (25mg three times a day) for women experiencing extreme nausea and vomiting during early pregnancy. Good sources for this vitamin include wheat, corn, liver, meat, and milk.
• Vitamin A is involved with reproduction, the immune system, and vision among other things. This is one that you don't want to have too much of as it can be harmful to the growing baby. The RDA is 5000-8000 IU depending on what source you look at. Sources of Vitamin A include animal sources (butterfat, liver, egg yolk) and plant sources (drak green or deep yellow vegetables or fruits, fortified margarine).
• Vitamin C assists in the formation of connective tissue, skin, tendons, and bones. The RDA is 60mg and this is easily met with dietary intake. Vitamin C rish foods include citrus fruits, papayas, strawberrries, melons, broccoli, potatoes, tomato, cabbage, green or chili peppers.
• Vitamin D assist the body in maintaining calcium balance and absorption. Adequate intake is 5 mcg (adequate intake is used when insufficient evidence exists to develop an RDA). Most people are able to get adequate Vitamin D from sunlight exposure. Very few foods contain this vitamin. Cod liver oil and some fish (salmon, mackerel) contain high levels.
• Vitamin E assists in absorption of Vitamin A, is an antioxidant, and is responsible for maintaining cellular membranes. It is extremely rare to be deficient in Vitamin E. The RDA is 15mg. Food sources include nuts, seeds, and vegetable oils. Green leafy veggies and fortified cereals contain significant amounts.
• Vitamin K is essential for blood clotting. No supplementation is necessary unless a known defieciency (rare). Foods rich in vitamin K include green, leafy vegetables such as spinach, broccoli, asparagus, watercress, cabbage, cauliflower, green peas, beans, olives, canola, soybeans, meat, cereals, and dairy products.

Coming soon.....Minerals!

Flu Vaccine (seasonal and H1N1) Q&A