The Knowledge Vaccine A practical strategy is the "CMV knowledge vaccine," which has been proposed by CMV experts for decades and which can and should be "administered" and implemented now, to protect women from acquiring CMV during pregnancy. The components of this "CMV knowledge vaccine" are simple: an ounce of CMV awareness and three simple precautions. First, pregnant women must know that CMV exists before they can make a conscious effort to reduce their exposure and risk. Second, the recommended three simple precautions are based on the knowledge that toddlers and young children are "hot zones" for CMV and transmit CMV to their parents. Young children commonly, yet silently, excrete CMV in their saliva or urine for up to 1 year and will transmit the virus to 45%-53% of their parents within that year. Most infected parents will remain asymptomatic. Furthermore, 9%-20% of CMV-seronegative women who work in day care centers with young children will acquire CMV infection. The three tips to reduce exposure to the most common sources of CMV involve:
Despite this overwhelmingly positive information on CMV prevention methods, less than one half (44%) of obstetricians surveyed in 2008 by the Centers for Disease Control and Prevention reported counseling their patients about CMV prevention. In addition, the most recent American College of Obstetrics and Gynecology (ACOG) Practice Bulletin, published in 2015, disappointingly stated: By taking this stance, ACOG denies the factual evidence that women welcome information on CMV prevention methods and do not find such information "burdensome or impractical." Furthermore, such paternalistic attitudes rob women of their power over their own reproductive health. Frustrated by the lack of CMV awareness and education provided by the medical community, families affected by CMV have strived to promote CMV education through nonprofit organizations, websites, blogs, and social media. In addition, these motivated families and friends, have addressed the public health problem of CMV through public policy and legislation. In five states (Hawaii, Illinois, Tennessee, Texas, and Utah), laws regarding CMV awareness have been passed that require healthcare providers to discuss CMV with pregnant women, and in eight additional states, CMV legislation has been proposed or is in discussion.These efforts have resulted in public health initiatives and education programs aimed at disseminating information on CMV. The greatest risk reduction strategy available now to prevent CMV transmission to pregnant women is education about CMV. Patients; healthcare professionals, especially obstetricians and midwives; and public health agencies should be partners in providing women with factual information and allowing them to make informed choices regarding their pregnancy health and prevention of CMV. In other words, spread the word, not the virus. Cytomegalovirus (CMV) is the most common virus that most people have never heard of and remains a neglected public health problem for women and children.CMV infects 2%-4% of pregnant women for the first time as a primary infection during pregnancy, and it is transmitted to the fetus, resulting in a congenital infection in 40% of these pregnant women. Congenital CMV is well recognized as a common, endemic congenital infection, infecting over 30,000 newborns each year in the United States. Although many newborns congenitally infected with CMV may have no symptoms or sequelae, up to 8000 each year will have in utero growth restriction; petechiae; liver and spleen disease; thrombocytopenia; congenital and progressive hearing loss; vision loss; brain maldevelopment syndromes; microcephaly; and permanent neurodevelopmental and motor disabilities such as cerebral palsy. In addition, fetal and neonatal death from in utero CMV occurs in approximately 400 babies each year. Yet, despite this well-recognized and well-accepted public health impact, only 9%-15% of women of childbearing age, including those with graduate degrees and those entering medical school, have even heard of CMV. Most people have by now have heard of the Zika virus, a potential epidemic threat to pregnant women and their babies that has many similarities to congenital CMV. This is because of a vigorous, strategized, education campaign by our local, state, and national public health officials, as well as pediatric and obstetric organizations, medical schools, clinics, and hospitals promoting Zika awareness and prevention strategies for all pregnant women. In addition, pregnant women are routinely counseled about HIV, rubella, and toxoplasmosis, which also may infect their unborn baby. Meanwhile, year after year, CMV gets the silent treatment. What can be done now to reduce CMV infection in pregnant women, thereby reducing CMV infection in the fetus and newborn? Such guidelines may be difficult to implement because they often are considered impractical or burdensome. At present, such patient instruction remains unproven as a method to reduce the risk of congenital CMV infection article from Gail Demmler-Harrison, MD (http://www.medscape.com)
PRE-PREGNANCY PLANNINGPre-pregnancy planning is an optimal time to take note of your overall health and sense of well-being. This includes an evaluation of the following:
EXERCISING DURING PREGNANCYExercise in pregnancy has many benefits, including:
Many women ask the question, what exercise is safe to do when both trying to become pregnant and/or after becoming pregnant? While there is a lot of information out there, one safe basic principle is that what constitutes safe for each woman applies largely to her baseline level of physical activity. GENERAL GUIDELINES FOR EXERCISING SAFELY DURING PREGNANCY
Lifting WeightsFor weight lifting enthusiasts, it is safe to continue lifting, however, it is advised not to increase the amount of weight or reps while pregnant. This is recommended so that highly oxygenated blood and essential nutrients are not diverted away from the fetus to the recovering maternal muscle tissue. YogaYoga can be comforting, however hot yoga can be dehydrating and can be dangerous with movements such as deep twisting or backbends in later trimesters when the fetus is growing, especially as the ligaments are relaxed significantly during pregnancy which could lead to injury. Remember to hydrate actively. Cardiovascular ActivitiesSolo cardiovascular activity, such as walking, jogging/running are generally considered safe. Caution is advised with biking to avoid major accidents or falls. Other types of aerobics are generally safe as well so long as the expectant mother is following the basic principles above. Always talk with your trainer to discuss how you can modify both the intensity and duration of a workout as you progress in pregnancy while still staying active. Having a healthy baby is just as important as having a healthy new mama! Be Strong. Be Healthy. Be in Charge! from: speakingofwomenshealth.com by: Heather Foreman Hirsh, MD Pharmacists should use caution when providing antibiotics to pregnant women, as prenatal antibiotic use has been linked to subsequent asthma in offspring. This association particularly holds true for children already at risk for asthma and allergy, according to research published in the Annals of Allergy, Asthma, and Immunology. In the study, researchers identified 298 mother-child pairs living in disadvantaged areas of urban Chicago who had information concerning systemic antibiotic use and were followed through the child's third year of life in the previous Peer Education in Pregnancy Study. The investigators looked for asthma diagnosis from a physician by age 3 and reported wheezing in the third year of life. Both were assessed based on the mother’s self-reported answers to the questions, “Has a doctor ever told you that your child has asthma?” and “Has your child's chest sounded wheezy or whistling?” Of 103 children born to mothers who took antibiotics during their pregnancies, 22% were diagnosed with asthma by age 3, compared with only 11% of the 195 children born to mothers who did not take antibiotics during pregnancy. In terms of the culprit behind this trend, the researchers hypothesized that the modification of microbial load could be occurring prenatally, affecting the maturation of the infant immune system and increasing a child’s risk for developing asthma. “Pre- and perinatal events are essential in shaping the development of the immune system, and systemic antibiotic use during this time could alter the maternal or placental microbiome, leading to an increase in the child's risk of developing asthma,” the authors wrote. Wheezing, however, was only weakly linked to the development of asthma in children born to mothers who took prenatal antibiotics, though the study authors noted that a similar trend for wheezing could be defined in a larger cohort study. The researchers commented that the prevalence of asthma has doubled in developed countries over the past 30 years, with poor and minority children being diagnosed more frequently. They expressed concern about pregnant women taking antibiotics, especially when symptoms are not distinctly caused by a bacterial infection. Still, the authors advised caution in providing antibiotics pregnant women, rather than discouraging the practice altogether. However, they advised that antibiotics should be avoided unless absolutely necessary. “It’s important for pharmacists to note and notice if their patients are pregnant, why they are taking antibiotics, and if they are aware of any potential risks. Ideally, pharmacists could track the number of courses of antibiotics used during the pregnancy and be vigilant for overuse,” study author Brittany Lapin, MPH, told Pharmacy Times. “I think it is important for pregnant women to use antibiotics only when necessary and to watch for overuse.” The International Pharmaceutical Federation (FIP) recently published a report that called for greater pharmacist involvement in antimicrobial stewardship efforts and detailed specific contributions that pharmacists can make. “Pharmacists can’t just expect others to do it,” said Fred M. Eckel, ScD, Editor-in-Chief of Pharmacy Times. “We must make our own contributions if we want to fix this problem.” from :Rachel Lutz www.pharmacytimes.com Diagnosis and management of PID. Pelvic inflammatory disease or PID describes infection and inflammation of the upper genital tract; this may involve the endometrium, fallopian tubes and/or ovaries, as well as the surrounding peritoneum. PID is a common cause of morbidity and accounts for one in 60 general practitioner consultations by women under the age of 45 years.1 With a single episode of PID, the incidence of subfertility is 20% due to tubal and ovarian adhesions. There is a risk of tubo-ovarian abscesses, chronic pelvic pain and a significantly increased risk of ectopic pregnancy.1 Repeated episodes of PID may increase the risk of permanent tubal damage exponentially. Clinically more severe disease is associated with a greater risk of sequelae.2 Aetiology Most cases of PID result from a vaginal or cervical sexually transmitted infection; this may be asymptomatic. Subsequently there is direct ascent of micro-organisms from the vagina or cervix to the upper genital tract.2 On occasion PID may lead to Fitz-Hugh-Curtis syndrome, which describes the situation where infection spreads along the upper peritoneum to the liver capsule causing perihepatic ‘violin string’ adhesions. It is thought that Chlamydia trachomatis and Neisseria gonorrhoeae are responsible for most cases of PID.3 Other potential micro-organisms include Gardnerella vaginalis, Mycoplasma hominis and Trichomonas vaginalis.1 Human immunodeficiency virus (HIV) infection has been found to be associated with an increased incidence of Chlamydia trachomatis infection. Women with HIV infection have an increased risk of progression to PID and tubo-ovarian abscess formation.1 Sexually active women that are in their teens or early twenties are at increased risk of PID, as are women from lower socio-economic backgrounds. Presence of a sexually transmitted infection, previous pelvic infections, unprotected sexual intercourse, sexual intercourse at an early age and multiple sexual partners are risk factors for PID.4 Less commonly instrumentation of the cervix and/or of the uterus can result in endogenous bacteria inoculating the endometrium and consequently leading to PID. The relative risk of PID is higher in intra-uterine device users however the absolute risk remains very low, in the order of one in one thousand.2 Clinical features and diagnosis At presentation, women with PID may range from asymptomatic to being systemically unwell. Ascending infection from the endocervix may cause endometritis, salpingitis, parametritis, oophoritis, tubo-ovarian abscess and/or pelvic peritonitis.1 PID attributed to chlamydial infection tends to be asymptomatic and diagnosis is retrospective when a patient presents with subfertility due to tubal adhesions. In contrast, PID caused by Neisseria gonorrhoeae tends to be acute.1 The most common presenting complaint is acute lower abdominal or pelvic pain in association with fever in a sexually active woman.2 Bilateral lower abdominal pain is typical with deep dyspareunia; abnormal vaginal or cervical discharge which is often purulent and abnormal vaginal bleeding, including post coital or intermenstrual bleeding and menorrhagia are other associated features.5 Nausea and vomiting may be a feature in PID. On examination, there may be a mild tachycardia and fever. There is likely to be bilateral lower abdominal tenderness; rebound tenderness and guarding may be elicited. If there is right upper quadrant tenderness Fitz-Hugh-Curtis syndrome should be suspected. Bimanual examination is likely to reveal adnexal tenderness and cervical excitation; there may be a tubo-ovarian abscess that may be appreciated on bimanual palpation.2 Mucopurulent discharge from the cervix or vagina may be seen on speculum examination, and high vaginal and endocervical swabs should be taken. An elevated white cell count and C-reactive protein supports the diagnosis of PID in conjunction with the clinical findings.5 Liver function tests may be deranged in the presence of Fitz-Hugh-Curtis syndrome and in acute cases. Differential diagnoses may include appendicitis, diverticulitis, urinary tract infection, ectopic pregnancy, ovarian torsion or rupture. A pregnancy test is required in all women of childbearing age. A diagnosis of PID should be made on clinical grounds. Moreover negative swab results do not rule out a diagnosis of PID.2,5 A delay in diagnosis or treatment of PID can result in long-term sequelae, such as chronic pelvic pain and tubal infertility. If a diagnosis of PID is made, testing for other sexually transmitted infections is recommended.6 Hospital admission is recommended if there is a suspicion of ectopic pregnancy or a surgical emergency such as acute appendicitis, a tubo-ovarian abscess is suspected or there is diagnostic uncertainty. Severity of symptoms and signs such as nausea, vomiting and a fever greater than 38°C may indicate that hospital admission may be necessary.3 Transvaginal ultrasound examination is not helpful in diagnosis but may demonstrate tubo-ovarian abscesses. If classic findings of PID are noted on ultrasound, no further imaging is required.7 If additional imaging is warranted MRI is recommended over CT because its overall accuracy is greater than 93% and does not carry the additional risk of ionising radiation.7 Management Since there are no widely accepted clinical criteria for PID, early empirical treatment is common. Antibiotic regimens for the treatment of PID must cover Chlamydia trachomatis, Neisseria gonorrhoeae, anaerobes, Gram-negative aerobes and streptococci.1 This provides cover for the most likely sexually transmitted infections as well as endogenous vaginal and lower gastrointestinal flora. Preferably treatment should be started as early as possible to minimise the risk of future ectopic pregnancy and tubal infertility. However, seeking medical attention may be delayed, as clinical features may not be apparent or appreciated by patients in the subclinical stage. Those women with HIV may present with more severe symptoms of PID, it may be appropriate to manage these patients on an outpatient basis however parenteral treatment may be needed. Outpatient therapy is as effective as inpatient treatment for patients with clinically mild to moderate PID, however hospitalisation should be considered in selected cases.6,7 Antibiotic regimens that may be considered for outpatients are as follows: ofloxacin 400 mg orally twice daily plus oral metronidazole 400 mg twice daily, both for 14 days OR ceftriaxone 500 mg as a single intramuscular dose, plus oral doxycycline 100 mg twice daily and oral metronidazole 400 mg twice daily, both for 14 days. Ofloxacin should be avoided in patients who are at high risk of gonococcal PID because of increasing quinolone resistance in the UK.1 A clinical review at 72 hours is recommended in those women with a moderate or severe clinical presentation of PID. There should be demonstrable clinical improvement at this review and if there has been little improvement, hospital admission or an alternative diagnosis should be considered.5 At this review antibiotic sensitivities from swab results are likely to be available. Treatment should be continued even in the absence of negative swab results. Ideally sexual partners within the last six months should be seen in a genito-urinary medicine clinic so that screening, treatment and contact tracing may be implemented.5 Hospital admission should be considered if there are severe symptoms and signs of PID, if oral therapy does not lead to resolution of symptoms, if there is concern about the presence of a tubovarian abscess or if there is diagnostic uncertainty.2 Surgical management includes laparoscopy which may help early resolution of the disease by dividing adhesions and draining pelvic abscesses. It has been suggested that ultrasound- guided aspiration of pelvic fluid collections may be equally effective. In the case of Fitz-Hugh-Curtis syndrome adhesiolysis may be performed, however there is no evidence as to whether this is superior to antibiotic therapy.5 In a woman presenting with PID it may be necessary to consider removing any contraceptive intrauterine device after appropriate counselling about the risk of pregnancy. In this situation emergency hormonal contraception may be appropriate.1 Prognosis PID may be asymptomatic but may cause substantial morbidity. A low threshold for empirical treatment of PID is recommended because of the lack of definitive clinical diagnostic criteria and because the potential consequences of not treating of PID.4 Patients should be advised to avoid unprotected intercourse until treatment and follow-up including contact tracing has been completed.1 Clinical review at 72 hours is recommended in those women with a moderate or severe clinical presentation to ensure improvement. Further review at 2-4 weeks may be helpful to ensure clinical response in addition to screening and treatment of sexual contacts.5 Preventing gonococcal and chlamydial infections represents the most effective means of reducing the incidence of PID. Interestingly over the past decade the incidence of pelvic infection in England has fallen by over a half.3 Educating women about the sequelae of untreated sexually transmitted infections as well as emphasising how to prevent transmission of such infections is important. For example, The National Chlamydia Screening Programme (NCSP) is targeted at the highest risk group for chlamydia infection in England who are sexually active. This group may be offered opportunistic screening in general practice.8 Furthermore, women on hormonal contraception presenting with breakthrough bleeding should be screened for sexually transmitted infections. Some postpartum women may notice a soft section above and below their belly button that can be felt when they contract their abdominal muscles. This soft area occurs during pregnancy and results from a thinning and widening of the connective tissue that joins the two sides of the rectus abdominus muscle. The separation, termed a "diastasis recti" is a normal process of pregnancy and allows the belly to expand and make room for the growing baby. After pregnancy, it is recommended to start the special exercises listed below, that help effectively target weakened abdominal muscles and allow for a gentle, slow progression. Before you do any abdominal exercises, you should consult with your doctor to make sure your body is recovered from delivery and any incisions are fully healed. The postpartum abdominal exercises featured below take you through five levels. Traditional abdominal exercises, such as sit-ups, put too much stress on a postpartum tummy and back, and are not recommended for new moms. This series of exercises, developed by Shirley Sahrmann, a physical therapist who specializes in abdominal rehabilitation, were designed to target the areas most weakened by pregnancy--below the belly button--without creating stress on the back and abdomen. They're amazingly effective, but it is important for you to go slowly and master each level before moving on to the next one. When to Start: A C-section mom can start these exercises once the incision has healed (stitches are dissolved or taken out) and you don't feel pain when contracting your tummy. If you had a vaginal birth you can get started once any incisions or tears are healed. The first exercise to try is simply pulling your belly button in towards your back. Hold for five seconds and release. Keep breathing as you hold and try and work up to 5-10 of these contractions several times a day. Basic breath: Lie on your back with your arms at your sides, knees bent, feet resting on the floor. Inhale and exhale a few times. Don't flatten your back or tilt your pelvis, just let the natural curve in your back remain. Breathe in slowly and deeply. Now, breathe out and tighten your tummy muscles, pulling your navel towards your spine. Remember to concentrate on contracting the muscles below your belly button without flattening your back. When you are able to contract and relax your abdominal muscles without moving your back, you have learned to properly isolate the correct muscles. You can then try the first Sahrmann exercise. Sahrmann Exercise #1 Lie on the floor with knees bent and arms at your side. Hold your tummy in by doing your basic breath contraction. Keeping one knee bent, slowly slide the opposite leg out until it is straight with the floor, and then slide it back up to bent knee position. Relax your tummy. Repeat with the other leg. Remember not to flatten your back and to keep the curve of your spine relaxed. When your abdominal muscles are contracted it helps to stabilize your pelvis while your legs and lower tummy muscles work. This prevents strain in your back muscles, and trains your abdominal muscles to protect and support your spine. When you can comfortably do 20 legs slides on each side you are ready to move on to exercise #2. Sahrmann Exercise #2 Lie on floor with knees bent and arms at your side. Pull in on your tummy and hold, then raise one knee towards your chest and slowly straighten it out parallel to the floor- about 2-3 inches above the floor without touching it. Return extended leg to starting position, knees bent, feet resting on floor, tummy relaxed. Repeat on opposite side, keeping one knee bent as you extend the other leg. Work up to five repetitions on each side without stopping, building to 20 repetitions or more on each side before moving on to exercise #3. Sahrmann Exercise #3 Use you basic breath as you bring your legs up one at a time towards your body with knees bent. Keep one leg bent as you slowly lower the other leg down to the floor and back up. Repeat on the opposite side, working up to ten times each leg before moving on. Sahrmann Exercise #4 Use your basic breath as you bring both legs up, knees bent. Slowly extend one leg out, parallel with the floor but not touching it. Return the leg to the starting position and repeat with opposite leg. Work up to 10 repetitions each leg. With each repetition remember to keep breathing, contract your tummy as you move, and don't let your back pop up. If the arch in your back keeps popping up during the exercise, then you're not strong enough to progress to this level, and need to go back to the previous exercise until you build greater strength. When you can repeat this exercise 20 times on each leg without discomfort or arching your back, move on to exercise #5. Sahrmann Exercise #5 Bring both legs to your chest using your basic breath one at a time. Straighten both legs up in the air, at a 90-degree angle from your hips. Keeping your legs together, slowly lower them down toward the floor. Only lower your legs as far as you feel comfortable doing so. If you feel your back beginning to arch, bring your legs back up and lower legs again only as far as you can without arching the back. Work up to 20 repetitions. If you notice back pain with this exercise, discontinue doing #5 and maintain at level #4. Exercises to Help Repair Your Abs
-- By Catherine Cram, M.S. Reprinted from Prenatal and Postpartum Exercise Design, by Catherine Cram, M.S., and Gwen Hyatt, M.S., Copyright 2003, with permission from DSWFitness. Anyone thinking about pregnancy, should also be thinking about prenatal care. This care is important for the mother’s health and the health of the child. Whenever possible, it should begin prior to pregnancy. A visit with your health care provider prior to pregnancy to review your immunizations, start a prenatal vitamin with folic acid (which can prevent certain birth defects if begun prior to pregnancy) and otherwise “check in” is always a good idea. Once you are pregnant, regular prenatal care visits during pregnancy are just as important to your baby’s future health as regular visits for well child exams after birth. A first prenatal visit, best done before the 12th week of pregnancy, may typically involve a physical exam, a pelvic exam, lab work (on blood and urine), sexually transmitted infection screening (to check for Hepatitis B, syphilis, chlamydia and HIV) and a Pap smear test. Your health care provider calculates your approximate due date at this first visit. Often, an ultrasound will be ordered to confirm how far along the pregnancy is. If you are at least 10 weeks pregnant, your health care provider might listen for the heartbeat. This can be difficult before 12 weeks of pregnancy. Subsequent prenatal visits are every four to eight weeks until you are 28 weeks pregnant. At all prenatal visits, you can expect your health care provider to weigh you, check on the size of your uterus, check your blood pressure and listen to the baby’s heart rate. An ultrasound at about 20 weeks is often done to view the baby’s organs and measure growth of the baby and the placenta. Around 15 to 22 weeks, blood tests are available to screen for genetic and spinal cord abnormalities. If you have these done, and the blood tests for genetic or spinal cord problems are abnormal, your provider will probably offer a high resolution ultrasound and amniotic fluid testing to determine if there is really a problem. Other tests you may be offered during pregnancy depend on your age, overall health and medical history. At 26 to 28 weeks, expect to have blood tests to check for anemia and be encouraged to take a glucose challenge test to check for gestational diabetes. From weeks 28 to 38, prenatal visits are every two to four weeks. The baby’s position will be checked to make sure the baby is pointing head down. After 38 weeks, prenatal visits are weekly until delivery. Your provider may start antiviral medication if you have a history of genital herpes to prevent a herpes outbreak. You should be offered a test for Group B Strep, and if you have this bacteria on your skin, you will be given antibiotics in labor to prevent the bacteria from affecting the baby at birth. Your health care provider may want to check your cervix for dilation and thinning as you get close to your due date or if you go past it without delivering. If you have a pre-existing medical condition or complications that arise during pregnancy, the schedule your health care provider recommends may be different and other tests may be suggested. You can get more information and details on pregnancy, prenatal care, prenatal tests and screens, childbirth, parenting classes, help paying for prenatal care and more athttp://www.womens health.gov/ pregnancy/index.html. A healthy baby depends on taking good care of yourself. Stay physically active, eat plenty of fruits and vegetables, drink lots of water, take your prenatal vitamin, get good sleep and see your health care provider throughout pregnancy. Article from Dr. Alisa Hideg @ www.spokesman.com Question: Why do postmenopausal women need GYN care? Answer: When the menstrual cycle has ended, many women think they no longer need to check in with their gynecologist, but it is not that simple. An annual exam is needed to test a woman's lymph nodes for enlargements, the cervix for abnormalities, the breasts for lumps, and the pelvis for pain or abnormalities. During the postmenopausal period, a woman is at her highest risk for cervical cancer. The only way to screen for cervical cancer is through a Pap test and internal exam. A common postmenopausal symptom is vaginal dryness. Not all women will experience vaginal dryness, but for some it can cause pain and discomfort while walking or during intercourse, usually beginning during menopause. Over-the-counter products such as K-Y Jelly or Astroglide can help ease the pain. If they don't, talk to your gynecologist about possibly undergoing hormone replacement therapy. Not all women need HRT, but it is often recommended if hot flashes and night sweats worsen. Women cannot avoid menopause or postmenopause and the symptoms that accompany them. But there are a few things you can do to lessen the effects:
If you are in the postmenopausal stage of life, it is important to remember that any sight of blood is abnormal. Since the reproductive years have run their course, there should be no vaginal bleeding. If there is, call your gynecologist immediately. Does it feel as difficult to shed those post-pregnancy pounds as it did to go through labor? According to new research conducted by the University of Chicago, you're not alone. In fact, the study found a full three-fourths of women were still heavier a year after giving birth than they were before they became mothers. "Many of my patients are new moms who have struggled with weight gain either during or after pregnancy and find themselves in my office looking for a solution to the frustration of not being able to get back to their pre-pregnancy weight status," says Kristin Kirkpatrick, M.S., R.D., a wellness manager at the Cleveland Clinic Wellness Institute. For the study, researchers followed 774 women and interviewed them one, six, and 12 months after they gave birth; it showed that approximately 47 percent held on to 10 extra pounds a year afterward, while about 24 percent retained more than 20 pounds. "First things first: If you gain above and beyond what is considered healthy and normal during your pregnancy, either because of the perception that you're 'eating for two' or an abandonment of healthy eating and exercise patterns, it will be tough to get back to your pre-pregnancy weight," says Kirkpatrick. Beyond that, she warns, taking on excess pounds during and after pregnancy sets your baby up for a higher incidence of struggling with his or her weight, too. Whether new mothers are suffering from hectic schedules or changes to their taste and smell or they've opted not to breastfeed, there are many reasons shedding those extra pounds can be so difficult. Real talk, though: Kirkpatrick says that if a new mother hasn't shed that baby weight by the six-month mark, it becomes even more difficult to do so. As if that weren't enough, "a woman’s physiology changes dramatically during pregnancy to nourish the baby and prepare for childbirth," says Kirkpatrick. "These changes include increases to blood volume, metabolism—specifically to glucose, lipids, and amino acids—and [changes in] hormones." Okay, so that's the bad news. But there are several things you can do to shave off some weight. Here, a few of Kirkpatrick's top recommendations: 1. Keep nutrient-dense foods handy. "When you reach for a snack, think fruits and vegetables, whole grains, healthy fats, and lean sources of protein," says Kirkpatrick. 2. Steer clear of fatty, sugary foods. "Once your baby transitions to solids, resist the urge—for both of you—to indulge in the macaroni and cheese, pizza, chicken nuggets, fries, and cookies." 3. If you can, consider breastfeeding. "Yes, studies vary on whether breast-feeding can lead to weight loss, but it can't hurt," says Kirkpatrick. 4. Count your calories. "Do it either by hand, with the help of a registered dietician, or by use of a phone app to ensure that you're not going over the amount of calories you need every day," says Kirkpatrick. 5. Stay hydrated. "We sometimes confuse being thirsty for being hungry," says Kirkpatrick. "Plus, you’ll need plenty of fluids after having a baby, so make sure you always have a decaffeinated drink—preferably water—on-hand." 6. Maintain your former eating schedule. "Your schedule will change, yes, but don’t let that change your eating schedule," says Kirkpatrick. "Resist the urge to skip meals." 7. Go for a jog. "If you live in a climate that permits it, register for a great jogging stroller—you don’t have to jog, by the way, just walk—and go out with your baby for at least an hour every day." Past relationships and emotional health may have a much greater influence on menopausal women's sexual function than hormones. This is according to a new study published in the Journal of Clinical Endocrinology & Metabolism. The research team, including Dr. John F. Randolph of the University of Michigan Medical School, says that when a woman goes through menopause, both sexual function and reproductive hormones are subject to changes. Past studies have assessed how hormonal changes affect sexual function - defined as incidence of desire, arousal, orgasm and pain during intercourse - among menopausal women. Some of these studies have indicated that hormones such as testosterone - the primary sex hormone in men, although women produce it in small amounts - and estradiol play a role in sexual function among this population, but Dr. Randolph and colleagues say the results have been mixed. Analyzing sexual function, hormone levels of more than 3,300 women As such, the team set out with the aim of answering this question: "Are baseline or concurrent serum levels, or changes in levels, of measured reproductive hormones related to domains of sexual function in midlife women as they transition through the menopause?" To reach their findings, the researchers analyzed data from 3,302 women aged 42-52 years who took part in the Study of Women's Health around the Nation (SWAN). At study baseline and during annual follow-up visits throughout the 10-year study, the women were required to complete a questionnaire that asked about their frequency of masturbation, sexual desire, sexual arousal, orgasm and any pain experienced during sexual intercourse. In addition, blood samples were taken from the women and assessed to measure levels of a number of reproductive hormones - including testosterone, dehydroepiandrosterone sulfate (DHEAS) - which the body can convert into either testosterone or estradiol - and follicle-stimulating hormone (FSH), levels of which naturally increase during menopause. Relationships, emotional health 'tremendously important' to women's sexual function Results of the analysis revealed that women who had high levels of testosterone or DHEAS experienced sexual desire more frequently and masturbated more often than women who had low levels of these hormones. Women who had high levels of FSH, however, masturbated less frequently than those who had low levels of the hormone. But perhaps the most interesting finding was that hormone levels appeared to have only a subtle influence on women's overall sexual function. In fact, the team found that having fewer sad moods and higher relationship satisfaction was more strongly associated with better sexual function. Commenting on these findings, Dr. Randolph says: "While levels of testosterone and other reproductive hormones were linked to women's feelings of desire and frequency of masturbation, our large-scale study suggests psychosocial factors influence many aspects of sexual function. A woman's emotional well-being and quality of her intimate relationship are tremendously important contributors to sexual health." In addition, the researchers say that menopausal women should consider whether emotional well-being or relationship satisfaction may be playing a role in diminished sexual function before undergoing hormone treatment, such as testosterone therapy, of which the long-term health effects are unclear. Articles written by Honor Whiteman |
Dr. Jaspal SachdevDr.Jaspal Singh Sachdev is the Resident Consultant and Head of Unit of Obstetrics and Gynaecology at Park City Medical Centre a Ramsay Sime Darby Hospital. Archives
December 2016
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