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So it’s my honor tonight to introduce our
speakers, Dr. Suzan Carmichael andDoctor Betty Shachar, and their lecture
entitled, Taking Care of Yourself andYour Baby: Nutrition and Fitness Before
andDuring Pregnancy, Research and
Recommendations. Dr. Carmichael is an associate professor
of pediatrics atStanford University’s School of Medicine. She received her PhD from UC-Berkeley and
spent two years at the Centers forDisease Control before joining the March
of Dimes to do research oncauses of birth defects. Her dissertation was on the pattern of
weight gain during pregnancy andrisk of preterm delivery. Her research has focused largely on
nutritional, environmental, social, andgenetic contributors to structural birth
defects andother perinatal outcomes, such as preterm
delivery. Dr. Betty Shachar is an MD OB-GYN from
Israel. She is a post-doctoral research fellow at
the March ofDimes Prematurity Research Center at
Stanford. Her main interest of study is risk factors
forpreterm birth, in particular the
inter-pregnancy interval. So please join me in welcoming our
speakers tonight. . >> Thank you all for coming tonight. So, to start out with a brief outline of
what we’re going talk about asFelice said, we’re gonna talk about a
recommendations, and research. I think mine might be a little heavier on,
on recommendations than actual research. But we’re going talk about maternal weight
and weight gain. Diet and supplements, andthen I’ll take about those and then Betty
will talk about physical activity. So, before I get started I’ll just give
youa little bit more background about myself. Felice mentioned my dissertation was on
weight gain and preterm delivery. Basically just want to let you know that
maternal andinfant nutrition has always been a passion
of mine. It’s kind of been the one thing that has
been constant through mydifferent career steps. So the dissertation fit that. I was a nutritionist for the WIC program. It’s a nutrition education and supplement
program for low income women. I was a Peace Corps volunteer fora little while in Honduras, doing again
maternal and infant nutrition. And then my other piece of experience is
that I do have two boys. So I’ve been through pregnancy a couple of
times andI can sort of relate to the changes in
your body, the changes in your weight, andthe crazy changes in your appetite. So first we’ll talk about pre-pregnancy
weight andbasically we’re usually talking about body
mass index or BMI and that’s calculated asyour weight in kilograms divided by your
height in meters squared. And for better orfor worse we’re all familiar with the
obesity epidemic I’m sure. And then this, this slide just sort of
gives you a visual of that. I’m trying to figure out where I can point
from. So this is basically a heat map from the
CDC of prevalence ofobesity by state in 1987 versus 2008. The darker colors are obviously more
prevalent,at higher prevalence of obesity. But it just shows you how striking the
epidemic has been and really how recent. It’s only been the last, you know,couple of decades this has really emerged
as a big problem. And actually an interesting statistic is
that for the first time, average lifespanis shorter for the first time for current
generations than for previous generations. And this is attributable to the obesity
epidemic. So why is pre-pregnancy weight important?Well, it is associated with a number of
different adverse maternal andinfant health outcomes. And although I’m going to focus on obesity
more it’s true at both extremes ofthe spectrum of BMI and that underweight
women and obese women are atincreased risk of different, somewhat
different set of adverse outcomes. So things like diabetes, and hypertension,
preterm delivery,growth restriction of the baby are
associated with the extremes of BMI. What can we do about it?Preconception care, ideally, is very
important tohelp people be as healthy as they can at
the start of pregnancy. Unfortunately, we don’t always do a great
job of that in our health care system. And also about half of all pregnancies are
not planned. So that’s a very striking figure, but it
makes it kinda hard to dothe preconception care and intervene
before a woman gets pregnant. So I think the best we can do, you know,
we need to be careful about what kind ofinterventions we try to implement during
pregnancy. But basically knowing a woman’s
pre-pregnancy weight helpsa clinician know what her risks may be andthen monitor her appropriately and give
appropriate advice based on that. And I’m gonna give you a little bit, a
little window into some ofthe research that we’ve done in this area
of obesity and pregnancy outcomes. Okay.
So, this is a schematic that just kind ofgives you an idea of how we might think
about the research questionof the association of obese, obesity with
pregnant, adverse pregnancy outcomes. So, basically, we’re interested in what
are the mechanisms andthe mediators that are responsible for
this association. And, as well, we’re really interested in
what kind ofprotective factors may allow us to sort of
intervene orstop this progression to an adverse
outcome among obese women. Some of the common mechanisms that we’re
thinking about and working on andtrying to understand that may be
responsible for these associations forexample, of obesity with preterm delivery
are inflammation and infectionbecause those are both higher and a bit
different in obese versus non obese women. Some of the most commonly cited mediators
would be the higher prevalence ofdiabetes and hypertension in obese women
perhaps being responsible. And then some of the protective factors
that can protect againstthe negative effects are that we study our
nutrition and exercise. So, I’m gonna give you a few examples of
how we’ve tried to really understand thisassociation of obesity with in particular,
neural tube defects. Neural tube, because most of our,a lot of our research has been on, on
structural birth defects. So, neural tube defects are when the
neural tube does not close properly. And it may be at the top of the spine or
the lower part of the spine. A couple of the most commonly, ormost familiar outcomes, neural tube
defects, are spina bifida and anencephaly. So we know that neural tube defects are
about twice aslikely among women who are obese as women
who aren’t obese. But still keep in perspective that even
though it’s a two-fold increased risk,these are still relatively rare. They affect less than 1 per 1,000
deliveries. But still we wanna understand how to
prevent themeven when they aren’t when they’re that
rare. So if we think about obesity, it’s a
pretty broad category. And one thing that we’ve tried to think
about, well, what is it about obesity,not all, sometimes people refer to healthy
obesity versus unhealthy obesity. And or maybe there’s a spectrum of sort ofthe unhealthiness of obesity depending on
what else is going on. So abdominal obesity is so this is sort of
the, the apple shape if you will. Where the weight tends to be gained in the
waist andthen the alternative is sort of the, if
you will, the pear shape, orpeople who tend to gain weight in their
hips and the abdominal type isassociated with worse endocrine milieu,including worse glycemic control, which is
important to pregnancy outcomes. So, what we did is in one of our studies
of neural tube defects,is we looked at the association of obesity
with neural tube defects overallin our study, and here you see the 1. 3 is
the overall association,and when we’re doing these studies we
either do odds ratios or risk ratios. But basically one means, when you compare
the two groups, the ratio is one,there’s no association. And then on the y-axis will be, sort of,
the fold increase ordecrease in risk for your, your two
groups. So here when we looked overall we saw a
slight increased risk of neural tubedefects among women who were obese versus
not obese, but then we asked women,we usually do telephone surveys for a lot
of our birth defect studies. We asked women about when you gain weight
do you tend togain it in your waist or your hips. So trying to get at that pear versus apple
phenotype and we found that womenwho were obese and tended to be more the
abdominal type of obesity there,that’s where we were, that’s what was
driving the increased risk is those women. Whereas, the women who tended to have the
other body type the obesity was notassociated with the increased risk. And that sort of fit with our hypothesis
of thinking that maybe that the worstglycemic control is associated with, is
driving the increased risk for NTDs. And then in thinking about thisin a similar way rather than type of
obesity, we thought about well what other,what factors may, are the,is the association of different other risk
factors with neural tube defects similar,operating similarly in women who are obese
versus not obese. And again, that helps us really understand
what’s driving that association. So one thing we know, is that nutrition
and particularly folic acid is reallyimportant to neural tube defects and
intake of certain nutrients andfolic acid in particular, or folates is
known to be protective. So, if you see in my slides if you see an
odds ratio orrelative risk that’s less than one, that
means reduced risks. So, here, for example, there are two
studies that I’m illustrating. And this one was conducted by our
colleague, Martha Werler. And what she did was,she looked at well, is folate intake above
this amount versus less than that?Is it’s association, or it’s protective
effects against neural tube defects,is that similar among women who are higher
weight and lower weight. In their study, they cut it at not
obesity, butrather 70 kilograms pre-pregnancy weight,
about 150 pounds. And what they found was that Folate, the
usual oops. The usual protective effects that we see
were observed forthe women who were lower weight, but not
for the women who were higher weight. So it seemed to be helping in the women
who had the normal weight, butnot the women who were higher weight. And then another study that we did was
looking at more holisticallyat nutrition and that we, I’ll talk more
about diet quality in a little while, butbasically it’s like an overall sort of
score of the quality of your diet. And what we found was that among women
with normal BMI there wasa protective association. So, diet quality, higher diet quality was
associated with lower risks. But among obese women, it wasn’t. So basically the take home message from
these studies was that, well,maybe, it may be that the ideology ofwhat’s causing NTDs among obese women may
be a little bit different thanwhat we’ve seen in the general population
with regard to nutrition and folic acid. So basically these kinds of studies I’m
giving you are an example kind oflike we’ll know an association and try to
go the next step and try to understand it. In research your steps are often, they
feel like baby steps, butit’s just kind of the nature of trying to
make progress. It’s usually not a magic bullet, buteach step hopefully gets us a little
closer to understanding associations. So here’s another one of those sort of
interaction slides. So this one sort of is, is demonstrating,
well,what about if a woman has obesity and
diabetes?Are those the women who are driving the
risk, again, with this sort of hypothesisabout is it glycemic control that may be
driving this ends increased risk. And so this study was conducted by our
colleague Adolfo Correa when hewas at CDC. And basically the reference group,the comparison group, was the women that
we expected to be best off which waswomen who did not have diabetes and they
had normal BMI. And so we found out that women who had no
diabetes butwere obese, they weren’t at increased
risk. And remember we usually are seeing,overall in the population, an increased
risk there. But if we excluded the women with
diabetes, they weren’t at increased risk. Women who’d had gestational diabetes andnormal BMI again weren’t really at
increased risk. But then if you had gestational diabetes
and obese the risk starts to pop up. If you have pregestational diabetes and
normal BMI it’s again higher andthe worst is if you have the
pregestational diabetes and obesity. So, again, it’s kind of showing, well, if
we kind of dig in a little bit deeper,is it everyone who’s obese or should we be
particularly concerned abouttaking care of women who have multiple
risk factors?So, now, I’m going to move on to my second
topic which isweight gain during pregnancy. And this slide just gives you a general
feel for what the pattern,the average pattern of gain looks like. Basically in the first trimester and this
is on average,in the first trimester gain tends to be
pretty minimal, I mean some women gain,some women lose weight, but on average
it’s pretty flat. And then after that, it tends to be rather
linear if you, again, this is averaging. Everybody knows that that’s not their
particular case,just like we know that we know that we
don’t have 1. 3 children. But that gives you a feel for the pattern
of gain and how it looks. And, then this slide just tells you a
little bit more about what all thatgain is going towards. So, I don’t know if all of you are already
familiar with all of this, butbasically half of it’s going to the baby. Half of it’s going to mom. And all the things that, that you’re
building. And again, the average increase in
calories that are really needed,thought to be needed to build all of this
in first trimester, it’s about null. And then in the second andthird trimesters, it’s about 350 to 500
extra calories per day. But what I want to really impart is that
all of these are averages andwe know that we’re all over the board in
what really happens. And just because one isn’t on the average
doesn’t mean that they’re not going tohave a good outcome. Also it’s really amazing how muchadaptability there is in the human body,
especially during pregnancy. For example there were some studies like
over 50 years ago that really weretrying to figure out what were the
metabolic requirements of pregnancy. And it was found that women who were
undernourished actually hada lower actual, you know, incremental
energy intake need than women whowere normal weight or perhaps overweight. And, part of the explanation for that is
because of the adaptability. Somehow, your body kind of, in a lot of
ways, knows what it needs, andhas a really wide range of ability to
adapt and to change, you know,how well, how efficiently it’s using what
you’re, what you’re taking in. So, just want to point that out to put all
of this, these averages in context andjust really appreciate how much your body
really does adapt andkind of know, it knows what to do a lot of
the time. So are all of you familiar with the
Institute ofMedicine’s weight gain recommendations
during pregnancy or not?Anybody familiar with them?Yes, no?It’s a safe way to raise your hand. Okay, so, that’s interesting,
cause I’m notsure how much people already know, or what
kind of advice, you know, you’re given. So, basically the Institute of Medicine
came out with recommendations forweight gain. It had a thick report from 2009. The first report was in 1990. That’s when, it’s the 1990, 93 to 96 when
I was doing my dissertation work. My adviser had been on the original
committee and we were trying to follow-upand fill in some of the gaps in research
that they found in doing that report. But, basically a lot of research, a lot of
consensus work went in,has gone into these recommendations. And they’re basically, they’re different,
by BMI category. They’re ranges. And one of the new things they did in the
09 report was to provide, excuse me,a rate of gain, as well as just a total. And, basically, during the first
trimester, it’s recommended, you know,negligible weight gain, as if we can
control it. But basically this shows the short of
average weekly gain that is, issort of expected to reach this, this total
gain for a term, a full-term pregnancy. They also added recommendations for twins
in the recent report andrefined the recommendation for obese
women. And again, these are, you know,
recommendations. Most women, I don’t know if it’s most
exactly,but a lot of women don’t gain within the
recommendation andthey tend towards gaining more than the
recommendation. But again, it’s just, it’s a, it’s a
recommendation, it’s a gauge. And it’s, it’s important because,to monitor weight gain during pregnancy
because it provides clues. It’s like, it’s not the end all, be all on
its own, but I think in the context of,you know what else is going on with a
woman it can provide clues to whether,everything else is going well or not. On some people, especially when I was
doing my doctoral work, there was a lot ofdebate about whether we should even
measure weight gain during pregnancy. I mean, I can’t imagine prenatal care with
actually er, er,pregnant women never actually stepping on
a scale. But it’s debated I guess partly because of
it’s sensitivity. But it’s never been intended that it would
be just considered in isolation,what your weight gain is. It’s more of, it’s part of the whole
picture of what’s going on. So what can we do about weight gain?Again, I don’t think it’s something that
we need to harshly control oranything, it basically is good to monitor
andthen give appropriate advice as one sees
how it’s going. I’m not going to talk about research on
this particular topic because Ifeel like well I don’t a whole lot of time
to talk, andalso a lot of research really went into
coming up with those recommendations,so suffice it to say that research is what
led to those. And then the last topic I’m gonna talk
about is nutrient intake and nutritionduring pregnancy as it relates to food and
nutrients rather than body mass index. So, again, this picture shows you all,to build all of these things naturally we
actually need, we need an increase inenergy but we also need an increase in a
lot of different nutrients as well. So then the question is, how do you get
that andwhat you should do during pregnancy and
this was just a quick Amazon you know –no, I’m sorry not Amazon, Google on books
that might be on Amazon. On, you know, you put in nutrition during
pregnancy advice andyou get like the, I, I don’t even know
what all these are butit’s, you could spend your whole pregnancy
trying to read up on it. So my advice is to basically, the Public
Health Service andother organizations recommend to take a
multivitamin mineral supplement whenyou’re planning pregnancy and during
pregnancy. And as far as dietary recommendations,
anybody can, you know, look on the web andsee what it says, see what, you know,different people are saying, but my
general advice is to keep it simple. And if, if you’re reading things that are
stressing you out,because they get so detailed or whatever,
then, then try something else. Try another set of recommendations. And really the recommendations for a
healthy diet you know,when you’re not pregnant are very similar
to when you are pregnant. And so in that vein I’ve included a couple
of books here. I really like the Eat, Drink, and Be
Healthy by Walter Willett at Harvard. He’s very practical. And that just really spoke to me. It was very readable. It’s not trendy. And then I haven’t actually read Michael
Pollen’s recent food rules. But I have read other books by him, he’s
at Berkley, and he gives again,it’s not like eat this particular nutrient
but more general advice abouthow to eat and how to sort of select what
you’re eating in general. And so those tend to be the kinds of
advice that I think are the most helpful,the most holistic, the most perhaps easier
to follow andnot get obsessed about hopefully. But just to share with you a few of the
food rules from,from Michael Pollan to give you a feel if
you haven’t read him before. Because I think they’re true but they’re
also somewhat amusing. So eat only foods that will eventually
rot. So that might exclude some of the
Halloween candy that we all just got. If it came from a plant, eat it. If it was made in a plant, don’t. And again, it would be hard to follow this
strictly, but I think you get the idea. Eat the rainbow, which does not mean
Skittles. Eat all the junk food you want as long as
you cook it yourself. Isn’t that freeing?Eat more like the French, or the Japanese,
or the Italians, or the Greeks, which,I think, means don’t eat like us in the
U. S. and break the rules once in a while. you know, to enjoy food and don’t feel
like you’re married to the rules. Eating should be enjoyable. It’s something we all do together. It represents community. There’s so much more to it than just a
nutrient. He also says you know, if the ingredient
list is something thata third grader can’t pronounce, then try
to avoid it. But, anyway. I like, I like his stuff. So as far as a little bit into the
research we’ve done on nutrition andagain, I’ll use neural tube defects as an
example. So here it says there’s been a reduction
in neural tube defects afterfortification in 1998. And do you guys know what nutrient I’m
talking about?Anybody?So, folic aid. So, basically there was a lot of research
that was done showing that folic acid,which is a B vitamin comes from the word
foliage. Basically a lot of research was done
showing that it was protective againstneural tube defects and that led in 1998
tomandated folic acid fortification of the
food supply, and that’s primarily grains. It’s all the things that were already
fortified with things with thiamine,riboflavin, iron, and niacin. So now it’s also folic acid. I’ve always thought it fascinating that
most people don’t even, there was somuch debate in the scientific community,
but the general public doesn’t evenrealize there was a nutrient added to the
food supply at that point. But basically it’s a huge, it’s been
lauded as one of the mostimportant public health successes in the
last couple of decades because it reallyhas substantially reduced the prevalence
of neural tube defects, which is great. One of the main challenges, though, that
we face in doing research on nutrition,is that naturally, nutrients co-occur. So it’s, they co-occur in a vitamin
supplement,they co-occur in anything that we eat. And so that just makes it harder from a
research perspective to actually isolatethe effects of a particular nutrient. Or even a particular food for that matter. So one of the things that we’ve done,
we’ve done lots of single nutrientresearch, but one of the things we’ve done
recently is take a step back andtry to come at it from a different
direction and study diet quality,which is more, I mentioned it recently in
the context of one of the slides. But it’s been more a holistic approach. Basically it’s an overall score based on
different food groups andnutrients that you’ve eaten and this
approach hasbeen used a lot in more chronic diseases
like cardiovascular disease andthen the cancer research world, adult
mortality, and it’s been so,shown to be, if you have a better overall
diet quality, you have better outcomes. All, all different types of outcomes. But it really hasn’t been done in the
field of birth defects orreally not so much in reproductive
outcomes in general. So, the idea is, if you look at diet
quality, if your diet quality is better,does that effect outweigh the effect of
any particular nutrient. So because in our bodies, I mean, as we
metabolize these things, as we use them,nutrients depend on each other. There are, you know you look at the folic
acid orfolate cycle and it has B12 in it, it has
choline in it, it has B6 in it. All these things sort of, they all work
together. So, from this perspective that’s kind ofwhat drove thinking about diet quality
rather than just single nutrients. So, one of our recent studies was on birth
defects anddiet quality index and basically, the diet
quality index was basedon USDA food pyramid, if any of you are
familiar with that. Basic food dietary food guidelines with
some modifications to make itmore applicable to pregnancy. Recently the food pyramid has been
replaced by the my plate cartoon. But basically we saw that Diet Quality
Index wasprotective against neural tube defects and
a couple of other birth defects. And that was independent of, it didn’t
matter how much folate orfolic acid the woman took or whether she
took multi-vitamins or not. There was an independent effect of diet
quality. So basically the message is that it’s good
to take a supplement. It’s also good to try to have a generally
good diet, sowhat you eat is still important. Just a couple more slides again to kind of
in that vein of thinking aboutinteractions and if we have, maybe we have
one thing that puts us at increased risk,but is there something else we can do to
lower our risk. So we’ve done a lot of work on stress and
pregnancy outcomes. And so one we did in particular, again
NTDs is an example, is we looked atwhether the association of stress with
NTDs was similar regardless ofwhether a woman took a multivitamin or
not, during very early pregnancy. So neural tube defects happen in the first
few weeks of pregnancy before most womeneven know that they’re pregnant, even if
they’re planning a pregnancy. And so what we saw was, that for women who
did not take vitamins,if they had increased stress they had an
increased risk. But among women who did take vitamins the
increased risk was much lower. So, hopefully, you know, maybe that means
again, we can’t really take cause fromthis so it’s association and so forth, and
it’s one study. But it suggests that perhaps it’s possible
thatnutrition can protect against these
negative, other negative risk factors. And then one more, this is my last
research slide. Again, in the context of these multiple,
thinking about multiple risk factors. So here we looked at well, actually, this
was not our work. This was an Adolfo Corea, again from CDC,but using data from the National Birth
Defects Prevention study whichwe’ve been part of for many years in our
group. And basically this was heart defects and
NTDs and clefts. And the reference group was women who did
not have diabetes or take vitamins. No, no, I’m sorry, the reference group was
women who did not have diabetes andthey did take vitamins. So that’s kind of what we’re thinking of
as our lowest risk group. And women who, so this is the light blue
group here. Women who just. . . these first two bars here are women who
had either one or the other. So this is the women that had no diabetes
but they didn’t take vitamins. This is the risk for women who had
diabetes anddid take vitamins, so they had one of the
two risk factors. But as you see, it’s starkly, much more
increased risk for women who had both. So hopefully this is, again, saying if
you, if you take vitamins maybe itcan help protect against the increased
risk associated with diabetes. And some animal work has been really
interesting, showing that one ofthe mechanisms by which diabetes may be
causing birth defects,this was from animal models but it, it may
be oxidative stress may be the mechanism. So that kind of ties in, that makes sense
that if you’re taking a vitamin you’regetting higher doses of a lot of different
antioxidants. It could be protective for that reason. So my last slide is basically as far as
all the advice and so forth avoid,try to avoid feeling this way and anything
that’s making you feel that way duringpregnancy or otherwise when it comes to
all the dietary advice especially. I advocate for the simpler the better, the
more general the better, keep it simpleand that’s basically where I’ll conclude
and hand it over to Betty. >> So hello again and thank you for having
me here. I’m Betty Shachar and I’ll try to keep it
a little bit more simple I think about andshorter physical activity in pregnancy. Happy to answer any question in the, at
the end. Did it move?Hm. Why is it that small?Okay, I’ll try to use my computer instead
of this. So the, my goal in this presentation isactually to answer the common questions of
every woman. Should I do any exercise during pregnancy?What kind of activity am I allowed to do?Should I avoid some kind of activity?And what should I be aware of while
exercising. I’ll start with some, background. The first US guidelines forphysical activity during pregnancy were in
1985 and they were very conservative. There wasn’t much data about physical
activity during pregnancy at that time. They didn’t, they suggested to limit
vigorous activity to more than,more, no more than 15 minutes andnot to let maternal heart rate exceed 140
beats per minute. Also, obese women were recommended not to
do any physical activity during pregnancyor women who didn’t do any physical
activity before pregnancy were alsorecommended not to begin activity,
physical activity during pregnancy. So, what have actually changed since then?The decades of research that has
established a variety ofhealth benefits of physical activity,
activity forvirtually everyone, regardless of age,
gender, or physical capabilities. And the landmark was the Physical Activity
Guidelines for Americans in2008 which has a specific role forthe physical activity, during pregnancy
and the postpartum period. So what are the benefits of physical
activity during pregnancy?We all know then what is the general
benefits of a healthy heart,mind and body. And what Susan explained much of they’re
less likely to gain weight andwe all know now about the adverse outcome
of pregnancy associated with obesity. It’s also suggested to reduce stress, and
stress by himself is a risk factor foradverse pregnancy outcome, in particular,
preterm birth. So there’s also a lot of data about
physical activity andspecific birth outcomes. For example preterm birth. There is converging evidence that’s
suggesting physical activity may actuallyreduce the risk of preterm birth but I
must stop here and say Women who feelcontractions or any other signs of preterm
birth or had previous preterm birth inthe past should not continue to do any
physical activity during pregnancy. so this is important, even though as you
can see it,it has been related to reduced risk for
preterm birth. What about preeclampsia or hypertension
during pregnancy?So again there is a bulk of evidence that
suggests thatphysical activity during pregnancy may
reduce the risk of preeclampsia. But there is another recent Danish study
thathave shown that women who reported extra
physical activity ofmore than seven hours per week actually
had a higher risk of preeclampsia. So it is still should be decided in the
literature and future studies might,might help us understand the relationship
between physical activity andthe risk for preeclampsia. What about gestational diabetes?This is more. . . there is agreement that physical activity
during pregnancy has been shown tobe effective in the treatment of
gestational diabetes. And most studies indicate that exercise is
a safe andreasonably effective therapy in
gestational diabetes. What about the effects of the baby?So, early studies were, they were
concerned about fetal distress. People in the literature have showed thatmaternal exercise may contribute to fetal
distress. But actually what we are sure now that
physical exercise isnot related to fetal stress. And also not related to, about birth
weight. Early studies again showed decrease in
mean birth weight andincrease risk of low birth weight. Recent reports show that there is no
relationship between physicalactivity during pregnancy and mean birth
weight. As with preterm birth, women that are,there is a suspicion that their baby might
not grow well, forexample, there is a suspect IUGR,
intrauterine growth retardation,are recommended not to do any physical
exercise. So what are the current guidelines?Healthy women, who are not alrerady in
highly active ordoing vigorous intensive activity, should
get at least two anda half hours of moderate intensity aerobic
activity per week. And the recommendation is for at least 30
minutes every day. So what kinds of activities can you do?There are forms of safe exercise including
walking,swimming, cycling, aerobics and even
running. Activities to avoid —
you should better notdo much exercise on your back. Avoid heavy lifting, and standing around
for too long. Holding your breath when working out. Any exercise that can compromise your
balance, there is change in balance duringpregnancy so please, the recommendations
are to avoid this kind of thing. Avoid jumping and most of the sports team,
that basketball, volleyball,things that might cause trauma orfall are best, are best to avoid during
pregnancy. Better to avoid. What should you be aware of?Please start slowly. It has been some time,especially if it has been some time since
you have exercised. Consume extra daily calories in according
with the amount ofcalories you think you have exercised. Avoid overheating by hydrate, by staying
out of the sun. And these are the recommendations for most
of the women. It’s important to understand that not all
women should exercise. There are women with specific heart
problems, lung disease. As I said, signs of preterm labor or
previous preterm delivery,an incompetent cervix, women with multiple
pregnancy, with vaginal bleeding,with ruptured membranes or placenta previa
which is when the placenta is exterior,it’s on the cervix, should not, should not
exercise during pregnancy. And these are just the summary of the
warning signs, when to stop,when to stop exercising. If there’s vaginal bleeding, if you feel
dizziness or feeling faint. Increased shortness of breath. Any kind of headache, headache. Muscle weakness,uterine contractions, any signs of preterm
delivery as I mentioned before. Decreased fetal movements and chest pain. If you have any of these please stop and
turn to your health provider. After delivery. . . So a lot of time there’s the question,when exactly I can start going back to
exercise after delivery. So it’s different among different women,
butin general we know that the, whenever you
feel ready, it’s okay. There’s no association between a rapid
going back to physicalactivity after delivery, and any kind of a
adverse outcome. So it’s better to a gradual return to
physical activity,but when you feel ready, and it’s always
good to ask your health provider. It’s okay for you to go back to your usual
physical activity. In conclusion, research indicates that
pregnant women should beencouraged to be physically active during
pregnancy. And there, if there are, of course, no
contraindication. And such participation is not harmful and
in fact,may be of great benefit of the mother
during pregnancy and after pregnancy. Thank you and if you have any questions
please.

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