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Advice

  • Are you Tired or Iron Deficent?

    As summer steams up, many of us start feeling a little lethargic. If you are living in a hot and humid area, it is easy to get the pregnancy doldrums that make our maternity weight feel like it is double, even if you aren’t expecting twins. For many women the hot weather is not the only cause of pregnancy fatigue, it may also stem from a lack of sufficient iron in your diet.

    Research shows that only one in five women begin their pregnancy with sufficient iron levels. No matter the geography, iron is the most common and widespread deficiency in women around the world and the leading cause of fatigue in women. Other symptoms from low iron are poor concentration and quick mental fatigue as well as a low tolerance for exercise and physical exertion.

    During pregnancy women’s iron requirements double and without the proper diet and supplementation iron reserves can continue to deplete with each subsequent pregnancy. Studies show that as many as 50% of pregnant women are iron deficient and 20% of non-pregnant women. Clearly we all need to be getting more iron in our diet or at least supplementing more.

    If your diet has 15mg of iron and 30mg of iron supplementation you are probably meeting your iron requirement during pregnancy. If you are not meeting your iron requirement, an easy way to add more iron to your diet is to eat more iron-enriched cereals and grains (read the labels) as well as snacking on dried fruits such as raisins and prunes. Also, foods in the bean family such as lentils, chick peas and soybeans are all high in iron as well. We all know that dark leafy greens like Popeye recommends such as spinach and collards are rich in iron and very good for you.

    Other foods high in iron are red meat and egg yolks. But even if you are a vegetarian or a vegan there are still plenty of iron rich food options for you. Talk to your doctor about a supplement (or have a blood test) if you suspect you may be low on iron in your diet, particularly if you are pregnant.

  • Is your Baby getting enough Vitamin D?

    Breastfeeding your baby is a great way to not only bond with your baby but to give them the very best customized nutrition and antibodies that they need to be healthy.  However the one vitamin that you may be lacking in providing through your breast milk is vitamin D. Vitamin D is an important part of both your pregnancy diet while your baby’s bones are developing and your breastfeeding diet as your baby continues to grow and develop.

    If you do not get enough Vitamin D in your diet when you are pregnant your baby may develop a condition called rickets from soft bones. Also by getting enough Vitamin D while you are pregnant you increase your chances of having a healthy, uncomplicated pregnancy.

    While breastfeeding it is important that you eat a healthy diet as your nutrient intake is what feeds your baby the vitamins and minerals they need to be healthy as well. Depending on how much vitamin D you are getting with your diet and sun exposure, you may or may not be providing enough vitamin D for your baby. If you do not have enough vitamin D in your diet, you will need to give your baby a vitamin D supplement (and you should probably a supplement for yourself too).

    Vitamin D deficiency is linked to a number of factors including:

    Not enough sun exposure outside.

    Having dark skin

    Being overweight or obese

    General recommendations for Vitamin D for pregnant women by the Vitamin D Council are 4,000-6,000 IU/day. Researchers found that moms that took at least 4,000 IU a day where more likely to have uncomplicated births and their newborns were likely to have enough vitamin D when he or she was born. Women without enough Vitamin D in their diets were more likely to have premature births, develop gestational diabetes, have preeclampsia and more likely to have a C-Section.

    The Vitamin D Council’s recommended intake of vitamin D for babies is 1,000 IU/day.  If you are getting enough vitamin D as a breastfeeding mother, then your baby is also getting enough vitamin D and does not need a supplement. If you baby does need a supplement you can give them prescription vitamin D drops directly or add them to food or drink for your baby.

    If you as a breastfeeding mother are taking a supplement of 6,000 IU of vitamin D each day, then your baby does not need a vitamin D supplement as your breast milk will have enough. If you are not taking a supplement (or you are taking less than 5,000 IU/day of vitamin D) and not getting a good amount if sun exposure, then you need to give your baby a vitamin D supplement.

    If you are getting a good amount of skin exposure to the sun each day, then you are probably getting enough vitamin D to make your breast milk rich with vitamin D. However most mothers are not able to get enough skin exposure every day to meet this requirement and do need a supplement 5-6 days a week. When you are not getting enough sun exposure for a number of days your breast milk will quickly clear itself of vitamin D unless you are taking a supplement.

    The upper limits for Vitamin D intake is 2,000 IU/day for babies and 10,000 IU/day for pregnant women. So, unless you are over supplementing, it is hard to exceed these limits. Formula milk varies with how much vitamin D in the formula. Most formula milk has between 40-100 IUs of vitamin D per 100 calories. You will need to figure out how much formula your child has a day to add up the vitamin D IUs they are getting. Based on this result you can figure out if you need to supplement your baby with vitamin D or not and how much to supplement. Remember to adjust your supplements as your baby’s intake of formula may increase over time.

    Although exposing your skin to the sun is a great way for pregnant and breastfeeding women to increase their vitamin D supply for both themselves and their babies, you also want to be careful not to burn. Although skin exposure for your baby will increase their vitamin D directly, your baby’s skin is extra sensitive and should not be exposed directly to the sun for at least the first six months, according to the American Academy of Pediatrics. Even after 6 months you will need to be careful of your baby’s sun exposure, especially in the hot summer months as burns can happen quickly to your baby’s sensitive skin.

    Vitamin D supplements are a good subject to bring up with your pediatrician. However it is also good to educate yourself on this subject as well so you can have a very informed conversation with your doctor on how to best supplement your baby if needed.

  • New Research Supports Vaccinating your Child on Time

    The vaccine controversy has raged for a number of years, particularly with celebrities sharing personal cases of why they have chosen not to vaccinate or why they are in favor of delaying vaccinating their child.  New research may add more fuel to the fire of that argument or at least more support for following wide spread agreed upon practices by the medical community to vaccinate your child in a timely manner as recommended by your doctor.

    Current statistics show that one in eight children have been under vaccinated due to parent’s concern over vaccines and refusing or delaying their child’s vaccines. These parents are concerned that their child may be receiving too many vaccines at one time or for their young age or their child's small size.

    By inspecting the data more closely, it has been discovered that the opposite is true. A recent study published by JAMA Pediatrics found that the risk of an adverse reaction to a vaccine, such as a fever or in extreme cases, a seizure, increased in older toddlers from 16-23 months old, versus younger children 12-16 months old (which is the recommended age range for receiving the vaccine). This research suggests that delaying vaccinations was not a safer choice, as many presumed it might be. Instead the younger children with less well developed immune systems actually had fewer side effects from the vaccine despite having less robust immune system than the older toddler, who was more likely to have a side effect.

    In the editorial written by Dr. Kristen A. Feemster and Dr. Paul Offit , she stated in response to these findings, “vaccines are recommended at certain ages and intervals to optimize the immune response, ensure protection when a child is most at risk for disease acquisition, and minimize adverse events.” Her editorial goes to state that this type of research supports the well-established safety and timing of the current vaccine schedule for children.

    Avoiding the vaccines altogether is even riskier as more and more cases of measles are cropping up across the United States from children and young adults who have never been vaccinated with sometimes fatal results. This is a risk that many parents do not take into consideration when choosing to delay or refuse vaccines as many may think that these older less frequent diseases, such as measles or whooping cough, are no longer a threat. As more parents refuse vaccines, there is a much greater likelihood of a breakout from these older diseases which can quickly become more widespread in an unvaccinated community. The risk is even greater in today’s global economy with diseases passing quickly across borders with people traveling more frequently and with air travel.

    While you are pregnant, this is a good time to do your research and talk with your pediatrician about any concerns in vaccinating your child. If you have not yet chosen a pediatrician, this is the time to interview and choose one that you are comfortable with – remember this is a doctor who you will be visiting quite often in the early months and years of your child's life and perhaps for the entirety of their childhood and early adulthood. This person will be your trusted advisor for many a well-child visit and any time your child gets sick.

    It is important that you do your own research as well with vaccinating so you know where you stand when decision time comes up. Celebrities with well stated public opinions on these matters are just one data point and who are usually not medical experts. So do not give undo weight to their opinion over well conducted clinical research. Your pediatrician is the best place to start if you have any questions or concerns about vaccinating your baby and making an informed decision on your approach to vaccination.

  • Why the French Look so Fit so soon after Pregnancy

    Now we have new evidence not only why French Women don’t get fat but why they bounce back so quickly after having a baby compared to most of us in the United States and other countries.

    In most countries, the US included, women are often sent home ASAP after the baby, sometimes as soon as the next day following delivery. Once at  home women are left to fend for themselves for both caring for their baby, breastfeeding their newborn and recovering from birth both physically and mentally.

    In France, however, women see their gynecologist within the first month of birth for a full checkup and discussion session. They then routinely get twelve half hour sessions with a specialist in postnatal physiotherapy to rehabilitate their pelvic floor and abdominal muscles. This specialist also checks the abdominal muscles for any damage or separation caused during pregnancy and French postpartum women are then given exercises to tone them up.

    Many of us develop “mommy tummy” following delivery that oftentimes never fully goes away. This is the horizontal roll of fat along your stomach that hangs down in two sections if you bend over. The technical name for this is abdominal diastasis and it is often an indication that the abdominal muscles have not fully closed back together again after childbirth. This separation is caused during pregnancy when the front abdominal muscle that wraps around the baby starts to pull apart. In France this abdominal area is checked before women even leave the hospital and they are then given a set of exercises to heal the damage. In most places in the US, women are overlooked in this department and sent home fully oblivious to any damage caused to their abdominal muscles and pelvic floor during pregnancy nor are they given any instructions on what to do about it.

    Oftentimes women unknowingly exercise these stomach muscles too vigorously too soon after birth, like doing sit-ups or running (particularly if they used to be super fit before they were pregnant and are eager to resume their fitness routines), which further contributes to increased separation and damage of this muscle. In France women are shown how to strengthen their pelvic-floor muscles to close the gap and then introduced to more advanced abdominal exercises.

    Knowing this, it is a good idea to ask your doctor to check your abdominal muscles before leaving the hospital to determine if you have any separation and, if so, to understand the degree of it. It is common to have more of a problem if you have had more than one baby or if you had a big baby.

    If you do have a gap ask your doctor to prescribe for you some basic stretching exercises to help to begin closing this gap. Ask your doctor to show you how to feel the gap when you lie on your back so you can also monitor the progress at home.

    Even if we don’t live in France we can at least reap some of these postnatal benefits by educating ourselves on what they are doing so well. We can also speak up to our doctors for the same rehabilitation advice so we can be healthy and happy postpartum and lose the "mommy tummy" for good!

  • Attention Expectant Moms – Drive Carefully!

    Drive Safely! Drive Safely!

    A new study by the Canadian Association Journal cautions that pregnant women, particularly those in their second trimester, have a significantly higher risk of getting into car accidents than women who are not pregnant. Although the cause is still uncertain, it did find the risk of getting into a serious accident rose 42% during the middle trimester of pregnancy.

    Although I usually attribute such news or assertions to stereotypical data skewing, this research does seem to have some valid data behind it to warrant a cause for concern. The study leader, Dr. Donald Redelmeier, told NPR that he suspects the normal symptoms that accompany pregnancy and which may be more pronounced during the second trimester such as fatigue, insomnia and stress, are likely the reason for this uptick in driving accidents.

    This would make sense as numerous studies have shown that fatigue is as big or sometimes bigger culprit than alcohol in many motor vehicle accidents. Also, pregnant women oftentimes have to deal with nausea, morning sickness and even under eating and unusual diets during this time. Physiologically expectant woman have increased hormones associated with pregnancy, namely progesterone and estrogen, which can lead to looser tendons and ligaments, thus further lack of coordination and reaction time when driving a car.

    Now hopefully this study does not give us one more thing to be paranoid about during pregnancy as we already have such a laundry list of “don’ts” but increased awareness and vigilance is not a bad thing. Dr. Redelmeier tells NPR, that telling pregnant women to be careful drivers “seems like incredibly banal advice to give. I realize that. But every one of our crashes in the study could have been avoided by a small change in driver behaviors.” Those small changes included minimizing speed and distractions (not texting or reading email while driving or talking on cell phones while driving) and simply taking care to follow traffic rules could have avoided an accident.

    Maybe skipping that morning coffee has increased the risk as well (they didn’t check out that variable)! In any case, go ahead and grab your keys and drive where you need to go, but just be a little extra careful to pay attention as you do have a baby onboard.

  • Diet matters for a Healthy Pregnancy

    A recent study led by Englund-Ögge with the Department of Obstetrics and Gynecology at the Institute of Clinical Sciences at the Sahlgrenska Hospital in Gottenburg, Sweden showed the diet was very important for a healthy pregnancy and for lowering the risk of a preterm birth. Dr. Linda Englund-Ögge told Reuters Health in an email.

    "Diet really matters when it comes to preterm delivery and it is very important for pregnant women to choose or to increase the intake of an overall healthy diet consisting of fresh and raw vegetables, fruit, whole-grain products, certain fish and to drink water."

    In recent years there has been more interest and more research done concerning maternal diet how it affects the risk of preterm delivery. In this study 66,000 Norwegian women participated between 2002-2008 to study the effects of diet and maternal health. Those who had a “Prudent Diet” consisting of cooked vegetables, salad, onion/leek/garlic, fruit and berries, nuts, vegetables oils, water as a beverage, whole grain cereals, poultry and fiber-rich bread had the lowest instance of preterm birth. Those with a “Western Diet” which included more salty snacks, sweets and chocolates, French fries, white bread, ketchup, sugar-sweetened drinks, pasta and processed meat products had a much higher instance of preterm birth.

    There were a total of 3,505 preterm deliveries. The researchers found that women who adhered most closely to the Prudent Diet were 11 percent less likely to have preterm deliveries compared to women who didn't follow the diet as closely.

    "We would like for doctors, midwives and all others who work with pregnant women to reinforce the important message that pregnant women should be encouraged to eat a balanced and healthy diet," Englund-Ögge said.

    "There are modifiable risk factors that people can address to enhance their pregnancy outcomes," Dr. Louis Muglia told Reuters Health.

    Based on this study, he said, a balanced diet with more foods rich in vitamins and other micronutrients probably facilitates a full-term pregnancy. Additionally women that followed the prudent diet were also more likely to have other beneficial lifestyle habits which would contribute to good pregnancy outcomes. These women were more likely to maintain a healthier weight, smoked less and avoided alcohol.

    "So I think there are a lot of things that go along with that prudent lifestyle that increases the likelihood of having a healthy pregnancy and reduces the likelihood of a preterm birth as well," Muglia said.

    This research is helpful in relying the message that we assumed for years, that as expecting moms we can positively affect our developing baby’s health by eating healthy foods during pregnancy and following a healthy lifestyle. The research noted that even the women in the “Prudent Diet” category did indulge in Western eatting from time to time and did indulge in sweets sometimes as well, but it’s the overall diet pattern that mattered the most. This is good news for all of us as it’s impossible to be perfect in pregnancy or anytime!

  • 6 Tips for a Healthy Pregnancy

    1. Eat 5-6 well-balanced meals each day. Morning sickness is actually lessoned when you don’t let yourself go too long between meals, symptoms can actually get worse on an empty stomach. Meals do not have to be big, but try and vary your food choices and stick to healthy snacks and meals.

    2. Drink plenty of fluids throughout the day. Sometimes with morning sickness it’s easier to not drink as much with a meal and drink more between meals. Aim for 8-10 glasses a day while avoiding or limiting caffeine.

    3. Exercise – it’s important to stay active during pregnancy, just stay cognizant of your exertion level and  hydrate frequently. Remember your ligaments and tendons are looser, so wear supportive athletic shoes to exercise and use good judgment in choosing your exercise-- no wind sprints or downhill skiing! Also, take more breaks and keep in mind that your center of gravity is also shifting. Staying fit during your pregnancy will improve your overall health and make your postpartum recovery much easier.

    4. Don’t drink alcohol or smoke. Also be careful about exposing yourself to second hand smoke. The jury is still out how much alcohol is safe during pregnancy. It is better to abstain drinking alcohol altogether than risk your baby’s health. There will be plenty of times for Happy Hours when your baby is older!

    5. Wear comfortable clothing that you can move around in and that does not restrict blood flow. Non restrictive shoes are particularly important as you approach your third trimester. During this period of your pregnancy it is typical for feet to accumulate fluid and swell. Remember to prop up your feet during the day whenever possible to reduce any swelling.

    6. Consult your doctor before taking any medications, even seemingly benign over the counter medications such as Tylenol have been found to be risky during pregnancy. Also consult your doctor for herbal remedies as these too can be risky for your baby's development.

    There seems to be a lot of “be careful” advice and “don’t do’s” during pregnancy which can sometimes feel overwhelming. For the most part you can use common sense and listen to your body about what is and is not a healthy choice during this time. Now your get to eat, drink and think for two, not just yourself which is an adjustment for most of us.  It is an incredibly important time during your baby’s development so although you don’t need to guilt yourself over every slip up you also want to use your best judgment for your baby’s optimal health and development. You owe it to yourself and your baby to be the best expecting mom you can be! Motherhood starts during pregnacy, so now is a great time to adopt healthy habits.

  • Walking is as good as Running, maybe Better

    New research out by the Life Science Division at Lawrence Berkeley National Laboratory discovered that walking is one of the best things you can do for your body, sometimes even better than running. This is good news for many expecting women and new mothers who are looking for a form of exercise that is safe and easy to do with their constantly changing bodies.

    The study showed that while walking can be less vigorous than running, if you expend the same energy walking as you did running (this means you would have to walk vigorously and for a longer period of time than you would run for the same effect), you could potentially affect even more positive health changes than running for reducing blood pressure, lowering cholesterol, diabetes risk and cardiovascular heart disease. In fact, the more you walk, the greater the benefit.

    For many pregnant women, running is no longer a safe or comfortable exercise option as ligaments are loser during pregnancy along with increased weight and a shifting center of gravity which throws off balance. Running is also not doable for most women postpartum as your body is still healing and vigorous exercise in general is not recommended in the early weeks and even months following delivery. Running is particularly unadvisable for nursing moms who may suddenly have a heavy milk supply and a fuller chest. Tight sports bras are not a good choice as they can cause clogged ducts and mastitis. Walking, however, is an excellent way to ease back into exercise without hurting yourself while also allowing you some bonding time with your baby outdoors. Pushing a stroller while walking gives you the added strength and cardio workout that is even better exercise than walking alone.

    The study noted that to achieve the full benefits walking you need to clock in 10,000 steps a day. The good news is that these steps can be spread over the course of the day and you will probably find many of your day to day chores, errands and daily activities can expend up to half of that step requirement. However, if you are not used to walking this much, you should start slowly and gradually build up to this amount as you are safely able to do so. Also, make sure you invest in a good pair of walking or cross training shoes with adequate support for your joints to lessen the impact. Proper athletic shoes will help you avoid injury and comfortably walk further. (Please note that 10,000 steps of vigorous walking while pregnant should only be done with your doctor’s ok, and not for those who are early weeks postpartum.)

    Pregnancy is a great time to make positive changes in your health and fitness routines for life. You will need the stamina not only for labor when you deliver your baby in the coming months but also for caring for your newborn which can be a marathon in itself. So if you are not on bed rest and you are in good enough health to slip on your walking shoes, look into clocking a few more steps into your daily routine. Also don’t forget to hydrate frequently and avoid getting overheated by taking breaks as needed. Happy walking!

  • Tylenol during Pregnancy may be linked to ADHD

    It seems there are so many rules during pregnancy that it gets very confusing about what we need to take, like Folic Acid, and what we should avoid, like alcohol, caffeine and many pain medications. Now the latest research has uncovered that many seemingly benign over the counter pain relievers, including Tylenol, that are often prescribed to pregnant women, may not be as safe as we thought.

    A new study from Demark published Monday in the journal of JAMA Pediatrics now suggests that over-the-counter pain relievers with acetaminophen when used during pregnancy may be associated with ADHD behavioral problems in children. Although this is new research and the study authors were careful to state that “exhibiting ADHD-like behaviors” is not necessarily the same as being diagnosed with ADHD. All the same, it is cause for concern and for caution in taking medication containing acetaminophen as the active ingredient. This news is especially alarming since Tylenol has long been considered one of the safer medications pregnant women were advised to take for a fever, headache or the many aches and pains of pregnancy.

    If you have taken Tylenol during pregnancy do not panic. The study suggests that the risk is more highly associated with taking acetaminophen for long periods of time and particularly later in pregnancy. The women in the study that reported used acetaminophen pain relieving medications for 20 weeks or more had a 50% increase in requesting ADHD medication in their children later on. It is too early to assume that this is a cause and effect relationship but there is certainly enough evidence to avoid Tylenol and any medication containing acetaminophen during pregnancy if possible or at least to be very cautious in dosage and how long it is taken during pregnancy.

    This study reminds us to be extra vigilant about medications during pregnancy and to be sure to consult your doctor if you have any questions about any medication. No question is a stupid question for your doctor. Also it is important to do your own research on medications in addition to consulting your doctor as studies such as this one are very new and may not have made the rounds to all the medical communities. It is also important to have these conversations with your doctor to inform them of new information that may not have been known when they were in medical school and is not yet common knowledge.

    This study is also a reminder that we cannot assume that what we did prepregnancy exercise-wise, work-wise, or medication-wise is also safe during pregnancy and nursing postpartum. Also, it is a constant re-evaluation of what is best as our bodies are constantly changing during pregnancy, so nothing is static. If you are having pain issues there are many non pharmacological ways you can explore to deal with pain including massages, baths and acupuncture to name a few. While we do not want to be paranoid about everything we do, it is also better to err on the safe and conservative side during pregnancy when in doubt.

    Knowledge is power. It is important to do your own research during pregnancy and make your own informed decision about everything you decide to do. The end of day do not stress over your choices, just know you did the best you could do which is really what parenting is all about. None of us is perfect and guilt gets us nowhere, but informed decisions are the best way we can be the responsible and loving parent for our child that we all want and strive to be.

  • Folic Acid during Pregnancy may reduce Baby’s risk of Autism

    Most of us have received the news flash that we should take our prenatal vitamins and in particular we should take our folic acid when we are pregnant. Folic acid is an important vitamin for helping prevent neural tube defects in babies. However, did you know that it may help reduce autism?

    Now this is even more relatable a reason for most of us as autism is almost always in the news, seemingly on the rise or at least on the rise in terms of diagnosis and is surrounded by a shroud of mystery and debate over how a child can get it or be born with it.

    A new study in Norway found a very strong correlation between a reduction in autism and women who took folic acid supplements four weeks before their pregnancy and through at least the 8th week of their pregnancy. Women who took Folic Acid daily during this time period saw a 40% reduction in autism in their children (when they were tested about 8 years later) as compared to the children of the pregnant women in the group who did not take folic acid for this time period. This is a huge reduction in autism!

    Apparently timing does matter. The earlier you can start supplementing with folic acid prior to conception, the better. The study found that in terms of autism risk that the folic acid supplements did not seem to have any impact beyond the 22nd week of pregnancy. The crucial time interval was from four weeks before conception to eight weeks into the pregnancy.

    Of course it does not hurt to continue on with folic acid throughout your pregnancy and who knows, maybe there’s further benefits or risk reductions that are yet to be uncovered from continuing with folic acid beyond the first trimester. However, what researchers have uncovered so far is enough evidence to start any woman even thinking about having a baby to be popping a folic acid supplement right away.

    So what is folic acid? It is the B vitamin that helps with the construction and repair of DNA molecules which is the genetic code that controls all of the body’s cells, including the brain cells. It is especially important to take it early in pregnancy during the development of the baby’s spine and nervous system to prevent neural tube defects, including spina bifida. Doctors typically recommend that all women who are planning on getting pregnant to take 400 micrograms of folic acid daily from a multivitamin and continue taking this amount throughout their early pregnancy.

    Now with 1 out of 88 children diagnosed with autism we hope that this research will help us reduce the risk of childhood autism and increase awareness of our ability to potentially prevent this disability by supplementing with Folic Acid early in our pregnancy and even before. Knowledge is power so let’s empower ourselves and those we know with this scientific knowledge and preventative health measure of supplementing daily with Folic Acid if we are pregnant or hope to become pregnant. It’s an easy lifestyle adder that can reap benefits in our child’s health and well-being for a lifetime.

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