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  • Hopkins Looks Into Fitness Guidelines For Pregnant Women

    This article by Meredith Cohn, The Baltimore Sun

    Study to see how much exercise is healthy for mom, baby.

    Her Asics laced up and her water bottle at her side, Meredith Dobrosielski stepped onto the treadmill for a robust half-hour walk.

    For the Towson runner, this wasn't just any trip to the gym. The session took place in a lab at Johns Hopkins Bayview Medical Center in Baltimore. And each step offered information on the impact of exercise on her fetus. Dobrosielski is about 8 months pregnant.

    Doctors expect the information collected to fill in some gaps in the data on how much pounding is OK for a developing baby. Eventually, they hope to be able to develop personalized workout schedules for women in different states of fitness.

    "We do know that not only can exercise be done, it should be done," said Dr. Andrew J. Satin, professor and vice chairman of the department of gynecology and obstetrics for the Hopkins School of Medicine. "But the level of fitness should impact the individual's prescription."

    Not too long ago doctors used to tell all women not to exercise when they became pregnant, but that advice has changed, said Satin and Dr. Linda Szymanski, a fellow in maternal fetal medicine helping conduct the research. But there still is little data about what's too much for the elite athlete verses the couch potato and those in between. Satin said much is based on "opinion and common sense."

    They believe research is limited because doctors fear testing pregnant women. But nine months into the study, there have been no adverse reactions. As a precaution, the hospital's labor and delivery area is close by.

    About 60 women in their third trimester of pregnancy take turns on the treadmill. Some are regular runners and others are sedentary. Everyone takes a moderate walk, and the regular runners also run until they hit their peak capacity but don't linger there. Several measurements are taken over the sessions from fetal heart rate and blood flow to the womb to fetal movement and amniotic fluid levels. The fetuses are examined by ultrasound before and after treadmill work.

    Over time, the doctors plan to measure the impact on fetuses; partner with biomedical engineers to develop new ways to monitor the fetus, perhaps wirelessly during exercise; and collect long-term data on the pregnancy outcomes. The treadmill tests are the first step and some solid data should be available in a couple of months.

    Doctors and groups such as the American College of Obstetricians and Gynecologists and the American Pregnancy Association now give blanket advice to pregnant women to get 30 minutes of exercise a day.

    Potential benefits include improvement in general health and a decreased chance of gestational diabetes and hypertension, among others. Also, these groups say, that labor, delivery and recovery can be easier.

    But the advice is based on recommendations from government and groups such as the American College of Sports Medicine that non-pregnant people get such exercise. And it's filled with notes of caution for those who are just starting and those with certain conditions. The college suggests seeing a doctor first, starting slow and stopping when there's pain or bleeding — advice Satin doesn't dispute.

    He added that doctors do know driving up a heart rate and maintaining it there for too long can cut off blood flow to the fetus. Getting overheated and dehydrated are also problems. Joints also can become lax and balance may be off, so some exercises should be avoided, such as street biking late in pregnancy. Contact sports, horseback riding and downhill skiing also may cause injury from blows or falls.

    But he and others say not everyone has gotten the message that exercise is beneficial.

    It was a big change in 2008 when physical guidelines were published for Americans, including pregnant women, said James Pivarnik, who works with the sports medicine college and is professor kinesiology and epidemiology and director of the Center for Physical Activity and Health at Michigan State University.

    He said the guidelines do indicate "that the elite runner can continue doing what she is doing for a bit, provided her health care provider is in the loop, and that she has no warning signs or other issues." But he said "boutique" recommendations are hard with so many possible circumstances.

    "Pretty much the aerobic recs are the same as for anyone," he said.

    Pivarnik agreed more research is needed, such as Satin's. He's now looking at how much weight lifting is good for pregnant women.

    Szymanski said the incomplete data has only confused the message. "[Pregnant] women express frustration because a number of doctors give different advice. Some still tell them not to exercise, especially if they haven't been exercising."

    Outdated information and myths perpetuated by the Internet still mean many women who had been exercising — up to a quarter by some accounts — stop because they fear they will harm their babies, the doctors said.

    Satin said it's actually a really good time to suggest starting an exercise program. Women are more apt to take care of themselves when they are pregnant. They'll quit smoking, eat better and exercise for the sake of the developing baby and then carry over the good habits, he said.

    As long as jogging is comfortable, runners can keep at it. Stationary bikes and running in a pool also are good exercises, Satin said. And walking is safe for nearly everyone. The fetuses are not "flipping and flopping," he said. In fact, the entire uterus is moving with the exercise motion, buoying the fetus.

    Satin said his interest in pregnant athletes grew out of his work with women in the military who wanted to stay physically fit. He was formerly a professor and chair of the Uniformed Services University F. Edward Hebert School of Medicine in the obstetrics and gynecology department. Szymanski also is an exercise physiologist and collegiate athlete.

    Dobrosielski, who is about to have her second child, said she decided to participate in the study because she wanted to help other women. She's been running "forever" and played field hockey in high school and college. An ankle injury stopped her from running after 4 months, but everyday she runs in a pool, or does yoga, lifts weights or rides a stationary bike.

    She knows she won't lose as much of her fitness and will be able to return to running, even racing, quickly. Others should be able to find out what's good for them, she said.

    "It's a special population and there's so little time for study," she said of pregnant women. "I felt comfortable exercising and I knew when I needed to stop. I think it's important for all women to exercise and maybe this research will convince them to do that."

    Exercising while pregnant

    Several medical organizations recommend 30 minutes of exercising a day for pregnant women.

    •If you're just beginning or have a condition, consult your doctor. Start slow and stop if you have pain or bleeding.

    •Don't get overheated, stay hydrated and take breaks.

    •Your joints may be lax and your balance off, particularly in later months, so avoid unstable ground or consider a stationary bike or running in a pool.

    •No contact sports, but some weight training is OK. Avoid lying on your back after the first trimester.

  • 2 Studies Present New Data On Effects Of Alcohol During Pregnancy

     

    These new studies have recently been reported.

    Scientific data continue to indicate that higher intake of alcohol during pregnancy adversely affects the fetus, and could lead to very severe developmental or other problems in the child. However, most recent publications show little or no effects of occasional or light drinking by the mother during pregnancy. The studies also demonstrate how socio-economic, education, and other lifestyle factors of the mother may have large effects on the health of the fetus and child; these must be considered when evaluating the potential effects of alcohol during pregnancy.

    A very large population-based observational study from the UK found that at the age of 5 years, the children of women who reported light (no more than 1-2 units of alcohol per week or per occasion) drinking did not show any evidence of impairment on testing for behavioral and emotional problems or cognitive ability. There was a tendency for the male children of women reporting "heavy/binge" drinking during pregnancy (7 or more units per week or 6 or more units per occasion) to have poorer behavioural scores, but the effects were less clear among female offspring.

    A second study, published in Pediatrics, based on a population in Western Australia examined the associations between dose, pattern, and timing of prenatal alcohol exposure (PAE) and birth defects and found similar results, that there was no association between low or moderate prenatal alcohol exposure and birth defects.

    Data from a randomly selected, population-based cohort of non- indigenous women who gave birth to a live infant in Western Australia (WA) between 1995 and 1997 (4714 participants) were linked to WA Midwives Notification System and WA Birth Defects Registry data. Information about maternal alcohol consumption was collected 3 months after birth for the 3 month period before pregnancy and for each trimester separately.

    Low alcohol consumption was defined as less then 7 standard drinks (10g) a week, and no more than 2 drinks on any one day. Women who consumed more than 70g per week were classified as heavy drinkers and women consuming more than 140g were classified as very heavy drinkers.

    Overall, current scientific data indicate that while drinking during pregnancy should not be encouraged, there is little evidence to suggest that an occasional drink or light drinking by the mother is associated with harm. Heavy drinking, however, is associated with serious developmental defects in the fetus.

  • Drinking More Milk And Less Soda Helps To Build Strong Bones

    This article by Elena Conis, at the Los Angeles Times

    Want strong bones? Eat foods high in calcium and vitamin D, get plenty of exercise — and maybe steer clear of soda.

    In recent decades, as consumption of the beverage has steadily displaced the consumption of others —particularly milk — studies have consistently linked soda consumption with weaker bones. Now scientists are trying to figure out how and why, precisely, drinking soda may affect skeletons.

    One theory is that a component in cola may cause bone to deteriorate; another is that people who drink soda simply drink (and eat) fewer nutritious foods.

    In the 1990s, several studies suggested soft-drink consumption might be linked to lower bone mass and reduced bone accretion — the process by which bone is built up — in children, especially teens.

    In a study of 127 teens that was published in the Journal of Adolescent Health in 1994, teenage girls who drank carbonated beverages were three times as likely to suffer bone fractures compared with girls who didn't drink soda. A study by the same author published in the Archives of Pediatric Adolescent Medicine in 2000 showed the same effect — and an even stronger one for girls who drank cola beverages, who were five times as likely to suffer bone fractures.

    Researchers surmised at the time that soda took its toll on bones because children who drank soda did so in place of milk. Soda drinking was also seen as a marker for a generally unhealthful diet lacking items that help foster strong bones.

    It does seem to be true that soda drinkers have worse diets overall. In a study published this month in the Journal of the American Dietetic Assn., for example, among 170 girls followed from age 5 to 15, those who drank soda at age 5 were less likely to drink milk throughout childhood than 5-year-olds who did not drink soda. And they were more likely to consume diets lacking in calcium, fiber, vitamin D, protein, magnesium, phosphorus and potassium.

    Such findings are significant because as much as 90% of bone mass is acquired in youth, particularly from age 16 to 25, says Dr. Jeri Nieves, director of bone density testing at Helen Hayes Hospital in West Haverstraw, N.Y.

    Children who fail to get enough bone-building nutrients and bone-thickening exercise in their youth end up with increased risk of osteoporosis and fracture as they get older, adds Dr. Robert Murray, director of the Center for Healthy Weight and Nutrition at Nationwide Children's Hospital in Columbus, Ohio.

    But there is also evidence that drinking sodas — specifically, colas — may take a direct toll on the skeleton, says Dr. Katherine Tucker, professor of health sciences at Northeastern University in Boston.

    In a large, well-designed study published by Tucker and colleagues in the American Journal of Clinical Nutrition in 2006, women enrolled in the ongoing Framingham Osteoporosis Study who drank just three or more colas a week had a 3.7% to 5.4% lower bone mineral density in their hip bones when compared with women who didn't drink the beverage.

    The study also showed what scientists call a dose response: The more soda participants drank, the lower their bone mineral density.

    The effect was seen only with colas — non-cola soft drinks, such as ginger ale and orange soda, had no effect on bone density. That finding led Tucker and colleagues to suggest that the phosphoric acid in cola is behind its bone-weakening effects.

    Phosphoric acid is added to colas for its tangy flavor. It's not normally found in the food chain, Tucker says. When ingested, it causes the acidity of the blood to increase; to adjust the blood's pH, the body draws calcium out of bones and into the bloodstream.

    These proposed effects of phosphoric acid on bone are largely theoretical, but they are supported by animal studies and some human research. A Danish study published in the journal Osteoporosis International in 2005 measured the blood levels of bone minerals in a group of men after they consumed a low-calcium diet and 2.5 liters of soda daily for 10 days, and then again after they consumed a normal diet and 2.5 liters of skim milk for 10 days.

    During the cola-drinking period, the men had higher blood levels of the bone mineral phosphate, the bone turnover protein osteocalcin and a substance called CTX — results that indicated minerals were being removed from bone, and not replaced, during the soda-drinking period.

    Scientists are continuing to test the theory that phosphoric acid in soda harms bones. But even if it turns out that phosphoric acids cause only small or temporary changes in bone composition, these can add up over time, Tucker says.

    In the meantime, Nieves suggests, it's probably wise to limit your intake of soda.

    "It's not like alcohol, where one drink a day is OK," she says. "Because bone mass is constantly changing throughout life, soda can cause bone loss at any stage."

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