Posts Tagged ‘ gestational diabetes ’

5 Things Every Pregnant Woman Should Know (Though Your Doctor Won’t Tell You)

Wednesday, April 17th, 2013

Jennifer Margulis, Ph.D., an award-winning journalist and a Schuster Institute Fellow at Brandeis University, has just released a new book called The Business of Baby. In it she takes on a number of controversial issues facing those who are thinking of becoming pregnant, are pregnant, or are new parents. Here she offers a guest blog post with her take on 5 key things that every pregnant woman should know. 

1. Prenatal vitamins can make you sick: Not all prenatal vitamins are created equal. Some “natural” brands, whether over-the-counter or prescribed by a doctor, contain harmful additives, including petroleum-based dyes like Red 40. The nausea you’ve attributed to pregnancy hormones may actually be from the vitamins you’ve been told to take.

2. Ultrasounds are not medically recommended: Though some doctors do them at every visit, routine ultrasounds are not recommended by the American College of Obstetricians and Gynecologists for normal pregnancies. There is no evidence that ultrasounds improve pregnancy outcomes but there is an increasing body of evidence that prolonged exposure to ultrasound can cause harm.

3. How much weight you gain is not as important as what you eat: Every woman gains weight differently but all pregnant women need nutritious, fresh, high quality food. The fat your body stores during pregnancy is there for a reason: to give you reserves for breastfeeding after the baby is born. It’s much more important to eat high quality protein, healthy fats, fresh vegetables and fruits, whole grains, and unprocessed foods than to worry about the amount of weight you’re gaining. Doctors actually look down on nutrition as irrelevant and unimportant, says Michael Klaper, M.D., director of the Institute of Nutrition Education and Research in Manhattan Beach, California. “There’s an inherent contempt for nutrition built into Western medicine,” Klaper explains. “Nutrition is a sissy sport among physicians.”

4. You can avoid gestational diabetes and anemia: With a healthy whole food based diet and enough exercise, most women can avoid common pregnancy problems. According to Stuart Fischbein, M.D., a Los Angeles based obstetricians with 30 years experience, the key is to eat proactively, avoiding processed sugar and doing enough exercise (to prevent gestational diabetes) and eating iron-rich foods (like eggs, red meat, and green leafy vegetables) along with foods high in vitamin C to help your body absorb the iron (to prevent anemia).

5. Your doctor believes birth is an illness: Growing a human being inside your body may be the most magical, spiritual, awe-inspiring time of your life, but your obstetrician has been taught to look for worse case scenarios and view your pregnancy as an accident waiting to happen. If you want a care provider who shares your wonder and a gentle birth, pick a well-trained midwife over a doctor.

 

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Is Maternal Obesity Linked With Autism? Let’s Take A Closer Look At the Study

Monday, April 9th, 2012

You may have seen or heard this morning about a new study that found links between maternal obesity and risk for autism. Here’s a breakdown on the study, the findings, and the take-home message.

What Did This Study Do? The research – published in Pediatrics – explored links between maternal metabolic conditions – specifically diabetes, hypertension, and obesity – and neurodevelopmental disorders in early childhood – particularly autism spectrum disorders (ASD) and developmental delays (DD). The sample was informative – it is a population-based sample in California that is participating in a very large investigation. That said, it’s important to keep in mind that maternal history of diabetes and hypertension during pregnancy, and obesity prior to pregnancy, were gathered retrospectively via a phone interview with the mother when kids were between 24 and 60 months of age, and also from medical records when available (which they were for over half the sample). I highlight this to emphasize that this is far from a definitive study  - not that it’s a bad study, just that it is more like the first word, rather than the last word, on this topic. Do note that the available data suggested that moms could reliably report retrospectively (when they compared their responses to available medical records) – but still, this is not as informative as a prospective study. Moms were selected based on the profiles of 3 types of youth – those with ASD, those with DD, and a general population (GP) control group with neither condition. The researchers then set out to examine if there were links between the maternal metabolic conditions and these three groups of kids. So keep in mind here that this is a statistical test of association, not a more controlled experimental test that can, if you will, “prove” the associations. These kinds of studies are critical first steps to determine if future research is warranted – and not the last steps that convince the scientific community that there is a causative process at play.

What Did They Find? Keeping all of the above in mind (you have to in order to make sense of the results), the study did find a statistical link between a mother’s report of having any of the metabolic conditions and the odds of having a child diagnosed with ASD and DD. It was a moderate statistical finding (meaning statistically significant but clearly not the only factor that contributes risk for ASD and DD). To give you a sense of the data, here are the percentages of mothers with a metabolic condition, broken down by youth diagnosis:

ASD: 28.6% of the mothers

DD: 34.9% of the mothers

GP: 19.4% of the mothers

So you can see how this is a moderate statistical link – for example: 1) the majority of moms of kids with ASD did not have any metabolic conditions, 2) almost 20% of the moms of kids from the general population control group did have a metabolic condition; and 3) the finding comes from the somewhat elevated rates in the ASD and DD groups compared to the GP group. More fine-grained analyses showed that obesity in particular was associated with ASD (after controlling for other factors) – but that diabetes had an effect on a number of cognitive and social outcomes.

What’s The Take-Home Message? There are two messages from my point of view. First, from the perspective of science, the study authors devote most of their attention in their discussion of the results on the biological mechanisms by which maternal diabetes – not maternal obesity – may impact brain development in babies. This is an important avenue for future research and a key contribution from the study. Second, from the perspective of being a prospective parent, the real take-home is that management of maternal metabolic conditions is not only critically important for a number of health outcomes, but also for promoting brain development in the early years of life. Rather than focusing on metabolic conditions as “causes” of disorders, it’s probably better advised to consider them as modifiable influences on development. Maternal obesity is important in this sense because it is one of many factors associated with diabetes – though keep in mind that gestational diabetes can of course occur without obesity. Diabetes – whether in place prior to pregnancy or occurring during pregnancy – is important because it might have biological influences on brain development. So this study just reinforces the bigger message that I hope everyone is aware of – that pregnant women should get vigilant care for potential or existing metabolic conditions during pregnancy, especially diabetes. It’s critical for the well-being of both mom and baby.

Image of word “diabetes” via Shutterstock.com

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