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Gestational Diabetes:  Too Much of a Good Thing?

10/25/2016

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Almost everyone has a bit of a sweet tooth, and for some women, pregnancy can make this even more pronounced.  I mean, after all, there’s cake, pie, ice cream, chocolate, cookies..I’m getting hungry just thinking about it.  However, whenever that occasional indulgence becomes a regular event, we can begin to see some negative effects on your pregnancy, particularly if you develop diabetes in pregnancy.

What is gestational diabetes?  All moms develop some level of insulin resistance during pregnancy, which is important to allow the baby to drawn nutrition from mom’s blood, but some moms are overachievers :)  When we begin to see excess glucose (sugar) in the mother’s blood, that’s what happens with gestational diabetes.

When do we test for it?  Generally, screening occurs between 24-28 weeks of pregnancy, but early screening is indicated for those with a history of gestational diabetes, insulin resistance and with some other risk factors.  For those tested early who don’t pass the screening, we can initiate treatment sooner.  For those who pass the early screening, they aren’t totally off the hook until they also pass the screening between 24-28 weeks.

How do we test for it?  There are a couple of testing regimens, but they all involve drinking a prepackaged sugary drink (sorry, they’re generally kind of gross) and checking blood sugar levels at appointed times after you’ve finished the drink.

So, why are you making me drink that nasty drink again?  Gestational diabetes can lead to excessive birth weight.  While that little marshmallow is certainly cute with all of those rolls, larger babies increase the risk for both cesarean section and for birth-associated trauma while in the birth canal.  This is often associated with the baby’s shoulders being stuck in the vagina.  Additionally, there is increased risk of preterm birth and respiratory distress for babies with mom with gestational diabetes.  There is also a greater chance for both short term (requiring admission to the NICU) and long term (developing diabetes later in life) issues with your baby’s glycemic control.  Maternal glucose control that requires medicine may also increase the risk of late pregnancy loss and is also often an indication for fetal monitoring during the latter part of pregnancy.

But I really like my sweets...  Gestational diabetes not only affects your baby, but it can also increase your risk of preeclampsia (high blood pressure in pregnancy that can threaten the lives of both mom and baby) as well as maternal development of diabetes later in life.

In short, diabetes in pregnancy does matter, to both mom and baby.  Be sure to talk to your doctor about how to reduce your risk and how best to control it if you do develop gestational diabetes.

Nick
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To Dye or Not To Dye

10/18/2016

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Its so hard to feel like yourself when you are pregnant: Your clothes don’t fit, your body is constantly changing, you feel tired all the time, and you can barely see your toes.  You just want to feel normal and spoil yourself, but don’t know what is safe while you are pregnant.  This segment will focus on hair and hair products- what’s safe and what’s not based on the latest research. 

1. Can I color my hair while I am pregnant?  I get this question all the time.  You can get highlights in any trimester because the chemicals don’t touch the scalp, but you should wait until after the first trimester to dye your hair.  Because the color is placed directly on the scalp, it can potentially get absorbed into your blood and make its way to the baby via the placenta.  The first trimester is very important for growth and development and products that can be potentially harmful to a developing baby should be avoided in the first trimester.  Though we do not actually have any studies that show that hair dye is harmful to developing babies, that is because it is really hard to get pregnant women to volunteer to test out various chemicals while they are pregnant.  Because there is so much blood flow to the scalp, it is best to avoid chemicals that could potentially cause birth defects in the first trimester.  If you absolutely need to dye the roots in the first trimester, please use a vegetable based dye, which means avoiding any products that use ammonia or peroxide.  Many women use a henna product since it is plant based.   

2. What about a relaxer or a Brazilian Blowout?  Again, we don’t know the effects of these chemicals on a developing baby.  So the answer is, if you absolutely need to get one of these types of treatments, please wait until after the first trimester.  Also be aware that because your hair and skin undergo changes from the hormonal milieu while you are pregnant, these treatments may not have the same result while you are pregnant.  Another thing to consider is that these products have a very strong odor: Just as you can have sensitivity to certain types of foods while pregnant, you may have a more intense reaction to the smell of these chemicals while pregnant.  

3. What’s the best way to get rid of unwanted hair while I am pregnant?  Shaving and waxing remain safe methods to get rid of hair while you are pregnant, but many women experience more pain and sensitivity when they are pregnant.  Avoid hair removal or bleaching creams-similarly to dying your hair, they can be absorbed through your skin into your blood stream.  Also avoid laser hair removal because it can cause pigmentation changes (light or dark spots where the hair is removed).  Electrolysis is also not recommended: It either uses an electric current or heat to remove hair, and the safety of these methods are not known.  Electrolysis can also cause pigmentation changes while pregnant.  

There you have it, a general guide to hair care in pregnancy!  As always, if you have specific questions be sure to discuss these with your provider, but remember, you can still treat yourself to the hair look you want during pregnancy :)


Pam
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Maintaining your Breast Health:  An Owner's Guide

10/11/2016

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As we take time to commemorate breast cancer awareness month and remember those who have battled breast cancer valiantly and lost, we also would like to celebrate those who have won their personal struggle against breast cancer.  For all of those who brave women who have overcome breast cancer, we salute you.  For those who have been fortunate to avoid a personal experience with breast cancer, we would like to offer a few suggestions on how to continue good breast health.

How many women are affected by breast cancer? Even in absence of a genetic predisposition to breast cancer, a woman faces a 1 in 8 chance (about 12%) of getting breast cancer in her lifetime.  That means, if you and seven of your girlfriends go to dinner, odds are that one of you will likely be affected by breast cancer in her lifetime.  For women who are BRCA 1 carriers, this may increase to 55-65% chance of breast cancer by age 70, and it increases to 45% by age 70 with BRCA 2 mutation.

What are risk factors for breast cancer?  Age (older than age 50), genetic mutations, early menses (starting your cycle prior to age 12), later or no pregnancy (first pregnancy after age 30), late menopause (after age 55), lack of physical activity, being overweight or obese after menopause, dense breast tissue, use of combination hormone therapy (estrogen and progesterone) after menopause, use of HIGH (not low) dose combination birth control pills (estrogen and progesterone), personal history or family history of breast cancer, personal history of atypical hyperplasia or lobular carcinoma in situ of the breast, previous radiation therapy, history of DES use and drinking alcohol.

What are warning signs of breast cancer?  New breast lumps (although not all breast lumps are cancer); thickening or swelling of the breast; irritation, redness, flaking or dimpling of breast skin; pulling in of the nipple (retraction); painful nipples; discharge, including blood, other than breast milk; change in size or shape of the breast; and new breast pain.

Who should be screened and when?  Screening guidelines vary depending on the organization’s guidelines are used.  The American College of Obstetricians and Gynecologists (ACOG) suggests annual clinical breast exams and mammograms annually beginning at age 40 for women of average risk.  Although this varies slightly in comparison to the US Preventive Task Force and American Cancer Society guidelines, given the frequency of affected women as well as the more rapid progression of breast cancer in comparison to cervical cancer, we generally use the ACOG guidelines. Lastly, self breast exams are recommended monthly in all women.  This is generally best done in the shower while the tissue is softest.

What about BRCA testing?  It may be considered in those with a close relative (i.e. mother, sister, grandmother) diagnosed with breast cancer earlier than age 50, cancer in both breasts in the same woman, breast and ovarian cancers in the same woman or same family, multiple breast cancers in the same family, two or more BRCA-associated cancers in the same family member, male breast cancer and Ashkenazi Jewish ethnicity.

Is there anything I can do to decrease my risk?  Maintaining a healthy weight, exercising regularly, either avoidance of or limiting alcohol consumption, avoidance of carcinogens (chemicals that can cause cancer), limiting radiation exposure (except with medically indicated testing), breastfeeding children, limiting use of combined hormone replacement (use of estrogen and progesterone, used to avoid endometrial cancer in menopausal women with a uterus), and using lower-dose birth control pills when possible.

If you have any concerns about breast health, please be sure to contact your provider for more information.  Once again, we would like to take a moment to honor those brave women (and the families of those women) who have faced, or are facing, breast cancer.   While we certainly want to acknowledge you this month, know that you are in our thoughts all year.

Nick
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Can my weight affect my chances of getting pregnant?

10/4/2016

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Yes, your weight and fertility are very intimately intertwined, and so being underweight, overweight or obese can affect your ability to become pregnant.  What most women don't realize is that your weight can affect your ability to ovulate.  Even if you are only slightly overweight or underweight, this can affect your ability to ovulate, and if you are not ovulating you will not get pregnant!  For some women, even losing or gaining as little as 5 to 10 pounds can help their cycles become more regular, which may help with ovulation.


If you are worried that your weight is affecting your fertility, calculate your BMI!  BMI, aka body mass index, is how your doctor will refer to your weight and is a measure of body content based on height and weight.  A BMI within the 19-25 range is considered normal while a BMI in the 25-30 range is considered overweight.  A BMI over 30 is considered obese.  If your BMI is under 18.5, you're considered underweight.  Your BMI does not have to be within the normal range to become pregnant but any movement towards the normal range may help you start ovulating.

Being underweight can impact fertility.  Women with lower than normal BMI either because of nutrition or extreme exercise (think of Olympic gymnasts or ballerinas and extreme endurance athletes) can experience hypothalamic amenorrhea (a fancy way of saying that a women’s menses stop due to disruption of the normal hormonal change).  Of course no period for these women means no ovulation and hence no pregnancy.  Usually weight gain and increased body fat will cause them to resume normal periods (go for the extra slice of pizza!).  

Being overweight or obese can impact fertility.  Women who are overweight or obese are at increased risk of having polycystic ovarian syndrome, where hormonal imbalances prevent them from having normal periods and hence ovulating.  Most of these women will notice that even losing 10 to 20 pounds will cause them to resume their normal cycles and start ovulating again.  

Your partners' weight matters too!!!  Unfortunately we women always think it is our fault, but studies have shown that men with a BMI over 30 (which is considered obese) have a lower sperm count.  If you and your partner are both overweight or obese, then start an exercise or nutrition regimen together.  In addition to increasing sperm counts and successful ovulation, couples who exercise together have more frequent intercourse (what a fun way to burn some calories!).  This may be doubly beneficial to your chances of conceiving!

Remember weight loss and achieving a weight closer to a normal BMI will not only make you more likely to conceive but will also help you have a more healthy pregnancy.  It will decrease your chance of having miscarriage, gestational diabetes, preeclampsia and as well as your need for a cesarean section.  Additionally, a small weight change that returns your cycles to normal can reduce the need for medications (and their side effects) to improve fertility.  Be sure to talk to your doctor if you think your weight is affecting your fertility!

Pam
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