UVA Health System Blog

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Maternity Monday: All About Gestational Diabetes

On April 20, 2015 | At 9:17 am

Gestational diabetes is a common condition that affects up to 10 percent of pregnant women. We talked to Annelee Boyle, MD, a maternal-fetal medicine specialist at UVA Health System to find out more about it.

Stories about preconception, pregnancy, childbirth and postpartum

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

What causes gestational diabetes?

We don’t know exactly what causes gestational diabetes, but if you think about it, there are certain hormones that the placenta produces that increase a woman’s glucose levels. That’s because glucose, a type of sugar, is a fuel the fetus needs to grow, so it makes sense, in certain women, their bodies can’t compensate for what is a normal physiological response.

How is gestational diabetes diagnosed?

If we have a suspicion that a woman is at risk in the first trimester, we’ll check with a sugar test at her first visit. At-risk women may be overweight, have a family history of diabetes or have had gestational diabetes in prior pregnancies. We screen everyone at the end of the second trimester, about 24–28 weeks gestation, using a simple glucose tolerance test. That’s where you drink a sugary liquid, fondly described as “the gross orange stuff,” and have your blood drawn an hour later.

The liquid contains 50 grams of glucose. This allows us to see how your body responds to a large influx of sugar. If your blood glucose is high on the screening test, then we get a more detailed glucose tolerance profile. During this diagnostic test, you drink twice as much glucose and, instead of drawing your blood once, we draw four times over three hours.

Why do you test at 24-28 weeks?Patient with diabetes montitor

We test then because we know we can make a difference in outcomes. Diabetes in pregnancy affects mom, but it also affects the fetus. Babies born to moms who are diabetic are at higher risk of:

  • Stillbirth
  • Birth defects
  • Getting too large, which puts them at higher risk of birth injury

No pregnancy has zero risk, but by controlling blood sugar, the risk for mothers with diabetes is about the same as mothers without diabetes. That’s really our goal: to give babies and mom the best shot.

How do we treat gestational diabetes?

For a lot of women, following a diabetic diet and increasing physical activity, particularly after meals, will control their gestational diabetes. Our fabulous nutritionists can help with meal planning. I encourage my patients to take about a 10-minute walk after each meal. For other women, gestational diabetes is a little more difficult to control. In these cases, oral medication may do the trick. As a last resort, we may have to use insulin, which I try to avoid because people don’t like giving themselves shots, but it may be necessary in some cases. Whether you do the shots, pills or no medication at all, you have to test your blood sugar about four times a day and do what it takes to keep it within the proper range.

Does this mean your pregnancy is considered high risk?

It is higher risk. I don’t like to say high risk because women may feel they have a big sign or target on them, but it does require some special care and attention.

Do you need to see a maternal-fetal medicine (MFM) doctor if you have gestational diabetes or can you see your regular obstetrician?

It depends on your regular OB. I know a lot of doctors are very comfortable dealing with diabetes that’s well controlled with diet and exercise or even with oral medication, but if you need insulin, I would recommend seeing a specialist. A woman and her doctor should work this out together. If you do get to the point that you need medication, either with pills or with insulin, we would recommend an ultrasound to make sure the baby is growing properly. That can be done at a high-risk doctor’s office or at your own doctor’s office. You may also need to monitor the baby’s activity through something like a non-stress test or biophysical profile. Those are two different tests, but both look to see if the baby is healthy and active.

Are you more likely to get gestational diabetes with subsequent pregnancies?

You are. Think of pregnancy as a stress test for your body. You’re also eight times more likely to develop type 2 diabetes later in your life if you have gestational diabetes. I tell my patients to look at this as positive. Knowing you’re at increased risk for type 2 diabetes, you can make better choices and changes outside of pregnancy. By placing a high priority on maintaining your weight and staying physically active, you may be able to stave off type 2 diabetes.

What can you do to prevent it?

Try to enter a pregnancy at the peak of health. If you’re at normal weight before pregnancy, you’re less likely to develop gestational diabetes. Also follow a reasonable diet and exercise plan while you’re pregnant. Your baby really only needs an extra 300 calories a day, and you probably don’t need to gain any weight until after the first trimester. Remember:  You’re eating for two, but you’re not eating for two linebackers.

When does gestational diabetes go away?

It should go away when we remove the placenta because the placenta is what causes the extra hormones that increase your glucose. But sometimes it doesn’t go away. We want to test everyone with gestational diabetes at six weeks after birth to make sure it’s gone and the patient isn’t really a type 2 diabetic. If you have gestational diabetes, let your primary care doctor know and be tested periodically, usually once a year, to make sure you’re not developing type 2 diabetes outside of pregnancy.

Anything else?

The word diabetes sounds really scary, but you can still have a healthy pregnancy. We’ll work with you to achieve the very best outcome for you and your baby.

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Maternity Monday: Prenatal Genetic Counseling FAQs

On April 13, 2015 | At 9:27 am

Pregnancy — or even planning a pregnancy — comes with a lot of questions.

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

You may have heard that the older you get, the higher your baby’s risk of Down syndrome. Maybe one of your relatives has sickle cell anemia or cystic fibrosis. How do you know how high your baby’s risk is? Are the screening tests you’ve read about worth it?

We sat down with prenatal genetic counselor Logan Karns, who frequently sees couples wrestling with these issues, and asked her some common questions.

What is prenatal genetic counseling?

Genetic counseling is a process of gathering information and evaluating the risk for a woman to have children with certain genetic conditions. I look at the couple’s family history and, if they are already pregnant, we discuss any screening tests they may have had.

If they are at a higher risk to have a child with a specific genetic condition, or if they have already had a screening test that indicates a birth defect, we talk about the next steps. This helps them to decide if they want to have more testing.

What are the chances of a significant birth defect in a low-risk pregnancy?

The background risk for any couple to have a child with a birth defect is 2-3 percent. The risk increases if the mother:

  • Is over 35
  • Has a family history of birth defects
  • Had a previous child with a birth defect

Many birth defects happen by accident, with no known cause. When they do happen, most women wonder whether the birth defect happened because of something that they did. We try to reassure women that this is not the case.

What are the more common conditions you’re looking for?

  • Spina bifada
  • Cystic fibrosis
  • Down syndrome
  • Heart defects
  • Sickle cell anemia

“Common” is, of course, a relative term, and everyone needs to look at a number and decide whether it feels like a high risk or a low risk to them.

When should a couple see a genetic counselor?

what is prenatal genetic counseling

Prenatal genetic counselor Logan Karns

Usually I see couples in their first trimester. But it’s also not uncommon for me to see women in their second trimester, after they have received abnormal results from a screening test or procedure.

The best time for us to see people is before they are pregnant. We go through their family history, answer questions and talk about different approaches to screening based on either their family history or their ethnic background.

It is helpful to hear the information and make choices ahead of time. It can be more complicated when couples come in and they are already pregnant, and they have to make choices in a timely way. If we review the family history and identify something that requires testing, then timing can be a critical element.

What prenatal screenings and tests detect genetic conditions?  

First trimester screening

Type of test: Blood test and ultrasound

When performed: Weeks 11-14

Recommended for: All pregnancies

Screens for: This test gives you your baby’s risk for certain chromosomal abnormalities, including Down syndrome. However, as it’s not a diagnostic test, you’d need more testing to determine if your baby has these conditions.

Non invasive prenatal screening (NIPS)

Type of test: Blood test

When performed: After 10 weeks

Recommended for: High-risk pregnancies, women over 35

Screens for: Specific chromosomal abnormalities. Like first trimester screening, this is a screening test and you’d need a diagnostic test to be completely sure. 

Chorionic Villus Sampling (CVS)

Type of test: Placental cells collected either by using a catheter that goes through your cervix or by inserting a needle through your abdomen (similar to amniocentesis)

When performed: Weeks 11-13

Recommended for: High-risk pregnancies, women over 35

Screens for: Chromosomal abnormalities and genetic disorders

Amniocentesis

Type of test: Amniotic fluid cells collected through a needle inserted into the amniotic sac through your abdominal wall.

Timing: Weeks 15-22

Recommended for: High-risk pregnancies, women over 35

Screens for: Chromosomal abnormalities and genetic disorders.

QUAD Screening

Type of test: Blood test

Timing: Weeks 15 to 21

Recommended for: All pregnancies, offered to women who haven’t already had a screening test

Screens for: Down syndrome, trisomy 18 and spina bifada, but like FTS and NIPS, you’d need a diagnostic test if your results are abnormal.

A lot of these tests are recommended for women over 35. What’s so special about 35?

Because amniocentesis and CVS are considered invasive tests, there is a risk of complications, including miscarriage. The chance to have a miscarriage depends on which test you choose. At 35, the odds of having a baby with a chromosomal abnormality like Down syndrome or Trisomy 18 are about equal to the odds of having a complication from one of these diagnostic tests.

Why is NIPS only recommended in high-risk pregnancies?

The majority of studies involving NIPS have so far only looked at high-risk women.  At this time, there is not enough information about the ability of the test to be helpful to low-risk women. The current recommendation from the American College of Obstetricians and Gynecologists is therefore not to offer NIPS to women considered low-risk. UVA has chosen to follow those recommendations.  This may change as more published data become available.

I’m adopted and don’t know my family history. Should I still see a genetic counselor?

Genetic counseling isn’t just about going through your family history. We can still talk to you about your risk factors, including your ethnicity and the chances of a birth defect based on your age.

What happens if screening does reveal a significant birth defect?

When a birth defect is diagnosed during a pregnancy, support services are available to help parents decide how to manage their pregnancy. This is obviously a very painful and complicated time. We work with pregnant women and their families to outline all the options, help them choose how they would like to proceed and get them the support that they need.

Interested in meeting with a prenatal genetic counselor? You can:

 
 

Maternity Monday: Expecting the Unexpected — High-Risk Pregnancy

On March 30, 2015 | At 8:47 am

Laura Aimone’s pregnancy was progressing along normally, although she did feel tired in her second trimester, which she didn’t expect. “I just kind of figured that’s what me being pregnant was,” she says. Her baby was measuring small, but doctors at University Physicians for Women at Northridge were monitoring it.

Stories about preconception, pregnancy, childbirth and postpartum

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

Headaches: A Warning Sign

Due on August 28, 2013, Aimone began experiencing bad headaches in July. “I didn’t know that was a sign of anything,” she says. Headaches can, in fact, indicate preeclampsia, a serious pregnancy-related condition characterized by high blood pressure. It can cause poor growth, placental abruption (separation of the placenta from the uterus) and damage to the mother’s organs.

Preeclampsia is diagnosed by testing for protein in the urine. But when Aimone next went to her doctor, a test didn’t find any protein. While her blood pressure was elevated to 130/95, her baby looked fine during an NST (non-stress test), which measures a baby’s heart rate and movements. Aimone was ordered to take it easy, but she admits she didn’t understand what that meant. She took a yoga class that night that which left her with a horrible headache; when she called UVA’s Labor and Delivery Department, the staff had her come in.

Aimone’s blood pressure was high but it went down after resting and there still wasn’t any protein in her urine. Tests again showed the baby was in good condition. “They said, “We’re not going to deliver the baby tonight. I think my husband and I said, ‘Well, no, we’re not going to deliver the baby tonight! We have six weeks to go and I’m going to be late because first pregnancies are late.’”

Aimone was scheduled to do a 24-hour urine test, which more accurately measures the amount of protein in the urine, but without those results doctors still weren’t prepared to officially diagnose her. Still, at this point she learned what taking it easy really meant when doctors told her she could get out of bed to use the bathroom.

What is a High-Risk Pregnancy?

Aimone’s pregnancy had quickly progressed from normal to high-risk. A high-risk pregnancy means there are complications that could affect the mother, the fetus or both.

Women with a high-risk pregnancy often see a maternal-fetal medicine specialist (MFM). Other names for this type of doctor, who has specialized training in treating high-risk pregnancies, are:

  • High-risk obstetrician
  • Perinatologist

“Fortunately, the vast majority of pregnancies proceed along fairly normally and don’t really need to be seen by someone who’s a high-risk obstetrician. Most women are low risk,” says Donald Dudley, MD, division director of the Division of Maternal-Fetal Medicine at the University of Virginia. “But for moms-to-be who are high risk, at UVA, we have a team of maternal-fetal medicine specialists who treat women at our Maternal and Fetal Medicine Clinic at the new Battle Building.“

Women with high-risk pregnancies usually spend more time with the doctor and are seen as often as twice a week throughout their pregnancy. They also need additional blood tests, ultrasounds and possibly specialist visits. For women for whom these additional visits become a hard to manage, UVA doctors often set up programs with local care providers and use the telemedicine program, making appointments less of a burden.

Diagnosis of Preeclampsia

Farmer Waverly trick or treats on UVA's Lawn with her parents in 2014.

“Farmer” Waverly trick or treats on UVA’s Lawn with her parents in 2014.

After her visit to Labor and Delivery, Aimone had a scheduled appointment for a special ultrasound called a biophysical profile, which is used in high-risk pregnancies to measure the baby’s breathing, movement, amniotic fluid, muscle tone and heart rate. It showed the baby was in great condition. The results of the 24-hour urine test were in, though, and they showed Aimone did have preeclampsia, so Megan Bray, MD, sent Aimone back to Labor and Delivery for an assessment.

“She was very direct,” Aimone says. “She said, ‘At the point where your health risks outweigh the baby’s health risks, that’s when we deliver the baby, because that’s how we fix your preeclampsia.’ I wanted to make it to 37 weeks, but she said it wouldn’t be any longer than that. I was kind of bummed about that. I really wanted to go into labor naturally.”

After bedrest, more headaches and another trip to Labor and Delivery, Aimone’s water broke at 35 weeks, 5 days. She delivered her daughter Waverly, who weighed 3 lbs, 15 oz, on July 29. Waverly spent 10 days in UVA’s NICU (neonatal intensive care unit). Aimone’s doula assisted at the birth and Aimone had the opportunity to hold her daughter before she went to the NICU. Waverly is now a healthy, happy little girl who keeps her mom and dad Ben busy.

Who Has a High-Risk Pregnancy?

Anyone who gets pregnant can have a high-risk pregnancy, but most women won’t, says Dudley. A lot of rare conditions can cause high-risk pregnancies, but some of the most common risk factors include:

  • Multiples (twins, triplets or higher)
  • Previous history of diabetes
  • Blood pressure issues, such as pre-eclampsia
  • Lupus
  • Fetuses with birth defects
  • Previous history of preterm birth
  • Women at risk for preterm birth for any number of reasons, including, cervical insufficiency

Make An Appointment

Make an appointment with a maternal-fetal medicine specialist at UVA.

In many cases, these risk factors mean there’s a risk for preterm labor and/or preterm birth. Dudley says preterm birth is a significant problem in the U.S and the leading cause of neonatal infant mortality worldwide. “Having babies in the NICU is really what we want to avoid. We want to have babies go home with the mom right away. That’s the optimal outcome.”

Other factors that put a pregnancy in the high-risk category: Going past the due date and the mother having late-onset high blood pressure are examples.

What About Gestational Diabetes?

Having gestational diabetes doesn’t mean you necessarily need to see a maternal-fetal medicine specialist. Dudley says it depends on the comfort level of your provider. Gestational diabetes is a common pregnancy condition that affects many women. If you’re seeing a midwife or a nurse practitioner, you should see a high-risk doctor, he says. “Most good general obstetricians can manage you, but most of them would want you seen by a high-risk obstetrician to confirm the management plan and to have that kind of insurance.”

Preventing a High-Risk Pregnancy

It’s not always possible to prevent a high-risk pregnancy, especially if you already have an underlying health condition or you’re pregnant with multiples. But here are a few steps you should take:

Before you get pregnant:

  • Eat a healthy diet
  • Don’t be overweight
  • Maintain a healthy lifestyle
  • Exercise regularly
  • Take prenatal vitamins containing folic acid
  • Stop smoking and taking drugs unless prescribed

Once you’re pregnant:

  • Get early prenatal care
  • Continue prenatal vitamins
  • Continue a healthy diet with green, leafy vegetables and include extra calcium and extra protein
  • Do some aerobic exercise  (check with your doctor first!)
  • Minimize chemical and drug exposures
  • Don’t smoke, take drugs or drink alcohol

Worried About the Risks?

If you have underlying health conditions, you may want to consider preconception counseling. Dudley says MFM doctors prefer women with high-risk conditions like lupus, complex high blood pressure, kidney disease, diabetes, seizure disorders and other conditions see a high-risk doctor for preconception counseling.

“We can go over a plan for what we’re going to do when they achieve pregnancy, make sure they’re on medications that are safe for pregnancy as best we can, and that way when they’re pregnant they’re already in an optimal condition,” he says. Women with lupus have a higher risk of preeclampsia, fetal death and other problems; however, if they have their babies while in remission and on medication they usually have good outcomes, Dudley says.

Preconception counseling isn’t the norm because at least half of all pregnancies are surprises. But ideally, a woman with a serious health condition will call an MFM first, Dudley says. This is critical, because maternal mortality rates in the U.S. are increasing. “It’s driven a lot by women who have underlying heart conditions achieving pregnancy and then having problems toward the end of their pregnancy.

“We love to do preconception counseling. It helps us provide a strategy that hopefully will ensure the best possible outcome from the very beginning.”

Choosing a Hospital to Minimize Risk

Worried about a high-risk pregnancy, though you don’t have underlying conditions? Choosing a hospital with a NICU might be your best bet.

Laura Aimone and her husband Ben watch over their daughter Waverly in UVA's NICU.

Laura Aimone and her husband Ben watch over their daughter Waverly in UVA’s NICU.

“Mainly you need a NICU if there’s going to be some need for specialized care. The main one is preterm birth, but if you have a baby that is delivered at term that has a heart defect or spina bifida or some other problem, you would still need a NICU,” says Dudley.

Sometimes, it’s actually care for the mother that’s just as important, if not more so. “There are high-risk maternal conditions where the baby will do fine. For example, the baby’s at term and the mother develops severe preeclampsia. Then the mother needs to be in a place with high-risk maternal care and adult care, but the baby doesn’t always need anything special. You really want a hospital that has comparable levels of care for the mom and the baby. It’s the combination of the two.”

Even without the risks that could affect their pregnancy, some women choose the safety net of a hospital with a NICU to avoid last-minute emergencies.

Aimone expected to have a normal pregnancy and did until the very end. She planned to have her baby at UVA in part because of convenience, but also because of the care UVA provides. UVA is right around the corner from her house. “God forbid anything happen, we wanted to be at UVA. Everyone was like, ‘Oh nothing will happen. It’ll be fine.’ But it did.”

Make an Appointment

Make an appointment with a maternal-fetal medicine specialist at UVA.

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Maternity Monday: Stacy Lynn’s Miscarriage Story

On March 23, 2015 | At 9:38 am

It’s a common story, about miscarriage — that there is no story. People don’t talk about it, and yet it can be a truly traumatic loss.

Stories about preconception, pregnancy, childbirth and postpartum

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

It’s also a fairly common one; studies show that anywhere from 8 to 25 percent of all known pregnancies end in miscarriage. Despite the silence around miscarriage, many women have experienced it.

That’s certainly what Stacy Lynn found to be true. The more she broke the silence, the more she discovered other women who had had miscarriages. She told me her story to help others know they are not alone

Getting the Bad News

I hadn’t heard the heartbeat yet. They tried to find it. They said, “We don’t hear it, but that doesn’t mean anything. Sometimes we just can’t find it, so we have to do an ultrasound.”

And then the woman giving the ultrasound said, “I’m sorry.” And in my head, I think, “So sorry about what?”

Then the doctor comes in and gives me a hug. “I’m really sorry; sometimes this happens.  The fetus stopped growing at 8 weeks.” And then it hit, and I just bawled, and she hugged me.

I am tearing up just thinking about it. I didn’t think I would.

After the Miscarriage

My husband came rushing over. He told me, “If we can survive this, we can survive anything.” He really helped me. So I had to have a D&E, so I had to sit with it all weekend and just deal with it.

After the D&E, I developed an infection. I woke up a few days later, shivering and so sick. I called. They had left tissue inside; I had to have another procedure. During that entire process, I wanted to move on but couldn’t. I was pretty depressed.

My husband said really good things to me. He is my life support. He let me cry, he never judged me, he had lunch with me every single day to check on me. He would give me silly tasks to do, tell me, “The car needs an oil change, can you do me a favor and go do it?” Things like that to get me out of the house. Which was really good.

My sister in law had a baby a couple days before my miscarriage, so I didn’t want my family to come down. It was really hard to be around a friend of mine who was pregnant and had a healthy baby. I didn’t want my friends to visit. I was a mess.

After a couple weeks, I was still really depressed. My husband said, “I don’t want this to define you. This is not who you are. You are very happy. You always see the good in everything. This happened, and it’s sad, and we can be sad about it. But this cannot define you. I want you to live your life.” He really pulled me out of depression. I’m so thankful for that.

Getting Pregnant Again

I worried I wouldn’t get pregnant again. My husband said, “It will happen when your body is ready. Don’t stress about this. We know you can get pregnant.” We ended up getting pregnant five months later; it turned out my body was ready.

Throughout the pregnancy, I was a nervous wreck. I had kidney stones from five weeks until I delivered, so I would see blood and was so terrified. We didn’t tell anyone, and then only close friends and family. We did not post anything on Facebook. We didn’t plan on having a baby shower – we’re Jewish so we don’t have baby showers anyway; it’s bad luck. We were not acknowledging him until we held him in our arms.

After a miscarriage, Stacy had her son, Remi.

New Hope

My son was born early, at 32 weeks, in the UVA NICU. It was one year since the miscarriage.

We named him Remi, a name we picked flipping through the channels when I was about six months along. Remi was the name of a French contestant on American Ninja Warrior, which created a spark in us, since we had traveled to Paris between the miscarriage and this pregnancy. Little did we know that name would be so fitting for Remi, who had to fight to live right from the start. At 21 months now, he is no longer my little nugget, but a precocious toddler who is succeeding in numerous ways.

A lot of people are asking if I’m going to have a second child, but mentally I’m not there, because I’m terrified of having another miscarriage, and I’m terrified of having a micropreemie.

I will tell you I had the most amazing experience at UVA with Dr. James, who will be delivering any future children of mine, as she was wonderful and made the whole situation, which was scary at times, better. Looking back, I think what a great experience it was.

Healing From Stigma and Blame

I think if more people talked about miscarriages, it would make a person going through it not feel as alone. I felt so alone. It seemed like nobody else had this experience, everyone got pregnant right away, and it was all so easy. If people could talk more about it there wouldn’t be this stigma.

My mom gave me advice. She actually had a baby, born at 28 weeks, back in the 70s, and he lived for a couple of hours. When I had the miscarriage, she said, “I’m so sorry, Stacy; I’ve been in your situation. I understand. It is out of your control. You did nothing wrong. You can’t control it. As women, we like to control things. But there’s nothing you could have done differently.”

As horrible as the miscarriage was, if I hadn’t had that, I would not have had Remi. He’s the best thing that ever happened to me.

Share Your Story

Have you had a miscarriage? Let us know in the comments below what helped you heal. 

 
 

Maternity Monday: Miscarriage, A Common Taboo

On March 16, 2015 | At 9:48 am

I thought a quick scan through a Google search about miscarriage would reveal more information than I could fit into this blog post.

Stories about preconception, pregnancy, childbirth and postpartum

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

I was wrong. In fact, my quick scan turned into a lengthy search, and the very large gap of information underscored a sentiment that seems pervasive:

You don’t talk about miscarriage.

But why? I wanted to know. Everyone online and the women I talked to for this story expressed the same thing: There’s silence around miscarriage. And it needs to be broken, because this taboo makes it a lonely, isolating experience, on top of the already-difficult physical and emotional loss.

The closest thing I could find for an answer was that the lack of medical reasons for miscarriage—and there’s more often than not no clear reason for it—leaves the why of what happened a blank. As Diane Rozycki, MD, told me, “Miscarriages can happen due to a variety of reasons. They can also be unexplained, with chromosomally and structurally normal fetuses in apparently healthy women.”

As with most mysteries humans face, we tend to fill in the gaps. Women who have miscarriages often feel responsible, at fault and ashamed; the pregnancy “fails,” and they feel they have failed, too.

Miscarriage Risk Factors

But even when a cause is implicated, most of the risk factors for miscarriage aren’t something a woman can control, like:

  • Maternal age: Risk increases with age
  • Maternal disease, acute infection as well as endocrine disorders (uncontrolled diabetes and thyroid disease, for example)
  • Structural abnormalities of the uterus
  • Fetal chromosomal abnormalities or congenital anomalies

Two risk factors, a woman being extremely overweight or exposed to certain medications and substances, can, in some cases, be controlled, but they certainly are not predictors of miscarriage.

Miscarriages Are Common

And the thing is, miscarriages happen more frequently than generally assumed. Rozycki again: “Miscarriage in early pregnancy is common. Studies show that about 8 to 20 percent of women who know they are pregnant have a miscarriage some time before 20 weeks of pregnancy; 80 percent of these occur in the first 12 weeks. Loss of unrecognized or subclinical pregnancies is higher.” (That is, you can have a miscarriage without even knowing you’re pregnant. You might experience symptoms, like pain and/or bleeding, but not necessarily.)

The situation seems like a catch-22: No one knows how common miscarriages are because we don’t talk about them, and we don’t talk about them because we don’t know how common they are. It doesn’t help that in the US, cultural convention tells us to hide pregnancy until after the first trimester, the time when most miscarriages happen. So paradoxically, the time when women arguably need the most support, feel the most tired and nauseaus as well as the most worried, is exactly when they are supposed to hide their pregnancy and, should it happen, their miscarriage.

One article talking about the misconceptions people have about miscarriage reported:

The survey of more than 1,000 women and men found 65 percent believe miscarriage is rare, when in reality it occurs in one in four pregnancies. While knowledge of miscarriage rates was low, respondents accurately assessed that it is traumatic, with 66 percent believing the emotional impact is severe and potentially equivalent to the loss of a child. Research shows understanding the cause of miscarriage can reduce feelings of guilt or blame; however, currently the origin is only identified in 19 percent of patients.

Life After Miscarriage

The good news about miscarriage is, it may be beyond your control, but it doesn’t mean you’re beyond hope for having a baby.

“If you have had a prior miscarriage, you can be at increased risk for another,” Rozycki says. “But it does not mean you are infertile. Even women with recurrent pregnancy loss (three consecutive miscarriages) have a good chance of eventually having a successful pregnancy.” She does advise that women wait for two to three months before getting pregnant again.

And, whatever the taboo or misperceptions, you are not alone. As one woman told me, “It’s still painful right now, looking back at it, but I have to say time decreases the intensity of what happened. Do whatever self-care works for you. Give yourself time, and reach out for support.”

Odds are, when you do, you’ll find someone who knows exactly what you’re going through.

Next Monday, we’ll hear a personal story about the mix of emotions that can occur with a miscarriage.

Worried About Miscarriage?

The best bet: Talk to your doctor. Find a caring, expert OB/GYN:

 
 

Maternity Monday: Prenatal Vitamins & Other First Trimester FAQs

On March 9, 2015 | At 10:15 am

Parenting books and baby blogs are great resources, but they can also supply an overwhelming amount of information for newly expectant mothers. I took a look at some common questions for the first trimester of pregnancy and caught up with Vanessa Gregg, MD, for the answers.

Stories about preconception, pregnancy, childbirth and postpartum

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

Do I Need Prenatal Vitamins? 

Yes — prenatal vitamins are beneficial for both the mother’s changing body and the developing fetus. It’s ideal to begin taking prenatal vitamins before conception. Although most women get the nutrients they need via their diet, prenatal vitamins provide that extra boost.

Gregg warns moms that it may take some self-discipline to include all of the major food groups in the diet during pregnancy, especially when you have cravings, but it’s important to try.

What’s Important in Prenatal Vitamins? 

Dr. Gregg tells her patients that one important ingredient in prenatal vitamins is folic acid.

What is that and what are the benefits, you ask? Folic acid:

  • Is a type of B vitamin
  • Helps produce red blood cells to prevent anemia for mother and baby
  • Helps form the neural tube (the brain and spinal cord) to decrease the number of potential defects while the fetus is forming

Before conception, you should take about 400 micrograms of folic acid. Bump up the dose to 600 micrograms during pregnancy. “It’s one thing you can easily do to help have a better outcome,” says Gregg.

Prenatal vitamins also contain many other valuable ingredients, including iron, which many pregnant women need more than they would outside of pregnancy.

Should I Avoid Any Particular Food?

One important thing to be wary of is raw or undercooked food like meat, eggs and fish, as these foods can lead to food-borne illnesses. Some types of fish have higher concentrations of mercury, which has been linked to birth defects.

Prenatal vitamins contain folic acid and other nutrients for expectant moms and their babies.

Look for folic acid in your prenatal vitamin of choice.

Safe options for expectant moms are:

  • Shrimp
  • Salmon
  • Catfish
  • Pollock
  • White (albacore) tuna, limited to about six ounces a week

You should also be cautious of listeria infection, a food-borne illness caused by bacteria. Listeria infection can lead to miscarriage, stillbirth and premature delivery. As a precaution, women should avoid unpasteurized milk products, and heat lunch meats like hot dogs and cold cuts before eating.

Gregg also advises expectant mothers to peel all food skins themselves and thoroughly wash fruits and vegetables. She tells her patients, “If you’re in doubt, skip it and eat something else!”

Am I Really Eating for Two?

You may want to indulge all of your cravings, but there is no increased caloric need within the first trimester. Over the course of a pregnancy, the caloric intake will increase to about 300 extra calories per day — not an outrageous amount!

While it’s important to have a healthy weight gain during pregnancy, the expected weight gain for each mother varies depending upon her pre-pregnancy weight. The average weight gain for a single pregnancy in a woman of normal body weight is between 25 and 35 pounds. But, as Gregg reminds expectant mothers, gaining too little or too much weight can create pregnancy complications later on.  Your obstetrician or other prenatal care provider can advise you as to how much weight gain is appropriate for you.

What Bodily Changes Should I Expect?

There aren’t many changes that occur within the first trimester. Some women may notice a temporary thickening of the hair or hair growth in unexpected areas like their face, chest, abdomen and arms. However, it isn’t until the baby further develops and grows that changes like stretch marks and darkening areas of the skin may occur.

The most common experiences during first trimester are:

  • Fatigue
  • Breast tenderness
  • Morning sickness, the body’s way of processing new hormones

Is There Really Such a Thing as ‘Pregnancy Glow’?

While there isn’t necessarily a medical reason for the “glow,” Gregg certainly believes it exists. However, she attributes it to the rounding of the expectant mother’s face or the positive, excited attitude and outlook she exudes. In addition, hormonal changes of pregnancy may change the texture or oiliness of the skin, which can contribute to the “glow” of pregnancy.

“Pregnancy is an amazing time. It’s phenomenal, the changes the body goes through to accommodate a growing person,” says Gregg. She encourages all her patients to enjoy the experience and look forward to the joy of a new addition to the family.

 
 

Maternity Monday: Planning a Pregnancy

On March 2, 2015 | At 9:00 am

You’ve found the right job, you’ve got the right guy, you feel those maternal instincts kicking in. You want to get pregnant. It’s the natural next step, right? Although we realize that sometimes pregnancies just happen without any planning, learning the best practices to plan your pregnancy is helpful for any woman who is sexually active. Not only will you be at your best, but it will help your unborn baby be as healthy as he or she can be, too.

Stories about preconception, pregnancy, childbirth and postpartum

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

Having a baby is a personal decision that should be discussed with your partner. Only you will know when you are truly ready in regards to your professional life, your relationship and your financial situation. Your doctor can help you plan a pregnancy in regards to your health and expectations. If you think the right time has arrived for you to get pregnant, we are ready to help prepare you for your journey to motherhood.

Taking All of the Right Steps for a Healthy Pregnancy

When you and your partner decide it’s time to start trying to get pregnant, you should begin taking extra care of yourself. Taking the right steps toward a healthy lifestyle not only helps you get pregnant, but also will protect your baby in the critical first weeks when you may not realize you are pregnant. During this time you should:

  • Avoid smoking or drinking alcohol due to the harmful effects it may have on an undeveloped fetus.
  • Be at a healthy weight; being underweight or overweight may cause complications in your pregnancy going forward.
  • Increase your intake of folic acid. Your body and the fetus need extra folic acid for a number of reasons. Folic acid helps to prevent spinal cord injuries, cleft lip, cleft palate and types of heart defects on baby. Your body needs the folic acid in order to make red blood cells and prevent anemia. It also helps to produce and repair DNA, which helps to promote rapid cell growth in your developing baby.
When planning a pregnancy be sure that you are at your best. Take Folic Acid, exercise, and rid your body of toxins.

When planning a pregnancy be sure that you are at your best. Take Folic Acid, exercise, and rid your body of toxins.

The Center of Disease Control (CDC) suggests that all women of child-bearing age take 400 mcg of folic acid each day, which you can buy at many grocery stores and pharmacies. You can also find foods high in folic acid like:

  • Dark leafy greens
  • Asparagus
  • Citrus fruits
  • Beans
  • Peas
  • Avocado

UVA pediatrician Ina Stephens, MD, also suggests an organic, toxin-free diet. “It’s never too early to start eating right and changing your lifestyle,” she says. “It’s as important to take care of yourself before you get pregnant as it is when you find out you are carrying a baby.”

“Prenatal exposure is still a mystery,” Stephens says. “Any changes to eat right and exercise and remove toxins from your life will help.”

Birth Control Myths

When you stop taking birth control, you may wonder how long it will take to get completely out of your system. Each woman is different, and each birth control method is different, too.

According to Stephens, birth control medication leaves your body fairly quickly. “That’s why you take a daily pill,” she explains. “When you miss a pill, your body doesn’t get those hormones.”

However, since your menstrual cycle lasts several weeks, you will probably need to stop taking birth control pills several days before you can get pregnant. Also remember, birth control pills are not 100 percent preventative, so there is still a slight chance to become pregnant while taking them.

What to Know About Your Family History

Your family health history will play a role in your child’s life and there are things that you and your OB/GYN  should discuss and consider before your baby is born.

If your parents or grandparents suffer from diabetes, heart disease, hypertension or a number of other illnesses, be sure to mention that to your OB/GYN. You may be more likely to develop complications during pregnancy. However, these diseases can be treated and managed during pregnancy.

Talk to your doctor about genetic diseases that could affect your baby such as sickle cell anemia, cystic fibrosis and many heart conditions.

There’s a lot to know and a lot to think about when planning a pregnancy, so don’t be afraid to ask questions. The most important thing to remember is that your baby will need you to be at your very best in order to grow into a healthy human. Those first few days and weeks of pregnancy are very important, so starting a healthy routine before you know you’re pregnant is your best bet!

 
 

Maternity Monday: A Journey Through Preconception, Pregnancy, Childbirth and Postpartum

On | At 8:07 am

“Should I take prenatal vitamins before conception?”

Stories about preconception, pregnancy, childbirth and postpartum

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

“Why doesn’t anyone talk about miscarriage?”

“Does the baby really need all this stuff?”

We’ll be answering these questions and more every Monday for the next few months. Follow our Maternity Monday series for all you need to know about:

Preconception

First Trimester

Second Trimester

Third Trimester

  • Creating and choosing a birth plan
  • Your partner’s role
  • Breastfeeding 101
  • The best shower gifts

 After the Baby Comes

  • What to expect in the first month
  • Helping older siblings adjust
  • Postpartum depression
  • Sleeping tips for mom and baby
  • Unusual health issues

Don’t miss a post! Sign up to receive email updates.

 
 

Cholesterol: The Good, the Bad, & the Balance

On February 25, 2015 | At 9:16 am
Running shoes in my office desk

Running shoes in my office desk: Walking is one way I’m beating my high cholesterol.

I’ve always had high cholesterol. But I’ve never worried about it. Why?

  • My mother told me it was genetic – “Grandma had high cholesterol, and she lived to age 93!”
  • My good cholesterol has always been the really high part – so doctors have never had a problem with my final number.
  • I’m an active, healthy person: I’ve always exercised regularly and eaten my vegetables.
  • Also, I was a vegetarian for several years. Surely that means something?

So everything was fine…

…until a couple months ago, when my new doctor at UVA, Allison Lyons, MD, reviewed my numbers and put up a red flag.

The Red Flag of Bad Cholesterol

She emailed me (how cool is it that my doctor and I email back and forth when I have questions?) saying:

Your HDL (good cholesterol) is great but your bad cholesterol (LDL) is a little higher than I would like. My goal would be <130 for you. How much do you eat in terms of cheese, red meat, dairy, sweets, etc.? I would like to control it with some changes in diet first, and we can then recheck in one year.

I balked. Me? Have a health issue? But considering our family had followed the Paleo diet for a while, so that we still tend to avoid carbs and rely heavily on meat, and also I’d fallen off my running routine, maybe this was a sign that I did need to make some changes. I asked Lyons what she recommended I do. Her reply:

I would try to cut back on red meat (only having once per week). I would also try to walk for 30-40 minutes per day. Both of those things together should help.

Oh dear. This prescription sounds fairly simple, but for me, this seemed impossible. A rush of resistance flooded my brain, as I thought of all the reasons I absolutely would flunk my doctor’s charge.

The Barriers to Balance

  • I’m not that big a fan of chicken. My kids would not want it every night.
  • I only like fresh fish. Which is hard to get and expensive.
  • Pork is red meat, and it’s my favorite.
  • I don’t have time to walk for 40 minutes EVERY DAY!
    • Mornings are out, because I can’t wake up early enough in the winter (not to mention it’s cold!).
    • My lunchtime is when I meet with friends I can’t see otherwise.
    • After work is when I’m spending time with my kids, helping with homework and getting them fed and bathed and put to bed.
    • And after that, I’m exhausted, it’s dark, and it’s time to spend with my partner.

Cholesterol, Not All Bad 

What is cholesterol, exactly?

Believe it or not, cholesterol is not the evil trespasser in your blood whom you should vow to destroy at all costs. In fact:

  • You need it. As Lyons told me, “Cholesterol is a fatty substance that is present in everyone’s blood and is necessary for your body to function.”
  • You make it. Also, you don’t just get cholesterol from meat, dairy and eggs. Your own liver produces cholesterol, all on its own.

The kicker? The liver is an overachiever. Lyons says, “When you eat a diet that is high in cholesterol, your liver tends to make more cholesterol as well.”

Good thing the U.S. government decided to stop warning us about cholesterol recently.

Cholesterol, Not All Good

So, why worry about cholesterol, if your own body makes it? As with most things in life, the issue boils down to balance.

There’s two types of cholesterol:

  • LDL, the “bad” cholesterol, is the culprit responsible for blockages and deposits.
  • HDL, the “good” cholesterol, actually tries to eat up and remove LDL cholesterol.

“When you have too much cholesterol in your body, it starts to deposit in your blood vessels, like dirt in a pipe. When it sits on the surface of the blood vessels for a long time, it becomes calcified and hardens.” The result?

  • Blockages that clog the pipe, slowing blood flow, causing heart disease and peripheral artery disease
  • Deposits or plaques that weaken, flake off and get lodge in arteries, causing heart attacks and strokes

Your cholesterol numbers help doctors determine if you’re in the right balance of good and bad.

The best-case scenario: Bad cholesterol under 100, good over 50, and the total number less than 200.

My numbers:

Total Cholesterol: 250
LDL: 159
HDL: 74

I felt doomed.

Making Hard Heart Changes

But I couldn’t stop thinking about my dad. His was a number even worse than my cholesterol. He was only 52 when he suddenly, with no warning, dropped dead of a heart attack. It was the worst thing that ever happened to me. And I just can’t imagine doing that to my kids.

So, after the winter holidays, I did what a lot of people do and made some New Year’s Resolutions, including lowering my cholesterol. I made this goal a priority – to myself, to my partner, to my kids, to my friends.

And the impossible became possible.

Finding Time to Exercise

I started walking 30-40 at lunch every day at work. This actually happens to be a refreshing break, even when it’s cold. My mind is cleared for the rest of the day, I get some fresh air and light and some personal time. I look forward to this. I eat at my desk. I limit friend-lunches to once a week, even if that means pushing people out a while.

And if I miss a day walking, I have found other ways to exercise at home that aren’t too disruptive to my kid time: either having a half-hour dance party with the kids or doing a free, half-hour workout video on grokker.com. On the weekends, I walk the dog (who needs to lose weight).

Food Fix

This actually wasn’t as hard as I had anticipated.

  • I found out pork (red meat? White meat?) was allowed.
  • I now stop for fish on my way home one night a week. I get the fast-cooking kind that doesn’t take a lot of time and effort.
  • We use ground turkey instead of ground beef.
  • I keep my vegetable portions larger than everything else on my plate.
  • I drink almond or coconut milk and mostly avoid cheese and other dairy, though I do eat a yogurt at lunch every day.

Of course, I have to wait until October to see if these changes have had the desired effect. But I will check in then and let you know!

Find Out More About Cholesterol

Want to know more about your cholesterol and getting heart-healthy? Check out the articles and recipes at Club Red.

 
 

Babies, The Heimlich and Celiac Disease: January 2015 Roundup [VIDEO]

On February 6, 2015 | At 9:21 am
Lentils are a gluten-free alternative for people with celiac disease.

Have celiac disease? Lentils are gluten-free and add texture and protein to your meals.

These three things don’t sound related, but we wrote about all of them in January 2015, and then some.

For celiac disease sufferers, avoiding gluten is essential. One writer shared her personal story, tips for managing celiac disease and why most people shouldn’t eliminate gluten.

Kenneth Liu, MD, decided to become a neurosurgeon after watching a PBS show when he was eight — and he loves his job. He answered our 7 Quick Questions.

Did you know physical and occupational therapy is a major part of our Neonatal Intensive Care Unit? Meet two therapists who work with premature babies.

One of our nurse practitioners performed the Heimlich maneuver on a man who was choking. Read her story and learn how to perform this lifesaving technique.

We spent Martin Luther King, Jr. Day discussing diversity in healthcare and teaching local students about careers in medicine. View the photos from our events.

Finally, we continued our weekly podcasts:

The Health System in Charlottesville News

Becker’s Hospital Review named the Medical Center to its list of “100 hospitals with great women’s health programs.”

Quitting smoking is extremely difficult, even after a cancer diagnosis. Cancer Center employee Lindsay Hauser helps cancer patients give up cigarettes for good.

Thanks to a holiday book drive, the Ronald McDonald House is getting 10,000 new books. The house provides lodging for families while their kids get treatment at the Children’s Hospital.

George Hoke, MD, explained what a hospitalist is and why he loves his job.

Brad Haws, CEO of the UVA Physicians Group, lost 120 pounds by changing his diet and exercise habits. He and other locals and doctors share tips for living healthy at any age.