Pregnancy and women’s health

JAMES M. Brown III, MD, and Rachel Chua, MD, both Fellows of the American College of Obstetrics and Gynecology based in Lake Charles, Louisiana, are our specialist consultants for today. They will discuss various topics on pregnancy and women’s health, inspired by queries emailed to us by our readers.

Mother’s diet and the fetus

In general, women who are overweight have an increase risk of health issues including blood clots, gestational diabetes and hypertension, all of which can lead to complications in pregnancy and delivery. Also, women who come into pregnancy with poor glycemic (diabetic-blood sugar) control have a higher risk of neural tube defects as well as other birth defects, including cleft palate, cleft lip septal anomalies hydrocephalus and limb reduction and miscarriage.

Dr. Brown stated that the reason obstetricians routinely check all women for gestational diabetes is because poor glycemic control typically leads to bigger babies and more complicated deliveries requiring c-sections. “Shoulder dystocia, where the shoulder could not pass thru the birth canal, is one of the complications and is an emergency,” he added.

Also, if a baby is used to a certain amount of glucose coming across the umbilical cord, its pancreas will try to produce insulin to control the glucose. The baby will then store the sugar and gain weight. At delivery, when the cord is cut and the flow of glucose from the mother to the baby is interrupted, the baby pancreas may still continue to produce insulin and causing a precipitous drop in the blood sugar. This is dangerous to the brain of the newborn. When detected, intravenous glucose is provided immediately until the pancreas is able to regulate its insulin production.

Normal weight women, who regularly feast on junk food and sweets in the early pregnancy gain weight more easily, and so with the fetus. It has been shown in rats that when a pregnant mother ate a diet that was high in sugar, fat, and salt, their offspring was more likely to have high triglycerides and cholesterol, and be at a higher risk of heart disease. They also had higher glucose and insulin levels and were at a higher risk for type 2 diabetes.

It is essential for women to maintain a normal weight, especially when they are planning to get pregnant or are pregnant.

Foods to avoid during pregnancy

Pregnancy instinctively suppresses the immune system to a degree to prevent rejection of fetus as a “foreign body.” As such, pregnant women are more prone to infection, and should avoid foods that are not cooked, such as sushi, raw oysters, or even steaks that are grilled rare, or medium. Well cooked items are safer for pregnant women. Processed foods are also unhealthy for both the mother and the fetus. And so with high cholesterol extremely spicy foods. Fish is good for both, but because of mercury concern in fish, and its effects on the fetus, the variety of fish that usually have high mercury content should be avoided also. As a rule, the larger the fish the greater mercury it contains, because it eats up a lot of smaller fishes with mercury in them.

The sea foods with lowest mercury level, which may be served two 6-0z servings per week, include: Anchovies, Butterfish, Catfish, Clam, Crab, Crawfish, Croaker, Flounder, Haddock, Herring, Hake, North Atlantic Mackerel, Chub, Mullet, Oysters, Ocean Perch, Salmon (canned, fresh), Sardines, Scallops, American Shad, Shrimps, Sole, Tilapia, Freshwater Trout, Whitefish and Whiting. Others not on this list have “highest, high, and lower” mercury contents.

Warning: definitely dangerous for the fetus and the mother are cigarettes and alcohol, regardless of the amount. These chemicals can cause mental retardation, impaired growth, weakened immune system, and a host of respiratory and other illnesses.

All of us in general, and especially pregnant women, should minimize salt intake and avoid canned foods, like vegetables and processed meats, which contain high levels of salt as a preservative. Luncheon meats are to be avoided for the same reason. Besides their high salt content, processed foods are unhealthy in themselves as shown by scientific studies.

“It is also prudent for pregnant (even expectant) mothers to watch their weight and limit their intake of carbohydrate (bread, cakes, ice cream, sweets, etc.) and avoid junk foods like potato chips, French fries, and fast foods in general,” stresses Dr. Brown.

Tumors of the uterus

Typically, uterine fibroids/myomas (tumors of the womb) are benign (not cancerous). In view of this, the rule “if they don’t bother you, we won’t bother them” is generally assumed, especially since they are such a common finding, according to Dr. Rachel Chua. Usual symptoms of symptomatic fibroids are bleeding and/or pain, and for these reasons, they are treated regardless of size and age of the patient. Type of treatment will depend on the woman’s age, pregnancy plans, and surgical risk factors, including body habitus and medical history.

However, menopausal women with an enlarging fibroid need to be aggressively treated due to increased risk of malignant transformation from benign fibroma to leiomyosarcoma, a form of cancer, warns Dr. Chua.

If a patient is not done with childbearing, the uterine fibroids can be removed either hysteroscopically (for fibroid within the uterine cavity) or laparoscopically (for fibroids that are subserosal, on the outer surface of the uterus).

If a patient is done with childbearing, hysterectomy is the choice, especially if there is pathology of the ovaries as well. As for giant fibroids, laparoscopic vaginal hysterectomy is still an option, with the advent of the Morcellator. Robotic hysterectomy is state-of-the-art, which allows vaginal removal of an enlarged uterus and its cervix thru a laparoscope, saving the woman from a large abdominal incision.

This husband-and-wife OB-Gyne team successfully performed Robotic hysterectomy recently to remove a 16- week-size uterine fibroid tumor (about the size of a large cantaloupe). Prior to the availability of Robotic Surgery, this would have required opening the abdomen. Dr. Brown has been doing Robotic surgery for this condition in Lake Charles.

Medical treatment for fibroids with Lupron is used only preoperatively to decrease blood loss. A treatment offered at some larger university settings is uterine artery embolization, blocking the artery with a clot, to cut off the blood supply to the fibroid to reduce its growth and size. This procedure is performed by an interventional radiologist.

The progressive advances in medicine and surgery, which are mind-boggling, are a welcome boon to people’s health and well-being around the globe.

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