Traveling and Smoking during Pregnancy leads to Obesity

The next two weeks I'll be busy traveling for different meetings, so my posting will be extra light. However, before I embark on my travels, I want to leave you with this headline from Yahoo! news: Smoking Mothers Lead to Fat Children.

Apparently, Japanese researchers have found that children of women who smoked at any time during pregnancy are three times as likely to be obese. This does not bode well for my state - which has the 5th highest obesity rate in the nation, and where nearly 30% of women smoke during pregnancy. It seems beyond low birth weight and prematurity, later obsesity is yet another reason to quit smoking if you become pregnant. Not to mention, you will reduce your risk for heart disease, cancer, and stroke.

Quitting smoking is difficult, but help is available.

Sex may not work, but sweeping the membranes might

Last week I wrote about a study that suggested sex doesn't get the contractions rolling. This week, however, a study was published that suggests there is something that might work. It's called sweeping or stripping the membranes. To do the procedure, your doctor or midwife will place 1 or 2 fingers through the opening of your cervix and separate the membranes of the amniotic sac from their attachment to the lower part of your uterus. The goal is to trigger a local release of prostaglandins, or the hormones responsible for softening the cervix and stimulating labor. The procedure can be uncomfortable, and often results in period-like cramping, irregular contractions, and sometimes bleeding. (Sex is looking pretty good right now even if it doesn't work, huh?)

In this research, the investigators reviewed 22 studies of nearly 3,000 women and examined labor outcomes. They found that women who had their membranes swept were more likely to give birth before 41 weeks gestation. Further, they found there were no differences in risks of infection for either mother or baby.

The authors concluded that the decision to sweep the membranes needs to be balanced with the discomfort of the procedure. Interestingly, they also suggest that routinely sweeping the membranes does not seem to produce important clinical benefits - although they aren't the ones who've been pregnant for 10 months. Ultimately, this is an important decision to discuss with your health care provider. Meantime, Barry White anyone?

Talk therapy works for postpartum depression

A couple of months ago I wrote a piece on light therapy for postpartum depression (PPD). A study released this month shows that talk therapy - with a professional or a mom peer - can help also. This is an important finding, because many women prefer not to take antidepressants when they are breastfeeding.

In this study, the investigators reviewed 10 clinical trials that included nearly 1,000 women. The trials tested psychological and social interventions that included cognitive behavioral therapy (CBT), counseling, and peer support groups facilitated by a health care professional. They found that women who received any of the psychological or social therapies were 30% less likely to have depressive symptoms within one year after giving birth compared to women who received postpartum care as usual. Additionally, peer support groups appeared to be just as effective as formal psychological care, such as CBT, which is great news for moms who can't afford a weekly trip to a therapist.

The study authors additionally noted two key take-home points. First, PPD is treatable, and a wide variety of treatment options is available. Second, social support is critical for moms who are experiencing PPD. Sometimes there is a tendency for new moms to try to pretend all is well, because they're "supposed" to be happy about their new addition. But having support from other women who've experienced PPD can help to normalize the experience and reduce the stigma associated with having a postpartum mood disorder.

So if you or someone you know is experiencing PPD, know there is help. Postpartum Support International is a great resource to find a peer support group in your area. Additionally, Postpartum Progress is a blog written by mom and advocate Katherine Stone, who experienced postpartum obsessive compulsive disorder. She provides a broad array of information on postpartum depression and other mood disorders that readers will find helpful.

Meditation: It does a mind-body good

For those of us who meditate, we know it works. It calms the mind, brings clarity and focus, and helps to ease the effects of challenges in our lives. Some folks are skeptical about "all that mind-body" stuff, and they're not going to be swayed by personal opinion. So it's really nice when research backs you up and says, Yep, it's not all in your head. This stuff really works.

Where is this great evidence, you ask? The National Academy of Sciences (which, by the way, is the adviser to the U.S. on science, engineering, and medicine) publishes a weekly rag. In the most recent edition there was a study on meditation. And how it works. And not just for long-time practitioners.

The researchers enrolled 80 Chinese college students into their study. They randomly assigned 40 students to a test group and 40 to a comparison group. They taught the test group a form of meditation known as integrative body-mind training, which incorporates meditation and mindfulness work. The group practiced for 5 days 20 minutes at a time. The comparison group was taught a relaxation technique, which they also practiced for 20 minutes daily over 5 days. Before and after the 5-day training, the students were given a variety of tests to examine their emotional states and concentration abilities.

They found that compared to the relaxation group, the meditation group had less anxiety, fatigue, depression, and anger. They also showed decreases in stress and increases in their immune response. All in 5 days. 100 minutes. With no previous training.

You too can receive the benefits of meditation. There are a host of guided meditation CDs that can get you started (just check out your favorite book store or Amazon). A practice called yoga nidra is one of my favorites. And you don't have to spend a lot of time. Just 20 minutes a day to be on your way to less stress and greater relaxation. Sounds too good to be true, huh? But it isn't.

Barry White, pregnancy, and labor

It has been standard practice to tell healthy women who want to get labor going to turn up the volume on Barry White and get busy with their partner. However a study published this month suggests that having sex likely won't pump up the contractions.

Researchers recruited 210 women who were going to be inducted for non-emergency reasons. They assigned each women by chance to one of two groups. The first group was told to have sex to encourage labor. The second group was given no advice about sex before their induction.

They found that women who were told to have sex were more likely to do so - 60.2% compared to 39.6% in the group that was given no advice. However, they also found there were no differences between the two groups in rates of spontaneous labor - or labor starting on its own before the scheduled induction. There also were no differences between the groups in how many women had a C-section or in their babies' birth outcomes.

Bottom line: increasing sexual activity doesn't seem to promote labor. So if your libido is low, don't feel like you have to have sex to get the ball rolling. On the other hand, if sex sounds good, have at it. While an orgasm might not promote labor, it might be your last one for a while - so enjoy!

Poor quality relationships may lead to a broken heart

This summer I wrote about a study that showed women who keep their feelings to themselves during an argument with their partner were more likely to have depression and irritable bowel syndrome, and also more likely to die.

A study published this week in the Archives of Internal Medicine provides further support that having a poor marital relationship contributes to bad health - specifically bad heart health. Researchers in Britain studied over 9,000 men and women. They asked the participants questions about their close relationships (including their marriages), such as how much support they receive and how much stress and worry the relationship causes. After adjusting their calculations for other factors that can affect heart disease, such as age, obesity, high cholesterol, depression, and work stress, they found that people who reported negative close personal relationships were more likely to have heart disease and heart attacks.

Now this is not to say you should run out and divorce your partner if your relationship isn't quite up to snuff. However, it does suggest that relationship maintenance might be in order - especially if you have children or jobs that limit couple time. Schedule a "date night." Make time for sex. Remind yourself why you got together in the first place - and tell each other about those great qualities. Also make time for yourself - even if it's only 10 minutes in a hot bath. If these steps don't lead to improvement, couples therapy is always a great option.

Virtually nursing-in? Try nipple-soothing peppermint

If you plan to do some extra breastfeeding today as part of the great virtual breast fest, here's a tip from a recent study on preventing and soothing those nipple cracks that might arise.

Researchers studied whether peppermint gel, lanolin gel, or a neutral ointment were better for soothing the nipple pain and cracking that are often associated with first-time breastfeeding. They enrolled 216 women into the study and randomly gave them one of the 3 gels. They did not tell the women which gel they received, but they did tell them to use the gel daily for the first two weeks of breastfeeding. They found the peppermint gel was much more effective than either lanolin or a neutral ointment in reducing the rate of nipple and areola (the area around the nipple) cracks and pain.

Sore nipples are a common reason some women fail to continue breastfeeding in the early days of trying. However, breastfeeding is so beneficial to moms and babies that women's health researchers will take time to figure out how to keep mom comfortable while she and her infant learn to feed.

Now if we could only figure out how to keep the general public feeling comfortable when they see a mom breastfeeding....

Panic attacks possibly linked to heart disease and death

If you've ever had a panic attack, this headline may not surprise you. Many of the symptoms of panic attacks can mimic a heart attack: racing heart, chest pain, sweating, nausea, dizziness, and shortness of breath. These symptoms usually peak within 10 minutes, and they can be accompanied by fear of leaving home. Approximately 1 in 75 people experience panic disorder, and it is more common in women than men.

Researchers investigated the relationship between panic attacks and heart disease in a study of nearly 3,400 postmenopausal women. They found that women who had experienced a panic attack in the previous 6 months were four times as likely to have heart disease, and three times as likely to have a stroke. These women also were 75% more likely to die from heart attacks and stroke.

If you are in this population of women (i.e., a postmenopausal women who has been diagnosed with panic disorder or who has experienced panic attacks), these findings may seem worrisome. However, it is important to note (as the investigators do) that the number of women who actually had an event (i.e., heart attack, heart-related disease, or stroke) was extremely small - only 81 women, or 2.5% of the those studied. Still, it is something to discuss with your doctor, who may recommend additional tests to evaluate your heart and vascular health.

Meantime, also know there is treatment for panic disorder. Anti-anxiety medications and cognitive behavioral therapy can help to alleviate the symptoms and improve your quality of life.

Pregnancy weight gain - one size doesn't fit all

Most women know about the traditional weight gain recommendations for pregnancy: 25-35 pounds if you're normal weight (body mass index = 20-25), up to 10 pounds more if you started the pregnancy underweight (BMI <> 25). However, a new study published this week in Obstetrics & Gynecology suggests that these guidelines may be out of date, at least as far as obese women are concerned.

Investigators analyzed data from more than 120,000 obese women in Missouri to see how the weight they gained during pregnancy affected three outcomes: blood pressure, rate of cesarean sections, and the infant's birth weight. They found that 23% of obese women gained less than 15 pounds, 31% gained the recommended 15-25 pounds, and nearly 50% gained more than 25 pounds. The women who gained less weight during pregnancy had the best outcomes, including less pregnancy-induced high blood pressure and normal weight babies.

The researchers also calculated optimal ranges of weight gain during pregnancy based on pre-pregnancy BMI. Women with BMIs of 30-34.9 had the best outcomes when they gained between 10 and 25 pounds. These same women were more likely to have low birth-weight babies when they lost weight, but they had fewer other complications like high blood pressure and C-section deliveries. Women with a BMI of 35-39.9 did best when they gained less than 9 pounds. For women with a BMI of 40 or higher, losing up to 9 pounds produced the best outcomes.

As you can see, this study's findings contradict the current guidelines, which were established in 1990 when obesity wasn't so common. However the current guidelines may be no more. The Institute of Medicine plans to reevaluate its recommendations for weight gain during pregnancy to reflect more recent evidence about pregnancy and birth outcomes.

What does this mean for you? If you are obese and pregnant, or planning to become pregnant, talk to your doctor or midwife about the best weight gain - or weight loss - strategy. And remember, no matter what weight you are, it's important to eat a nutritious and well-rounded diet while pregnant and postpartum.