After A Miscarriage...

Experiencing a miscarriage, particularly later in the pregnancy, can be emotionally devastating, but here is some interesting research from a British Medical Journal report, encouraging women who experience a miscarriage to get pregnant again quickly.

From the LA Times:

After a miscarriage, the time a woman should wait before trying for another pregnancy is controversial. Some practitioners believe that there should be no wait time; the World Health Organization encourages women to wait at least six months.

A study published online Thursday in the British Medical Journal reports that women who conceive within six months of their miscarriage have the best chance of having a healthy, successful pregnancy.

The study looked at data for more than 30,000 women who attended Scottish hospitals between 1981 and 2000. All of the women had had a miscarriage in their first pregnancy before getting pregnant again. The women were divided into five categories based on the interval between the miscarriage and subsequent pregnancy: less than six months, 6-12 months, 12-18 months, 18-24 months, and more than 24 months.

The scientists found that women who conceived again within six months were less likely to have a caesarean section, preterm delivery (defined as birth before 36 weeks) or an infant of low birth weight (less than 5.5 lbs), compared with women in the other categories.

They were 66% less likely to have a miscarriage than women who waited six to 12 months to conceive, 48% less likely to have an ectopic pregnancy (in which the pregnancy occurs outside of the womb), 43% less likely to terminate their pregnancy and 70% less likely to have a stillbirth.

The longer the interval between miscarriage and subsequent pregnancy, the greater the risks were seen to be.

The authors wrote in their paper that “women who conceive within six months of an initial miscarriage have the best outcomes and lowest complication rates in their subsequent pregnancy.” Perhaps, they suggested, this is because women who become pregnant soon after a miscarriage are more motivated to stick to health-related behavior to ensure the success of their next pregnancy.

Byron Russell

Pregnancy Weight And Childhood Obesity Linked

A report from RedOrbit. The importance of this study is the link between obesity late in life and weight at birth, meaning that excessive weight gain during pregnancy puts the child at higher risk of obesity (and associated health risks) later in life. This highlights the necessity of a healthy diet during pregnancy -- and before conception.

A new study funded by the U.S. National Institutes of Health has discovered a link between the weight gain of pregnant mothers and the risk of obesity in their children.

In a population-based study, Dr. David S. Ludwig of Children's Hospital in Boston and Columbia University economics professor Janet Currie looked at all known births in the states of Michigan and New Jersey from 1989 through 2003.

According to their findings, which were published in the August 5 edition of The Lancet, expectant mothers who gained 50-pounds during their pregnancies were twice as likely to have a high birthweight infant as those who only gained 20.

For purposes of the study, high birthweight was defined as anything over 8 pounds, 13 ounces.

Furthermore, in their research, Ludwig and Currie "found that if the same woman gained roughly double the weight during one pregnancy compared with another, her baby was on average half a pound, or 200 grams, heavier than its sibling, a large difference for newborns," according Shirley S. Wang of the Wall Street Journal."

"The more weight the women gained, the higher the risk of having a high-birth-weight baby," Wang also noted in a Thursday article. "Women who gained more than 52 pounds, for instance, were 2.3 times as likely to have a high-birthweight baby as women who gained 18 to 22 pounds, within the recommended range of gain for overweight women."

"In view of the apparent association between birthweight and adult weight, obesity prevention efforts targeted at women during pregnancy might be beneficial for offspring," the researchers write in the 'Interpretation' section of their paper's summary.

"Research is urgently needed into how to help women of reproductive age attain and maintain a healthy weight before and during pregnancy," Dr. Neal Halfon and Dr. Michael Lu of the University of California's Center for Healthier Children Families Communities wrote in an article accompanying the research paper. "With a growing focus on preconceptional health, there is an opportunity to develop effective interventions to help women conceive at a healthier weight."

Byron Russell

Acupressure Effective for Relieving Morning Sickness

This study shows the effectiveness of stimulation of the acupuncture point Neiguan (P6) for preventing morning sickness and vomiting during pregnancy. Neiguan is located on the inner wrist, about 2 finger-widths above the wrist crease toward the elbow. Acupuncture treatments on a number of points (St36, Liv3, Sp9, LI4) is even more effective, but acupressure on the wrist is something you can try at home.

From PubMed:

Morning sickness control in early pregnancy by Neiguan point acupressure.

de Aloysio D, Penacchioni P.

Department of Obstetrics and Gynecology, Bologna University, Italy.
Abstract

OBJECTIVE: To evaluate the antiemetic effect of acupressure at the Neiguan point. METHODS: Sixty women in early pregnancy were entered into a randomized, double-blind, cross-over, placebo-controlled trial. During a 12-day period, organized in four steps of 3 days each, the women were divided into two homogeneous groups to test the effectiveness of unilateral and bilateral acupressure. RESULTS: Use of acupressure resulted in a significantly lower frequency of morning sickness compared with placebo treatment. More than a 60% positive effect was found with unilateral and bilateral acupressure, compared with an approximately 30% positive effect of placebo acupressure. Changing from unilateral to bilateral pressure on the Neiguan point caused no significant statistical difference. No noteworthy side effects occurred. CONCLUSION: Acupressure on the Neiguan point relieves morning sickness

Byron Russell, LAc

Acupuncture, diet and post-natal recovery

Although acupuncture treatments for fertility are pretty well-known now, and the benefits of this treatment are extremely well-researched, we hear less about post-partum acupuncture -- treatments for the new mother AFTER the baby is born. These treatments – combined with a healthy diet – are extremely important in helping the mother regain her strength and energy. I emphasize to all of my fertility patients that the goal isn’t simply to ‘get pregnant’, or even to deliver a healthy baby, but to do that and to be healthy enough to enjoy this new life and support your new family.

I recently completed a course on acupuncture and fertility, and here is an excerpt from the notes on that class, taught by Debra Betts a well-respected acupuncturist in New Zealand.

The Road to Recovery
Adequate rest to ensure complete recovery from childbirth is an important part of Traditional Chinese Medicine. Pregnancy can be challenging to the body, and labor certainly is. A basic idea in TCM is that it will take a woman at least a month to fully recover from childbirth, an idea not necessarily widespread in Western society. Though partners or relatives are usually available to help for a week or two, many new mothers are left to their own devices (and a newly busy and sleepless schedule) after that. The demands of modern society and the pressures of our work world often prevent partners from helping more, and prevent some Moms from feeling comfortable asking for more help.

It may be an appealing idea that “super moms” will be fit and ready for action within a week or two following birth, but this is not the reality for most women. While they may be able to cope, (and will be rewarded by plenty of verbal feedback on how well they are doing), several months later it is often hard to shake off the tiredness and exhaustion. Breast-feeding can exacerbate this situation, particularly if the new mother isn’t getting adequate nutrition.

Remembering that the ideal is a happy new Mom who is able to enjoy her new family duties, weekly acupuncture treatment starting from 2 weeks postpartum for a total of 3 weeks to promote stamina and an efficient recovery can be recommended. This is also a good time for evaluation for more serious problems that may result from a difficult labor or more severe exhaustion. Acupuncture can also be useful at this time to balance emotions, aid perineal healing and help with any breastfeeding problems.

There is also a long documented history in traditional Chinese medicine of women taking dietary remedies to encourage lactation and to promote their recovery from childbirth with an emphasis on building blood and energy. Specific foods are seen to be especially valuable, for example:

Foods that improve Qi (energy) include;
Oats, rice, potatoes, sweet potatoes, pumpkin, mushrooms (button and shitake), yams, dates, grapes, Kidney beans, tofu, beef, chicken, tuna, egg, jasmine tea and spices such as; basil, cinnamon, clove, dill, fennel, ginger, nutmeg, rosemary, and thyme.

Foods to build blood include;
Corn, beetroot, all dark leafy greens, mushrooms, apricots, avocados, dates, kidney beans, sesame seeds, chicken, mussels, eggs and soy milk as well as the obvious iron rich foods such as red meat and spinach.

Byron Russell

Taking Charge of Your Fertility: Book Review and Tips

A lot of patients ask for information on fertility and I recommend a number of books. One that is very interesting is Taking Charge of Your Fertility, by Toni Weschler, MPH. It is subtitled "The definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health." It is an easy-to-read overview of natural approaches to enhancing fertility, as well as a discussion of the medical options for fertility and for birth control.

The center piece of her discussion is what she calls the Fertility Awareness Method. Basically, this a method to become aware of the signs of fertility, primarily temperature changes and changes in cervical mucous. I find this method of particular interest because it allows a woman to determine her specific fertility cycle and best days for getting pregnant, as opposed to taking the standard 28-day cycle, ovulation on day 14 as a guide. Ovulation can occur as early as day 8 for some, and very late for others, day 22 or beyond. For couples who are timing their sexual intercourse to coincide with fertile days, using the statistical generalization of 'day 14' may mean missing the actual days when fertility can occur, and missing their goal of pregnancy. Acupuncture and herbs are very good at regulating the menstrual cycle -- and helping a patient get to the ideal of a 28-day cycle, but it is always better to know the exact period of fertility for a particular patient, especially for those who have a long history of birth control use (the Pill) and irregular cycles.

Here are a few of my tips for fertility, some of which are also discussed in Ms. Wechsler's book.

1. Avoid the use of lubricants. Most are harmful to sperm, including saliva and glycerin (which is found in most lubricants). Changes in pH and osmolality both affect sperm motility and life span. Wechsler notes that canola oil and baby oil have shown minimal negative impact of sperm activity, and that egg white is considered by some to be the best option for those needing natural help, with some concern for the fact that egg white is not determined to be bacteria free. Pre-Seed Lubricant is a commercial option that has been created to avoid negative effects on fertility.

2. Related to the first item, douches, vaginal sprays and tampons are not recommended. Anything which alters the pH of the vagina or affects cervical mucous can negatively impact sperm motility and one's chances of getting pregnant.

3. Excessive exercise and low body fat can reduce fertility. This is something I discuss with patients regularly. For achieving pregnancy, and regulating the menstrual cycle, adequate intake of healthy fats and oils is very important. Reducing stress on the body is also important, and that includes avoiding over-exercising. Moderation is very important, as well as getting adequate rest and sleep.

4. Caffeine, nicotine, marijuana, alcohol and other recreational drugs should be eliminated or reduced. This seems obvious to most people, but it is worth mentioning. With my patients, I evaluate the stress-impact of these changes. Recreational drugs have to be eliminated, but for those who can't function without coffee or tea, it is sometimes better to reduce than to eliminate. The stress of going completely without may have a more negative short-term impact than the caffeine. For those with fertility challenges that persist for 4 months or more, it becomes more important to eliminate any factor which impacts fertility.

5. Anti-histamines -- this is an interesting one for those with allergies, and it is worth considering alternatives to their use if you are experiencing challenges in getting pregnant. Antihistamines can alter the cervical mucous -- which is usually not a good thing. Expectorants can be used to thin cervical mucous. This is an effect which is rarely discussed. For men, steroids, antimalarial drugs and ulcer medications can suppress sperm production.

6. Hot tubs, saunas, jacuzzis -- anything that increases the temperature of the testicles can reduce male fertility, or cause sterility in some. Avoid overheating -- it takes at least 6-weeks to recover, and may take up to 3 months. For men whose sperm is very sensitive to heat, wearing boxers and loose pants becomes important, as well as to avoid sitting with legs crossed for long periods. Bike riding can also have a negative impact for some, even long hot baths.

Byron Russell

Timing Your Fertility

Here are some tips from FertilityFriend on the timing and frequency of sexual intercourse in promoting pregnancy. This is an update on what was generally recommended in the past, particularly regarding the frequency of intercourse.

The Fertile Window

Sperm may last up to 5 days in cervical fluid and the egg may last up to 1 day after ovulation -- but these are the extremes. Intercourse during the two days prior to ovulation and on the ovulation day is more likely to produce a pregnancy.

Your fertile window is made up of the days in your menstrual cycle when pregnancy is possible. The length of this fertile phase is determined by the maximum life span of your partner's sperm and your egg. Sperm can survive a maximum of five days in fertile cervical fluid and your ovum can survive for up to one day. Your theoretical fertile window is thus six days long, comprised of the five days before ovulation and the day of ovulation. You only have a chance to conceive when you have intercourse on these days. This means that pregnancy is technically possible from intercourse on any of these six days. The likelihood of actually becoming pregnant, however, is dramatically increased when you have intercourse in the three days immediately leading up to and including ovulation. This makes a practical fertile window of just three days.

Frequency of Intercourse --

In the past it was suggested that the male refrain from ejaculation for 3 days prior to intercourse, giving the sperm cells a chance to mature in the epididymis, and giving the semen volume and sperm count time to build. But, this is no longer thought to be true. Frequent intercourse during the fertile window produces a higher chance of pregnancy.

There has been some speculation that couples who are trying to conceive should reduce the frequency of sexual intercourse during the fertile window to increase sperm supply. This is not true for most couples. While couples with known male factor issues should consult their doctor for the best intercourse strategy, couples with normal fertility and no known sperm issues should not reduce the frequency of intercourse in the fertile window. Your probability of conception is increased when you have intercourse multiple times in your fertile window. While it is true that sperm concentrations decrease slightly with increasing intercourse frequency, frequent intercourse is still more likely to result in conception than infrequent intercourse for couples with no male factor fertility issues. Each additional act of intercourse within your fertile window increases your probability of conception for that cycle.

Byron Russell

Sulfa Drugs Linked to Birth Defects

While the most common antibiotics were not linked to birth defects, the study shows that sulfa drugs and nitrofuranritoins were. Something to keep in mind during pregnancy. Here is an excerpt from the article and a link to the full report.

CDC Study Links Two Antibiotics to Birth Defects. No added risk was found, however, for most commonly used infection-fighters

However, the study found that two types of antibiotics were linked with a higher risk for several birth defects: nitrofurantoins and sulfonamides, sometimes called "sulfa drugs," which are prescribed for urinary tract and other infections.

Women whose children had anencephaly, a fatal malformation of the skull and brain, were three times more likely to have taken sulfonamides, the study found. Sulfonamides were also tied to an increased risk for such heart defects as hypoplastic left heart syndrome and coarctation of the aorta, choanal atresia (a blockage of the nasal passage), transverse limb deficiency and diaphragmatic hernia, an abnormal opening in the diaphragm that results in severe breathing difficulties.

Nitrofurantoins were also associated with multiple birth defects, including anophthalmia and microphthalmos (eye defects) and several congenital heart defects. Mothers whose children were born with a cleft lip or cleft palate were twice as likely to have taken nitrofurantoins, the study found.

US NEWS and WORLD REPORT

Byron Russell