Tuesday, August 20, 2013
Miscarriage and Exercise
I don’t know which pregnancy it was, but I had recently found
out I was pregnant and because I am the biggest blabber mouth I know, I
mentioned my new pregnancy to a middle-aged woman I didn’t know that well at church. After the
meeting, we were putting away the chairs. She stopped me and took a chair away
from me and said “you shouldn’t be lifting these.” It was embarrassing. I was
even embarrassed for her because it dated her. The days of don’t lift anything, don’t walk more than a mile, don’t get your heart rate
above 140 bpm as a flat guideline for every pregnant woman is gone.
My first pregnancy, I was pretty clueless about everything about pregnancy so I had that archaic attitude. I thought pregnant woman were only allowed to walk for exercise. So that's all I did and kept on eating like I was running 5 days a week. I gained 70 lbs.
My second pregnancy, I must of read something about how we can do anything we were doing before. I was about 6 weeks pregnant and it was the first warm day we had that year, just before spring came. I went hiking with Jackson on my back (so carrying about 40 lbs). I was hiking on a new trail and it turned out to be the steepest trail I've ever found in my area. I got my heart rate up very high very fast and I got hot. Later that day I noticed that I had been spotting a little. This never happened with my first pregnancy so it freaked me out.
Long story short, weeks of worrying, internet searches, internal debates about going into the doctor or not, my pregnancy ended at 11 weeks with a miscarriage.
I know miscarriages can be absolutely devastating to women, but for me the emotions were disappointment with a whiff of guilt. I couldn't shake the thought that my exercising had killed my baby and then I miscarried. My doctor afterward said that it wasn't anything I did, that it was just a doomed pregnancy. He said it was a good thing--it showed that my body was fertile and doing what it's supposed to.
I still had that guilt and fear when I went into my 3rd pregnancy. I didn't push myself hard at all. I biked because that was the lowest impact exercise I could do and still get my heart rate up a little. After the 1st trimester I picked up my effort a little, but by then I was so out of shape, I couldn't really do much. End result, I gained 60 lbs.
The goal for my third pregnancy is to gain the rcommended 25-35 lbs which I know I will only be able to do if I exercise daily. (I just love eating too much.) So, my question is: How much can I exercise during my pregnancy and not increase my risk of miscarriage?
Hold on tight, I'm going to talk about research for a while. If you just can't stand it, skip down a few paragraphs where I'll give my take on the answer to this question.
There is one study, a danish study of about 92,000 women that found a 3.7 times increase in risk of miscarriage for women that exercised 7 hours a week compared to women that didn't exercise at all. Women that exercise half that much had a 2.2 times risk than a woman that didn't exercise at all. This was specifically for women 11-14 weeks pregnant, but the other gestational age groups also had greatly increased risk of miscarriage. I have seen this study referenced several times when you look up miscarriage risk and exercise. It was one of those studies that made the national headlines.
Here is the problem with the study: 1) By the author's own admission, the study has some bias and data collection problems. 2)The study did not take into account if the women were exercising prior to their pregnancies. 3)It did not take into account if the pregnancy was chromosomally normal. We know that 70% of miscarriages are due to a chromosomal problem of the pregnancy. No one caused it, it just happens.
This study, however, took into account if the miscarriage was chromosomally normal. Of Chromosomally normal pregnancies, women that exercised had a 40% decrease in risk of miscarriage. This supports what my doctor said, that miscarriages are usually just doomed pregnancies and there is nothing I or any other woman did to cause it.
This study did account for previous exercise and found that women who had been running or dancing before their pregnancies and continued to do so had no change in risk of miscarriage compared to women who just stopped exercising with their pregnancy.
This study and this study found protective affects of exercise against miscarriage. This study found no difference in risk.
The only other study that showed an increased risk of miscarriage related to exercise found that strain or exercising more than normal during the time of implantation lead to an increase risk of miscarriage by about 2.5 times.
With only a handful of studies that are saying conflicting things, more good research needs to be done.
When thinking about my miscarriage, there are some stupid things I did. I wasn't in shape at all--the winter months tend to do that. Not being in shape isn't what was stupid, but going out and hiking with 40lbs on my back up a steep hill for the first time in months was. How quickly my heart rate and body temperature went up should have been a good indicator I was doing too much while pregnant.
So to answer the question, we don't know yet and it is all relative. If you were doing nothing physically before trying to get pregnant, while you are trying to get pregnant and the beginning weeks of a pregnancy are not the time to start a running regimen. I read an article of an interview of elite runner Paula Radcliffe who ran 50 miles a week during her pregnancy. This, relative to her, wasn't that big of a deal because she was used to running 100 miles a week.
Pregnancy isn't the time to push yourself hard to get fit fast; the goal should be to maintain some semblance of your fitness level before you got pregnant. This is why it is so important to get fit before you get pregnant.
Paula Radcliffe, Marathon world record holder racing (left) and running pregnant (right).
My first pregnancy, I was pretty clueless about everything about pregnancy so I had that archaic attitude. I thought pregnant woman were only allowed to walk for exercise. So that's all I did and kept on eating like I was running 5 days a week. I gained 70 lbs.
My second pregnancy, I must of read something about how we can do anything we were doing before. I was about 6 weeks pregnant and it was the first warm day we had that year, just before spring came. I went hiking with Jackson on my back (so carrying about 40 lbs). I was hiking on a new trail and it turned out to be the steepest trail I've ever found in my area. I got my heart rate up very high very fast and I got hot. Later that day I noticed that I had been spotting a little. This never happened with my first pregnancy so it freaked me out.
Long story short, weeks of worrying, internet searches, internal debates about going into the doctor or not, my pregnancy ended at 11 weeks with a miscarriage.
I know miscarriages can be absolutely devastating to women, but for me the emotions were disappointment with a whiff of guilt. I couldn't shake the thought that my exercising had killed my baby and then I miscarried. My doctor afterward said that it wasn't anything I did, that it was just a doomed pregnancy. He said it was a good thing--it showed that my body was fertile and doing what it's supposed to.
I still had that guilt and fear when I went into my 3rd pregnancy. I didn't push myself hard at all. I biked because that was the lowest impact exercise I could do and still get my heart rate up a little. After the 1st trimester I picked up my effort a little, but by then I was so out of shape, I couldn't really do much. End result, I gained 60 lbs.
The goal for my third pregnancy is to gain the rcommended 25-35 lbs which I know I will only be able to do if I exercise daily. (I just love eating too much.) So, my question is: How much can I exercise during my pregnancy and not increase my risk of miscarriage?
Hold on tight, I'm going to talk about research for a while. If you just can't stand it, skip down a few paragraphs where I'll give my take on the answer to this question.
There is one study, a danish study of about 92,000 women that found a 3.7 times increase in risk of miscarriage for women that exercised 7 hours a week compared to women that didn't exercise at all. Women that exercise half that much had a 2.2 times risk than a woman that didn't exercise at all. This was specifically for women 11-14 weeks pregnant, but the other gestational age groups also had greatly increased risk of miscarriage. I have seen this study referenced several times when you look up miscarriage risk and exercise. It was one of those studies that made the national headlines.
Here is the problem with the study: 1) By the author's own admission, the study has some bias and data collection problems. 2)The study did not take into account if the women were exercising prior to their pregnancies. 3)It did not take into account if the pregnancy was chromosomally normal. We know that 70% of miscarriages are due to a chromosomal problem of the pregnancy. No one caused it, it just happens.
This study, however, took into account if the miscarriage was chromosomally normal. Of Chromosomally normal pregnancies, women that exercised had a 40% decrease in risk of miscarriage. This supports what my doctor said, that miscarriages are usually just doomed pregnancies and there is nothing I or any other woman did to cause it.
This study did account for previous exercise and found that women who had been running or dancing before their pregnancies and continued to do so had no change in risk of miscarriage compared to women who just stopped exercising with their pregnancy.
This study and this study found protective affects of exercise against miscarriage. This study found no difference in risk.
The only other study that showed an increased risk of miscarriage related to exercise found that strain or exercising more than normal during the time of implantation lead to an increase risk of miscarriage by about 2.5 times.
With only a handful of studies that are saying conflicting things, more good research needs to be done.
When thinking about my miscarriage, there are some stupid things I did. I wasn't in shape at all--the winter months tend to do that. Not being in shape isn't what was stupid, but going out and hiking with 40lbs on my back up a steep hill for the first time in months was. How quickly my heart rate and body temperature went up should have been a good indicator I was doing too much while pregnant.
So to answer the question, we don't know yet and it is all relative. If you were doing nothing physically before trying to get pregnant, while you are trying to get pregnant and the beginning weeks of a pregnancy are not the time to start a running regimen. I read an article of an interview of elite runner Paula Radcliffe who ran 50 miles a week during her pregnancy. This, relative to her, wasn't that big of a deal because she was used to running 100 miles a week.
Pregnancy isn't the time to push yourself hard to get fit fast; the goal should be to maintain some semblance of your fitness level before you got pregnant. This is why it is so important to get fit before you get pregnant.
Paula Radcliffe, Marathon world record holder racing (left) and running pregnant (right).
In the News: People without Celiac disease shouldn't eat gluten-free
The gist of the article is that for people that do not have Celiac disease, a gluten-free diet is not recommended. The diet hasn't been shown (beyond personal testimonials) as a benefit for the general population and people are missing out on important nutrients by excluding whole grain wheat products.
I can't throw gluten-free completely out the window, even though it currently reeks of a fad diet.
Sometimes it's hard to see facts and fiction through all the hype. Throw hope in the equation and you get some true die-hard followers. So many people swear their gluten-free diets make them feel better or make their child with Autistic Spectrum Disorder (ASD) have improved behavior. It's hard to argue against that.
I can't find any actual research that support gluten-free diets for weight loss, gluten sensitivity or even treatment for ASD. There hasn't been much research on so far. (That should tip you off that something is a fad if there hasn't been any time for any research to be done on it.) There are a few articles that have shown it doesn't help: here and here and here
In a few years, there may be research to show there are people with gluten sensitivity and they do benefit from reducing gluten from their diet.
I'm not trying to convince any people doing a gluten-free diet that they should stop. If there are any body doing that, I'm sure I've thoroughly ticked them off. I just want to prevent the average person that has heard the "gluten-free" hype and feels like gluten is somehow evil and something they are supposed to avoiding. Gluten-free food is quite expensive and I'd rather you spend your money on fresh fruits and vegetables.
Monday, August 5, 2013
Gearing up for Pregnancy -- a check list
1) Develop a strong mental attitude
Pregnancy is mind boggling to me--how it works, how our bodies can do something so stinking amazing, and how extraordinarily hard it is to go through, especially for some women. Women have traditionally been known as the "weaker sex". If a man ever went through pregnancy, he would never, ever have said something like that. I've been thinking about this for a few weeks and I keep thinking about that clip from the movie Avatar where the Colonel is giving them their safety briefing.
My second pregnancy, which I miscarried at 11 weeks, wasn't planned. (Obviously we didn't do a great job of preventing it.) When I got that positive pregnancy test, I cried. I wasn't overjoyed that I was pregnant. It took a few days to get excited about it because I was not ready to go through pregnancy again.
Going into pregnancy sort of feels like going into war. Imagine the difference of going into a pregnancy with a strong mental attitude. An attitude of, this is going to be tough, but I'm a strong woman and I'm going to rock this pregnancy. I'm not going to complain to my family and friends constantly about my laundry list of symptoms (like I'm the only woman that's ever been pregnant or had pregnancy symptoms before.) I'm not going to let my pregnancy symptoms completely take over my life and health and happiness*. I'm going to be positive and strong.
*Obviously I'm not talking about women that have symptoms so severe they end up in the hospital to get rehydrated or put on bed rest to stop preterm labor or the like.
2) Have well established habits (the good ones)
When all those ca-razy pregnancy symptoms show up, including the big belly, it's going to challenge your will to exercise and eat nutritiously. Having well established habits of daily exercise and being disciplined about what you eat will make success much more likely.
It took me a while to figure out the best way for me to exercise was to wake up early enough to go out and run before my husband goes to work. I've been doing that consistently for about a year now and I love it. I'm used to getting up sometime between 5:00-6:00. I'm used to running in the cold and snow and rain and in the dark. I hope that when I get pregnant, my habit will be stronger than my symptoms.
I'm an Idaho girl, and I love my potatoes. When I get pregnant, I crave more than anything else, potatoes. Not the wholesome baked kind, but the fried and salted kind. During my last pregnancy, there were too many times I sent my husband out to get me fries (and a burger and shake) from the yummy burger grill down the street at 8:00 at night, after I had already had my dinner. Cravings and eating because you feel tired and yucky can kill your weight gain goals. I'd be a big fat liar if I said I have developed perfect eating discipline habits. But, hopefully, I've been doing better with it and I won't give in to temptation as often with my next pregnancy.
3) Aim for a healthy weight
This one is a by-product of doing #2-- being in the habbit of regular exercise and eating right. There's a two-fold purpose for this one. Number one, being under or overweight can affect your ovulation cycles and thus affect fertility. Infertility is a super complex (and heartbreaking) issue that can't be oversimplified and fixed by "be a healthy weight", but that is a place to start. The second reason is that women that are underweight or overweight or obese are much more likely to have pregnancy problems than women at a healthy weight, such as gestational diabetes.
4) Embrace the Folic Acid
Of course all nutrients are important, but folic acid is one that is of particular interest to all women. It is shown that taking a folic acid supplement in the weeks BEFORE CONCEPTION and the first three months of pregnancy can reduce as many as 75% of serious birth defects in the spine, nueral tube and brain (spina bifida, anencephaly) . The key here is that the defects can happen before you even know you're pregnant. Thus the importance that all women take folic acid supplements on a regular basis, just in case there are any surprise babies.
How much?
Look for a supplement that has 400 micrograms. Any general or women's multivitamin will have that amount. After you get pregnant, the recommended amount increases to 600 micrograms.
Do I have to take a pill?
I'd be the first to line up in the anti-supplement line, but this is one of those circumstances where a supplement is most likely needed. Most women just don't get enough. If you wonder if you are an exception to the rule, here are some foods that are high in folate or folic acid.
Folate (the natural form of folic acid) is found in dark green leafy vegetables:
1 cup raw broccoli = 63 micrograms
1 cup raw spinach (cut) = 58 micrograms
1 cup romaine lettuce (cut) = 76 micrograms
Nuts:
1 oz dry roasted peanuts (28 nuts) = 41 micrograms
2 Tbsp peanut butter = 24 micrograms
1 oz dry roasted almonds (22 nuts) = 9 micrograms
Legumes:
1/2 cup cooked garbanzo beans = 80 micograms
1/2 cup peas (boiled) = 47 micrograms
1/2 cup refried beans = 14 micrograms
1/2 cup cooked lentils = 179 micrograms!!
By law, many grain foods are fortified with folic acid in varying amounts. The white flour sitting in your pantry has been fortified with folic acid. Breakfast cereals are often fortified with folic acid, sometimes as much as 100%, but usually 25%-50%.
Personally, I feel like the risk of having a baby with neural tube defects is scary enough (not sure how high the risk actually is) that taking the multivitamin doesn't seem like that big of a deal for the benefit. Another option would be to find a stand alone folic acid supplement, but CAUTION in taking too much folic acid--it can hide a serious health condition. Specifically taking 1000 micrograms or more of folic acid a day can mask the symptoms of pernicous anemia which comes from vitamin b-12 deficiency. So stick with the 400-600 micrograms!
This is the inexpensive multivitamin I grabbed a few months back--it has 400 micrograms of folic acid. I will need to get an actual prenatal vitamin once I get pregnant. (I'll talk about nutrient needs during pregnancy at that time.)
5) Talk to your doctor
I'm going to be a big fat hypocrite on this one--I've never gone to a doctor before any of my three pregnancies. The other day, I tried to schedule an appointment with my OB, but his next available appointment was in October...lame. If I had gone to my doctor, I would have had a discussion with him to ease my mind about miscarrying how much exercise I can do during pregnancy. I would have also asked him his opinions on my going to a midwife for my next pregnancy and if he had any recommendations.
Before you get pregnant is a better time to talk to a doctor about health concerns you have. You may have questions or concerns about previous pregnancies. Go to your doctor, be honest about symptoms you've been having, be honest about your lifestyle, and ask questions. If you don't understand something your doctor is saying, ask him to repeat it or explain it differently. Don't be scared to look dumb. It's dumber to not ask a dumb question. Get the most out of your money for that doctor's visit. This is a great time to see if you're meshing well with your doctor and perhaps it's time to look for another if they aren't attentive to your needs.
March of Dimes - Getting healthy before pregnancy
In the News : How to Talk to Your Daughter About Her Body
I love this article in the Huffington Post by Sarah Koppelkam. It's not often that I completely agree with articles on health or nutrition. I wish every woman would do the things she says, not just for their daughters, but for their own health and happiness. It's a very short article so go and read it.
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