Friday, May 25, 2012

Tuesday, May 22, 2012

Pregnant? Keep Moving! Part II

By Karolina Gonzalez, MAS

Regular physical activity is important during pregnancy, but there are many safety concerns that you will have to keep in mind. It is important to pay close attention to the exercise you choose as well as your diet. And don’t forget to discuss with your doctor your daily exercising routine to make sure you and your baby are not at risk for any complication!

What Exercises Are Safe During Pregnancy?

Most exercises are safe to perform during pregnancy, as long as you exercise with caution and do not overdo it. Throughout your pregnancy and mainly beyond the 7th month, non-weight-bearing activities such as swimming, bicycling and stationary cycling and those with gentle, rhythmic movements are excellent choices. On the other hand, weight-bearing exercises are any activities that you perform on your feet, putting your muscles and bones against the force of gravity. For instance, walking is a recommended weight-bearing activity during pregnancy.

During the third trimester, the increasing volume and weight of the uterus moves the pregnant woman’s center of gravity forward. To counteract this and maintain stability, it is natural for the mother-to-be to lean backward. The change in posture places extra strain on the muscles, ligaments and joints in the lower back, causing pain. Exercise during pregnancy may reduce back pain, since it will help you to strengthen your back muscles.

You should proceed with caution while practicing other weight-bearing activities, such as jogging, running, racquet sports, or dancing, because you are at higher risk for falls that might harm you or your baby. Activities involving high impact or reduced oxygen availability should also be avoided, especially after week 12, as are those with high risk of accidents. A few examples are horse-back riding, skiing or skating, and diving.

Listen to your body!

As pregnancy progresses, some activities may become harder. The most important rule is to pay attention to what is going on physically. Levels of fatigue and breathlessness are a good guide for you to know when to stop. If you feel muscle strain or excessive fatigue, modify the moves and/or reduce the frequency of the workouts. Any exercise should be stopped at once if pain, blurry vision or dizziness is experienced.

Pay attention to your diet!

Make sure that you're eating a well-balanced diet. Normally, after the 13th week of pregnancy energy requirements increase by about 300 calories a day, even without exercise. This energy requirement is increased further when daily energy expenditure is increased through exercise. In weight-bearing exercises, such as walking, the energy requirement progressively increases with the increase in weight during the course of the pregnancy.

A related consideration to calorie intake and exercise during pregnancy is adequate carbohydrate intake. Pregnant women use carbohydrates at a greater rate, both at rest and during exercise, than do non-pregnant women. Some evidence suggests that eating a low-glycemic (a measure of the speed at which a food is likely to increase the level of blood sugar in the body) diet during pregnancy may cut the risks of complications before delivery, such as gestational diabetes. It may also reduce the chances of having a high birth weight infant, which may play a role in the development of certain health problems later in his life, such as obesity (Moses et al., 2006).

Try following these recommendations:

ü  Choose whole grains. Good options include 100 percent whole wheat bread and pasta, oatmeal, barley, cracked or sprouted whole wheat products, high bran cereals, buckwheat and couscous. Limit white bread and rice, instant oatmeal, pretzels, popcorn and rice cakes.

ü  Eat plenty of vegetables. Low glycemic index options include peas, corn, carrots, eggplant, cauliflower, broccoli, tomatoes, green beans, lettuce, red peppers, onions, mushrooms, cabbage, sweet potatoes and lima beans.

ü  Incorporate fruit. In addition to containing many nutrients that are vital for the health of your baby, most options are low on the glycemic index. Watermelon and dates are two to limit, but cherries, plums, coconuts, kiwis, oranges, strawberries, grapefruit, prunes and peaches are good options.

ü  Choose plenty of low-fat dairy foods. Not only do they contain calcium for your growing baby's bones, but most options are low glycemic index. Yogurt, cottage cheese, and milk are healthy choices. 

Drink plenty of fluids, even if you don't feel thirsty!

It is important to drink plenty of fluids, especially during the summer months. When the weather is hot, exercising in the early morning or late evening can help prevent you from getting overheated. If you're exercising indoors, make sure the room has enough ventilation. Also, consider using a fan to help keep you cool.

Continue exercising after your baby is born!
As for postpartum resumption of activities, it is known that any of the physiological and morphological changes of pregnancy persist for four to six weeks postpartum. Physical activity can be resumed gradually as soon as physically and medically safe. Work with your doctor to create a plan to go back to your active lifestyle! For nursing moms, interested on the effects of exercise on breastfeeding, we have very interesting previous posts that might help you. Click here for the first of the two posts.

1.    Artal R, O’Toole, M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period.  Br J Sports Med. 2003;37:6–12. 

2.    Moses RG, Luebcke M, Davis WS, Coleman KJ, Tapsell LC, Petocz P, Brand-Miller JC. Effect of a low-glycemic-index diet during pregnancy on obstetric outcomes.  Am J Clin Nutr.  2006;84:807–12.

Saturday, May 19, 2012

Baby Behavior Goes to Washington!

Ok, it was Virginia but that's pretty close!! Some of us are traveling to share our information in our nation's capital and the rest of us are going to Medford, Oregon! Have a great weekend and we'll be back next week with a new post.

Tuesday, May 15, 2012

Pregnant? Keep Moving! Part I

By Karolina Gonzalez, MAS

The Centers for Disease Control and Prevention and the American College of Sports Medicine (CDC and ACSM) have recommended 30 minutes or more of moderate intensity physical activity on most, and preferably all, days of the week for the general population.

But what if I’m pregnant?
In 2002, the American College of Obstetricians and Gynecologists (ACOG) published exercise guidelines for pregnancy. They suggested that despite the fact that pregnancy is associated with profound anatomical and physiological changes, in the absence of medical or obstetric contraindications, 30 minutes or more of moderate exercise a day on most, if not all, days of the week is also recommended for pregnant women.  This will allow them to get the same associated health benefits from being physically active during pregnancy as before pregnancy. Exercise maintains fitness, strengthens muscles, and boosts circulation. It also prevents varicose veins and constipation, improves emotional well-being, and helps prevent excessive weight gain. However, these recommendations did not define ‘moderate intensity’ or the specific amount of weekly caloric expenditure from physical activity required for pregnant women to maximize the benefits of being physically active.

As a former dancer, I love the thrill of moving my body to the music I love. I got used to moving around, and I try to get some physical activity every day. Once I got pregnant I asked myself: How safe it is to keep my normal exercise routine? Will it be harmful for the baby? Should I make any modification?

Researchers in Denmark examined the relationship between physical exercise during pregnancy and the risk of preterm birth. Self-reported data on physical exercise during pregnancy were collected prospectively for 87,232 singleton pregnancies included in the Danish National Birth Cohort between 1996 and 2002. Results showed a reduced risk of preterm birth among the almost 40% of women who engaged in some kind of exercise during pregnancy in comparison with non-exercisers. The type of exercise did not affect the association, and the results were not altered when the degree of preterm birth was taken into account (Juhl et al., 2008). Another group of researchers conducted a prospective observational investigation at the Naval Medical Center, in San Diego, California. They evaluated the influence of exercise, by level of activity, on maternal and perinatal outcome in a large low-risk healthy obstetric population of working women. Based on their findings, exercise does not appear to affect antenatal, intrapartum, or postpartum complications, even after evaluating these women for confounding variables such as maternal age, race, gravidity, parity, maternal illness, height, pre-pregnancy weight, weight gain during the pregnancy, prior preterm delivery, smoking, and stress (Magann et al., 2002). These findings do not contradict current recommendations.

However, current ACOG guidelines are based on studies published before or during 2002. According to a recent review, healthy pregnant women can benefit from exercising at a moderate intensity for a longer duration than recommended in the current ACOG guidelines. Researchers found that increasing physical activity energy expenditure to a minimum of 16 metabolic equivalent task (MET) hours per week, or preferably 28 MET hours per week, and increasing exercise intensity to ≥60% of heart rate reserve during pregnancy, reduces the risk of gestational diabetes mellitus and perhaps hypertensive disorders of pregnancy, such as gestational hypertension and pre-eclampsia, compared with less vigorous exercise. To achieve the target expenditure of 28 MET hours per week, one could walk at 3.2 km (nearly 2 miles) per hour for 11.2 hours per week (2.5 METs, light intensity), or preferably exercise on a stationary bicycle for 4.7 hours per week (~6–7 METs, vigorous intensity). The more vigorous the exercise, the less total time of exercise is required per week, resulting in ≥60% reduction in total exercise time compared with light intensity exercise. They also found that light muscle strengthening performed over the second and third trimester of pregnancy has minimal effects on a newborn infant’s body size and overall health (Zavorsky & Longo, 2011).

Please consult with your doctor on how to safely exercise during pregnancy

It is not advisable to start a demanding regimen during pregnancy, though. Excessive or improper activity can be dangerous to the woman and the baby. Every pregnant woman should be carefully evaluated before recommendations on physical activity participation during pregnancy are made. We should also take into account that certain obstetric complications may develop in pregnant women regardless of the previous level of fitness, which could preclude them from continuing to exercise safely during pregnancy (Artal & O’Toole, 2003). All active pregnant women should be examined periodically to assess the effects of their exercise programs on the developing fetus, so that adjustments can be made if necessary. Work with your doctor to make sure you and your baby are not at risk for possible complications derived from your workout plan.

Next time: We'll share some information about safe exercises during pregnancy

1.         Juhl M, Andersen PK, Olsen J, Madsen M, Jørgensen T, Nøhr EA, Andersen AM. Physical exercise during pregnancy and the risk of preterm birth: a study within the Danish National Birth Cohort. Am J Epidemiol. 2008; Apr 1;167(7):859-66.
2.         Magann EF, Evans SF, Weitz B, Newnham J. Antepartum, intrapartum, and neonatal significance of exercise on healthy low-risk pregnant working women. Obstetr & Gynecol. 2002;99(3):466-472.
3.         Zavorsky GS, Longo LD. Exercise Guidelines in Pregnancy. New Perspectives. Sports Med. 2011; 41 (5): 345-360.

Sunday, May 13, 2012

Thursday, May 10, 2012

What does the Face of Breastfeeding Really Look Like?

In seeing the pictures from TIME magazine this morning and knowing that this spread is intentionally designed to create a stir, I was still amazed by the ability of the (I’m sure highly paid) designers and photographers to give these breastfeeding mothers such a harsh look. That is an amazing trick. I have to wonder how the mothers in the magazine were asked to pose when they stood in front of the camera with their children.  Were they asked to look strong… defiant…determined? I doubt that the harsh faces we see are those that their own children see very often.

Those of us who live in the real world know that mothers’ faces are not often harsh. Ok, maybe when their toddlers have dumped the dog food on the rug (again), or when their 7-year-olds have lost their homework (again) or when their teenagers “find” a ding in the back door of their cars (again). But, outside of those situations, mothers’ faces most often hold different expressions. They might be (in no particular order) warm, curious, tired, concerned, knowing, laughing, proud, determined, loving, vulnerable, wistful, or sometimes silly. But not harsh.
The mothers that I see are trying to do the best they can with the information and the resources that they have at hand, whether or not they are breastfeeding their babies. The mothers that I see reach out to each other with compassion and a depth of understanding that comes from facing common challenges.  Regardless of how you feel about the content of the article or of the choices made by the women, the pictures and headlines used by the magazine are intended to elicit a fiery, passionate, and profitable response. 

The TIME staff intends that the pictures will create hits, tweets, updates, shares, blog posts (sigh), rants, and conversations. I’m sure that they will be wildly successful. But those of us who live in the real world have a choice about how we will react.  We can let them color our view of motherhood, or not. We can let them manipulate us into thinking that infant feeding choices “classify” women into one type of mother or another, or not.  I vote not.

Tuesday, May 8, 2012

Does Avoiding Cow’s Milk While Breastfeeding Change Baby Behavior?

Breastfeeding mothers restrict milk in their diets for a variety of reasons. They may think that eliminating milk or other allergenic foods from their diet can improve their baby’s crying and frequent waking behaviors or reduce risk of allergies. Parents may hear stories of maternal milk restriction improving a baby’s crying and/or “colicky” behavior.  (Mannion 2007) Let’s take a look at the facts.

Lactose intolerance

The sugar present in cow’s milk that is sometimes linked to allergies is also present in breast milk. Thus, eliminating milk from the diet of the breastfeeding mother will not drastically change the amount of these milk byproducts in the breast milk. Babies’ digestive systems already have the enzyme needed to break down the lactose, or milk sugar, as well. Gas is a normal side effect of digesting lactose in babies! There is no need to eliminate milk from the mother’s diet for “lactose intolerance” because lactose is naturally in the breast milk. True lactose intolerance does not develop until later in childhood and babies are not allergic to lactose.

A true cow’s milk allergy is an allergy to the protein in cow’s milk, and occurs in 7.5% of infants. In exclusively breastfed infants, the incidence rate is 0.5% and it is thought that the protein in cow’s milk is transferred to the infant through the mother’s breast milk. (Denis 2012)  With this allergy, you would see increased crying and night waking due to pain, but you would also see some obvious symptoms such as rash or hives and/or blood or mucus in your baby’s bowel movements. If you see any of these symptoms or suspect your baby has an allergy, call your doctor.

Mothers avoiding highly-allergenic foods during pregnancy

Avoiding highly allergenic foods such as milk and eggs has not been shown to protect babies from developing food allergies. Avoiding these specific foods can also be harmful to the mother’s nutrition, especially her calcium intake. The baby’s nutrition may be negatively affected as well. (Mavroudi 2011)

Mothers avoiding highly-allergenic foods while breastfeeding

A 2008 Cochrane Review showed that avoiding high-allergenic foods, even in women with family history of food allergies, is not likely to substantially decrease her child’s risk of food allergies. Again, this diet restriction can also negatively affect the mother’s nutrition status. (Mavroudi 2011)

Mother and baby avoidance diet

In the high risk (family history of food allergies) older infant (already eating solid foods) reducing intake of highly allergenic foods did show a significant decrease in symptoms of food allergy, such as eczema, at 1 to 2 years of age. However, this did not affect allergies later in life. (Mavroudi 2011)

What about mom’s diet?

If you do choose to eliminate dairy from your diet, there are many vitamins and minerals that you will be lacking. It’s important to find other sources of calcium and Vitamin D especially, not only for your bone health but for your breast milk as well. Foods such as yogurt and cheese may be less likely to trigger an allergic reaction IF your baby is indeed allergic to milk. Ask your doctor or a dietitian for more information. (Mavroudi 2011)

Bottom Line
Breast milk contains many antibodies that protect your baby against allergies, ear infections and many other diseases. More research is needed to determine without a doubt whether cow’s milk intake in breastfeeding mothers indeed may cause allergies in at-risk infants and whether it affects changes in baby behavior, such as crying and more frequent waking. If you are breastfeeding and have a history of food allergies in your family, talk to your doctor, especially if the symptoms listed in paragraph 3 above occur in your baby. Even if mothers avoid allergenic foods, prevention of food allergy was only seen for the short-term (Mavroudi 2011) and Denis et al recommends that mothers not restrict diary as a means to prevent allergies in their babies.
Mavroudi A and Xinias I. Dietary interventions for primary allergy prevention in infants. Hippokratia. 2011;15(3): 216–222.
Denis M, Loras-Duclaux I, Lachaux A. Cow's milk protein allergy through human milk.  Arch Pediatr.2012;19(3):305-12.

Mannion CA, Gray-Donald K, Johnson-Down L, Koski KG. Lactating Women Restricting Milk Are Low on Select Nutrients. J Am Coll Nutr. 2007; 26(2): 149-155.

Friday, May 4, 2012

Mothers and Babies: Face to Face and Heart to Heart

Last fall, as part of our series on senses, we posted information on the sense of sight. We explained that, when babies are born, they can only see clearly about 8-12 inches away and much of what they see appears blurry. While learning to control the muscles of their eyes, young babies focus on faces of their caregivers and as they get older, they are able to focus on faces for longer and longer periods of time.  When you consider that newborns tend to be held at chest level (about 8-12 inches from the caregiver’s face) for long periods, and that social interaction is important for survival, it makes sense that faces would be a baby’s favorite thing to look at!

A study published late last year describes another possible benefit of spending time face-to-face with your baby. Researchers in Israel measured the heart rates of mothers and their 3-month old infants as they interacted with each other. They also videotaped each 3-minute interaction so they could compare aspects of the interaction (for example, facial expressions, body movements, and vocalizations) with shifts in the mothers’ and infants’ heart rates.

After analyzing the videos and heart rate measurements, they found that the heart rates of the mothers and infants synchronized during the face-to-face interactions. Synchronization means that the mother’s heart rhythms became more like the infant’s and the infant’s became more like the mother’s. In addition, when the mothers and babies were focused most intently on each other (looking right at each other eyes, vocalizing, etc) their heart rhythms were even more coordinated. This could mean that if you are stressed and your baby is calm, each of your heart rates will change a little to be more similar to the other’s heart rate. This can lessen your stress. Alternately, if your baby is upset, simply letting her see your face can be calming.

So, what does this mean?

Eye contact with your baby can have a calming effect on your baby and you. Here are some other ways to increase face-time with your baby.
  • Sit so your baby can see your face during feeding time.
  • When your baby is older and eating in a high chair, maintain eye contact whenever you can as your baby explores his food.
  • When it’s time for immunizations, make sure your face is in full view of your baby as you repeat calming words.
  • During tummy time, get down on the floor face-to-face with your baby, this may help her tolerate tummy time a bit longer.
  • When other friends or relatives are holding your baby and she is beginning to look uncomfortable, stand next to her and let her see your face. That may be all that she needs to calm down a bit.
Parents often describe the calm feeling they get when they look at their babies. It is interesting that there may be a physiological reason behind this feeling and future research will provide even more information about the connection between parents and their babies.

Feldmen R, et al. Mother and infant coordinate heart rhythms through episodes of interaction synchrony. Infant Behavior & Development. 34; 2011: 569– 577

Tuesday, May 1, 2012

Baby Behavior is coming to Alaska!

Over the last few years, we've been to Washington, Hawaii, Arizona, Texas, Nevada, Maryland, Delaware, Oregon, Georgia, and Tennessee to spread the word about Baby Behavior!

Today, we are excited to share the Baby Behavior information in Alaska!

We will be back in California on Friday with a new post.