Qn of the Month: Are there Physical Activity Guidelines for Post-Pregnancy?

MH900427748A: Yes! In the United States, postpartum physical activity recommendations come from two main sources: the American Congress of Obstetricians and Gynecologists (ACOG) and the U.S. Department of Health and Human Services 2008 Physical Activity Guidelines for Americans. In the United Kingdom, recommendations come from a 2006 statement issued by the Royal College of Obstetricians and Gynaecologists. Guidelines from the 2008 U.S. Physical Activity Guidelines for Americans are to aim for a minimum of 30 minutes of physical activity most days of the week (so at least 150 minutes a week) of at least moderate intensity. The good news is that this amount can be spread out into 10 minute blocks of moderate intensity activity throughout the day. Much more manageable if you’re handling a young infant!

A recent study reviewed the physical activity guidelines similarities and differences among 5 countries (Australia, Canada, Norway, United Kingdom, and United States).  Although there are quite a few variations between the country-specific guidelines, one thing is clear: physical activity is good post-pregnancy and brings a host of benefits! Advantages for mothers can include an improved mood, improved weight control, increased weight loss, maintenance of cardiorespiratory fitness, reduced depression and anxiety. Recommended types of physical activities from these different country guidelines are aerobic, pelvic floor exercises, strengthening, stretching and walking. Overall, it may be best to build up the intensity of exercise gradually in the postpartum period depending on your body. If you’ve had a cesarean birth, it is likely best to speak with a health care provider first, before resuming previous physical activity levels.

Hopefully in the future, there can be more consistency across countries and more specifics provided within each guideline to help postpartum women.

(Sources: ACOG. Exercise during pregnancy and the postpartum period. ACOG Committee Opinion No. 267. Obstet Gynecol. 2002; 99(1):171–3. [PubMed: 11777528]

U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans.Washington, D.C.: 2008. ODPHP Publication No. U0036. http://health.gov/paguidelines/. Accessed September 25, 2015.

Evenson KR, Mottola MF, Owe KM, Rousham EK, Brown WJ. Summary of International Guidelines for Physical Activity Following Pregnancy Obstet Gynecol Surv. Obstet Gynecol Surv. 2014 Jul; 69(7): 407–414. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4134098/pdf/nihms-616584.pdf. Accessed September 19, 2015.)

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Qn of the Month: I Had Gestational Diabetes in Pregnancy. Can I Forget About Blood Sugars Now That Baby’s Out?

Not quite – let me explain why.

Like me, you may have had gestational diabetes (GDM) during pregnancy, or you are currently experiencing it. Regardless, no one likes it, but it’s something we endure for the sake of delivering a healthy baby. The worst part I found was not so much that I had to constantly watch what I ate, but because I had to poke my finger to check the blood glucose level at least four times a day. The best part though is post-delivery when blood glucose levels often quickly improve and you can enjoy high carbohydrate foods again. But before you sigh with relief, forget all about blood glucose checking and throw away your testing kit, there are still a few things you should know now that you have a history of GDM.

As you may already know, gestational diabetes carries risks for both the mother and the developing fetus within the womb, as well as to the post-natal infant immediately after delivery. Women who have gestational diabetes are also at a higher risk of developing type 2 diabetes later in life. I was given some differing bits of advice from different countries. When I was in the United Kingdom (UK), a midwife told me that after the baby was born, to check my blood glucose level every year on baby’s birthday. In Singapore, however, my OBGYN doctor told me to randomly check my blood glucose level once in a while after a high carbohydrate meal.

So what should really be done now that baby’s out? In the United States, the American Diabetes Association (ADA) provides some guidelines for post-partum women who have had a history of GDM. Recommendations call for women with a history of gestational diabetes to be tested at the 6-12 weeks post-partum check-up for persistent diabetes. This should be done using the oral glucose tolerance test (OGTT) involving a standard glucose load and comparing the results to non-pregnancy diagnostic criteria. The reason for this is because while most women’s blood glucose levels return to normal post-delivery, some women may continue to have high blood glucose levels.

It is also recommended that women with a history of GDM should have lifelong screening for the development of diabetes or prediabetes at least every 3 years. In those found subsequently to have prediabetes (i.e., results indicating they are on the borderline of being diagnosed with type 2 diabetes), ADA recommends these women to receive lifestyle interventions or the medication named metformin to prevent diabetes.

So if you’ve have a history of GDM, you can relax…but not too much. It is still important to take care of your health and body, and to a certain extent be somewhat mindful of what you are eating. This means being aware of and possibly limiting high carbohydrate nutrient poor foods, avoiding excessively large portion sizes, having regular spaced meals/snacks during the day and staying active. And you’ll still need to periodically have your blood glucose levels checked!

(Source: American Diabetes Association. Standards of Medical Care in Diabetes – 2014. Diabetes Care. Jan 2014; 37 Suppl 1: S14-S80. http://care.diabetesjournals.org/content/37/Supplement_1/S14.long#sec-22. Accessed May 30, 2014. Note that there is a correction published for one of the sections within this article at http://care.diabetesjournals.org/content/37/3/887.1)

Pregnancy Nutrition: Tips for Mothers-to-Be

Congratulations, you’re pregnant!! You may be feeling a strange mixture of excitement, joy, anxiousness and anticipation right now. You may also be wondering how to best take care of yourself and the little one now growing inside of you. Here are some nutrition tips below to help you on your pregnancy journey:

Try to eat a varied, well balanced diet, with plenty of fruits and vegetables. Aim for at least 3 meals 1-3 snacks a day. No, you don’t really need to ‘eat for two’, but starting in the 2nd trimester you can add on an extra 340 calories a day to your intake. Then in the 3rd trimester you can increase this slightly to an extra 452 calories a day. In terms of actual food though, 340 calories is not a huge amount more. It is equivalent to about an extra 12 ounce cup of semi-skimmed milk and a slice of toast with jam. Alternatively, it could also be equivalent to about 6 oreo cookies or just 2/3 of a Starbucks’ iced lemon pound cake, so think about how/where you spend those extra calories!

Make sure you take at least 2-3 servings of a calcium rich food/beverage daily. Examples are cow’s milk, yogurt, cheese or calcium fortified soymilk, oatmilk or other calcium rich alternatives. Most health professionals also recommend starting daily prenatal multivitamins, as well as a calcium supplement depending on your nutritional status and intake during pregnancy.

Lastly, go easy on those carbs. If rice or pasta is your staple, or you have a sweet tooth, it is easy to go overboard on the cookies, cakes, sweets, noodles and white rice, using pregnancy as your excuse. Don’t get gestational diabetes like I did! It’s definitely no fun poking your finger 4 times a day…So space out your carbohydrate intake throughout the day, and go easy on the sweets which don’t offer much nutritional value. If you do get gestational diabetes, don’t worry things will improve after you give birth. But a history of gestational diabetes does increase your risk of having type 2 diabetes later in life, so you will still need to be careful post-labor. If you had gestational diabetes, then after baby is born, still make it a point to check your blood glucose levels periodically using a self-testing glucometer kit or get a fasting blood glucose level check every year around your baby’s birthday.

And of course, do your stretches, walking, swimming and/or other exercises as you are able to (with your doctor’s advice) to keep moving and flexible!

‘D-Day’ Jitters

As I write, a good friend of mine is going in to have her first baby delivered by C-section today.  When she shared her feelings of nervousness over this upcoming ‘D-Day’, I remembered that I felt a similar way less than a year ago. Especially for first time mothers-to-be, it can be such a mixed bag of emotions. First, there is the great UNKNOWN of the delivery itself—what exactly will happen? We are always told by others to expect the unexpected, that what we imagined the delivery to be like will rarely happen, and not to expect things to go as your birth plan.  And that is true. You have to relinquish control over the circumstances. So many things can happen during the delivery process to mom and baby that often it’s really a miracle both can come out healthy and safe at the end.

Then there is the question of pain. “What will the pain level really be like?” I remember my sis-in-law telling me, “It’ll be a hundred times worse than your period.” Not very comforting to hear…I remember watching episodes of this UK program called ‘One Born Every Minute’ where different situations are shown of women giving birth. But even then, there is a certain surreal feeling to watching them.  I think no matter how many birth stories you watch or have your friends tell you about, it still can’t compare to really experiencing the pain yourself on that actual day.

To cap it all off, with D-Day comes the awareness that this day — this one moment — will likely be the single, biggest, most life-changing moment of your life. There are few other moments in life where you know things will change as radically and dramatically as this. Marriage as you know it as a two-some will be irrevocably changed forever. Change can be good and welcomed, but also somewhat unsettling.

Of course, there is also much joy, excitement and anticipation. You’ll finally be able to see the little one who’s been kicking in your belly these last 9 months! And, yippee, you’ll soon be freed from all those pregnancy aches and pains (for me, it was no more gestational diabetes)!

I had an added worry, as our baby had stopped growing in the womb from 36 weeks gestation, so the decision was made to bring her out early by induction.  We didn’t know the cause of this intrauterine growth retardation and didn’t know if she would be alright. For those who know the story, I felt like I was standing on the shore of the Jordan River, about to cross, and not knowing what was on the other side. I had to relinquish control and cast myself utterly into God’s hands, to have Him lead and guide me over to the other side through this great ‘unknown’.  Just like the Israelites who had to depend on God to help them cross the Jordan River, and on God to lead and guide them through the subsequent 40 years in the wilderness (in my case this would be 20 years until she goes to college!).Yet, over everything there is a sense of peace as well, because I am reminded of ‘Emmanuel’, that God promises to always be there with me in and through it all.

During labor, the doctors accidentally gave me an overdose of the epidural drugs which caused my blood pressure to plummet so quickly I blacked out briefly. Then the baby’s heart rate started to plunge sharply every time I had a contraction. As it turned out, her umbilical cord was wrapped around her neck. We’re so thankful she came out earlier and was tiny enough to make it unscathed through the birth canal!