As the days grow longer and warmer, many of us look forward to spending more time outdoors. Whether it’s time with family at the beach or getting some time to do those outdoor chores, everyone needs to make sure they take steps to guard against the damage caused by the sun. When I was growing up, sunscreen was hardly ever used and was often promoted as a way to get an even darker tan. Fast forward more than a few decades and most of us recognize that “tan” is a euphemism for sun damage. Unfortunately, wrinkled skin is not the only eventuality of over-exposure to the sun’s damaging rays. Skin cancer in all its various forms can be directly linked to exposure to the sun’s UVA and UVB rays.

Learning the steps to take to prevent you and your family from the damaging effects of the sun can help ensure that you enjoy your spring and summer months while maintaining good skin health.  The National Council on Skin Cancer Prevention has named the Friday before Memorial Day as “Don’t Fry Day” to increase awareness about sun safety. They have a simple message to take steps to minimize the damage the sun can cause. These steps include avoiding tanning and burning, staying in the shade when possible, using liberal amounts of sunscreen, and wearing protective clothing if you cannot avoid sun exposure. They even have a catchy phrase to help us remember the steps: Slip! Slop! Slap! and Wrap. When outside, both on sunny and cloudy days, slip on a tight woven shirt, slop on broad spectrum sunshine with at least an SPF of 30, slap on a sun-shading, wide-brimmed hat, and wrap on UVA and UVB resistant sunglasses to protect your eyes from sun damage.

Each of these steps will help ensure that you minimize your risk of developing skin cancer in your lifetime. Sadly, skin cancer is on the rise in the United States, and it is estimated that over two million cases of basal cell and squamous cell skin cancers will be diagnosed this year. In addition, over 76,000 Americans will be diagnosed with the more serious malignant melanoma. Many of these diagnoses can be avoided if we take steps to limit our over-exposure to sun.  One effective way is to avoid time outdoors between the hours of 10 a.m. and 4 p.m. when the sun’s UVA and UVB are most potent. If this is not possible, try to cover up sufficiently with clothing and hats that block out the sun’s rays. Be sure to wear hats that cover sensitive areas that are often missed like ears and the back of necks. When possible, try to find shade and always provide shade for children. Children are particularly vulnerable to sunburns, and burns they get today can be the underlying cause of skin cancers they may develop in adulthood.

Sunscreens are great for helping to reduce the impact of the harmful effects of the sun’s UVA and UVB rays, but they are vastly limited. The key to successful sunscreen use is to use one with at least an SPF 30, which will block UVB rays, which cause you to burn. An SPF 30 product will block 97 percent of UVB; however, that does not mean that SPF 60 blocks twice as much or last twice as long. All sunscreen needs to be reapplied at least every two hours—and more often if you sweat or get wet. It is best to apply sunscreen 30 minutes before sun exposure.

SPF ratings have no impact on the sun’s UVA rays which can be even more damaging. These are the rays that don’t cause your skin to burn but rather reach into the deeper layers of your skin and can cause more long-term damage like wrinkles and skin cancer.  So when looking for sunscreen, be sure to look for ones that also protect against UVA damage. Sunscreen makers can use both chemicals and barrier-type compounds to protect against UVA. Some makers use zinc oxide and titanium to block UVA while others include chemicals like Parsol 1789 and Mexoryl. Another key to using sunscreen successfully is to use adequate amounts. You should apply one ounce of sunscreen during every application. It’s estimated that most people apply far less and many do not reapply appropriately. Remember sunscreen is only effective if it is properly used.

Hopefully, you will heed the advice and try to limit overexposure to the sun’s harmful rays. Everyone wants to be able to enjoy the great outdoors and all it has to offer. Just be prudent when spending your time outside, and your skin will thank you today and in the years to come. 

Dr. Hardy is the solo physician with Atlantic Ob/Gyn with locations in Va. Beach and Chesapeake. Call 757-463-1234 or 757-548-0044 or visit www.atlanticobgyn.com.

We can all recount our mothers’ admonition to eat our fruits and vegetables. Truth is, mom was certainly on to something. A diet laden with fruits and vegetables can ensure that we get the proper nutrients to keep our bodies strong and prevent disease. Unfortunately, the typical American diet of highly processed foods does not always include the proper amounts of key vitamins and minerals needed to sustain good health. As an obstetrician, I am particularly concerned about the diets and nutritional health of young women in their childbearing years. Eating foods rich in iron, calcium, and folic acid can help a woman maintain optimum health now and help secure good health in the future. In the case of folic acid or folate, that future might be that of her unborn child.

Folate is found naturally in foods such as liver, beans and legumes, leafy green vegetables, and citrus fruits. A diet which includes healthy portions of romaine lettuce, spinach, asparagus, broccoli, cauliflower, beets, and lentils will give you a good amount of folate, which is a water-soluble B vitamin. Folate is instrumental in helping the body synthesize and repair DNA. It is also used by the body to produce red blood cells, aid with rapid cell division and growth, and help prevent anemia. All of these are especially important during pregnancy, particularly during the first 28 days when the fetus is developing key neurological structures. Folic acid is a synthetic compound that is used in vitamin supplements and fortified foods. Since its discovery in 1931, folate has long been recognized as an important component to diets, and most developed countries have instituted fortifying foods with folic acid to help improve the nutritional needs of their citizens. It is easy to find many products that will include folic acid as an added ingredient including cereals, breads, and juices among others.

Numerous studies have shown that proper amounts of folate help minimize several complications of pregnancy including miscarriages and neural tube birth defects, such as spina bifida and anencephaly. Anencephaly is a defect where a child is born without parts of the brain and skull, and infant death usually occurs shortly after birth. Spina bifida is a defect in the formation of the spinal column and can affect the spinal cord and nerves. Babies born with this defect can have a wide range of symptoms including physical and mental disabilities. Some born with spina bifida will only have mild symptoms while others may have more severe symptoms like paralysis and neurological deficiency. Clinical trials have also concluded that folic acid intake may also decrease the incidence of other birth defects related to heart, urinary tract, orofacial (cleft lip and palate), and limbs. Further studies are necessary to replicate and substantiate these findings.

In an effort to reduce the risks of these birth defects, all women in their child-bearing years are highly encouraged to increase their folate levels through diet and supplements. While some women will meet or exceed the Recommended Dietary Allowance (RDA) of 400 mcg per day with foods in their diets, many will not. The U.S. Food and Drug Administration mandated in 1996 that folic acid be introduced to grains and cereal products, and food labeling will show folate as a percentage of daily value or DV. So for instance, some healthy cereals actually provide 400 mcg of folic acid per serving, and the label will indicate that the DV value for folic acid is 100%.

If label reading and keeping track of all your nutritional DVs is not for you, taking a multi-vitamin that includes a minimum of 400 mcg or 0.4 milligrams (mg) is a great way to ensure that you are getting the essential folic acid your body needs. Vitamin makers have become very proficient at marketing vitamins to particular consumers based on gender, age, and health needs. Choosing a multi-vitamin formulated specifically for women will most likely include the recommended minimum. The important message is for all girls and women to have 400 mcg of folate daily through diet or supplements to minimize the risks of having a pregnancy that could result in a birth defect. It is estimated that around 50 percent of pregnancies are unplanned so even women who are not actively trying to become pregnant should be getting folate.

Some women may need to have additional amounts of folate in their diet depending on their health and pregnancy history. Consulting with your healthcare provider is the best way to find out if your personal needs may be different from the average recommendation. For instance, women on certain medications like certain antibiotics should not take folic acid as it may interfere with the absorption and efficacy of the medication. Similarly, some medications may interfere with the proper absorption of folic acid, and dosage may need to be adjusted. Women who have medical conditions that may compromise their ability to absorb nutrients will also require different recommendations.

The exciting news about folate is that it is now being studied to see if it can help with a myriad of medical conditions including heart disease, cancer prevention, Alzheimer’s disease, and hearing loss among others. Every day we learn more about how vitamins and minerals help improve health. However, it is important to always be prudent about medications and supplements. Check with your healthcare provider if you have any questions or concerns about what is right for you. n

Dr. Hardy is the solo physician with Atlantic Ob/Gyn with locations in Va. Beach and Chesapeake. Call 757-463-1234 or 757-548-0044 or visit www.atlanticobgyn.com.

While rare, a diagnosis of an ectopic pregnancy can be devastating news. Ectopic pregnancy occurs when the fertilized egg implants in a spot other than the uterus, most commonly in the fallopian tube. For this reason, ectopic pregnancy is sometimes referred to as “tubal pregnancy.” An ectopic pregnancy cannot be sustained and must be treated immediately to preserve both fertility and, in extreme circumstances, the life of the mother.  Luckily, only about two percent of pregnancies are ectopic.

Knowing the causes, symptoms, and treatments for an ectopic pregnancy can help women seek timely medical attention so that they can have the best outcome possible. While it is not known why every ectopic pregnancy occurs, the most common cause is a problem with the fallopian tube. In some instances, the tube may be congenitally misshapen or may have sustained damage from a previous surgery. A common cause is fallopian tubes that may be scarred or damaged from current or previous inflammation or infection. Pelvic inflammatory disease or PID—sometimes a result of gonorrhea or chlamydia infections—can leave permanent scarring which makes ectopic pregnancy more likely. While ectopic pregnancy is not entirely preventable, limiting one’s exposure to sexually transmitted diseases can help diminish the odds. Limiting the number of sexual partners and using condoms is especially important to minimize the spread of STDs that can lead to both infertility and increased rates of ectopic pregnancy.

Endometriosis can also cause fallopian tubes, uterus, and ovaries to be damaged and increase the likelihood of ectopic pregnancy. Women who have undergone infertility treatments with both medications and surgery may experience a higher rate of incidence. Finally, women who become pregnant while on birth control pills or while using an intrauterine device (IUD) have an increased risk of developing an ectopic pregnancy. However, the rate of pregnancy during contraceptive use is low.

A woman may experience a myriad of symptoms if she is developing an ectopic pregnancy. Since ectopic symptoms occur relatively early in pregnancy, some women may not yet know that they have conceived. Of course, a positive pregnancy diagnosis can give a woman a heads up that she may want to pay special attention to the early warning signs. These include lower abdominal pain, vaginal bleeding, and cramping. All are symptoms that the pregnancy is not proceeding normally. More severe symptoms such as sharper pelvic pain and signs of fainting may be clues that the ectopic pregnancy may have ruptured in the fallopian tube. Reacting to these early and late symptoms is extremely important and may have dramatic health consequences. Depending on when the diagnosis is made, there are several medical interventions that may be used to best treat an ectopic pregnancy.

Your healthcare provider will utilize blood tests and ultrasound as well as a physical exam to diagnose an ectopic pregnancy. A physical exam allows the provider to check for pain, tenderness, or a mass. Vaginal ultrasound can help confirm a diagnosis, and blood tests which measures the pregnancy hormone, human chorionic gonadotropin or HCG levels are necessary to evaluate an ectopic pregnancy. Depending on the symptoms, your provider may use all of these tools to properly assess treatment options. For instance, if the ectopic is picked up early enough, a medication called methotrexate may be injected into the mother to stop cell growth. Follow-up blood test for HCG levels can help the provider determine whether the medication is working to resolve the ectopic pregnancy. If the ectopic is further along, medication may not be an option. Laparoscopic surgery may be necessary to both confirm and treat an ectopic pregnancy.

In a best-case scenario, the ectopic can be caught in time to allow the surgeon to safely remove the ectopic pregnancy and preserve the fallopian tube by making repairs. If the ectopic pregnancy has ruptured or is causing heavy bleeding, the tube may have to be removed. Only in rare instances, will the surgeon have to perform a laparotomy to save a woman’s life. In this case, a woman will have to undergo an abdominal surgery. Ectopic pregnancy and its treatments can be traumatic for women and their families. Women should acknowledge the grief that is often associated with a lost pregnancy and seek help from their health care provider. Providers will often refer women to support groups or professionals who can help them deal with their feelings of loss.

Follow-up care is critically important after experiencing an ectopic pregnancy. Your healthcare provider can let you know your options about subsequent pregnancies. Many times, women who experience an ectopic pregnancy will conceive without problems and carry a successive pregnancy to fruition. Others may need to have some type of infertility intervention, but an ectopic pregnancy does not need to end your hopes of having or expanding your family. 

Dr. Hardy is a solo physician at Atlantic Ob/Gyn with locations in Chesapeake and Virginia Beach. For more information, please call 463-1234 or visit www.atlanticobgyn.com.

October 2011 will mark the 25th anniversary of the National Breast Cancer Awareness Month organization. Over the past quarter of a century, millions of organizations, companies, healthcare providers, patients, cancer survivors, and supporters have raised funds and most importantly awareness about breast cancer. A great deal has changed over these last 25 years. Mammography has improved to detect even earlier cases of breast cancer when treatments can lead to higher survival rates.

All those pink ribbons help to raise much-needed research funds and critical awareness about the benefits of early detection and possible risk factors that may increase your chance of developing breast cancer. Knowledge is powerful, and when women know what their risk factors are, they can be proactive about ensuring they stay as healthy as possible. A risk factor is simply a condition or set of conditions that may increase your likelihood of acquiring a disease. Risk factors do not mean that you will get breast cancer, and most women who get breast cancer have no known risk factors.

Some women are at higher risk than others of developing breast cancer in their lifetimes. Women who have had a previous breast cancer are at higher risk of developing a subsequent breast cancer. All women are at increased risk of developing breast cancer as they age, and the majority of breast cancers occur in women over the age of 50. Family history, heritage, race, and genetics all are factors that may increase a woman’s chance of developing breast cancer. Obesity and alcohol consumption can be a risk factor. Environmental factors like exposures to radiation and hormones can also increase the risk of getting breast cancer. There are many excellent resources to find out more in depth information about what your risk factors might be, including the American Cancer Society’s website: www.cancer.org.

Women who find that they are among the highest risk factor group may want to discuss with their health care provider the topic of chemoprevention for breast cancer. Over the last several years, a few medications that have historically been used in the treatment of breast cancer are now being investigated for their possible preventative qualities. These drugs fall into a few different categories and work in unique ways to lower breast cancer risk. Tamoxifen and raloxifene are called selective estrogen-receptor modulators or SERMs, and, as the name suggests, modulate or interfere with the estrogen in the body. Researchers believe that estrogen can stimulate the growth of breast cancer cells.

Both of these drugs are used to treat specific types of breast cancers which are estrogen-receptor positive. Tamoxifen has been studied for several decades and has been shown to reduce the incidence of estrogen-receptor positive cancers by as much as 48 precent in women who took it as a preventive therapy. However, as with any medication, there are known side effects, some of which are significant. Women taking tamoxifen are at increased risk of developing some gynecological cancers and major blood clots. Raloxifene works similarly to tamoxifene in interrupting the estrogen path that is critical for the growth of certain breast cancers. Raloxifene is a newer drug and has not been shown to be associated with the gynecological cancers but so far does not seem to have the same success rate as tamoxifene. Raloxifene also increases the risk of significant blood clots which can become life threatening.

The Federal Drug Administration has approved both tamoxifene and raloxifene for use as a medication to reduce breast cancer based on evidence from various studies conducted over many years. Women with an elevated risk of breast cancer need to work closely with their health care providers to calculate both their risk factors for breast cancer as well as their likelihood of developing health conditions from the side effects of these potent medications. Your health care provider will use many indices to determine your risk/benefit analysis including age, menopausal status, gynecological history and health including your Body Mass Index. Not all women with a high breast cancer risk will be good candidates for either drug.

Just as SERMs have changed how breast cancer is treated and prevented, newer drugs called aromatase inhibitors, such as exemestane, letrozole, and anastrozole are currently being used to treat breast cancer and are being studied for possible chemoprevention uses. These drugs work to stop aromatase, which is an enzyme used by the body to convert other hormones into estrogen. Early studies show that these agents may have fewer detrimental side effects like gynecological cancers and blood clots. Currently these drugs are just used as chemotherapy following surgery for breast cancer, and the FDA is awaiting results from a couple of studies to decide whether they will be approved for chemoprevention use.

Americans are well acquainted with chemoprevention. Think of the millions who are prescribed hypertension medicines or cholesterol-lowering medications to prevent the chance of having a heart attack or stroke. We have long known what causes cardiovascular disease and have prescribed medicines to help minimize an eventual event. Thanks to many Octobers of fund raising and research, we now have better ideas about what might cause some types of breast cancer and can prescribe medications that just might prevent this disease, too. 

Dr. Hardy is a solo physician at Atlantic Ob/Gyn with locations in Chesapeake and Virginia Beach. For more information, please call 463-1234 or visit www.atlanticobgyn.com.

 

 

 

 

 

 

 

 

 

Dr. Hardy is a solo physician at Atlantic Ob/Gyn with locations in Chesapeake and Virginia Beach. For more information, please call 463-1234 or visit www.atlanticobgyn.com.

During pregnancy, there is so much to think about. Is it a boy or a girl? What hospital, what obstetrician will deliver your baby? And of course, is the baby healthy? Over the past few years, new testing has become available to answer that question. Testing for nuchal translucency and first trimester testing can help determine if the baby has Down syndrome or certain other birth defects. While no testing is 100 percent accurate and no amount of testing can determine all birth defects, it now possible to help answer the question; is my baby healthy?

Kypros Nicholaides developed nuchal translucency in England, and large-scale studies have been completed in the U.S. including at Eastern Virginia Medical School in Norfolk, Virginia.

Nuchal translucency testing starts with a blood test on the pregnant woman. An ultrasound in the third month of pregnancy measures the clear space at the back of the developing baby’s neck. A second blood test is done in the fourth month of pregnancy. All this information is analyzed. A risk estimate is determined. In other words the chance the developing baby has one of these birth defects is calculated. Women are then counseled to help them decide what all the testing means.

Pregnant women who are 35 years old have a 1 in 270 chance of delivering a child with Down syndrome. Women who are 35 years or older are routinely offered amniocentesis to test for Down syndrome. Now an alternative exists. This process of testing for nuchal translucency and maternal blood can give the reassurance that the developing baby is all right and eliminate the need for amniocentesis.

The NT testing can also be offered to all pregnant women to help determine if their baby has Down syndrome or certain other birth defects. The advantages of the NT tests include a relatively accurate test for chromosomal problems without the risk of miscarriage associated with other more invasive tests like amniocentesis or chorionic villus sampling or CVS. The most common birth defects that NT testing tests for include Down syndrome or Trisomy 21. Down Syndrome is a genetic disorder associated with mental retardation and birth defects affecting the developing baby’s heart and kidney among others. Trisomy 18 can also be detected by NT testing. This genetic disorder is associated with multiple birth defects or infants die shortly after birth. This disorder is rare, occurring 1 in 8000 births.

Pregnancy is a special time in a woman’s life. Prenatal testing can help pregnant women answer the question, is my baby healthy? The testing can be completed in the first half of pregnancy (before 20 weeks). While 3-5 percent of pregnancies are associated with a birth defect, many can be determined prenatally. Other noninvasive tests are on the horizon. Various medical centers are exploring techniques to detect fetal birth defects with a simple blood test. One such test looks for the small amounts of fetal DNA that leaks into the maternal circulation.

In the future it is hoped that all genetic birth defects could be detected by simply drawing a blood sample from the pregnant woman. Ask your health care provider to help you decide if testing is right for you.

Dr. Hardy is a solo physician with locations in Chesapeake and Va. Beach. Please call 463-1234 or visit www.atlanticobgyn.com.

I recently saw a bumper sticker that read; “Real women don’t get hot flashes. They get power surges.” It’s good to see that some people can find the humor in the symptoms of aging. Unfortunately, for many women, hot flashes or flushes are no laughing matter. Understanding the causes, symptoms, and treatments for hot flashes can help many women deal with this common symptom of menopause.

In North America, hot flashes are common with 3 out of 4 women experiencing some degree of symptoms with perimenopause, menopause, or surgically induced menopause. For some women, hot flashes are a minor annoyance that is well tolerated. Other women may experience more severe symptoms and may find them to adversely affect their quality of life. The exact cause of hot flashes is not completely understood, but it is believed that during menopause, fluctuating estrogen levels interfere with the hypothalamus. The hypothalamus is the part of the brain that regulates body temperature.

Hot flashes are most usually experienced as a temporary feeling of heat that is centered on the upper chest and face and last two to four minutes. Sweating, sometimes a rapid heart rate, and an anxious feeling accompany hot flashes. Afterwards the hot flash is often followed by chills and shivering. Many women will experience these symptoms during sleep, which are referred to as night sweats. The duration of symptoms can last from a few minutes up to a half an hour. Some women may only experience hot flashes a few times a week, while others may have them repeatedly throughout the day. Women can be awakened by night sweats, and some women may have trouble getting back to sleep. For some, hot flashes and night sweats may be severe enough to disrupt a woman’s quality of life.

If you feel that hot flashes are problematic, you should seek the advice of your health care provider. Depending on the symptoms and your medical history, he or she may offer a myriad of options for treating hot flashes. Women with mild symptoms may benefit best from simple modifications to their habits. For instance, simply dressing in layers can let a woman quickly remove clothing if she becomes too hot. Some women find that certain foods or drinks like spicy foods or hot beverages or alcohol bring on their hot flashes. Limiting or avoiding these items can help to minimize hot flashes. Woman who smoke experience more severe hot flashes. So add hot flashes to the already long list of reasons to not smoke. Additionally, obesity is often associated with higher incidences of hot flashes. Shedding excess weight can help to minimize the number of hot flashes. Many women find that exercise and relaxation routines help to reduce the number of hot flashes. Yoga, deep breathing, and walking are great ways to reduce stress, lose weight, and control hot flashes. Exercise can also help to reduce insomnia often associated with night sweats.

When preventive measures and life style changes don’t seem to mitigate hot flashes, your health care provider may recommend hormone replacement therapy, which can be a very effective treatment particularly if your symptoms are severe. Depending on your personal and family history, including your risks for certain cancers or cardiovascular disease, a regime of estrogen, progesterone, or a combination of both might be effective. Your health care provider is the best source of information when deciding which therapy might work best for you. Estrogen works well for women who have had a complete hysterectomy, which includes removing the ovaries. A combination of estrogen and progesterone may work better for other women to reduce the risk of uterine cancer. Still other women may be recommended to take only progesterone therapy because of increased risks of breast cancer or blood clots. Any recommendation for hormone replacement will come after a complete physical and history to establish your personal health risks. Your health care provider can explain the benefits and risks associated with all treatments and help you decide if hormone replacement is right for you.

Women who have not had success with preventative measures and choose to skip the hormone replacement route may find relief from symptoms with several other medications or dietary supplements. While the efficacy of HRT has been well studied, there are fewer studies of supplements and medications that are used “off label.” For instances, some women find that low doses of antidepressants like Paxil, Prozac, or Effexor help relieve some hot flash symptoms. Likewise, a medication called clonidine, which is traditionally used to treat hypertension may also work to lessen symptoms. Neurontin is another medication designed to treat other conditions but has shown signs of helping some women with hot flashes.

When taking any prescribed medication, a woman should confer with her health care provider to discuss possible side effects and decide whether it may be a good option for her. While most dietary supplements do not require a prescription from your doctor, it is still vital that you share information about any you might be taking. Many over-the-counter products can still have side effects and interact with any prescription medications you might be taking. Currently, there is limited information about the effects of supplements like Black cohash or soy-rich products for helping with hot flashes, but some women seem to experience a diminishment of symptoms.

Hot flashes eventually subside as your body readjusts to the hormone levels established in menopause. However, there’s no need to suffer. Your health care provider can partner with you to find a solution particularly if your symptoms are severe. Whether it’s limiting triggers, getting more exercise or relaxation, taking medication or supplements, or just keeping a good sense of humor, next time you feel a power surge coming on, call your provider—right after you turn the air conditioner on! 

Dr. Hardy is a solo physician at Atlantic Ob/Gyn with locations in Chesapeake and Virginia Beach. For more information, please call 463-1234 or visit www.atlanticobgyn.com.

The advances made in obstetrics are quite extraordinary over these many decades. Sophisticated tests and procedures allow health care providers to offer state-of-the-art care to women to ensure they experience the healthiest pregnancies possible resulting in healthy babies. With all of this medical progress, it should not be ignored that one of the simplest steps a pregnant woman can take is to maintain a proper diet and strive for the best nutrition for both her and her baby. Simply put, the food you eat is the fuel from which your baby will grow and thrive.

 We all know the benefits of healthy eating, but these benefits are especially important when you are trying to achieve a healthy pregnancy and sustain a healthy fetus. Long before becoming pregnant, women of childbearing years should consider healthful eating to ensure optimal health. Studies have shown that women who want to become pregnant need certain levels of some nutrients, like folic acid, to minimize the risk of having a baby develop certain birth defects. Proper nutrition can also help achieve a healthy weight, which can help with fertility. The best place to start discussing nutrition is with your health care provider, who can guide you in what is the best diet for achieving and maintaining a healthy pregnancy.

 Women who are planning a pregnancy or who become pregnant will need to increase the amount of certain nutrients to ensure a healthy fetus. Two important nutrients are folic acid, also called folate, and iron. Women should be taking in 0.4 milligrams of folic acid every day to minimize the risk of neural tube defects. Neural tube defects occur very early in pregnancy when the fetus is just starting to form; conditions like anencephaly and spina bifida are examples of neural tube defects.

Women who have had a pregnancy involving a prior neural tube defect will need to take much larger amounts of folic acid. Folic acid occurs naturally in foods like green leafy vegetables, beans, nuts, orange juice, and liver. Since many women do not eat large enough quantities of these foods, vitamin supplements are usually necessary to achieve the desired milligrams.

Another important nutrient for pregnant women is iron. Iron-rich red blood cells carry oxygen to our organs and to the growing fetus in a pregnant woman. Pregnant women need extra iron during pregnancy to meet the needs of the baby. Generally, pregnant women will need 27 milligrams daily. The minimum requirements of both the folic acid and iron can be satisfied by taking a pre-natal multi-vitamin, which is specifically formulated to meet all the supplemental requirements of pregnancy.

However, pregnant women should not feel that taking a daily vitamin will be a nutritional magic bullet. Supplemental vitamins are only part of the equation. A proper diet of healthy foods is also essential to providing a healthy body for both mom and baby. A proper balance of vegetables, fruits, whole grain, lean meats, fats and oils, as well as calcium-rich milk and other dairy products like yogurt and cheese can all add up to nutrition meal plans that will help you stay healthy and provide enough nutrients for your baby.

The caloric intake during pregnancy varies from woman to woman, and your health care provider can help guide you as to the amount of weight you should gain during pregnancy. Much depends on your pre-pregnancy weight and body mass index (BMI). Women with a BMI between 18.5 and 24.9 should gain around 25 to 35 pounds, while women with higher BMI should try to limit weight gain to less than 24 pounds during pregnancy. Again your health care provider will be your best partner in achieving your nutritional goals.

Women with special risk factors like gestational diabetes or other conditions may have particular diets that will help address their individual health concerns. All women, regardless of risk factors, will need to limit or avoid exposure to some foods during pregnancy. For instance, pregnant women should avoid eating certain types of fish that may contain harmful levels of mercury to their fetus, such as large body fish like swordfish, king mackerel, and tilefish. Your healthcare provider can advise you about limits on other fish and seafood during pregnancy.

Another food concern during pregnancy is exposure to certain bacteria found in unpasteurized milk, soft cheeses, uncooked meats, and fish that can cause listeriosis. This condition can cause miscarriage or result in stillbirth. It is often difficult to diagnosis as the symptoms are similar to symptoms of the flu. For that reason, wash all fruits and vegetables, and avoid raw milk and cheese, raw or undercooked meats, fish and shellfish. Also avoid hotdogs or luncheon meats unless they are thoroughly heated.

Everyone can benefit from healthier eating. Cutting out fat-laden fast food and super sugary sodas and eating more fruits, vegetables, and whole grains is advice a physician would give to anybody. Pregnant women have one more reason—or maybe two in the case of twins—to eat better and get on a healthy nutritional path.

 

Dr. Hardy is a solo physician in practice with Atlantic Ob/Gyn with locations in Chesapeake and Va. Beach. Call 757-463-1234 or visit www.atlanticobgyn.com.

Seven years ago, the American Heart Association began their Go Red for Women campaign to raise funds and most importantly awareness about American women’s risk of cardiovascular diseases. More women will die from cardiovascular diseases like heart attacks and strokes than the next four causes of death combined. Yet many women under appreciated their risks and thought of cardiovascular diseases as striking their fathers, husbands, and brothers.

National Wear Red Day is always held on the first Friday in February; this year it’s February 4. Many women and men, organizations, companies, and health care providers will be wearing red to promote the goals of raising funds and, most importantly, awareness about the number one killer of women.

It’s estimated that around 80 percent of cardiac events in women are preventable by making proper choices regarding diet, exercise, and lifestyle. One goal of the American Heart Association is to educate women about risks factors and behaviors that can dramatically reduce their risk of premature death. Many of these measures are outlined in very clear and concise checklists on the American Heart Association's website: goredforwomen.org.

Another excellent choice for learning about how you can assess your cardiovascular health is to discuss this matter with your health care provider during your annual health examination. Your health care provider can help determine your personal risk for a cardiovascular event by exploring both your personal and family histories and evaluating your diet, exercise, and lifestyle choices. A complete history and physical including blood work can help your provider assess your personal risk factors for having a cardiovascular event. They can also help educate you about how you can take simple steps to minimize your risks.

Several medical conditions can contribute to elevating your risks of cardiovascular disease. These include diabetes, hypertension, high cholesterol, and a previous heart attack or stroke event. Any one of these conditions can increase your risks for a heart attack or stroke, and many women have several of these conditions concurrently. Diabetic women are 2 to 4 times more likely to die from a coronary event than their non-diabetic counterpart. This can be especially critical information for members of specific ethnic groups like Hispanics, Native and African Americans, and Asians who may be at higher risk of developing diabetes.

Many members of these groups may also be at increased risk of suffering from hypertension, or high blood pressure, which also can increase your risk of heart disease. High cholesterol is yet another contributing factor to increasing a woman’s chance of developing cardiovascular disease. Nearly half of all Americans have cholesterol levels which are considered too high (over 200 mg/dL for total cholesterol).

The upside of all this “awareness” is that all of these conditions can be either prevented or managed with the proper interventions. The easiest way is to pay attention to what you eat and how you move each day. Diabetes can be substantially minimized if you eat healthfully and exercise regularly to maintain a healthy weight and body mass index (BMI). Eating foods low in saturated fats and cholesterol as well as high in fiber can help minimize your chances of developing diabetes or high cholesterol.

Besides diet, staying physically active is paramount to maintaining good heart health. Whether you call it exercise, gardening, walking, or playing with your kids or grandchildren, all physical activity is beneficial and should be done often. We know that sedentary lifestyles adversely affect our health and increase risk of diabetes, high blood pressure, high cholesterol, and cardiovascular disease. Finally, avoiding activities that are hazardous to our cardiovascular health is critical. The advice is simple: don’t smoke! If you do smoke, try to quit. Your health care provider can offer you many helpful tips for quitting including information on support groups and medications that can make your transition to becoming a former smoker easier.

When diet and exercise are not enough to combat certain medical conditions, medical interventions and medications are often available to ensure that chronic conditions do not contribute to cardiovascular disease. For instance, proper monitoring of diabetes and treatment with insulin and other medications is imperative to reducing your cardiovascular risk. Similarly, medications for high blood pressure and high cholesterol can help to maintain proper levels that may substantially reduce your risk of a cardiovascular event like a stroke or heart attack

The statistic that one in every three deaths of women is caused by heart disease should be thought about every day, not just on the first Friday in February. Women should focus daily on how they can maintain good cardiovascular health by proper diet and exercise and getting treatment for medical conditions like diabetes, hypertension, and high cholesterol. National Wear Red Day is an outwardly visible way to highlight the need to take care of what’s on the inside each and every day.

Dr. Hardy is a solo physician at Atlantic Ob/Gyn in Va. Beach and Chesapeake. Call 757-463-1234 or visit www.atlanticobgyn.com

In October, I outlined the nature of premature labor—what it is and how to recognize the signs and symptoms. I also discussed the methods health care providers employ to correctly identify premature labor and some of the primary methods to stop labor.

If these initial treatments of bed rest, pelvic rest, and hydration do not stop labor-inducing contractions, further treatment may be required. Your health care provider will take many factors into consideration when deciding when and how to intervene to try and stop labor and prevent a premature birth.

Stopping early labor can greatly benefit an infant’s health but many variables must be considered when deciding how and when to stop labor including the health of both mother and baby. The unique nature of pregnancy requires that a health care provider simultaneously treat two patients at once, and this is particularly evident in the treatment of premature labor. Balancing the health of mother and infant can often make treatment of premature labor a delicate situation.

Contractions that cause the cervix to thin and dilate more than 2 centimeters between the 23rd and 37th week of pregnancy is considered premature labor. Whether to stop labor will depend of the baby’s age and weight and the health of the mother. Ideally, the longer a fetus has to develop and mature in-utero, the healthier he or she will be at birth and after. Labor is not stopped before 23 weeks because survival is unlikely. Premature labor after 34 weeks may also not be stopped because statistically these babies do quite well with current neonatal interventions available today. This middle ground between 23 and 34 weeks is where the health of mother and baby is evaluated to come up with the best-case scenario.

Health care providers will use several diagnostic tools to try and measure the maturity of a fetus, including fetal monitoring, ultrasound, amniocentesis, and blood tests to help estimate the age and weight of the baby. These tests can also help to determine whether the premature labor is putting stress on the baby. Sometimes, if the stress is great, it is better to deliver than to try to stop labor.

In some instances, delaying labor for just a few hours can be enough to insure that delivery will occur at a hospital with a neonatal intensive care unit (NICU). Healthcare providers are also concerned about the infant’s lung maturity and may give a mother glucocorticoid injections, such as betamethasone or dexamethasone, to help the fetus produce surfactant. These steroids, given preferably 24 to 48 hours prior to delivery can help with infant breathing and may reduce the incidence of respiratory distress.

Besides the infant’s health, providers must also weigh the health concerns of mother. Premature labor may be brought on by health problems of pregnant women such as hypertension in pregnancy and its related conditions: severe pre-eclampsia and HELLP syndrome. Likewise, women who experience complications from chronic conditions like diabetes, severe asthma, heart conditions, and infection among others may also need to deliver rather than risk complications from stopping labor.

Once a decision has been made to try to stop labor, several options are available and each depends on the suspected reason for the premature labor. If it is believed that premature labor is a result of an underlying infection, antibiotics may be given to clear up an infection as in the case of urinary tract infections. Antibiotics will also be given if a woman experiences premature rupture of membranes during premature labor. Treatment can help limit the risk of developing infections, which can risk the health of both mother and baby.

Other medications that can be given include tocolytic agents such as terbutaline, Indomethacin, or Nifedipine, which are given by injection or intravenously to slow uterine contractions during preterm labor. These medications work to relax the smooth muscles and blood vessels of the uterus. Generally, these mediations work for a short time and generally their effectiveness wanes over time. Sometimes, these medicines can stop labor long enough to intervene with other treatments like the corticosteroids previously discussed.

Women who have previously delivered a premature child are considered high risk for a subsequent premature labor event. These women may benefit from a progesterone treatment plan beginning in the fourth month of pregnancy. Studies have recently shown that these high-risk women, when treated with progesterone, carried a subsequent fetus longer. Another prophylactic technique used to prevent premature labor is the cervical cerclage, which is the stitching of the cervix to keep it closed. This procedure is usually done between 12 and 14 weeks preventively or later in the case of an emergency. While not usual, this is an option for women who may have an incompetent cervix as a result of defect or damage to the cervix to possibly prevent premature labor.

For many decades, preterm labor was treated with “strict bed rest” most likely because few other options were available. Studies have shown that long term bed rest does not lower the risk of premature labor and may pose a risk of blood clots for pregnant women. That said, health care providers may advise what is called expectant management, where a pregnancy is closely monitored for problems. Expectant management may occur at home or in a hospital setting and may involve stopping work, limiting activities, and spending varying amounts of time resting.

Luckily, premature labor only affects around 12 percent of pregnancies. Of course if you are in that 12 percent it can be tremendously frightening. Knowing the early warning signs, communicating with your health care provider, and maintaining a positive attitude will carry you and your baby far if you experience preterm labor. The fields of obstetrics and neonatalogy have made remarkable strides over the past few decades to ensure that even the earliest babies have a fighting chance to grow up healthy and strong.

For many decades, the March of Dimes has worked to reduce the number of premature births in the United States. It is estimated that over 500,000 infants will be born too soon this year. Approximately 1 in 8 infants will be born before their 37th week of gestation. Infants born too soon can suffer from myriad problems, including low birth weight, breathing difficulties, higher rates of infection, and underdeveloped organ systems. Many premature infants do not survive; in fact, prematurity is the leading cause of infant death. Those who do survive may have life-long health problems and learning disabilities.

Preventing premature birth begins with addressing the problem of premature labor. Premature labor is defined as uterine contractions that cause the cervix to dilate between the 20th and 37th week of pregnancy. All pregnant women should be aware of the signs of premature labor so that they can seek immediate medical advice if necessary. While some women fall into a higher risk group for premature labor, half the women who will experience premature labor do not.

Some premature labor risks factors are out of one’s control. For instance, women who have experienced previous preterm labor or preterm birth are at increased risk of subsequent preterm labor. Pregnant women with multiples or women with certain uterine or cervical abnormalities are also at higher risk. Pregnant women with chronic conditions like diabetes and hypertension can also experience higher rates of premature labor. If you are overweight or underweight when you become pregnant, that can increase your chances of premature labor. Women under the age of 17 or over the age of 35 are at increased risk of both premature labor and premature birth. Women who develop certain types of infection during pregnancy may also have an increased risk of going into premature labor. Most of these circumstances are beyond something you can control; however, many women will face premature labor because of factors and situations that they can avoid.

Studies show that women who smoke, drink alcohol, and use illicit drugs during pregnancy put themselves at greater risk of developing premature labor. Women who do not receive prenatal medical care are also at greater risk. Premature labor and births are also more prominent in women who experience extreme stress or do not have adequate emotional support during pregnancy. Whether or not you fall into one of these high risks groups, in order to have the healthiest pregnancy possible, it is important to try to reduce your chance of premature labor. It is also important to know the signs of premature labor.

Symptoms to look for include: contractions which occur at least ten minutes apart or occur more than 8 times in 1 hour; change in vaginal discharge or leaking of fluid or blood; low dull back pain; cramping that feels like a period with or without diarrhea, nausea, or vomiting. Any one of these symptoms alone can be a sign that you are in premature labor. It is very important to notify your health care provider if you have any of these symptoms. Of course, these symptoms can be indicative of some other condition in pregnancy, but it is important for your provider to determine if you are in labor.

Once contacted, your health care provider will ask you to elaborate on your symptoms and may recommend that you come into the office or go to the hospital to be evaluated further, particularly if you are leaking fluid or blood. In the case of contractions, your provider may recommend that you stop any activity, lie on your left side for one hour, and drink a couple of glasses of water or juice. You may also be advised to avoid sexual intercourse until your symptoms have subsided.

These steps may stop the contractions. However, if your symptoms continue, it is imperative that you notify your provider. If your symptoms stop with these measures but return, you should also contact your provider.

In an office or hospital setting, your health care provider will measure contractions with an external uterine monitor, which measures both uterine contractions and the fetal heartbeat. He or she may also check to see if your cervix is dilated. In some instances, ultrasonography may be used to measure the cervical length and assess fetal development. Pregnant women between 22 and 34 weeks may be given a fetal fibronectin (fFN) test to determine whether a protein is present in the cervix or vagina. This protein, which helps to bond the fetal sac to the uterus, is usually not present during these weeks of pregnancy. This test is good at predicting which symptomatic women are not in preterm labor, often saving women needless medical interventions like bed rest or medical interventions. Fewer than 5 percent of symptomatic women with a negative fFN test will deliver in the following two weeks.

If premature labor stops, your health care provider may want to monitor your pregnancy more frequently until you reach full term. However, if labor does not stop, your provider will need to discuss with you which options are available. Depending on the causes of labor, the number of weeks along, and the maturity of the fetus, your health care provider will let you know what the next step will be.

Premature labor is a complex condition which is always being studied and researched. Next month, I will discuss the various treatment options that are currently being used to stop premature labor and prevent premature birth.

Dr. Hardy is a solo physician in practice with Atlantic Ob/Gyn with locations in Chesapeake and Va. Beach. Call 757-463-1234 or visit www.atlanticobgyn.com.