Should I keep my heart rate no higher than 140 beats per minute when exercising? 

One of my pregnant patients recently asked me if she should keep her heart rate no higher than 140 beats per minute when exercising?

Answer:
There is presently no scientific basis and no official recommendation to keep the heart rate during pregnancy below certain levels.

Physical activity during pregnancy has benefits beyond maintaining or improving physical fitness, including helping with weight management, reducing the risk of gestational diabetes and preeclampsia, making it easier to cope with labor pain and easing recovery from childbirth.

ACOG, the American College of Obstetrics and Gynecology encourages pregnant women to engage in moderate-intensity exercise for at least 20 to 30 minutes a day most days of the week, as long as there are no medical or obstetric complications.  No upper level of safe exercise intensity has been established. Women who exercised regularly before pregnancy and have no pregnancy-related complications can engage in high-intensity exercise programs, such as jogging and aerobics, with no adverse effects.

Some modification of exercise routines may be necessary to accommodate physiologic and anatomic changes that occur during pregnancy, such as changes in the center of gravity, laxity of joints and ligaments and respiratory changes. Activities that involve a high risk of injury, such as downhill skiing and horseback riding, should be avoided, as should contact sports, scuba diving, skydiving and hot yoga.

What forms of exercise are safe during pregnancy?
Certain sports are safe during pregnancy, even for beginners:

  • Walking is a good exercise for anyone.
  • Swimming is great for your body because it works so many muscles.
  • Cycling provides a good aerobic workout.
  • Aerobics is a good way to keep your heart and lungs strong.
  • If you were a runner before you became pregnant, you often can keep running during pregnancy, although you may have to modify your routine.

Perinatal depression can be prevented

Mental health is essential for everyone including pregnant women. Perinatal or pregnancy depression affects about 1 in 8 new mothers annually in the United States. It can have a devastating effect on the mother as well as the infant.

Risk factors that can be used to identify individuals at risk for perinatal depression include:

  • a history of depression
  • history of physical or sexual abuse
  • unplanned or unwanted pregnancy
  • stressful life events
  • intimate partner violence
  • complications during pregnancy

Additionally, low socioeconomic status, lack of social support, and bearing children during adolescence have been associated with a greater risk of developing perinatal depression after delivery.

The Edinburgh postpartum depression test can screen effectively for your risk of having postpartum depression.

In addition, the interactive Zhung Self-Rating Depression Scale Quiz checks the level of depression to help decide how severe it could be.

Coronavirus 2019-COVID & Pregnancy

Pregnancy and Coronavirus COVID-19

UPDATE AS OF February 2020

There is still much unknown about 2019-COVID and pregnancy. Probably for now the best and most recent answers on 2019-COVID and pregnancy can be found on the CDC website.

On 2/3/2020 it was reported that a pregnant woman with Coronavirus infection was delivered by cesarean section in China at 37 weeks. Both mother and baby are doing well.

On 2/12/2020 The Lancet reported on 9 cases of COVID-19 in the third trimester pregnant women. All were delivered by cesarean section. Symptoms of COVID-19 infections in pregnant women were similar to non-pregnant individuals. There was no evidence for intrauterine infection in these 9 cases caused by transmission from the women to the baby. Also, there is no evidence that a cesarean delivery is needed to protect the mother or the fetus.

In February 2020, most information we have on pregnancy and coronavirus derives from information on MERS and SARS coronaviruses.

One was a report of 5 pregnant women from Saudi Arabia which concluded that MERS-CoV may pose serious health risks to both mothers and infants during pregnancy. Two of the 5 mothers infected with the virus died.

Pregnant women with severe acute respiratory syndrome (SARS) appear to have a worse clinical outcome and a higher mortality rate compared to non-pregnant women.

Though there were a limited number of pregnant women among these cases, it seems pregnant women are more likely to become infected and those who became infected with SARS were more likely to get sick.

Pregnancy is a time of low immune function which generally includes:

  • older people
  • diabetics
  • people with HIV infection
  • people with long-term use of immunosuppressive agents
  • pregnant women

Placentophagy – Eating Placenta

 

The existing data on postpartum placental consumption is anecdotal and there are no scientific data on this subject. Cats and other animals may eat their placenta but there are no major human cultures who view placental ingestion as an essential part of the postpartum period. Use of the placenta in the postpartum period is re-gaining popularity among some women in the US, Canada and Europe for no good reason. 

In one review of placentophagy or placental eating the autors state that “maternal placentophagy may have had deleterious consequences for the overall fitness of mother, offspring, or both, leading to its elimination from our species’ behavioral repertoire.”

The CDC had a case report of a baby that developed late-onset GBS disease attributable to high maternal colonization secondary to consumption of GBS-infected placental tissue after birth. The baby was very sick and had to be admitted with sepsis. Heating for sufficient time at a temperature adequate to decrease GBS bacterial counts might not have been reached. Consumption of contaminated placenta capsules might have elevated maternal GBS intestinal and skin colonization, facilitating transfer to the infant.

In a review of cross-cultural traditions of 179 human societies the authors found a “… conspicuous absence of cultural traditions associated with maternal placentophagy..”. In other words, they found no human culture that includes eating placenta after birth. 

The placenta can be consumed in many ways, raw or cooked however placental encapsulation is presently the most popular method.  

During placental encapsulation, the placenta is steamed and then dehydrated for 8-10 hours and ground into a powder form at which time it is then filled into vegetable capsules. Other methods of encapsulation use only your placenta and no other ingredients and vary in the processing methods such as not steaming for raw consumption, etc.  During this process, heating may not reach adequate levels to destroy all bacteria.

Depending on varying factors, each placenta yields approximately 75-200 capsules and it is recommended that the refrigerated capsules be taken 2-4 times per day during the first 6 weeks of the postpartum period. If you consider placental encapsulation, please follow the exact instructions of the facility who prepared the capsules. 

WHAT ARE CONSIDERED TO BE THE POSSIBLE BENEFITS OF PLACENTAL ENCAPSULATION?

As previously mentioned, there are no scientific data to support eating placenta such as placental encapsulation. Doulas and midwives who try to convince women that eating the placenta is beneficial (and who make money off placenta encapsulation), claim many things such as that it works against insomnia and postpartum depression, and that it can raise your energy and breast milk quantity. Nothing of his is true and there is no evidence whatsoever that these claims can be verified.  If there are any benefits of placental encapsulation it is that it makes money for those preparing the capsules, anything else is not scientifically proven.

Is the Placenta Considered Food?

According to a letter from the FDA Food and Drug Administration, human placenta cannot be considered “food”.

Here are excerpts from that letter:

“Human placenta is not a dietary ingredient under section 201 (fI!)( 1) of the Act.”

“It is not a vitamin, a mineral, an herb or botanical, or an amino acid (section 20l(ff)(l)(A-D) of the Act), nor is it a concentrate, metabolite, constituent, extract, or combination of any ingredient above (section 20 1 (fI)( l)(F) of the Act).”

“It also is not a “dietary substance for use by man to supplement the diet by increasing the total dietary intake (section 201 (ff)( l)(E) of the Act), nor is it a concentrate, metabolite, constituent, extract, or combination of any dietary ingredient. Human placenta also is not a food under section 201(f) of the Act.”

“Given that human tissue is not “food” or a “dietary ingredient,” and that it may transmit human disease, a dietary supplement that contains it is adulterated under the Act (sections 402(a)(l), 402(f)(l)(A), and 402(a)(3) of the Act).”

“The introduction or delivery for introduction into interstate commerce of any food that is adulterated is prohibited (section 301(a) of the Act).”

IS IT SAFE? WHAT ARE THE RISKS?

There are no data available on the safety of eating placenta and there is some evidence that it may be harmful to eat the placenta and capsules. In TCM, the capsules are considered “hot” or having “yang” energy and should not be used in the presence of infection or fever. this may exclude most placentas, as placentas are often infected, especially after long labors.

The Independent Placental Encapsulation Network (IPEN) reports side effects in less than 2% of their population and include things such as mild headache, stomach pain/abdominal cramping, other gastrointestinal disturbances such as diarrhea, loose stools or constipation, Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPS) rash, pelvic girdle pain, unexplained lack of milk supply and PMS type emotional symptoms.

When can I get pregnant after a miscarriage?

I am often asked by my patients “When can I get pregnant after a miscarriage? ”

The “can I?” question is sometimes confusing and has usually several different components:

  1. How long should I wait after experiencing an early pregnancy loss or miscarriage before getting pregnant again?
  2. When does fertility begin after a miscarriage?
  3. Are there complications if I get pregnant too early after a miscarriage?
  4. Am I more likely to miscarry again after a miscarriage?
  5. When it is safe to get pregnant again after a miscarriage?

Before I answer these questions, it is important for couples to understand what a miscarriage, specifically an early miscarriage is. An early pregnancy loss or miscarriage happens usually during the first 8-12 weeks of the pregnancy, but some physicians extend this period up to 20 weeks.

Fertility equals ovulation, and ovulation can be expected within 4-6 weeks after a pregnancy loss, though it can occur as early as 2 weeks after the loss. Fertility, therefore, begins as early as 2 weeks after a loss.

In the past, doctors suggested for patients to wait at least 3 months after an early pregnancy loss before trying to conceive and get pregnant. But recent studies have confirmed that women who wait 3 months or less after a loss had higher live birth rates when compared to women who waited longer, notably if the wait was over 12 months then fecundability decreased significantly when compared to waiting 0-3 or 3-6 months.  

So there is the answer. After an early pregnancy loss or miscarriage, you should try and get pregnant within 3 months to improve your chances of having a live birth.