Excercize, Pregnancy, and Pre-eclampsia

A new study has appeared in orgyn.com, a website dedicated to the research in the field of women’s health.  This study details the effects of exercise during pregnancy and the preventative factors with respect to preeclampsia (a condition diagnosed by high blood pressure and protein in the urine during pregnancy which, if left untreated, can lead to maternal seizure and death mother and/or baby).

Previously it had been thought that exercise could prevent preeclampsia since exercise lowers blood pressure.  This study showed that among the low to moderate exercise groups the rate of preeclampsia wasn’t affected at all.  However, in the high exercise group (over 420 minutes of exercise per week) the rate of preeclampsia actually increased.  While it’s good to be in general good health during pregnancy and exercise is a part of that, this seems to show that it’s not a good idea to exercise to the brink of body-builder status 🙂

Here is the full article:

AXX9K1Exercise and pre-eclampsia risks

Issue 25: 5 Jan 2009
Source: BJOG: An International Journal of Obstetrics and Gynaecology 2008;in press
Researchers have found that physical activity in early pregnancy may not have a protective effect against pre-eclampsia, and that high levels of exercise may actually increase the risk of developing the condition.

In a new paper published in the BJOG: An International Journal of Obstetrics and Gynaecology, the researchers from centers in Copenhagen and Odense, Denmark, in Oslo, Norway, and in Boston, Massachusetts, USA, write that it has been thought that physical activity in pregnancy protects against pre-eclampsia. This is based at least in part on physiological principles (such as exercise being understood to lower blood pressure) and has been supported by the findings of some case-control studies.

However, the researchers write, high quality empirical evidence on the association between physical activity and pre-eclampsia is limited. For the new study they analyzed data in the Danish National Birth Cohort, the largest prospective database of its kind, which enrolled 101,045 pregnant women between 1996 and 2002.

The study population consisted of 93,315 women with singleton pregnancies, of which 92,676 resulted in a liveborn child.

The women in the cohort were categorized into seven groups according to the amount of leisure-time physical activity they performed in the first trimester, as documented by telephone interviews. The groups were: 0, 1-44, 45-74, 75-149, 150-269, 270-419, and 420 or more minutes per week.

The researchers assessed the risks of pre-eclampsia and of severe subtypes of pre-eclampsia (including HELLP and eclampsia), according to the level of activity. They found no statistically significant relationships, including no protective effects, except for in the two groups with the highest levels of physical activity – where the risk of severe subtypes of pre-eclampsia was significantly raised.

The odds ratios for severe subtypes of pre-eclampsia, compared with the reference group who took no exercise, were 1.65 (95 percent confidence interval 1.11-2.43) for the women who took 270-419 minutes of physical activity per week, and 1.78 (95 percent confidence interval 1.07-2.95) for the women who took 420 minutes or more of physical activity per week.

Lead author of the paper Dr Sjurdur Ollsen said: “In our study we were unable to substantiate that physical activity in early pregnancy has a protective effect against pre-eclampsia. Another unexpected finding was that leisure-time exercise, in amounts that were only slightly higher than the recommended amount, seemed even to be associated with an increased risk of severe types of pre-eclampsia.” He suggested that further research is need to investigate this association, ideally utilizing large prospective cohort databases, but that in the meantime current recommendations on exercise in pregnancy should remain unchanged.

The journal’s editor-in-chief, Professor Philip Steer, commented that clinical guidelines in the UK stress that selective and moderate exercise during pregnancy, including aerobic and strength-conditioning exercises, can be beneficial, but he added: “While general fitness is a good thing in many respects, these data suggest that it may be unwise to exercise to peak fitness levels.

“This new research is useful as it provides us with an indication of how much exercise pregnant women should take. As with everything in life, too much of a good thing can be bad for you, and moderation in all things remains a good policy.”

Advertisements

Great Midwifery Article in the LA Times

Here’s a wonderful pro-midwifery article in the LA Times!

I also have the text here:

Midwives deliver

America needs better birth care, and midwives can deliver it.

By Jennifer Block
December 24, 2008
» Discuss Article (23 Comments)

Some healthcare trivia: In the United States, what is the No. 1 reason people are admitted to the hospital? Not diabetes, not heart attack, not stroke. The answer is something that isn’t even a disease: childbirth.

Not only is childbirth the most common reason for a hospital stay — more than 4 million American women give birth each year — it costs the country far more than any other health condition. Six of the 15 most frequent hospital procedures billed to private insurers and Medicaid are maternity-related. The nation’s maternity bill totaled $86 billion in 2006, nearly half of which was picked up by taxpayers.

But cost hasn’t translated into quality. We spend more than double per capita on childbirth than other industrialized countries, yet our rates of pre-term birth, newborn death and maternal death rank us dismally in comparison. Last month, the March of Dimes gave the country a “D” on its prematurity report card; California got a “C,” but 18 other states and the District of Columbia, where 15.9% of babies are born too early, failed entirely.

The U.S. ranks 41st among industrialized nations in maternal mortality. And there are unconscionable racial disparities: African American mothers are three times more likely to die in childbirth than white mothers.

In short, we are overspending and under-serving women and families. If the United States is serious about health reform, we need to begin, well, at the beginning.

The problem is not access to care; it is the care itself. As a new joint report by the Milbank Memorial Fund, the Reforming States Group and Childbirth Connection makes clear, American maternity wards are not following evidence-based best practices. They are inducing and speeding up far too many labors and reaching too quickly for the scalpel: Nearly one-third of births are now by caesarean section, more than twice what the World Health Organization has documented is a safe rate. In fact, the report found that the most common billable maternity procedures — continuous electronic fetal monitoring, for instance — have no clear benefit when used routinely.

The most cost-effective, health-promoting maternity care for normal, healthy women is midwife led and out of hospital. Hospitals charge from $7,000 to $16,000, depending on the type and complexity of the birth. The average birth-center fee is only $1,600 because high-tech medical intervention is rarely applied and stays are shorter. This model of care is not just cheaper; decades of medical research show that it’s better. Mother and baby are more likely to have a normal, vaginal birth; less likely to experience trauma, such as a bad vaginal tear or a surgical delivery; and more likely to breast feed. In other words, less is actually more.

The Obama administration could save the country billions by overhauling the American way of birth.

Consider Washington, where a state review of licensed midwives (just 100 in practice) found that they saved the state an estimated $2.7 million over two years. One reason for the savings is that midwives prevent costly caesarean surgeries: 11.9% of midwifery patients in Wash- ington ended up with C-sections, compared with 24% of low-risk women in traditional obstetric care.

Currently, just 1% of women nationwide get midwife-led care outside a hospital setting. Imagine the savings if that number jumped to 10% or even 30%. Imagine if hospitals started promoting best practices: giving women one-on-one, continuous support, promoting movement and water immersion for pain relief, and reducing the use of labor stimulants and labor induction. The C-section rate would plummet, as would related infections, hemorrhages, neonatal intensive care admissions and deaths. And the country could save some serious cash. The joint Milbank report conservatively estimates savings of $2.5 billion a year if the caesarean rate were brought down to 15%.

To be frank, the U.S. maternity care system needs to be turned upside down. Midwives should be caring for the majority of pregnant women, and physicians should continue to handle high-risk cases, complications and emergencies. This is the division of labor, so to speak, that you find in the countries that spend less but get more.

In those countries, a persistent public health concern is a midwife shortage. In the U.S., we don’t have similar regard for midwives or their model of care. Hospitals frequently shut down nurse-midwifery practices because they don’t bring in enough revenue. And although certified nurse midwives are eligible providers under federal Medicaid law and mandated for reimbursement, certified professional midwives — who are trained in out-of-hospital birth care — are not. In several state legislatures, they are fighting simply to be licensed, legal healthcare providers. (Californians are lucky — certified professional midwives are licensed, and Medi-Cal covers out-of-hospital birth.)

Barack Obama could be, among so many other firsts, the first birth-friendly president. How about a Midwife Corps to recruit and train the thousands of new midwives we’ll need? How about federal funding to create hundreds of new birth centers? How about an ad campaign to educate women about optimal birth?

America needs better birth care, and midwives can deliver it.

Jennifer Block is the author of “Pushed: The Painful Truth About Childbirth and Modern Maternity Care.”

VIDEO – Vacuum Extraction (WHO)

Here is a video put out by the World Health Organization regarding the practice of vacuum extraction versus forceps delivery.  This is commonly used when mom has an epidural and can’t push effectively, when the baby is presenting in a less than optimal position (ie not facing mom’s spine), and when the baby needs to be born immediately.

who-vacuum-e(Windows Media Player Required)

VIDEO – External Cephalic Version (WHO)

Here is an interesting video put out by the World Health Organization regarding the indications and counter-indications, as well as the procedure of external cephalic version (ECV).  ECV is where a skilled practitioner attempts to manuver a baby out of a breech presentation.  Enjoy!

who-why-breech-ecv

(Windows Media Player required)