Blog Hiatus

Written by yvonnethornton on May 29th, 2014

Thank you to all my blog readers! Your support is appreciated. I will be taking a break until after Labor Day so enjoy your summer.

- Yvonne S. Thornton, M. D., M. P. H

 

United States Pregnancy Rates Continue to Drop

Written by yvonnethornton on May 26th, 2014

For decades, pregnancy rates in US women have been sliding, and this is largely thanks to a steep decline in teen pregnancies, according to a new report.

The study showed that teenage pregnancies reached a historic low in 2009. For all US women between 15 and 44 years of age, the pregnancy rate in 2009 was 102.1 per 1,000 women, down 12% since 1990. The only time it has been lower was in 1997, and even then, the difference was slight. The birth rate for married women is 72% higher than for unmarried women; the abortion rate is five times higher for unmarried women than for married women, and has also dropped overall.

For women across all categories, unintended pregnancy accounts for almost all abortions, so the decline in abortion rates is closely correlated with the decline in unintended pregnancies, and this has been seen in all groups including married women. Increasing options and education are clearly beneficial for all women.

Pregnancy rates are down in every category except women over 30, the only group with a continually increasing incidence of pregnancy. Women in their 20s represent the largest group of pregnant women, but even their rates have dropped.

The data stopped at 2009 because the complete set of more recent data is not available yet, but newer statistics do suggest that pregnancy rates continue to decline, although at a slower pace than the dramatic drop from 1990 to 2009.

The recession that began in 2007 probably has had an impact. Birth rates plummeted during the Great Depression of the 1930s; a similar effect is probably taking place now. In addition, women have been having fewer children than their mothers and grandmothers, and more women are waiting until their 30s to start their families, waiting for either the economy or their personal financial situations to stabilize.

While the levelling-off of the decline in most categories may be a sign of the recession’s abating impact, the teen birth rate shows no signs of slowing its striking drop. In 2012, the teen birth rate was less than half its 1992 peak of 62 birth per 1,000 girls, making this the group with the largest decline. The data show that fewer teenagers are having sex as well as a significant increase in contraceptive use among the ones that do. The exact reasons for the decline may not be clear, but those teaching both abstinence and sexual health, including contraceptive use, are probably on the right track.

Even with the decline, the pregnancy rate in the United States is still among the highest in the industrialized countries. The countries with the ten highest birth rates worldwide are all located in Africa.

- Yvonne S. Thornton, M. D., M. P. H

 

Bleeding during Pregnancy – What You Need to Know

Written by yvonnethornton on May 22nd, 2014

Vaginal bleeding during pregnancy is almost always a source of worry for a pregnant woman, but it’s not always a sign that something is wrong. Studies such as this one show that around 20% of pregnant women experience early bleeding, and little more than half of those pregnancies end in miscarriage.  Even in this study, the number of pregnant women may have been underreported and therefore, the true number of women who have bled in early pregnancy is not known.  However, it is a common occurrence, which must be investigated by your practitioner when it happens.

Less Serious Causes

One of the most common reasons for bleeding early in pregnancy is implantation. Implantation bleeding occurs around two weeks after conception and is the result of the fertilized egg burrowing into the endometrial lining. Sometimes this bleeding is mistaken for a normal period, so a woman may not realize she is pregnant until the following month. Those women who are Rh-negative should be very cognizant of this fact because what is believed to be a late normal period, actually may be a miscarriage in disguise and can cause problems for subsequent pregnancies with respect to alloimmunization. Please refer to my health book, “Inside Information for Women” for more on Rh-alloimmunization.

Other causes of bleeding during pregnancy that do not indicate harm to the fetus can include a cervix that is more sensitive and tender than usual, which can lead to bleeding, especially after intercourse. However, there is no way to know for sure what is causing your bleeding without an examination, so bleeding during pregnancy should always be evaluated by your doctor.

More Serious Causes

Ectopic pregnancy is another reason for bleeding early in pregnancy. These are pregnancies that implant in the fallopian tubes or other location outside the uterus. This type of bleeding may be accompanied by pain, either sharp pain or cramping, and lower-than-normal levels of hCG, or there may be no pain at all, that is, until it ruptures. Women who have had ectopic pregnancies before, pelvic surgery, or infection in the fallopian tubes are more likely to experience an ectopic pregnancy in a subsequent pregnancy. Untreated, an ectopic pregnancy can result in a ruptured fallopian tube, causing massive hemorrhage and may lead to death of the patient.

A miscarriage, which is the lay term for a spontaneous abortion, will also cause bleeding, and unfortunately, cannot usually be prevented or stopped. Most miscarriages occur during the first trimester (the first 12 weeks of gestation), and may cause vaginal bleeding, cramping, and the passage of tissue through the vagina. A miscarriage, while heartbreaking in many instances, is not a sign that the mother did anything wrong, nor is it a sign that future pregnancies are likely to end in miscarriage.

Bleeding in the second half of pregnancy is more likely than earlier bleeding to be caused by something serious. These causes can include placental abruption, or placenta previa. In placental abruption, the normally-implanted placenta separates from the uterine wall prematurely, such as after a motor vehicle accident or after a fall or other blunt trauma. In placenta previa, the abnormally-implanted placenta is positioned too low in the uterus, partially or completely covering the cervix. Any bleeding during pregnancy requires immediate attention in order to properly diagnose and treat the condition.

Again, to emphasize the importance of bleeding during pregnancy, let me reiterate: Any bleeding during pregnancy warrants an immediate call to your doctor to rule out serious causes or take appropriate measures to treat them.

- Yvonne S. Thornton, M. D., M. P. H

 

Pregnancy Weight Gain: When the Guidelines Might Not Be Right for You

Written by yvonnethornton on May 19th, 2014

When you find out you’re pregnant, one of the first things your doctor will probably want to discuss with you is how much weight you should gain over the course of your pregnancy. The guidelines say that most pregnant women should gain between 25 and 35 pounds – more if they start out underweight, less if they are overweight to begin with. How does that weight gain break down?

  • 1  pound for the placenta
  • 2 pounds for amniotic fluid
  • 2  pounds for the increased weight of the uterus
  • 1 pound for increased breast size
  • 3 ½ pounds for increased blood volume
  • 6 ½ pounds for maternal fat stores
  • 6-7 ½ pounds for the full-term baby

All of this adds up to between 22 to 24 pounds that a healthy woman of normal weight can safely gain during her pregnancy.  The operative term here is “normal weight”.

However, many women don’t start pregnancy at their ideal weights. For a woman who is very underweight, somewhat more weight gain may be optimal, and may be the natural outcome of eating enough nutritious food to nourish herself and her growing fetus.

A much more common problem, though, is that of the woman who starts her pregnancy overweight. One in five pregnant women (20%) are obese at the start their pregnancy.   Gaining too much weight during pregnancy is one of the most preventable causes of complications, ranging from gestational diabetes to preeclampsia to overly large babies that require cesarean deliveries.

A woman who is overweight or obese can safely gain less than 25 pounds during her pregnancy as long as she eats a healthy diet. Keep in mind that “eating for two” should mean that you are eating twice as well, not twice as much.  The fetus usually weighs less than 1/20 of its Mom’s weight. So for an overweight or obese woman, switching to the healthy diet she needs for pregnancy may actually mean a reduction in calories, and gaining less than the recommended amount or even losing weight may be the natural result.  And, an obese pregnant woman shouldn’t get overly concerned about it.  If you are obese, you already have a fluffy substrate or matrix upon which your pregnancy will grow.  A numerical end-point, i.e., weight gain or loss, should not be used in obese pregnant women, but rather a healthy, balanced nutritional intake should take priority. 

This is perfectly fine as long as your doctor agrees (always discuss matters related to your pregnancy with your own doctor, because your situation is unique), and as long as your diet contains all the necessary nutrients and fluids you and your baby need.  I, as the principle investigator, have done the original research and have published the first and, to date, the only randomized clinical trial regarding the outcomes of nutritionally monitored obese pregnant women.  A well-balanced diet is the way to go resulting in less problems during the pregnancy.

A pregnant woman should be drinking lots of water – at least eight cups a day – and another four cups of skim milk, leaving very little room for soda or fruit juice (which are both mostly sugar). And eating all the fresh fruits, vegetables, lean meats, fish, and whole grains you need does not, for the most part, leave room for junk food.

The occasional treat is fine. A cup of coffee, a small serving of chocolate, and the like do not have to be abandoned entirely for nine months, and trying to do so would most likely set you up for failure anyway as the temptation to “cheat” would be too great. Tell yourself you can have treats – just not every day and not in large amounts.

Exercise will also help you feel better and keep your weight in check during pregnancy. Walking, swimming, and using a stationary bicycle are excellent exercises now. Keeping track of everything you eat and which exercise you perform each day and for how long can help you stay accountable and motivated.

Just because countless people – even strangers – will tell you that you “should” be gaining 25-35 pounds does not make this necessarily right for you. They don’t even know you!  Talk to your doctor to determine whether you can safely gain less; delivering a baby in better shape than they were in nine months ago is a very real possibility for many women. See my book, Inside Information for Women, for much more information on this and other women’s health issues.

- Yvonne S. Thornton, M. D., M. P. H

 

Men and Women Not Equal When It Comes to Alcohol Abuse

Written by yvonnethornton on May 15th, 2014

With media recently purporting the health benefits of moderate alcohol consumption (most popularly red wine, for the antioxidants), you may be wondering whether to add a daily glass (or two) of wine to your diet. Here are some reasons to think twice – or at least strictly moderate your intake.

Even though on average men drink alcohol in larger amounts than women, women’s bodies have a harder time metabolizing it. That means that if a woman matches her male companion drink for drink, she will be affected by the alcohol faster and more powerfully and will have more alcohol in her blood than him. She will also suffer more pronounced long-term health effects from overindulging.

Alcohol in Pregnancy

There is no justification for drinking any amount of alcohol at all when you’re pregnant, because there is no known safe amount. Drinking alcohol during pregnancy increases the risk of fetal alcohol spectrum disorders, which can cause birth defects and mental retardation. Because you may not know you’re pregnant for several weeks, you should also avoid alcohol if you are trying to become pregnant, and seriously consider whether drinking is wise if there is a chance you could get pregnant.

Other Health Concerns Related to Alcohol Abuse

Excessive alcohol consumption can cause reproductive health problems, such as disruption of the menstrual cycle, miscarriage, stillbirth, or premature delivery. In addition, excessive alcohol intake increases the likelihood of having multiple sexual partners, resulting in an elevated risk of sexually transmitted diseases and unintended pregnancy. Binge drinking is strongly linked to sexual assault, especially among college students.

Women also have a greater risk of cirrhosis of the liver and other liver diseases related to alcohol. Effects on the brain impact women more as well, and these can include brain shrinkage and memory loss. These effects tend to take place in women sooner and with shorter periods of alcohol abuse than in men.

Consuming too much alcohol also affects women’s hearts differently than men’s, and women have a greater risk of damage to the heart muscle. Alcohol consumption leads to a higher risk of cancers of the breast, colon, liver, esophagus, throat, and mouth.

What about the Benefits?

So what about those antioxidants in red wine? New studies show that they aren’t particularly effective at the low doses obtained from a daily glass of wine anyway. You’re better off getting your antioxidants from a balanced, healthy diet that includes lots of fresh fruits and veggies. You can get resveratrol, the specific compound found in red wine, from grapes and raisins (and, to a lesser extent, peanuts); a wide range of other antioxidants can be found in other natural foods such as berries, apples, beans, plums, and many, many more. So if it’s antioxidants you’re after, head to the farmers’ market or the produce department – not the beer and wine aisle.

- Yvonne S. Thornton, M. D., M. P. H

 

The Hobby Lobby Debate: Should Your Employer’s Faith Influence Your Options for Medical Treatment?

Written by yvonnethornton on May 12th, 2014

It’s amazing to me sometimes how politicized women’s health has become. Case in point: Republican Mike Huckabee’s recent comments calling women who rely on birth control “victims of their own gender” and saying that the “Obamacare” contraception mandate “insults women… by making them believe that they are helpless without Uncle Sugar coming in and providing for them a prescription each month for birth control because they cannot control their libido or their reproductive system without the help of the government.”

Wow.

Hobby Lobby, a company with 28,000 employees, must agree: they are trying to convince the Supreme Court that they should not have to provide insurance coverage for certain contraceptives for women, ostensibly because it goes against their CEO’s religious beliefs.

In an interesting side note, Hobby Lobby seems to have a problem with sticking to those beliefs consistently anyway, as while they deny IUD coverage to their female employees, they have no problem investing in companies that produce the contraceptive devices.

But this is not about tearing Hobby Lobby down; it’s about building women up, protecting them from tyrants and people who think that they can make medically sound choices for women based on religious faith rather than medical knowledge.

Birth control is one of the most common medications used by women, and protects them and their families from myriad health and financial risks. Exempting birth control from insurance coverage because of personal objections on the part of the CEO of the company is nothing short of ludicrous. Providing coverage for a necessary health service does not communicate religious agreement with it; it communicates compliance with a common-sense health policy.

Make no mistake: what’s at stake in this case (and the many that are sure to follow should Hobby Lobby come out on top) is the health of women and their families all over the country. The billionaires who run Hobby Lobby may not see an issue with forcing women to shoulder the financial burden of birth control on their own, but thousands of low-wage hourly employees will certainly have a different view.

What we’ve got here is not people who are simply trying to do the right thing, but rather people who are completely out of touch with the reality of the economic and health concerns many working families face. Emergency contraception is another method Hobby Lobby doesn’t want to cover, but I’m betting they aren’t going to step in and support those unplanned children when their families cannot provide for them adequately.

Policies involving women’s health (and all health policies, for that matter) must be grounded in medical fact, and not political ideology. Why should you or your daughters or her daughter have to make tough choices about medical care because of some politician or CEO’s personal religious beliefs? As doctors, it’s our job to advocate for women’s health, and that includes having options for birth control.

- Yvonne S. Thornton, M. D., M. P. H

 

Menopausal Weight Gain NOT Inevitable

Written by yvonnethornton on May 8th, 2014

It may seem like weight gain is an inevitable effect of menopause. It is indeed common, and there are several reasons why, including:

  • Levels of estrogen, which appears to have a weight-regulating effect, drop significantly during menopause.
  • Older women are less likely to get enough exercise than younger women.
  • Muscle mass declines, and this has a slowing effect on your metabolism. This means that you may need fewer calories, but if you adjust your food intake accordingly, creeping weight gain will likely be the result.
  • Older women are more likely to have jobs that demand very little in the way of physical labor; they may also eat out more with the kids out of the house.

And weight gain isn’t just a cosmetic issue – it also increases your risk of many health problems, including diabetes, heart disease, high blood pressure, and several types of cancer.

However, you still have plenty of control over your weight during and after menopause, so don’t fall for the notion that weight gain is natural or that there’s nothing you can do about it. Even though weight control may be more of a challenge because of physiological and lifestyle changes that take place during menopause, it still boils down to taking in no more energy than you expend.

If you find the pounds adding up, your first line of defense is to eat less. In your fifties, you probably need a couple hundred calories a day less than you did when you were younger. Make your food choices more carefully. No one needs empty calories, but menopausal women should be especially careful to choose mostly vegetables, fruits, lean meats, whole grains, and low-fat or non-fat dairy products.

Exercise is another key step to beating menopause weight gain. Exercise gives you more energy and burns fat, while building muscle. And maintain or increasing your muscle mass is important because the more muscle you have, the faster you burn calories all day long. Adults up to 65 years old need at least 30 minutes of moderate-intensity exercise five days a week, such as brisk walking, and at least two muscle-strengthening workouts a week. You may need to add even more if your goal is to lose weight.

A good support system is also important. Enlist the support of your family and friends, or better yet, find a partner to work out with who can help encourage you and keep you motivated – and do the same for him or her.

The answer to menopause weight gain isn’t glamorous or easy, and there is no secret formula. But with concentrated effort to control your diet and exercise habits, you can absolutely maintain or even improve your weight at any stage of life. For more information on menopause, see my book, Inside Information for Women.

- Yvonne S. Thornton, M. D., M. P. H

 

Dealing with Springtime Allergies during Pregnancy

Written by yvonnethornton on May 5th, 2014

Spring is here, and if you’re like many people, you’re dealing with the watering eyes, coughing, sneezing, and sniffling that pollen causes those sensitive to it. When you aren’t pregnant, you usually don’t need to think twice before popping a pill to relieve those symptoms, but once you are pregnant, you start to question everything you put into your body – and rightfully so. You want to do everything you can to keep your baby safe and healthy, but you also don’t need the continual stress of dealing with your allergy symptoms, whether they are caused by pollen, dust, pet dander, or whatever else triggers them. 

Many pregnant women deal with allergies. Some of these are women who have always had them and find that they don’t magically disappear just because they are now pregnant; some women find that they experience allergy symptoms during pregnancy that they have never had before. Sometimes swollen nasal passages, a common result of pregnancy hormones, can mimic the symptoms of allergy sufferers. This can occur alone or in conjunction with actual allergies, multiplying the misery of the affected woman.

What You Can Do

The best way to get relief, of course, is to avoid your triggers in the first place, whenever possible. Secondhand smoke (which is dangerous for you and your baby anyway), pollen, cat dander, and mold are all common triggers; so are paint thinner and other household chemicals. Use common sense and stay indoors when pollen is at its worst, invite your cat-loving friends to your house instead of going to theirs, and use natural cleaners that don’t make your symptoms flare.

If your best efforts to avoid symptoms are unsuccessful and you need to take a more proactive approach, the first step is to talk to your doctor to see what steps you can safely take. Even if you have been taking an allergy medicine for years, check with your doctor before continuing it now – and this includes prescription, over the counter, and homeopathic medicines.

There are some general guidelines for what drugs are safe in pregnancy. For example, over-the-counter antihistamines are usually considered safe for use by pregnant women, but they can make you sleepy. Pregnancy itself can also cause considerable fatigue, so this may not be ideal for you. Conversely, decongestants such as Sudafed or other decongestants containing vasoconstrictors like pseudoephedrine may constrict the vessels in your placenta and cause fetal compromise. The bottom line is that you should ask your doctor before taking any medication at all during your pregnancy to make sure the drug is safe for your individual situation.

Desensitization for allergies needs to be discussed with your obstetrician and your allergist in a mutual consultative meeting, understanding the risks and benefits. You can also try natural remedies such as using a neti pot (with sterilized water), as long as your doctor is aware of the treatment and gives you his/her approval.

- Yvonne S. Thornton, M. D., M. P. H

 

Understanding and Preventing Fetal Alcohol Spectrum Disorders

Written by yvonnethornton on May 1st, 2014

Do you know what the only preventable form of mental retardation is?  Fetal Alcohol Syndrome.

For some reason, there seems to be a lot of confusion among pregnant women about how much alcohol they can safely consume. The answer is extremely simple: NONE.  There is no amount of alcohol consumption known to be safe during pregnancy, and no specific minimum amount a pregnant woman must drink in order to put her baby at risk for being born with a fetal alcohol spectrum disorder (FASD).

Unlike an adult, the fetus does not have the liver enzyme alcohol dehydrogenase and consequently cannot metabolize alcohol; resulting in alcohol hanging around and causing damage. 

FASDs occur in babies whose mothers drank alcoholic beverages while pregnant, and can cause a range of symptoms including physical, behavioral, and learning problems. It is very common for a person with an FASD to have a combination of these problems. FASDs are entirely preventable – by simply not drinking while you’re pregnant. There is no known safe time during pregnancy to drink, and no known safe amount you can drink. And because women often don’t know they’re pregnant until several weeks in, any woman who might become pregnant should not drink, either.

Signs and Symptoms of FASDs

FASDs is a term that refers to the whole group of possible disorders babies whose mothers drank while pregnant are vulnerable to. The specific symptoms range from mild to severe and may include:

  • An abnormal facial appearance
  • A smaller-than-normal head
  • Short stature and low body weight
  • Problems with coordination
  • Hyperactivity, attention deficit, memory problems
  • Learning disabilities
  • Mental retardation
  • Speech delays
  • Poor reasoning skills
  • Sleep problems
  • Hearing or vision problems
  • Heart, kidney, or bone problems

Types of FASDs

There are several types of FASDs. The term used to describe an individual disorder depends on the specific symptoms present. For example, fetal alcohol syndrome refers to the more severe symptoms on the FASD spectrum. Fetal death is one such possible outcome of maternal drinking during pregnancy. Fetal alcohol syndrome sufferers may also have growth problems, problems involving the central nervous system, and abnormal facial features, among other problems.

Alcohol-related neurodevelopmental disorder can cause intellectual disabilities, and these individuals generally do poorly in school, especially when it comes to math, attention, memory, and impulse control. There are also alcohol-related birth defects which can range from hearing loss to heart problems and more.

Treatment for FASDs

There is no cure for FASDs. However, early treatments are imperative and can be effective at improving a child’s development and quality of life. Treatment options include medication for certain symptoms, certain types of therapy, parent education, and more. There is no one treatment that will be right for every child or every type of FASD. Early diagnosis and intervention, a stable and loving home environment, and involvement with special education services can all help people with FASDs overcome their disability and reach their full potential.

It’s never okay to drink alcohol while you are pregnant.  Read my book, Inside Information for Women, for more information on this. You’re only pregnant for a few months, and the choices you make now last two lifetimes: yours and your baby’s.

- Yvonne S. Thornton, M. D., M. P. H

 

What Your Home Pregnancy Test Can and Can’t Do

Written by yvonnethornton on April 28th, 2014

If you have just noticed that your period is late, your first inclination may be to run out and buy a home pregnancy test (HPT). With various brands now purporting to be effective as early as the first day of your missed period, it’s understandably tempting. However, be aware that these claims may not always be exactly accurate. You can improve your odds of getting an accurate reading by being familiar with when and how to take one of these tests, but understand that HPTs are no stand-in for the reliability of a test administered by a doctor.  These tests are from the urine and are imprecise.  The pregnancy tests taken from a blood sample are more accurate and will allow your gynecologist to see a “trend” in the amount of hormones in your system, in case there is an equivocal result.

How Soon Can You Take a Home Pregnancy Test?

Don’t get too excited about those tests that claim to work before your period is even late. Wait until a little later for the best results – once your period is a week late, go ahead and test. By this time, if you are pregnant, you’ll have enough HCG (human chorionic gonadotropin, the hormone produced in your body when you become pregnant) in your blood for the test to detect. Earlier than this, some HPTs aren’t precise enough to detect the smaller amounts of HCG present in the first days of pregnancy.

False Positive/False Negative Results

There are several factors that could interfere with the results of an HPT, including the design of the test itself, taking the test too early, and certain medications such as fertility drugs. Both false negatives and false positives are possible, but false positives are much rarer.

A false positive could occur after taking a medication such as a fertility drug that contains HCG, or it could mean that there was a pregnancy that was lost very soon after the fertilized egg had attached to the uterine lining. An ectopic pregnancy may also produce a positive HPT result, and this requires immediate medical attention. Most often, however, a positive result indicates a normal pregnancy. Either way, a positive result warrants an appointment with your gynecologist.

A false negative result is more likely than a false positive. This means that your HPT will indicate that you aren’t pregnant when you actually are. This can be life-threatening, especially if you are pregnant in one of your fallopian tubes or your cervix or your abdomen (ectopic pregnancy).  The pregnancy may rupture in the fallopian tube or cervix and cause hemorrhage leading to death. You may end up with a false negative if you take the test too early, check the results too soon (without following the package directions explicitly), or using urine that is diluted – for example, if you have recently drunk a lot of water. That’s why even though many HPTs claim to be accurate at any hour, your best bet is to take the test first thing in the morning, when more concentrated urine boosts your chances of getting an accurate result.  In the final analysis, you need to have the result confirmed in a doctor’s office.

What to Do After Taking the Test

If the test is positive, make an appointment with your gynecologist to confirm the pregnancy with a pelvic exam and a blood test.  Of utmost importance is to confirm that the pregnancy is actually in your uterus and not an ectopic pregnancy where it has an increased risk of rupture and hemorrhage. The sooner prenatal care begins, the better, so make this call immediately.

If your test is negative, and you have missed a period, you need to make an appointment to see your gynecologist as soon as possible. There are lots of reasons why you may miss periods, including stress, weight loss, strenuous exercise, and illness. However, if you missed a period, you are pregnant until proven otherwise.    Read more about pregnancy tests and early pregnancy in my women’s health book, “Inside Information for Women”.

 

- Yvonne S. Thornton, M. D., M. P. H