pregnancy health

Anemia During Pregnancy & Postpartum: what it is & what to do about it
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Anemia During Pregnancy & Postpartum: what it is & what to do about it

If you are like many moms, struggling with low energy can be a challenge during pregnancy. Understanding how to support your body as it faces the increased demands of growing a baby can help you to have a better experience, and improve your recovery during the postpartum weeks. For many moms, the lack of energy is due to low hemoglobin levels, which can be linked to low iron. There are many ways to boost these levels naturally, thus providing your body & baby with the nutrients they both need in order to thrive!

What is Hemoglobin?

In a nutshell, hemoglobin is component of your blood that carries oxygen to your cells. If your hemoglobin count is low, you can experience some or all of the following symptoms:

  • Low energy
  • General Fatigue
  • Shortness of breath (especially after climbing stairs or exerting yourself)
  • Heart palpitations
  • Dizziness or lightheadedness

How do I find out if I have low hemoglobin?

Having routine labwork performed during pregnancy can tell you where your hemoglobin levels are. In my practice, we often check these levels towards the beginning of pregnancy, and then again after you reach 28 weeks of pregnancy. As you progress in pregnancy, your blood volume expands, preparing you to be able to handle the blood loss that occurs with delivery. For many women, their total volume increases over 25%, and tends to peak by the time you hit the beginning of the third trimester. Testing your hemoglobin soon after 28 weeks tells us how your body has handled this blood volume expansion, and gives us time to really hit support should your levels be low at this point in pregnancy.

What if my hemoglobin levels are low?

If your results are low, my first step is to look at all of your lab results to see if we can get a clue as to WHY they are low. There are a few different types of anemia, and the two most common in my practice are:

  • Iron Deficiency: caused by a lack of iron, which can show up as low hemoglobin combined with a low hematocrit ratio on your lab results.
  • B12/Folate Deficiency Anemia: caused by a lack of adequate B12 vitamins and folate, and can be indicated by an elevated “mean corpuscular volume” (abnormally large red blood cells) on your lab results in combination with a low hemoglobin level.

In occasional instances, low hemoglobin levels can also happen if a mom bleeds excessively after delivery. This is one of the reasons that it is so important to get your hemoglobin in an optimal place before birth, as it increases the body’s ability to handle blood loss. But if your hemoglobin is low and you need iron support after having your baby, the following suggestions will also pertain to you!

What can I do to bring up my hemoglobin?

Some key factors to consider as you weigh your options for iron and vitamin support:

  • Typically natural-based supplements take consistency and time to really be effective. This is why to start helping your body early, as the body will then have time to respond. Many iron and vitamin supports will take one to two weeks to really start working to bring levels up.
  • Look for products and options that are whole-food or plant based when possible, as these will cause less constipation and be able to be more easily utilized by your body.
  • Pay attention to labels, and stay away from supplements that contain synthetic ingredients. This is particularly key when it comes to “folate”, as you do NOT want the synthetic form called “folic acid”. Due to genetic issues, many women are unable to adequately absorb synthetic folic acid and synthetic forms of B vitamins, which increases the specific problem of B12/folate deficiency anemia. To understand more about folate and the importance of methylated vitamins, check out this article here by Wellness Mama.

Now onto options for increasing iron levels!

Borderline anemia: if your levels are borderline, and you are looking for some general ways to boost your levels and provide more support to your body, these are some great ways to start:

  • Use cast iron cookware for cooking.
  • Eat foods high in iron (beans, lentils, red meat, liver, spinach, turkey, pumpkin seeds, broccoli, black strap molasses, etc.)
  • Increase your vitamin C intake with a high-quality Vitamin C supplement once or twice daily.
  • Make sure you aren’t mixing calcium supplements with your iron-rich foods or supplements (they will block the absorption of the other, negating the benefits of either one!)
  • Alfalfa Tablets, Moringa capsules & Yellow Dock tincture.
  • Drink several cups Red Raspberry Leaf tea daily during the 2nd and 3rd trimesters (and during postpartum as well), or drink several cups of NORA tea daily (a combination of Nettles, Oatstraw, Red Raspberry Leaf and Alfalfa). To learn my favorite recipe for Red Raspberry Leaf, click here or for NORA tea, check out this link.

True Anemia Support: for those who need to seriously boost their hemoglobin levels, here are some additional supplements to consider, in addition to the list above:

Many moms have found this combination very effective at bringing up their iron quickly (combined with some of the above suggestions):

  • Liquid Chlorophyll (drink 2-3 tablespoons daily, and 1/4c. daily during the first week postpartum)
  • Hemaplex Tablets (make sure it’s these tablets, as they do not contained the synthetic forms of folate)
  • Desiccated Liver capsules (grass-fed organic is best)

Others have found the combination of Chlorophyll with one or two of the following to work for them:

For additional information on anemia during pregnancy, I’d encourage you to check out the following links:

And for more suggestions on anemia in general, Aviva Romm has some great suggestions here: Aviva Romm on Anemia

I’d love to hear from you: what has helped to bring your hemoglobin up, and help you have adequate iron levels during pregnancy and postpartum?

Understanding Gestational Diabetes (and your testing options)
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Understanding Gestational Diabetes (and your testing options)

GDM

I recently worked on updating the information I give to clients on Gestational Diabetese screening during pregnancy. Compared to 12 years ago when I was first delving into midwifery studies, there is so much more helpful information out there about this subject! For this month’s blog post, I decided to share my updated “informed consent” handout (this is something that each client recieives in order to help them make a truly informed choice regarding their screening options), as well as some links that may be helpful for those who are wanting to research this topic further.

Informed Consent Regarding Glucose Testing and Screening for

Gestational Diabetes

What is Gestational Diabetes?

John Hopkins Medicine describes Gestational Diabetes as follows: Gestational diabetes mellitus (GDM)  is a condition in which a hormone made by the placenta prevents the body from using insulin effectively. Glucose builds up in the blood instead of being absorbed by the cells.

Unlike type 1 diabetes, gestational diabetes is not caused by a lack of insulin, but by other hormones produced during pregnancy that can make insulin less effective, a condition referred to as insulin resistance. Gestational diabetic symptoms disappear following delivery. Approximately 3 to 8 percent of all pregnant women in the United States are diagnosed with gestational diabetes.

Although the cause of GDM is not known, there are some theories as to why the condition occurs: The placenta supplies a growing fetus with nutrients and water, and also produces a variety of hormones to maintain the pregnancy. Some of these hormones (estrogen, cortisol, and human placental lactogen) can have a blocking effect on insulin. This is called contra-insulin effect, which usually begins about 20 to 24 weeks into the pregnancy.

As the placenta grows, more of these hormones are produced, and the risk of insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results.

For more information on understanding Gestational Diabetes and Insulin Resistance during pregnancy, I highly recommend checking into these websites: EvidenceBasedBirth.com and LilyNicholsRDN.com, and by reading Real Food for Pregnancy by Lily Nichols (available through my office lending library).

Risks Associated with GDM for mother and baby:

Ÿ Increased risk of developing Pre-eclampsia

Ÿ Increased risk of developing Type 2 Diabetes

Ÿ Maternal injury

Ÿ Increased risk of Cesarean section

Ÿ Shoulder dystocia

Ÿ Macrosomia (infant weight over 8lb 13 oz)

Ÿ Neonatal hypoglycemia

Ÿ Neonatal jaundice

Ÿ Stillbirth

Ÿ NICU stay

Ÿ Birth injury

Predisposing Risk Factors can include:

Ÿ Pre-pregnancy BMI >25

Ÿ Family history of diabetes

Ÿ GDM in previous pregnancy

Ÿ Polycystic Ovarian Syndrome (PCOS)

Ÿ Chronic hypertension

Ÿ Maternal age over 25

Ÿ Ethnicity (African-American, Native American, Hispanic, South & East Asian, Pacific Islander)

ŸPrevious macrosomic infant

Ÿ History of Cardiovascular disease

ŸPoor nutrition

Potential Signs and Symptoms of GDM:

Not all mothers will have any symptoms, but these are indicators of the possible presence of GDM:

Ÿ Polyuria (excessive urinary output)

Ÿ Polydipsia (extreme thirst)

Ÿ Weakness

Ÿ Poor healing/susceptibility to infections

Ÿ Size large for dates

Ÿ Recurrent glucose in urine

Ÿ Recurrent yeast infections

Ÿ Ketones in urine

Ÿ Excessive weight gain

Ÿ Polyhydramnios (excessive amniotic fluid)

Ÿ Polyphagia (excessive hunger)

What are my testing options?

The American College of Obstetricians (ACOG) recommends universal screening for every mom between 24-28 weeks for pregnancy. Women with a history of GDM or have high-risk factors are encouraged to screen as early as possible in pregnancy, and typically Glucola is used as the glucose load. Due to the preservatives, dyes and other ingredients found in Glucola, other glucose options are offered, such as a dye-free glucose drink, or the option of consuming 28 jelly beans per the article published by American Journal of Obstetrics and Gynecology. If opting for either of these tests, it is recommended to eat an average of 150 grams of carbohydrates daily for three days before testing. The standard testing procedure is as follows:

  • 1 hour Oral Glucose Challenge test: This involves drawing blood for blood sugar testing one hour after consuming a 50g glucose load (non fasting). Blood sugar levels should be under 140mg/dl. If the blood sugar levels are higher than this, then a 3 hour test is recommended to confirm or rule out a diagnosis of GDM.
  • 3 hour Oral Glucose Tolerance Test (GTT): This four-step test is performed after fasting for at least 12 hours, and includes drinking a 100g glucose drink. Blood is drawn fasting, and then again at 1, 2 and 3 hours after drinking the glucola. If two or more levels are out of range, the mother is diagnosed with GDM. Consultation with a physician is recommended, and transfer of care may become necessary should diet changes be insufficient to keep sugar levels within target ranges.

During recent years, more physicians are becoming comfortable with an alternative to the above traditional protocol as described here by Rebecca Dekker at Evidence Based Birth (near the end of the article):

Home blood sugar monitoring: “Another alternative could be for people to monitor their blood sugar levels at home and discuss the results with their care provider. This is another controversial way to screen for GDM. We didn’t find any studies on GDM screening that compared home blood sugar monitoring versus a standard oral glucose drink.

However, we hear of some people using this method. Basically, they are following a similar path that people do when they’ve been actually diagnosed with GDM. Usually, after a GDM diagnosis, mothers monitor their blood sugar levels four times a day, once after fasting (first thing in the morning) and again after each meal (AGOG, 2018).

The ADA and ACOG recommend that fasting blood sugar levels should be <95 mg/dL, and post-meal blood sugar levels should be <140 mg/dL at 1-hour. Other recommendations for healthy blood sugar level targets during pregnancy are even lower. For example, the California Diabetes and Pregnancy Program (CDAPP) Sweet Success recommends fasting/premeal levels at <90 mg/dL and post-meal levels at <130 (Shields and Tsay, 2015).

Monitoring your blood sugar levels at home might be an option for someone who cannot take a glucose test because of the side effects, or prefers not to drink the glucose solution. However, home blood sugar monitoring is demanding and has some drawbacks. Mothers may have to purchase their own testing kits, and they have to remember to set alarms and carry their testing supplies with them throughout the day. Some people would consider it a major downside that blood sugar monitoring requires constant finger sticks, although others may not mind. Since home blood sugar monitoring is usually done after GDM diagnosis, there is no clear-cut standard for screening/diagnosing gestational diabetes based on home blood sugar checks. It’s important to discuss any results with a care provider to determine if testing can be stopped, if home monitoring should be continued, or if consistent high values mean that treatment for GDM is needed. Also, with this method, it is important that mothers follow their normal diet while testing, to get a “real-life” picture of their blood sugar results over time.”

While this testing method has gained acceptance in some medical communities, it is important to note that it has not been officially documented as a standard for diagnosing GDM. However, research is ongoing, and this method does provide you with an accurate day-by-day picture of how your body is responding to your normal diet. For clients who choose to do home glucose testing (whether in addition to or in place of the Glucose Challenge Test), I am happy to provide you with a glucometer, supplies and a chart that you can use to track your glucose readings for two weeks.

What if I have Gestational Diabetes?

Many women are able to control GDM through regular exercise and dietary changes. For clients who test positive for GMD, I will ask you to read Lily Nichol’s books Real Food for Gestational Diabetes and Real Food for Pregnancy, and we will discuss a plan for your care, including necessary diet changes and logging, home glucose monitoring, and exercise routines. If additional insulin is needed to control sugar levels, this will result in a transfer of care, as insulin-dependence significantly raises risk factors making a homebirth not a safe option for mother and baby.

Conclusion: Informed Consent

I highly recommend checking out these websites for more information on Gestational Diabetes Screening:

I also would encourage you, regardless of your choice to screen for GDM, to spend time reading Lily’s Nichol’s books (mentioned above) and implementing her dietary suggestions for pregnancy. Excellent information is available at her website: LilyNicholsRDM.com

As an expectant mom, it is your responsibility to choose first whether to screen for Gestational Diabetes, and if so, which method of screening to utilize. This document is intended to begin the conversation and aid you in researching what is best for your health and the health of your baby, and I welcome your further discussion and questions at any time.

In your Client Information Folder you will find a document entitled “Consent & Waivers for Common Procedures”, on which is listed screening for Gestational Diabetes. Please indicate your choice on this form, after you have spent time reading the risks and benefits of screening and the type of screening.

Did you find this information helpful? I’d love to hear about your experience with GDM and your testing/treatment options! If you’re wanting to research this topic further, here’s some links to other helpful posts, many written by moms sharing how they made a decision regarding GDM screening for their pregnancies (note, many of these posts are personal opinons shared for your consideration, though they may not include documented studies or be supported by general medical literature):

If you have more to add, or resources to share, feel free to comment below!