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Pregnancy, Anxiety and the Pandemic: What can we do to help ourselves and when should we consider seeking help?

By Dr. Lauren Broch Phd, MS

Pregnancy is a time of mixed emotions and it is not uncommon to feel excited and exhilarated but also confused, overwhelmed and even anxious, at times. Concerns about contracting the coronavirus and its effects on you and your baby’s health, changes to your doctors’ office hours and practices and altered hospital policies, will understandably add further stress during pregnancy.  And while information regarding pregnancy and COVID-19 is continually evolving, this article provides a framework to help pregnant women better understand how to evaluate what might be going on and to provide practical information and tips to support good mental health during pregnancy.  

Our current understanding about COVID-19 effects during pregnancy

Although little is know about Covid-19’s impact on pregnant women, this is what we understand at the time of this blog:1 

  • There is no evidence to suggest that pregnancy increases a women’s risk for getting Covid-19 or for developing more severe symptoms is she has the disease.
  • It appears that pregnant women who are healthy will develop mild to moderate symptoms that are similar to non-pregnant women of the same age and health status. Further studies need to be done to elucidate these preliminary findings.
  • To err on the side of caution, the United Kindgdom declared pregnant women a vulnerable patient population, even though there is no available evidence to demonstrate an increased risk to pregnant women from Covid-19. Such a statement is based on data gathered from other viral infections. 
  • According to the CDC, there is no evidence that women with Covid-19 have an increased risk of miscarriage or other complications, if they are otherwise healthy. Pregnant women who had other coronaviruses such as SARS and MERS had a higher risk for preterm birth, as noted by the American College of Obstetricians and Gynecologists. Further studies need to be done to elucidate these preliminary findings.
  • There have been several small studies that have shown limited or no transmission of Covid-19 from pregnant women to their newborns. Further studies need to be done to elucidate these preliminary findings. 

If you have cough or shortness of breath or at least two of the following symptoms: fever, chills, sore throat, muscle pain, new loss of taste or smell, headache, contact your doctor, nurse or midwife. 

Questions to ask your doctor

Due to the pandemic, many pregnant women are uncertain about how mandated changes in hospital practices and social distancing will impact their birth plan and experience.  If you haven’t already, contact your doctor, nurse, or midwife prepared questions to ensure that you have the necessary information to revise your birth plan. Here’s a brief list of questions to include:

  • How does one contact the office and what are the office hours? What happens in case of an emergency? What is the protocol for prenatal visits and ultrasound visits? 
  • How does one access online antenatal classes to meet and talk to other pregnant women?
  • What measures have been put in place to ensure my safety when visiting the doctor’s office or going to the hospital? 
  • How will changes in hospital practices due to COVID-19 treatment at the hospital affect my birth plan, labor and delivery? (This question will obviously require careful detail of information of the different steps involved in labor and delivery).  
  • Will there be changes in protocol, anesthesia or other medications due to Covid-19 and be explicit about what they are?
  • Who will be able to be present in the delivery room? If no one can be present, how and where can my significant other or loved one, attend the birth? From another room, nearby?

A word about anxiety

Anxiety symptoms are relatively common during pregnancy.  A recent study of 2,793 pregnant women showed that 9.5% of women met criteria for generalized anxiety disorder (GAD) at some point in their pregnancy, with the first and third trimester having higher prevalences than the second trimester. 

Although anxiety is generally more prevalent in women with a pre-existing condition of anxiety, it can certainly rear its head in women without any prior anxiety, during this time of great upheaval. Cognitive behavioral therapy and relaxation techniques may be helpful for treating anxiety symptoms and may reduce the need for medication. Various other treatments such as yoga, massage therapy and acupuncture may be adjunctively helpful. In some cases, medication is needed, and it is important to choose an effective treatment with a good safety profile. 

Although most women can become more forgetful and have heightened emotions that include anxiety, it is important to recognize when the degree of anxiety is affecting your pregnancy. Some signs and symptoms to look out for include:

  • Interrupted or poor quality sleep 
  • Recurring nightmares or disturbing dreams 
  • Change or loss of appetite 
  • Frequent binge eating
  • Trouble concentrating 
  • Panic and feelings of fear worry 
  • Obsessive rumination about the pregnancy, delivery and postpartum period 

If you are experiencing these symptoms on a frequent basis, it is vital that you speak with a doctor, nurse, midwife or counselor to help support you through this challenging time. Depression and other mood issues can also increase and should be discussed with your healthcare practitioner if it is affecting your daily functioning.

Stress-relieving tips and practices 

To help relieve stress and anxiety during this special and challenging time of a pregnant woman’s life, we recommend focusing on the things that you can control that include taking care of yourself and your developing baby, avoiding those things that may cause additional stress and anxiety, and whenever possible and reaching out to others for connection, support and love. Toward this end, here are a few key suggestions abbreviated as the “SEEDS” to help reduce anxiety:

  • Structure each day by planning for success and fun: shower, dress, think of healthy meals to prepare, and plan one fun thing to do for yourself- take a bubble bath, play an instrument or pick up an old hobby, work on a blanket or other project for the baby’s room, watch a funny movie, read an old letter or diary, connect with an old friend are just a few suggestions. 
  • Eat:  Maintain a healthy diet of vegetables, fruit, whole grains and adequate proteins. Ask for extra help from your partner or friends and neighbors in taking care of other children or going grocery shopping. Drink plenty of water and fluids and supplement with a multi vitamin and other basic supplements (refer to Joanna’s article). 
  • Exercise and mindfulness:  Engage in regular exercise and practice deep breathing, relaxation and/or meditation. A little time for mindfulness goes a long way towards helping relax you and your baby. Spend some time in gratitude for the life that you are living and acknowledge the challenges and emotions that you are facing and feeling.
  • Diversion: Allow for diversion with family members and connect with loved ones and friends. Allow others to enjoy the growth of your baby through video sessions. Allow yourself an occasional splurge, choosing healthier snacks  (e.g., low calorie ice creams, fruits, nut butters).  
  • Sleep:  Make sleep a priority and keep regular bed and wake times that allow you ample time to wind down, and get 7-8 hours of sleep. Turn off blue light on your technology and limit screen time close to bed. Limit exposure to all media and news, especially around bedtime.

For further references related to COVID-19 and pregnancy please refer to the following link from the Harvard Medical School health blog post on April 2, 2020.

https://www.health.harvard.edu/blog/pregnant-and-worried-about-the-new-coronavirus-2020031619212

References

1 https://womensmentalhealth.org/posts/anxiety-during-pregnancy-options-for-treatment/
2 https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

Pregnancy Myths & Facts & What Balancing your Health During Pregnancy Really Means

By Joanna Foley, RD, CLT

Any woman who is either currently pregnant or who has been pregnant in the past knows that pregnancy comes with a LOT of information, advice, and “rules” about what you should and should not be eating and doing. While these guidelines mean well, they have the potential to lead to becoming overly obsessive about food and how you treat your body, and may cause unhealthy habits. Health certainly matters a LOT during pregnancy (& beyond), but the rules associated with food and nutrition during pregnancy likely don’t need to be as strict as the media makes them out to be.

Ultimately, the goal is to become mindful of your health, but not obsessive. This post will help bust some common misconceptions associated with health & pregnancy and clarify what is actually best for your health during this important and exciting time. 

5 Myths about Pregnancy & your Health (& what to do instead!)

  • Myth #1- I need to avoid all seafood while pregnant

While it is true that seafood can be a source of mercury in the diet, which can cause potentially serious harm to both you and your baby, not ALL seafood is off limits. The seafood that is highest in mercury and is most important to avoid include shark, swordfish, king mackerel and tilefish. However, it is completely fine and even encouraged to eat between 8 to 12 ounces a week of fish that is low in mercury, which includes shrimp, salmon, pollock, tilapia, catfish and canned light tuna. Fish like halibut and mahi mahi are safe to eat about once per week in a 4oz serving. Many of these fish are excellent sources of omega-3 fatty acids and other important nutrients that are crucial for yours and baby’s health. So don’t skip the seafood! Just be sure it is well cooked when you do enjoy it. 

  • Myth #2- Satisfying my cravings means overloading on fat & sugar

It’s no secret that pregnancy can lead to all sorts of food cravings, and this is okay! Scientists don’t really know what causes these intense cravings, though it likely has something to do with hormonal changes. 

Pregnancy cravings are often associated with less healthy foods like chips, cookies, ice cream, chocolate, and french fries. Yet this doesn’t mean you’re doomed to sabotage your health by only indulging in these foods. There are many healthier ways to satisfy cravings. Here are some ideas:

  • Ice cream: Nightfood ice cream has been recommended as the Official Ice Cream of the American Pregnancy Association thanks to its impressive nutritional profile. Nightfood is significantly lower in calories, fat, & sugar, and has more fiber, protein, and important vitamins and minerals that are key to a healthy pregnancy (& good sleep!). It contains no artificial sweeteners and comes in many delicious flavors. The best part is that you can try it for free!
  • Salty foods. You’ve probably heard that a diet too high in salt can lead to high blood pressure and a potentially dangerous condition called preeclampsia in pregnancy. Instead of loading up on chips, french fries, or adding loads of salt to your food, try first flavoring foods with other things like garlic, cinnamon, black pepper, lemon juice, etc. Instead of french fries, try roasted carrot or other veggie “fries”, or lightly salted nuts. Instead of always reaching for classic chips, try lightly salted air popped popcorn.
  • Other sugary desserts. While you may feel like you always want pastries, cookies, and chocolate, too much of these foods may contribute to excess weight gain and increase your risk of Gestational Diabetes. The more sugar we eat, the more often we crave it, so try cutting back gradually. For chocolate, choose 70% or greater dark chocolate which will have much less sugar and more minerals than milk or white chocolate. Next, try sticking to natural sugar sources like honey and maple syrup which also have a better nutritional profile compared to white sugar. Fruit is another great way to naturally satisfy a sweet tooth.

Ultimately, the goal is to experiment with other, potentially healthier, ways to satisfy your cravings before just reaching for what you’re used to or what first comes to mind. Also, be sure that you’re eating regular balanced meals to help prevent sudden onsets of extreme hunger or blood sugar crashes, which can make cravings worse. 

  • Myth #3- I should be weighing myself every day to make sure I am not gaining too much or too little

Weight is a hot and very personal topic during pregnancy. It is true that there are weight gain guidelines based on your pre-pregnancy weight, but keep in mind that these are just guidelines. The most important thing is that you are eating a varied and well balanced diet that contains enough calories to meet yours and your baby’s needs. Weighing yourself daily is not recommended and is likely to lead to obsessive behaviors that aren’t healthy in the long run. Instead, communicate with your doctor about what a healthy weight gain amount for you looks like and let your body do what it naturally wants to do. 

  • Myth #4- Caffeine is completely off limits.

Good news: you don’t have to completely say goodbye to your cup of coffee! Experts have stated that moderate levels of caffeine have not been found to have a negative effect on pregnancy. The current recommendation is to limit it to about 200mg or less per day, which is the amount in one 12 oz cup of regular coffee. 8 oz of tea on the other hand, contains between 25-50mg of caffeine, so you have more wiggle room there. Keep in mind, though, that less is still believed to be better, so try swapping out decaf and cutting back whenever possible. 

  • Myth #5- “Eating for two” means consuming twice as many calories as I normally would

While it IS true that a pregnant body requires more energy and nutrients, it isn’t the equivalent of double what you currently take in. According to the American Pregnancy Association, women need about 300 extra calories per day during the 2nd and 3rd trimesters on average, with no extra calories being needed during the first trimester. This amounts to a small to medium sized snack, or a slightly larger serving at dinner, for example. Ideally, these extra calories should be coming from nutrient dense foods, but it’s always good to be flexible with your eating and allow yourself the occasional treat or indulgence (see the tips for managing your cravings section!). Calorie counting is definitely not recommended during pregnancy since this, too, can lead to unhealthy eating behaviors and cause unnecessary mental stress as well.  

Bottom line

How you treat your body matters a ton during pregnancy for both yours and your developing baby’s health. Yet rather than become obsessive or have an “all or nothing” sort of mindset, try practicing more moderation and making slight modifications to your habits rather than going cold turkey. This allows you to have more freedom with your food choices and sets you up for better long-term success. Here’s to a healthy pregnancy, birth, and baby!

Tips for Choosing a Prenatal Vitamin

By Joanna Foley, RD, CLT

Whether or not you are currently pregnant of hope to become so in the near future, the topic of prenatal vitamins has probably come up. While it seems like it would be a simple task to choose a prenatal vitamin, there is a lot of variety on the market which can make the task a bit more complicated. You may be wondering what nutrients are most important, why you need a supplement, and how to choose the right brand. 

Keep reading to get these and other questions answered! 

Why a prenatal vitamin is so important

It’s no secret that pregnancy is a unique and crucial time for optimal nutrition for both mom and baby. A woman’s nutrient needs increase significantly during pregnancy to help build the placenta & nourish her growing baby. These nutrients play an important role in ensuring proper fetal development, reducing the risk of birth defects and complications, and supporting your body both in labor and for breast milk production after birth. 

You may be hoping that you can get all the nutrients you need from food alone. Yet unfortunately that is very hard to do, even for women who follow a healthy and balanced diet. Many factors play a role in increased nutrient needs in the body, making it very difficult to cover all the bases from diet alone. Therefore, taking a prenatal vitamin can help fill in any gaps in your diet to support the health of both your body and a developing baby.

What to look for in a prenatal vitamin

The nutrients in a prenatal vitamin benefit you and baby before, during, and even after pregnancy. It is a good idea to start taking a prenatal at least 3 months before planning to become pregnant, and continuing through breastfeeding or until you and your partner are done having kids. 

Keep in mind that not every prenatal will contain exactly the same combination of nutrients*, but choosing a supplement that is in line with the following guidelines can help ensure proper health for you & baby. 

  • Folate– This is arguably the most important nutrient during pregnancy since it plays a crucial role in the baby’s brain and nerve health and helps prevent birth defects like spina bifida. Look for supplements that provide a minimum of 400 mcg, but closer to 800 mcg is even better.

*Many prenatal vitamins contain folic acid, which is a synthetic form of the vitamin. It is better for most people to choose the more natural form, which is also known as the “methylated” form, which is more usable for the body. Look for the word “methyl” in front of folate on the ingredients label (ie “methylfolate”). 

  • B12: Also plays a role in nervous system health and preventing anemia for both mother and baby. Like folate, this vitamin should ideally be in a methylated form for better absorption. Look for the word “methylcobalamin” in a supplement.
  • B6: This is another essential B vitamin that plays a role in brain and nervous system development for babies. It is also essential to your body to convert food into energy and produce many brain chemicals called neurotransmitters. Vitamin B6 is also shown to help manage nausea and vomiting during pregnancy. A prenatal may contain between 2-10mcg, and more is usually better. 
  • Vitamin D3: There are 2 types of vitamin D used in supplements: D2 and D3. D3 is the most effective and usable form to raise blood levels and support yours and baby’s health. Look for prenatals that contain at least 1,000 IU of vitamin D3. 
  • Iron: This mineral helps protect against anemia, which can be serious and lead to less oxygen delivered to you or your baby. 27mg meets the total daily requirements during pregnancy.
  • Calcium: Supports yours and your baby’s bone health in combination with vitamin D. Most prenatals will contain at least 150mg. 
  • Vitamin A: Important for fetal development of the eyes, ears, limbs, and heart. Look for at least 5,000 IU or 2,400mcg, usually in the form of beta carotene.
  • Magnesium: This mineral is needed for so many reactions and processes in the body, and needs increase during pregnancy. Look for the forms of magnesium citrate or glycinate. Prenatals can contain anywhere from about 75mcg to 400mcg. 
  • Zinc: Pregnancy causes rapid cell growth which uses up zinc quickly, and zinc deficiencies during pregnancy may cause low birth weight, premature delivery and labor complications. The RDA for zinc during pregnancy is 11mg and a good prenatal should contain at least 8-10mg. 
  • Iodine: important for thyroid function which plays a role in baby’s development. 150mcg is a good amount for a prenatal. 

*Pay close attention to the dosing size when selecting and taking a prenatal vitamin. Many brands will require taking at least 2 capsules with food as one dose, so be sure you are taking the right amount. 

Should I be supplementing with anything else?

Eating well and taking a high-quality prenatal vitamin are the most important things you can do for you and your baby during pregnancy, but there are additional nutrients that may help further support yours and your baby’s health. 

Two additional supplements you may want to consider supplementing with include:

  • Omega-3 fatty acid: While all types of omega-3 fats are important, DHA is a specific type that is shown to be critical for brain, eye, immune and nervous system development in a growing fetus. In addition, DHA decreases throughout pregnancy in the mother as it is transferred to the fetus, so it is easy for a mother to become deficient. Most prenatal vitamins do not contain DHA, so supplementing is strongly recommended. While you can get some DHA from eating fish, the amount needed surpasses what is recommended for pregnant women to consume each week. 
  • Vitamin D3: While your prenatal will likely contain some of this important vitamin, studies have found that supplementing with ~4,000 IU of vitamin D daily had the greatest benefits in preventing preterm labor/births and infections, which is also backed by the American Pregnancy Association. It is always a good idea to get your blood levels checked before starting additional supplementation, though, and to coordinate with your doctor or other trusted healthcare provider for dosing specific to your needs. 

Other important nutrients for pregnancy

The following aren’t required to be taken as a separate supplement, but are important and should at minimum be made sure that you are getting enough of them through your diet (they may or may not be included in your prenatal vitamin):

  • Choline-Growing research is showing the importance of choline during pregnancy. Not all prenatals contain this, so if yours doesn’t, be sure to eat plenty of food sources such as egg yolks, meat, fish, and poultry.
  • Selenium-An important antioxidant found in foods like nuts and seeds, seafood, eggs, and brown rice.

In Summary

Hopefully this has helped answer your questions about choosing a prenatal vitamin that is best for you and your baby. It’s always a good idea to check with your doctor about all supplements you are taking. Taking the right supplements and following a healthy, balanced diet are two of the most important things you can do both for your body and for your future baby’s.