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Pregnancy

Maintaining and improving Iron levels

What is Iron?

Iron is an essential element that your body uses to produce red blood cells. One of the primary functions of red blood cells is to carry oxygen around your body. Haemoglobin is the protein in the red blood cells that carries oxygen. When health professionals test your haemoglobin level, it gives them ‘a gauge of the oxygen carrying capacity of the Red Blood Cells’ (Frye, 2006, p.580). When you iron level is low, it in turn affects your oxygen carrying capacity, which can make you feel lethargic.

What are ‘normal’ levels of iron in pregnancy?

The mother’s blood volume expands by 50%-60% in pregnancy (with peak volume at around 30 weeks) (Frye, 2006). This is to ensure a good blood supply to the most important organ of pregnancy; the placenta. It also allows for a significant amount of blood loss after birth.  However, it is the blood volume (also called plasma) not the red blood cells that increase, meaning that the red blood cells actually become diluted. Just like cordial. This means that in the first trimester of pregnancy, your haemoglobin level will drop, and will increase again (after the volume expansion plateaus around the 30th week) towards the end of pregnancy. In other words, it is normal for haemaglobin to drop in the first trimester of pregnancy due to the dilution of the blood (hence why most women are tired in this period), and it should be back up to the pre-pregnancy level at around 30 weeks. The World Health Organization defines anaemia (another word for iron deficiency) in pregnancy as a haemaglobin below 110g/L. Bryant & Larsen (2009) state that women with a ferritin of less than 10-15ng/ml are iron deficient.

Why is it important in pregnancy?

During pregnancy, your iron demands increase to account for the increased volume of blood circulating around your body, which is to ensure your baby gets enough nutrition through the placenta.

Iron demands in pregnancy and the puerperium

  • Increase in the red blood cell mass 400-500mg
  • Demands of the fetus and placenta 300mg
  • Blood loss at delivery and placental loss 200mg
  • Lactation 1mg/day

(Bryant & Larsen, 2009, p.17).

How do I know if my iron level is low?

You may be:

  • feeling fatigued
  • pale
  • short of breathe
  • less hungry

Blood tests are definitive; your health care provider may decide to do a Full Blood Examination (FBE) to test your Haemoglobin (Hb), and Iron stores (ferritin).

How do I Increase my iron in pregnancy?

An ‘acidic’ environment in the gut improves iron absorption. For this reason, antacid medications should be avoided taken at the same time as iron rich foods or supplements. Tannin also decreases the absorption of iron; tannin is in tea so avoid a cuppa with your iron intake. On the other hand, vitamin C may increase acidity and in turn absorption, so have vitamin C rich foods (such as red capsicum) with your iron intake. The best way to increase your iron in pregnancy is through your diet. If this is not sufficient, you may be advised to take an iron supplement. Most iron supplements cause constipation, so if this is something you are prone to, ask your health professional for a brand that minimises this.

Foods rich in Iron:

Nettle Leaf (comes in tea form), dark green vegetables such as spinach, prunes, grape juice, kidney, oysters and scallops (Frye, 2006). Please note: whilst seafood is a great source of iron, seafood should be cooked before eating in pregnancy due to the risk of listeriosis.

Through tablets:

There are many different tablets and liquids available to increase your iron. Only take supplementary iron if this is recommended by a health care professional.

Bryant & Larsen state that ‘only approximately ten per cent of oral iron is absorbed’ (2009, p.18). This means that from a tablet containing 100mg of elemental iron, 10mg will be absorbed.

Floradix liquid iron supplement

Iron Supplement Brands and what they contain:

  • Floradix; Iron (from ferrous gluconate) 7.50mcg (available to purchase on our online shop)
  • Fefol: Ferrous Sulphate 270mg (equivalent to 87.4mg of elemental iron) & Folic Acid 300mcg
  • Ferro-F-Tab: Ferrous fumarate 310 mg Folic acid 0.35 mg
  • Dartnell’s pregnancy tonic: 36mg of ferrous phosphate per dose. *States it does not cause constipation or stomach upsets.
  • Spatone: (per sachet) 5mg Free Ferrous Ionic state (Fe ²+ clinically proven 26 to 40% bioavailability compared to an average 5 - 20% from food and 3 -10% from iron pills)

MAMA says: if you are suffering from nausea and vomiting in the first trimester eat whatever you can; this is not the time to try to increase your iron! Hopefully you can concentrate on this in the second trimester.

References:

  • Bryant, C., & Larsen, S. (2009). Anaemia in pregnancy. Blood. 11(3), 17-18
  • Frye, A. (2006). Holistic Midwifery: A comprehensive textbook for midwives in homebirth practice. Oregon: Labrys Press.

Tests & Investigations explained; Toxoplasmosis

Toxoplasmosis is caused by a parasite, Toxoplasma gondii. This infection is not serious for you but can be for your developing baby. Although mostly exposure carries no symptoms, the most common sign in symptomatic patients is enlarged lymph nodes, especially around the neck or muscular pain and fever. Should exposure to this parasite occur to a woman during pregnancy, it can affect the unborn baby with varying degrees of severity. Depending on the time of exposure during pregnancy and fetal development, symptoms can vary from mild to eye disorders, liver or brain damage.

A women can acquire Toxoplasmosis from contact with infected cat faeces (directly or indirectly through soil), eating raw or uncooked food that is contaminated, not washing hands thoroughly after handling raw meat, gardening with direct contact in soil, from contaminated raw vegetables or fruits or drinking unpasteurised milk.

Women are not routinely screened for this antenatally, but you can have a blood test to check your immunity. If there is concern of exposure during pregnancy, Amniocentesis can be performed to detect infection, but this cannot reveal the severity of exposure. Babies can also be tested after birth.

There are several steps you can take to avoid infection: 

• Always wash your hands before preparing or handling food. 
• Make sure that all meat and chilled ready-meals are thoroughly cooked before you eat them. 
• When you have handled raw meat, remember to wash your hands, cooking utensils and surfaces thoroughly afterwards. 
• Don't eat cold processed meats, such as ham or salami. 
• Avoid unpasteurised milk and products made from it. 
• Always wash fruit and vegetables thoroughly.
• If you're gardening or handling soil or sand, wear gloves and wash your hands afterwards in case you have come into contact with cat faeces in the soil.
• Wash your hands thoroughly after contact with sheep at farms and outdoor play centres with animals, and avoid handling newborn lambs. 
• If you have a cat, use gloves when emptying the litter tray and wash your hands afterwards. Empty the litter tray daily.

MAMA Says: If you have a cat, maybe ask someone else to deal with the litter tray while you’re pregnant.

For more information, visit http://www.health.vic.gov.au/ideas/bluebook/toxoplasmosis

Tests & Investigations explained; Listeriosis

Listeria is an illness usually caused by eating foods contaminated with the bacteria known as Listeria monocytogenes. Other less common forms of transmission are indirect contact with contaminated soil, water or sewage. Listeriosis is a serious disease in pregnant women and their babies, newborns, the elderly and people with weakened immune systems.

The incubation period (between infection and symptoms) can vary but on average is about three weeks. Symptoms include: fever, muscle aches, and sometimes gastrointestinal symptoms such as nausea and diarrhoea. In the more severe form, symptoms also include collapse and shock. Infection during pregnancy can lead to miscarriage, stillbirth and infection of the newborn.

Listeria is widespread throughout nature, being commonly carried by many species of both domestic and wild animals. Outbreaks of illness have been associated with raw or contaminated milk, soft cheeses, prepared salads (for example, from salad bars), unwashed raw vegetables and ready to eat meat such as paté. People who are at risk can contract listeriosis through eating food contaminated with the Listeria bacteria. Babies can be born with listeriosis if their mothers eat contaminated food during the pregnancy.

To prevent listeriosis:

  • Thoroughly cook raw food from animal sources, such as beef, lamb, pork, or poultry
  • Wash raw vegetables and fruit thoroughly before eating
  • Keep raw meat separate from vegetables, cooked foods, and ready- to-eat foods (that is, do not allow the blood from raw meat to come into contact with other food)
  • Use separate cutting boards for raw meat and foods that are ready to eat (for example, cooked foods and salads)
  • Avoid unpasteurised milk or foods made from unpasteurised milk (for example, soft cheeses)
  • Wash your hands before and after preparing food
  • Wash knives and cutting boards after handling uncooked foods
  • Wash your hands after handling animals
  • Perishable foods should be stored in a cold (less than 5 degrees Celsius) refrigerator and be washed and eaten as soon as possible.

People at increased risk of listeriosis should not eat:

  • Pre-packed salads
  • Pre-cut fruit
  • Pre-cooked chicken
  • Raw meats
  • Cold delicatessen meats
  • Paté
  • Raw seafood
  • Smoked fish
  • Unpasteurised milk or milk products
  • Soft serve ice cream
  • Soft cheeses such as brie, camembert, ricotta, or blue-vein
  • Sprouted seeds and raw mushrooms

The diagnosis of listeriosis can be confirmed by a blood or other tests. Treatment involves antibiotics and supportive therapy. When infection occurs during pregnancy, antibiotics can often prevent infection of the foetus or newborn.

MAMA Says: Unlike most other food-contaminating bacteria, Listeria can grow in the refrigerator. However, Listeria bacteria are readily killed during cooking. So, think freshly prepared foods, served hot and if re-heating left-over foods the next day heat until piping hot.

For more information, visit http://www.health.vic.gov.au/ideas/bluebook/listeriosis

Tests & Investigations explained; Cytomegalovirus (CMV)

Cytomegalovirus (CMV) is a common viral infection and a member of the herpes family. Related viruses include Epstein-Barr (causes glandular fever), varicella-zoster (causes chicken pox) and herpes simplex (causes cold sores). This viral infection can be spread through coughing, contact with blood, urine or faeces, or via the mucous membranes such as the mouth and genitals.

In healthy people, CMV infection causes nothing more than a flu-like illness that lasts a few days. In certain people, however, including transplant patients and pregnant women, the effects can be much more serious. Once a person has contracted CMV, they will carry it for life. This is because the virus lies dormant inside the body and may or may not reactivate itself at any time.

Women can catch CMV during pregnancy and pass it on to the baby – this is called congenital CMV. Around one in ten infected babies will have lasting problems. These can include deafness, poor eyesight, intellectual disability and an enlarged liver or spleen.

Pregnant women should wash their hands after handling bodily secretions from babies or children, for example after changing nappies or wiping noses.

Treatment depends on the severity of the condition. In a healthy person, bed rest, drinking plenty of fluids and medical supervision are all that is generally required. Pregnant women and patients with suppressed immunity need careful medical monitoring and frequent testing, including blood, sputum and urine tests. Antiviral medication may be prescribed.

MAMA Says: Remember good hand hygiene and consult medical advice if you are concerned regarding exposure.

For more information, visit

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Cytomegalovirus

Exercise in the antenatal and postnatal period

Exercise in pregnancy is essential. Exercise will help you remain active, mobile and prevent you gaining excessive weight in your pregnancy. Unless you have complications, it should be possible to enjoy some level of physical activity throughout most of your pregnancy. You may need to modify your existing exercise program or choose a suitable new one if you were not a regular exerciser pre pregnancy.

Some of the benefits of exercising regularly throughout your pregnancy include:

  • Optimises your chances of a quick, easy birth
  • Increases your energy
  • Improves the strength of your back muscles which can help manage back pain and strain as your belly grows
  • Improves posture
  • Releases endorphins helping you feel good during your pregnancy
  • Stress relief
  • Improved sleep and management of insomnia
  • Preparation for the physical demands of labour
  • Can help you get your baby into the right position for birth
  • Faster recovery after labour
  • Faster return to pre-pregnancy fitness and healthy weight
  • Increased ability to cope with the physical demands of motherhood

Women should discuss their exercise plans with their midwife or doctor. Depending on your previous exercise program, you may be able to continue this during pregnancy; however you should check this first to receive clearance.

If you have been cleared to exercise, it is recommended that you:

  • Engage in at least 30 minutes of moderate-intensity physical activity on most days of the week
  • Combine Strength and Aerobic exercise
  • Let your body be your guide and back off if you feel faint, weak, or unwell
  • Increase your water consumption on your exercise days
  • Avoid over heating during exercise and back the intensity off if you feel this coming on
  • Don’t forget the pelvic floor

Suggested exercise activities during pregnancy

Activities that are generally safe during pregnancy, even for beginners, include:

  • Walking
  • Swimming
  • Yoga
  • Cycling – outdoors or on a stationary bicycle
  • Exercise in water (aquaerobics)
  • Stretching
  • Dancing (especially Belly Dancing)
  • Pilates
  • Pregnancy exercise classes

Cautions

There are some exercises that involve positions and movements that may be uncomfortable or harmful for pregnant women. General cautions include:

  • Contact sports or activities that carry a risk of falling (such as trampolining, rollerblading, downhill snow skiing, horse riding and basketball)
  • Competition sports – depending on the stage of pregnancy, the level of competition and your level of fitness
  • After about the fourth month of pregnancy, exercises that involve lying on your back – the weight of the baby can slow the return of blood to the heart. Try to modify these exercises by lying on the side.
  • In the later stages of pregnancy, activities that involve jumping, frequent changes of direction and excessive stretching.

Postnatal recovery

Resuming gentle exercise can be started within the first few weeks after birth, if you feel up to it. As a rule, your post birth recovery takes 4-6 weeks so after this timeframe you should be ready to resume your regular exercise routine. Remember the Relaxin hormone remains in your system for some months after birth so take care with vigorous exercise and stretching. Like in pregnancy, stay well hydrated, particularly if you are breastfeeding and gently increase your duration slowly as your fitness levels improve.

MAMA Says: Many women find themselves feeling heavy and extremely uncomfortable in late pregnancy. You don’t have to feel this way and the key is regular exercise.

For more information, visit

Pelvic Floor Exercises

The pelvic floor is a hammock of muscles which run from the pubic bone all the way back to the tailbone (coccyx) and support the uterus, bladder, vagina and bowel. The urethra, vagina and anus all have sphincters which pass through the pelvic floor. Pelvic floor exercises are most important for all women and these are also known as keigel’s exercises. Under the influence of relaxin, all of the tissues in the body relax. The exercising of the pelvic floor muscles during pregnancy and after the birth prevents things like vaginal prolapse and incontinence. Pelvic floor exercises are designed to improve muscle tone and integrity and can prevent the need for corrective surgery after birth or later in life.

If the muscles are weakened, the internal organs are no longer fully supported and you may not be able to control your urine, wind or bowels. If you have symptoms including difficulty holding onto urine, wind or bowels this can be a sign that your pelvic floor muscles are weak.

The pelvic floor can be weakened in many ways, including:

  • Pregnancy  - the weight of the uterus
  • Vaginal childbirth, which overstretches the muscles
  • Obesity
  • Chronic constipation and associated straining to pass motions
  • Chronic cough
  • Some forms of surgery that require cutting the muscles
  • Lower levels of oestrogen after menopause

In order to strengthen your pelvic floor you must know how to correctly perform the exercises. Squeeze the sphincters from the vagina, urethra, and back passage as if you were tightening the vagina, stopping the flow of urine and holding back wind.

The exercises

You can perform these exercises lying down, sitting or standing. Ideally, women should perform these daily but even up to three times a day is preferable.  Before you start, focus your attention to your pelvic floor muscles. Avoid contracting your abdominal muscles and try not to bear down or hold your breath. Gradually squeeze all three sphincters and increase the tension until you have contracted the muscles as hard as you can. Release gently and slowly. Then perform the exercises, which include:

  • Squeeze slowly and hold as strongly as you can for 10 seconds while breathing normally. Release slowly. Repeat 10 times.
  • Perform quick, short, strong squeezes. Repeat 10 times.

MAMA Says: See our specialist Women's Health Physiotherapist for an individualised examination of your pelvic floor, and plan to suit you!

For more information, visithttp://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Pelvic_floor

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