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Natural Treatment Options for PUPPPS

 

PUPPPS may sound like a cute acronym, but ask any pregnant woman who has experienced it and you will soon realize this condition is anything but cute.

PUPPPS stands for pruritic urticarial papules and plaques of pregnancy.  This translates to “itchy, allergy-like rash during pregnancy”.  PUPPPS is a hive-like rash that occurs in around 1 in 200 women during pregnancy.  The rash is itchy and most commonly starts on the abdomen and may spread to the legs, feet, arms, chest and neck but usually does not occur on the face.

We don’t know why some women develop PUPPPS during pregnancy but it most often begins in stretch marks and is more common in women with significant skin stretching. Women with large fundal measurements and those who are carrying large babies or twins and triplets are at greater risk.

Interestingly there is a higher rate of PUPPPS in women carrying boys. Statistics have shown that bw-pregnant-window70% of women with PUPPPS deliver boys. Researchers think this may be due to male DNA interacting with the mother’s body, leading to irritation.

The good news is that PUPPPS, aside from causing itching and irritation, has no long term negative effects on either the mother or the baby and tends to resolve on its own within a week of delivery.

Most treatments for PUPPPS involve hydrating the skin and keeping the mother comfortable.  Certain antihistamines may also be tried.  From a Naturopathic perspective, we focus on decreasing the allergic response of the immune system, supporting the detoxification properties of the liver, decreasing inflammation and helping to clear and possible underlying causes.

6 Natural Treatment Options for PUPPPS

  1. Increase vegetable consumption and vegetable juice consumption

To optimize liver function by supplying healthy antioxidants and cholagogues (plant based compounds that support optimal liver function). Ideal vegetables are dark green leafy vegetables, beets, carrots, broccoli, cauliflower, bok choy, brussels sprouts, kale and kohlrabi

Also increase consumption of canned tomatoes for the lycopene content, an excellent antioxidant and member of the beta carotene family – but be sure to choose organic canned tomatoes to decrease exposure to BPA. Glass containers are even better.

  1. High quality omega 3 rich oils

TomatoesOmega 3 fatty acids, such as those found in flax seeds, chia seeds, salmon and fish oil supplements help to improve the fluidity of skin membranes, decreasing the potential for stretch marks. Omega 3 fatty acids are also anti-inflammatory and can help to decrease the production of inflammatory mediators, decreasing redness and itching in skin rashes.

Consume omega-3 rich foods such as ground flax seeds and chia seeds daily. Consume omega 3 rich fish (those that are safe in pregnancy include salmon, tilapia, cod and Pollock) at least two to three times per week. An omega 3 rich fish oil supplement may also be recommended by your Naturopathic Doctor.

  1. Moisturize the skin with a soothing moisturizer

    Coconut oil is a safe choice for pregnancy and is highly moisturizing. Chickweed ointment is another stellar choice as chickweed is a natural antihistamine and can greatly reduce itching sensations.

  1. Dandelion Root (Taraxacum officinalis)

    allergy_dandelion medicineAnother highly effective treatment for PUPPPS. Dandelion acts as a hepatic and cholagogue – it enhances the function of the liver and gallbladder, clearing inflammation and congestion through that system. It is highly indicated for chronic skin eruptions, especially those that are hot, red or itchy.

    Dandelion is available as a tea (which will have diuretic effects) or as a capsule. For PUPPPS I usually recommend starting with a tea and introducing a supplement if needed.

  1. Milk thistle (Silybum marianum)

    Mike thistle is a liver supportive treatment that can be used to enhance the actions of dandelion root or on it’s own. It is effective in increasing the secretion and flow of bile from the liver and gall bladder. Milk thistle also promotes milk secretion and is encouraged for breast-feeding mothers.

  1. Avoid food sensitivities

    There is some research suggesting a correlation between food sensitivity (especially dairy) and PUPPPS. Consider food sensitivity testing or elimination diets to address symptoms.

PUPPPS can be a difficult condition to life with, and with the support of naturopathic medicine you may not need to!  Gentle and safe natural treatments are available.  Speak with your Naturopathic Doctor today to put together a plan.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Naturopathic Medicine during Pregnancy

Naturopathic Medicine is an integrative health care philosophy that recognizes the importance of health during conception, pregnancy, labour and birth.  Naturopathic Doctors work with your health care team (family doctor, midwife and/or obstetrician) to provide care to both the pregnant mother and unborn baby.

Naturopathic Medicine in PregnancyNaturopathic Medicine is a BABY FRIENDLY alternative

Naturopathic Medicine isn’t just for moms.  It’s for babies too.  During pregnancy and infancy Naturopathic Medicine can help your baby reach it’s full potential – for growth, intelligence and health.  It can also help prevent common childhood conditions, such as eczema, asthma and allergies.

Naturopathy SUPPORTS PREGNANCY

There is no better time to see a Naturopath than during pregnancy.  Your body is changing.  Your nutritional needs are changing.  You may be experiencing health concerns you have never had before.  Naturopathic Medicine supports your body, and your baby, with gentle, safe and effective medicine.

Conditions that Naturopathic Medicine can treat during pregnancy include:

      • Morning sickness
      • Heart burn
      • Fatigue
      • Insomnia
      • Anxiety and depression
      • Constipation
      • Hemorrhoids
      • Fluid retention and swelling
      • Lowered immune system
      • Nutrient deficiencies
      • Leg and foot cramps
      • Stretch marks
      • Gestational diabetes

Natural Therapies used by Naturopathic Doctors during Pregnancy

NUTRITIONwhole grains in pregnancy

Build nutritional foundations for a healthy pregnancy.  Guidance on selecting pre-natal vitamins and additional supplements.  Support for vegan, vegetarian and special diets.  Food and teas as medicine for heart burn, morning sickness, water retention, insomnia and more.

ACUPUNCTURE

Acupuncture can relieve back pain, anxiety and stress during pregnancy.  Acupressure is effective for treating nausea and morning sickness.  Acupuncture has also been used to effectively help rotate a breech baby, and for labour induction in post-date pregnancies.

HOMEOPATHY

A safe and effective treatment during all stages of pregnancy, labour and
post-natal care.  It is used to treat any number of conditions and provides pain management during labour and delivery and is equally effective in uncomplicated labour, difficult labour and caesarean sections.

MASSAGE

Massage therapy is a pregnant mother’s best friend.  It can provide physical and emotional relaxation, ease cramps, treat lower back and hip pain.  It can also lower blood pressure and increase blood flow to internal organs and the placenta.  It is very effective in reducing swelling and fluid retention during pregnancy.  At both the Integrative Health Institute and Oma Chiropractic and Wellness, we work as an integrative team with registered massage therapists to support pregnant women throughout their pregnancy and post-partum period with massage therapy.

CHIROPRACTIC MANIPULATION*

Maintaining a healthy spine and nervous system during pregnancy can prevent further postural problems that might occur during and after childbirth.  Chiropractic care reduces back pain and pelvic pain during pregnancy, labour and delivery.
*Although Naturopathic Doctors are trained in manipulation, Dr. Watson does not perform manipulation in her practice.  Dr. Watson refers patients to a chiropractor at Oma Chiropractic and Wellness who is well-versed in pregnancy care.

Naturopathic Medicine is SAFE in Pregnancy

Some therapies used in Naturopathy have the potential to be harmful if not used under the care of a trained Naturopathic Doctor.  Dr. Watson is here to make sure you make SAFE and HEALTHY choices for yourself, and your baby.

Diverse families are welcome.

  • Morning sickness
  • Heart burn
  • Fatigue
  • Insomnia
  • Anxiety and depression
  • Constipation
  • Hemorrhoids
  • Fluid retention and swelling
  • Lowered immune system
  • Nutrient deficiency
  • Leg and foot cramps
  • Stretch marks
  • Gestational diabetes
  • High blood pressure/ pre-eclampsia

Celiac Disease in Pregnancy

Celiac disease

Celiac disease is more than a gluten intolerance. It is an immune reaction that is triggered by exposure to gluten (a protein found in wheat, rye and other grains) that results in inflammation and damage to the digestive tract. The small intestines, the part of the digestive tract that is damaged by gluten in celiac disease, is also the location of most nutrient absorption. This inflammatory damage can lead to significant nutrient deficiencies and health problems outside the digestive tract.

More than 330 000 Canadians are thought to have celiac disease (rates have doubled in the past 25 years), but only one-third of those people have been diagnosed. Women have higher rates of celiac disease, although we’re not entirely sure why. Celiac disease does not always manifest clear symptoms (gas, bloating, diarrhea) so it can go for years without a diagnosis.

Celiac Disease During Pregnancy

Bread slicedWomen with undiagnosed or untreated celiac disease can experience negative outcomes in pregnancy – longer time to conceive, increased rates of neural tube defects, increased rates of miscarriage, more fetal growth restriction and increased low birth weight babies. Additionally, women with undiagnosed or untreated celiac disease have been found to have a shorter duration of breastfeeding (about 2.5 times shorter) than treated women with celiac disease.

The poor absorption of folic acid in celiac disease may be the primary cause of the majority of these outcomes. Folic acid is necessary for DNA replication and the production of new cells – two very important functions in early embryo development. We know that folic acid deficiency can lead to an increased risk of neural tube defects and has been linked with an increased risk of miscarriage. Additionally, deficiencies in zinc and selenium are common in untreated celiac disease. These nutrients are also necessary to ensure healthy pregnancy.  You can read more about the nutrient deficiencies in celiac disease in my article Nutrient Deficiencies in Celiac Disease.

There may also be an immune component to the impact of untreated celiac disease on pregnancy. It has been postulated that anti-transglutaminase antibodies may be able to damage the placenta or the maternal endometrial cells. These antibodies are only present during active, untreated celiac disease.

Testing for Celiac Disease in Pregnancy

Some researchers suggest that all women with unexplained miscarriages be tested for celiac disease. Some suggest that all women who are trying to conceive be tested. Still others recommend testing only if hemoglobin or ferritin (iron) levels are low. Testing is done with an initial blood test which can then be followed with a biopsy of the lining of the small intestine to confirm the diagnosis. Your Naturopathic Doctor or Medical Doctor can help you decide whether testing is warranted.

Managing Celiac Disease During Pregnancy

The negative outcomes of celiac disease on pregnancy can all be managed by consuming a gluten free diet and taking appropriate supplementation to ensure nutrient adequacy. In the majority of women, 6 to 12 months of a gluten free diet can reduce the risk of negative pregnancy outcomes down to normal levels. Using a professional quality prenatal or folic acid supplement can also help to improve pregnancy outcomes in women with celiac disease – discuss with your Naturopathic Doctor which gluten-free supplements will be most appropriate for you.

Select References

  1. Moleskia SM, Lindenmeyer CC, Veloskic JJ, Millera RS, Millera CL, Kastenberga D, DiMarinoa AJ. Increased rates of pregnancy complications in women with celiac disease. Ann Gastroenterol 2015;28:236-40.
  2. Tersigni C, Castellani R, de Waure C, Fattorossi A, De Spirito M, Gasbarrini A, et al. Celiac disease and reproductive disorders: meta-analysis of epidemiological associations and potential pathogenic mechanisms. Hum Reprod Update 2014;20(4):582-593
  3. Martinelli P, Troncone R, Paparo F, Torre P, Trapanese E, Fasano C, et al. Coeliac disease and unfavourable outcome of pregnancy. Gut 2000;46(3):332-5.
  4. Dickey W, Stewart F, Nelson J, McBreen G, McMillan SA, Porter KG. Screening for coeliac disease as a possible maternal risk factor for neural tube defect. Clin Genet 1996;49(2):107-8.
  5. Rostami K, Steegers EA, Wong WY, Braat DD, Steegers-Theunissen RP. Celiac disease and reproductive disorders: a neglected association. Eur J Obstet Gynecol Reprod Biol 2001;96(2):146-9.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Natural Labour Induction

As every pregnant woman approaches the last weeks of pregnancy they can’t help but start thinking of ways to bring on labour and get the chance to meet their baby sooner.

A pregnancy is considered full term at 37 weeks and the techniques discussed in this article should not be started until after this point.  Some women choose to wait until 40 weeks, or their due date to begin trying to naturally induce labour.

Below are suggestions for natural labour induction methods that can be attempted at home and also those that should only be administered by a qualified Naturopathic Doctor.

Techniques for Natural Labour Induction at Home

1.     Sexual intercourse

One of the simplest methods of inducing labour (if you’re up for it!)  The prostaglandins in semen can help with the dilating and effacing (thinning) of the cervix.  If you are able to achieve orgasm this can further open the cervix.  Additionally, sex can trigger the release of oxytocin, the ‘contraction’ hormone.  Sex, even this late in pregnancy, is perfectly safe for both the mother and baby.

2.     Nipple stimulation

Stimulating the nipples (manually or with a breast pump) can lead to increased frequency and strength of contractions.  Stimulating the nipples causes the release of oxytocin, the same hormone that is responsible for uterine contraction.  This technique is best done if you are already experiencing infrequent contractions, labour has stalled or you are several days past your due date.  There are several methods that are suggested:

i.   firm pressure of nipple with fingers for 2 minutes, rest for 3 minutes.  Repeat for 20 minutes.

ii.  15 minutes of firm nipple (including the areola) stimulation (alternating breasts midway through) each hour for several hours in a row.

3.     Exercise

Sometimes the best technique for inducing labour is encouraging the baby to assume the best position for labour and delivery.  Exercise, such as walking, swimming, belly dancing, or some yoga movements can help descend a baby into the pelvis and apply the necessary pressure on the cervix for dilation to occur.

4.     Pineapple

Fresh pineapple is a rich source of bromelain, an enzyme that some people think can encourage ripening of the cervix and bring on labour.  Eat fresh pineapple daily, juicing and canning pineapple destroys the bromelain.  Caution: large amounts of pineapple can contribute to heart burn or diarrhea in some people.

5.     Castor Oil

One of the oldest methods of bringing on labour, it is one that I don’t personally recommend unless you are past your due date.  Castor oil works by irritating the digestive tract and having purgative (vomiting) and laxative (diarrhea) effects.  This over-stimulation of the digestive tract also results in stimulation of the uterus and can be effective in bringing on labour.  However, many women would prefer not to be experiencing diarrhea or vomiting in their early labour.  If you choose to use castor oil start with smaller amounts (1-2 tablespoons) and mix with a nut butter (such as almond butter) to provide  some fat and protein to lessen the negative effects of the castor oil.

6.     Evening Primrose Oil

Evening primrose oil is a rich source of prostaglandins and can support the thinning and dilation of the cervix.  Gel caps are easily available in health food stores.  Insert 3 capsules as close to the cervix as possible each night at bedtime (wear a pad to bed in case there is a slight discharge.)

Techniques for Labour Induction Provided by a Naturopathic Doctor

7.     Red raspberry leaf tea

A botanical that is well known for it’s uterine tonifying properties.  It promotes stronger contractions of the uterus and is often used throughout the entire third trimester to ‘work out’ the uterus and get it ready for labour and delivery.  It is unlikely to induce labour on its own, but when used in combination with other methods it can speed up the progression of labour and promote strong, healthy contractions.

8.     Botanicals – blue cohosh and black cohosh

Blue cohosh (Caulophyllum thalictroides) and black cohosh (Cimicifuga racemosa) are uterine tonifying herbs.  They are known to cause contraction of the uterus and are thus contraindicated for use in early pregnancy.   They may be used in certain circumstances to stimulate labour and promote strong and regular contractions.  These herbs should never be taken without proper medical supervision from a qualified Naturopathic Doctor, midwife or obstetrician.

9.     Homeopathic Remedies

Homeopathic remedies are small doses of more potent substances and, as a result, are very safe for use during pregnancy, labour and delivery.  They are considered much safer than botanical remedies – no published studies exist showing any harm to the mother or fetus after use of homeopathics in pregnancy and labour.

The most common homeopathic remedies used to induce labour are pulsatilla, caulophyllum and cimicifuga.  Homeopathic remedies are taken by mouth at regular intervals to induce labour.  Dosages vary – contact your Naturopathic Doctor for an individualized plan.

10. Acupuncture

Acupuncture has been used for centuries to treat conditions associated with pregnancy (such as heart burn, nausea, and carpal tunnel syndrome) as well as for inducing labour.  Acupuncture to stimulate labour can be begun after 37 weeks gestation and is administered from once per week to once per day, depending on the desired outcome.  When performed after the due date, acupuncture has been shown in studies to have a success rate of up to 88% in starting labour.

Specific points are used to stimulate and strengthen uterine contractions, promote proper fetus positioning and encourage the downward movement of Qi (energy) which can bring on labour.

All published studies have shown acupuncture to be safe for both mother and fetus when applied by a qualified practitioner.  Be sure to find someone who is experienced in perinatal acupuncture protocols and techniques.

Your Naturopathic Doctor can also teach you proper acupressure techniques for you, or your birth partner, to administer to induce labour or manage pain during labour and delivery.

Remember, although most of these methods are safe and can be effective in encouraging labour in full-term pregnancies, it is important to make sure your primary health care provider (e.g. midwife or obstetrician) has given you the go-ahead for trying to induce labour.  There are some instances where waiting is the best approach for both mother and baby.

Also be sure any practitioners (Naturopathic Doctors, homeopaths, herbalists, acupuncturists, etc.) are fully qualified and knowledgable in pregnancy and labour.  Not all practitioners have the same level of experience – ask questions and only work with practitioners you have confidence in.

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Pain Medications in Pregnancy and Fertility

A large class of pain relief medications has been found to negatively impact fertility in as little as 10 days of use.

NSAIDs and Fertility

There has been evidence for over a decade that chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin,  ibuprofen (Motrin, Advil), naproxen (Aleve), celecoxib (Celebrex), diclofenac and others can reduce fertility by disrupting ovulation. More recent research has shown that even short term use of NSAIDs can inhibit ovulation with effects seen after just ten days of use.

NSAIDs interfere with ovulation by disrupting production of prostaglandins necessary for follicle development and ovulation. This disruption leads to a condition called luteinized unruptured follicle (LUF) syndrome. This condition results in women experiencing all the typical clinical signs of ovulation but does not result in the rupture of follicle and release of an egg at ovulation.

A 2015 study found that women taking naproxen (Aleve) for 10 days decreased the rate of ovulation by 75% and in women taking diclofenac, ovulation decreased by a startling 93%. In these women progesterone levels dropped also, likely as a result of the lack of ovulation.

Luckily the fertility-reducing effects of NSAIDs are temporary, with ovulation occurring normally in the next cycle for all the women in this study.

NSAIDs and Miscarriage

A further caution for women attempting to conceive: A 2011 study from the University of Montreal found that the risk of miscarriage is 2.4 times higher for women who took any type and any dose of NSAIDs in early pregnancy. Non-aspirin NSAIDs has also been shown to increase the risk of major congenital defects.

Safe Pain Relievers in Pregnancy and Fertility

Acetaminophen (Tylenol) is the only recommended pain reliever in pregnancy. It is recommended for intermittent and short-term use only.  Speak to your Naturopathic Doctor about natural pain relief in pregnancy as natural anti-inflammatories such as fish oil are not only safe in pregnancy, but can also benefit both mother and the developing fetus.

References

European League Against Rheumatism. “Non-steroidal anti-inflammatory drugs inhibit ovulation after just 10 days.” ScienceDaily. ScienceDaily, 11 June 2015. <www.sciencedaily.com/releases/2015/06/150611082124.htm>.

Nakhai-Pour HR, Broy P, Sheehy O, and Bérard A. Use of nonaspirin nonsteroidal anti-inflammatory drugs during pregnancy and the risk of spontaneous abortion. CMAJ, September 6, 2011

Mendonca LLF, Khamashta MA, Nelson-Piercy C, Hunt BJ and Hughes GRV. Non-steroidal anti-inflammatory drugs as a possible cause for reversible infertility. Rheumatology;2000, 39(8):880-882.

Stone S, Khamasta MA, Nelson-Piercy C. Nonsteroidal anti-inflammatory drugs and reversible female infertility: is there a link? Drug Safety;2002;25(8):545-51.

Gaytan M, Morales C, Bellido C, Sanchez-Criado JE, Gaytan F. Non-steroidal anti-inflammatory drugs (NSAIDs) and ovulation: lessons from morphology. Histology Histopathology;2006;21(5):541-56.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Preparing for Pregnancy: Detoxification

Working as a Naturopathic Doctor with a focus on pregnancy and fertility gives me a unique opportunity to influence the health of the future generation while simultaneously optimizing the health of the women and men in my practice. This is an opportunity I like to seize – a chance to make the next generation as vibrantly healthy as they can be!

Pre-Pregnancy Detoxifying

I am not a fan of the detox fad. I feel like it implies that our bodies are dirty or incapable of maintaining health – the very opposite of what I believe. But as with so many fads, there is an essential nugget of truth at the center of it – we are living in a world that is overwhelming our bodies with chemicals – in the air we breath, food we eat, clothes we wear, soaps we use to ‘clean’ our bodies. And our bodies can accumulate these chemicals, and they can cause changes in our hormones, in our cells and in our organ function.

The time prior to pregnancy is a wonderful time to detoxify your life. Not just your body, but your environment, thoughts and behaviours as well. A time to prepare for a fresh new beginning – the beginning of a life and a family.

Detoxifying Your Environment

A landmark study done by the Environmental Working Group found 287 chemicals in the umbilical cord blood of babies born in the United States – chemicals that are known to be toxic to the brain and nervous system, lead to developmental abnormalities and cancer.

This study highlights the importance of making changes now – of reducing our exposure to chemicals to decrease our future child’s exposure.

Here are three easy ways you can detoxify your environment prior to pregnancy

  1. household cleanerUse only natural cleaning products – the Environmental Protection Agency has found that in many homes the level of pollutants are three-to-five times higher than they are outside.Minimize your indoor chemical burden by using only all natural cleansing products and avoid these big offenders: upholstery shampoo, furniture polish, all-purpose sprays, bug sprays, bathroom cleansers, room deodorizers, fabric softeners.
  1. Avoid plastic wrap and plastic storage containers. Almost all plastics contain chemicals that have been shown to disrupt hormone balance and can impact fertility and potentially increase the risk of miscarriage.
  1. Change your personal care products, cosmetics and sunscreens. All of these products can contain a plethora of chemicals all with potential negative health effects. The Environmental Working Group maintains amazing databases of these products that can help you to make healthy choices for your self, and your environment. Be sure to check out their Cosmetics Database and their annual Sunscreen Guide.

Detoxifying Your Body

The two best ways we can detoxify our body is 1) decrease our exposure to chemicals and 2) support our body in eliminating them.

My top four suggestions for detoxifying your body are:

  1. Water Eat organic produce. Hundreds of pesticides and herbicides are sprayed on conventional produce at various stages of their growth and production. Nearly two-thirds of produce contains pesticide residues – an alarming number with unknown consequences on long term health. The simplest way to decrease exposure and minimize risk is by selecting organic produce. Following the Clean 15 and Dirty Dozen recommendations from the Environmental Working Group is great place to start for understanding which produce you should always purchase organic, and which have lower potential for pesticide residue.
  1. Drink an abundance of clean water. Water is the way that our bodies move nutrients into cells – and toxins out. Drinking fresh, clean water throughout the day can greatly enhance your detoxification – and can improve energy and concentration as well.
  2. Exercise regularly. Exercise supports the lymphatic system – one of the most important systems in detoxifying the body. In order for our lymphatic system to work, we need to move our muscles, forcing movement of lymph back towards our heart. Daily movement practice should be part of any detoxification plan, and any healthy lifestyle.
  3. Do a personalized cleansing program once or twice a year. A personalized cleansing program developed by a Naturopathic Doctor can help identify specific detoxification goals for your body and help you to achieve them. Individualized programs are especially important prior to pregnancy – enhancing detoxification while maintaining optimal nutrient status will support your body now, and your baby’s in the future.

Detoxifying Your Thoughts and Behaviours

No detoxification is complete without as assessment of your thoughts and behaviours. Each of us has thoughts, attitudes and behaviours that impact our health – both positively and negatively. Time spent in personal introspection or working with a counselor can help us to identify patterns of thoughts or behaviours that we would like to modify. The time prior to pregnancy is an ideal time to explore our own feelings on parenthood, our relationship with our parents, and ourselves. It is a great time to let go of thoughts and behaviours that are not contributing to an abundant state of health – to detoxify our thoughts and behaviours and prepare ourselves for our future as parents.

 

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

 

Blood Clots in Pregnancy

The risk of developing blood clots is increased during, and after, pregnancy. There are additional risk factors which may increase development of blood clots during pregnancy.

  • A history of blood clots
  • A genetic disposition to blood clots (such as Factor V Leiden)
  • Obesity
  • Long distance travel
  • Prolonged bed rest
  • Carrying multiple babies
  • Advanced maternal age
  • Pre-existing medical conditions.

If you are at risk for blood clots during pregnancy, there are some precautions you should take.

Common sense precautions that reduce the risk of clotting for all pregnant women

  1. Stay hydrated at all times.Water
  2. If you must be sitting for a long period of time, elevate your feet. Even a little bit can take pressure off the backs of your thighs. Get up every hour or two and stretch, walk around, get your blood moving.
  3. Eat a healthy diet with plenty of protein, B-vitamins, folic acid, magnesium and salt. Everything you do to support a healthy blood volume will reduce the risk of abnormal clotting.
  4. Get appropriate amounts of vitamin C, vitamin E and essential fatty acids. Everything you do that promotes healthy blood vessels and tissues will reduce the risk of abnormal clotting.
  5. Don’t overdo calcium. Make sure that your calcium intake is appropriately balanced with magnesium. Too much calcium can impede placental function with calcifications and increase the tendency of blood to clot. When the balance tips in favor of calcium, the balance may also tip in favor of clotting. Get enough, but not too much.
  6. Get moderate exercise every day or every other day. Ideal exercises include walking, swimming, low-impact or water aerobics, basically any low-impact exercise that gets the blood moving and the muscles contracting. Exercise improves circulation, and anything you do that improves circulation will reduce the risk of abnormal clotting.

There are also some natural foods and remedies that can decrease the risk of clotting. Discuss these with your Naturopathic Doctor to determine if they are appropriate for you during your pregnancy.

Naturopathic Prevention of Blood Clots in Pregnancy

  1. garlicGarlic – garlic has a distinct and potent anticoagulant effect. It can be grated fresh onto quinoa or rice, made into garlic butter, added at the last minute to spaghetti sauce. Epidemiological studies have shown garlic to significantly increase serum fibrinolytic activity in humans (breaking down of clots and preventing clot formation). Garlic oil and raw garlic are both effective for this purpose.  The increase in fibrinolysis occurs within the first 6 hours after ingestion and continues for up to 12 hours.
  2. Ginger – similar to garlic and onion, ginger is an inhibitor of platelet aggregation. However, ginger’s effects have been shown to be much more powerful. Ginger inhibits thromboxane formation, pro-aggregatory prostaglandins and significantly reduces platelet lipid peroxide formation – all of which contribute to clot formation.       In one study gingerol compounds and their derivatives were more potent antiplatelet agents than aspirin. In addition to acting on platelets, ginger also promotes fibrinolysis. Ginger promotes bile production and should not be used by those with gall bladder disease.ginger
  3. Purple Grape Juice – juice because the juice is made from the whole fruit, including seeds, and the seeds contain potent anticoagulants as well. Purple because much of the anticoagulant action comes from components in the skins of purple grapes. White grape juice does NOT have the same effect. Use 100% grape, not a blend or cocktail. Two cups a day were used in one study that found purple grape juice to be more effective than aspirin.
  4. Ginkgo biloba – Ginkgo is a very potent anticoagulant. It reduces the “stickiness” of blood and improves circulation. For pregnant women it would only be advisable for those who have actually been diagnosed with a clotting disorder, and should only be used under supervision of a Naturopathic Doctor. Gingko exerts its cardiovascular effects by regulating blood vessel tone, dilating blood vessels and inhibiting platelet aggregation, adhesion and degranulation.
  5. Bilberry – well-known for its antioxidant properties, bilberry is also a cardioprotective herb that protects and strengthens the capillaries. The flavonoids in bilberry (anthocyanosides) also have significant antiaggregation effects on platelets.
  6. pillsB vitamins and folic acid – B vitamins (especially B6, B12 and inositol) and folic acid decrease homocysteine levels. Elevated homocysteine levels increase the risk of clot formation. Pregnancy increases the body’s demands for B vitamins and folic acid. Likewise, birth control pills tend to deplete the body of these nutrients.
  7. Omega 3 fatty acids or fish oils – fish oils decrease production of clot forming substances and enhance the production of platelet anti-aggregatory substances. These action play an important role in decreasing inflammation and clot formation. EPA supplementation is most important for preventing clot formation (thrombosis).

 

Photo Credit: phalinn via Compfight cc

Fish Consumption During Pregnancy

The U.S. Food and Drug Administration and the U.S. Environmental Protection Agency made headlines this month when they released guidelines on how much fish pregnant and breastfeeding women should consume.

While previously both the FDA and EPA recommended maximum amounts of fish that should be consumed by pregnant women, no minimum has ever been established.

The new recommendations are based on emerging evidence that fish are an abundant source of omega 3 fatty acids, and that these nutrients can have a “positive impact on growth and development as well as on general health” (Stephen Ostroff, MD).

Pregnant and breastfeeding women are now recommended to eat at least 8 ounces, and up to 12 ounces (2-3 servings) per week of varieties of fish that are low in mercury.

Fish that are known to be high in mercury and should be avoided by pregnant and breastfeeding women, as well as children are:

  • Tilefish
  • Shark
  • Swordfish
  • King mackerel
  • Albacore tuna (“white” tuna)
  • Marlin
  • Orange roughy
  • Escolar

Fish that is encouraged due to lower levels of mercury include:

  • Shrimp
  • Pollock
  • Salmon
  • Tilapia
  • Cod
  • Light tuna

Fish oil supplements that are analyzed for mercury levels are also safe for consumption in pregnancy and offer the same health benefits to mother and baby as eating fish.

Selected references

FDA Press Release: FDA and EPA issue draft updated advice for fish consumption

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm397929.htm

Sea Choice: Healthy Recommendations
http://www.seachoice.org/seafood-recommendations/health-recommendations/

Health Canada: Mercury in Fish

http://www.hc-sc.gc.ca/fn-an/securit/chem-chim/environ/mercur/cons-adv-etud-eng.php

Health Canada: Fish Consumption Advisories

https://www.ec.gc.ca/mercure-mercury/default.asp?lang=En&n=DCBE5083-1

Managing Gestational Diabetes Naturally

The incidence of gestational diabetes (carbohydrate intolerance that is first identified during pregnancy) is increasing.  With up to 10% of pregnancies affected this is becoming a major health concern in North America.

Diagnosing Gestational Diabetes

It is standard practice in North America to screen all women for gestational diabetes using the oral glucose challenge test (GCT)  While this universal screening is controversial (the benefits of screening all pregnant women are not established, and there is a high rate of women testing positive for gestational diabetes who do not, in fact, have this condition) it is still common practice for women to be screened between 24 and 28 weeks.

Not every pregnant woman needs to be screened for gestational diabetes.  You have the option to decline this screening test.  However, all pregnant women with risk factors for developing gestational diabetes should be screened with the GCT.  Risk factors include:

  • Glucose in the urine (found on routine urinalysis)Naturopathic Treatment of Gestational Diabetes
  • Diabetes in a first-degree relative (parent, sibling or child)
  • History of glucose intolerance, including gestational diabetes in a previous pregnancy
  • Obesity
  • Previous infant with high birth weight

A high blood sugar level (greater than 7.8mmol/L or 140mg/dL) after the GCT is not diagnostic and does not mean you have gestational diabetes.  A diagnosis can only be made after a 100g three-hour oral glucose tolerance test (OGTT).

In Canada, to be diagnosed with gestational diabetes following the 100g three-hour OGTT you must exceed two or more of the following blood sugar values:

Fasting:                                                 95mg/dL             or            5.3mmol/L

          One hour after glucose load:          180mg/dL            or            10.0mmol/L

          Two hours after glucose load:         155mg/dL            or             8.6mmol/L

                   Three hours after glucose load:      140mg/dL            or             7.8mmol/L

Large babies and gestational diabetes

Complications of Gestational Diabetes

The potential risks of unmanaged gestational diabetes include:

  • Large birth weight babies and increased risk of shoulder dystocia and other birth traumas (including brachial plexus injury)
  • Higher rate of Caesarean section
  • Postnatal infant hypoglycemia
  • Increased risk of mother developing Type II Diabetes

Naturopathic Treatment for Gestational Diabetes

While I don’t believe that all pregnant women should undergo the glucose challenge testing, there are benefits to managing blood sugar during pregnancy and this should be a priority regardless of a diagnosis of gestational diabetes.

Here are my tips for managing blood sugar for all pregnant women, including those with gestational diabetes.

  1. Avoid simple sugars.  No “white” foods – no white bread, white pasta, white rice.  Avoid candies, cookies, cakes and other confections.
  2. Eat regular meals.  Eat at the same time every day.  Eat every three hours.
  3. Never consume a carbohydrate without a protein or fat.  For example: if you are eating an apple have some almond butter, almonds or yogurt at the same time.
  4. Increase dietary fiber.  Have a tablespoon of ground flaxseeds with every meal.  Mix ground flaxseeds with applesauce or yogurt or sprinkle on salads, rice, etc.  Ideally, grind your flaxseeds at home with a coffee grinder rather than purchasing them pre-ground.  If you do purchase pre-ground flaxseeds, keep them in the freezer for freshness.
  5. Swimming for gestational diabetesEat the majority of your carbohydrates at lunch rather than breakfast or dinner.  Keep portions of carbohydrate foods small (one slice of whole grain bread, one half cup of brown rice, one half cup of whole wheat or brown rice pasta, one half cup of quinoa, etc.)
  6. Exercise for at least thirty continuous minutes once or twice per day.  A walk is an easy way to do this but you could consider swimming or yoga or other activities to keep it interesting and to engage other muscles (insulin is used by skeletal muscles – get those muscles using it!)

For gestational diabetes specifically, inositol is a supplement that can be used safely in pregnancy and has been found in studies to improve insulin sensitivity and decrease glucose levels.  It takes a few weeks for maximal effects so see your Naturopathic Doctor as soon as you are aware of abnormal blood glucose levels to gain control over your blood sugar faster.

Gestational diabetes is usually well managed with diet, exercise and simple supplements.  In rare cases where drugs are necessary your Naturopathic Doctor can continue to provide support with lifestyle and dietary counseling and stress management to ensure you and your baby are healthy throughout pregnancy and beyond.

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Heartburn in Pregnancy

Every pregnancy is different.  Sometimes VERY different!  When I was pregnant with my first child I had few symptoms (aside from some swelling in my third trimester) and felt vital and healthy for the entire 9 months.  This time around, things are different – and uncomfortable!  I have been having heartburn.

What is heartburn?

Heartburn (also known as indigestion, acid reflux or gastroesophageal reflux disease – GERD) is a burning sensation in the esophagus and can have a number of different associated symptoms:

  • Burning sensation in the chest and throat
  • Sour, acidic taste in the mouth
  • Pain behind the breastbone or between the shoulder blades

Why does heartburn happen in pregnancy?

For a lot of women (me included!) heartburn is first experienced during pregnancy.   About half of all pregnant women experience heartburn.  It can occur at any stage but is most common during the second half of pregnancy.  Hormonal and physical changes both contribute to symptoms of heartburn in pregnancy.

  • During pregnancy, the placenta produces the hormone progesterone which relaxes smooth muscles.  Great for the uterus, not so great for the lower esophageal sphincter (LES) – the valve that separates the esophagus from the stomach.  This relaxation allows gastric acid to reflux up into the esophagus, causing painful burning sensations.  (FYI: this progesterone increase also contributes to constipation in pregnancy.)
  • Later in pregnancy, your baby grows larger and takes up more space in your abdomen.  This pushes upwards on the stomach and forces some stomach acid up into the esophagus.

What can I do about it?

There are many things you can do to manage your heartburn and decrease discomfort.  You don’t need to suffer!  Start with the lifestyle and diet changes, and if they are not effective consider trying some of the other options presented or see a Naturopathic Doctor for an individualized plan.

Dietary Changes

  • Avoid known heartburn triggers.  These are different for everyone but may include carbonated drinks, chocolate, caffeine, citrus fruits, tomatoes, mustard, vinegar, mints, spicy foods, fried or fatty foods.
  • Eat small meals frequently.  Avoid eating large meals and be sure to chew each bite thoroughly (allowing the digestive enzymes in your mouth to do their job.)
  • Limit beverages at mealtime.  Water and other fluids can distend the stomach and force food (and acid) up into the esophagus.
  • Try a sugar-free chewing gum.  This will increase saliva production which can help neutralize acid.  (Note – you may need to avoid mint gums if mint is a trigger for your heartburn.  I find this tip very helpful when heartburn strikes suddenly – and inconveniently – while I’m at work or away from home.)
  • Don’t eat right before bed.   Wait two to three hours after eating before lying down.

Lifestyle Changes

  • Sleep with your upper body elevated with several pillows or a sleep wedge.  This will allow gravity to do its work and keep stomach acid where it belongs.
  • Gain weight sensibly.
  • Wear comfortable clothing that does not constrict your waist and abdomen.
  • Sit upright rather than slouching.
  • Don’t smoke.  If you haven’t quit before pregnancy, book an appointment to discuss your habit with your Naturopathic Doctor now.

Medications and natural remedies for heartburn in pregnancy

For some women, lifestyle and dietary changes are not enough to manage heartburn symptoms in pregnancy.  In these instances a supplement or over-the-counter medication may provide the additional relief needed to get through the full nine months of pregnancy.

Over the Counter Medications

In general I don’t recommend over-the-counter antacids during pregnancy because they don’t address the cause of heartburn (relaxation of the lower esophageal sphincter) but rather function to neutralize stomach acid – a substance that has important digestive properties.

Additionally, some over-the-counter antacids contain aluminum or aspirin (such as Alka-Seltzer) or are high in sodium – all of which are not appropriate during pregnancy.

Generally speaking, the occasional Tums or Rolaid may be helpful – but be sure to check the label and discuss your options with your Naturopathic Doctor or Medical Doctor before taking any mediation.

Supplements and Natural Remedies

As a Naturopathic Doctor I always try to use the smallest intervention necessary to get optimal results.  I recommend starting with all of the dietary and lifestyle recommendations above before you try any of the supplements or natural heartburn remedies listed below.

  • Fresh pineapple can provide quick relief of heartburn symptoms in some people.  Pineapple is a natural source of bromelain and other enzymes.  These enzymes speed digestion and can minimize inflammation.
  • Slippery elm tea is an amazingly effective and safe way to decrease heartburn symptoms and prevent damage to the esophagus.  Slippery elm contains mucilage which soothes and protects the mouth, throat and stomach.  Pour two cups of boiling water over one tablespoon of slippery elm herb or powder, cover and let steep for 5 minutes.  Drink one cup three times per day or as needed.
  • Deglycyrrhizinated licorice (DGL) is a safe alternative to over-the-counter antacids.  It supports proper digestion, increases mucous production in the stomach and helps tonify the lower esophageal sphincter.  Licorice is not safe in pregnancy, however in DGL the harmful glycyrrhizin has been removed, making it a safe remedy for heartburn in pregnancy.  One capsule should be chewed (it must mix with saliva to be effective) as needed.
  • Homeopathic remedies are safe for pregnancy and may be used for heartburn.  Lycopodium is used for chronic indigestion, gas, bloating and heartburn.  Nux vomica for heartburn from coffee or rich foods, or heartburn associated with nausea.

When dealing with heartburn in pregnancy keep in mind that it will end.  Most cases of pregnancy heartburn resolve completely when the baby is born.  So do your best, try some of the suggestions above and look forward to the day when your baby arrives – for more reasons than one!

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Selected resources:

Public Health Agency of Canada – Healthy Pregnancy – Heartburn

Aly AM, Al-Alousi L, Salem HA. Licorice: A Possible Anti-inflammatory and Anti-ulcer Drug. AAPS PharmSciTech. 2005; 06(01): E74-E82..