Thursday, March 4, 2010

The Relationship of Maternal Health, Obesity and Diabetes


Today ABC News reported on the new World Health Organization(WHO) report that the United States ranks 33rd in the world on maternal health in childbirth. The W.H.O. had already given the United States a 37th ranking in total health of nations in the world last year.

Studies are showing that there is a rise in maternity morbidity and mortality rates with women especially with C-sections and other procedure related births especially within the first 42 days after delivery.

The W.H.O. reports that the deaths are related to women who appear to be stationary or sedentary immediately for prolonged periods, after having a C-section, and tend to be obese! A medical occurence known as a thromo-embolic event is the most likely culprit for causing this phenomenom in happening.

THROMBO-EMBOLIC EVENTS
Thrombo-embolic events are blood clots usually due to blood pooling in large veins or some arteries after an individual stays stationary for some significant period of time. The pooling of blood allows platelets and blood cells more time to adhere . Clots that form in this manner are called thrombi. Thrombi can occur in the low pressure vessels such as the lower leg , abdomen and right side of the heart.

When pressure abruptly rises from someone standing or having a valsalva manuever( straining from the waist) the "clot" can break off and travel to higher pressure areas such as the left side of the heart or to the brain where strokes happen. When this occurs an embolus has occured.

Recent studies indicate now that about one in every five maternal deaths is in women who have diabetes, asthma and complications of their delivery as a result of C-sections. C sections are even more dangerous because they offer the woman more risk of infection as well. A woman with a history of a C-section and even worse multiple C-sections has an even greater risk of maternal morbidity and mortality.

OBESITY RELATED TO MATERNAL HEALTH
Obesity has become the "Mother of All Chronic Illnesses" including maternal diseases. The risk of complications in pregnancy increase in women who are already overweight or obese at the time of pregnancy , but the risk of non-obese women who become obese in the middle of pregnancy rises higher as well. The risk is not only to the mother who now is a candidate of gestational diabetes and it's complications with out well controlled sugar; the risk also falls on the fetus who now is at risk of becoming obese, diabetic and gestationally much larger. Larger babies are more difficult to deliver and are at risk for complications during pregnancy and delivery. Women with gestational diabetes seem to have more fluid in the placenta(amnionitic fluid) a condtion called polyhydraminos.

Also note that obesity is associated with numerous pulmonary diseases including asthma other obstructive disease, restrictive lung disease, sleep apnea, and the Pickwickian Syndrome.

WHAT TO DO?
Many of the women who are susceptible to blood clots are women who are on estrogen medication or who smoke. The combined affect is very detrimental . Women who are diabetics also are at risk, but those who have poorly controlled sugar are particularly vulnerable.

There are some clotting factor disorders that need to be looked at. Clotting factors are made in the liver and are dependent upon Vitamins D, A, K, and E, Christmas factor and Von Willenbrand factor as well as Clotting factor VII and VIII must be tested for as well as anyone who has higher platelets and red blood cells than normal(polycythemia vera). Check your family history and be aware that bleeding can be a complication with clotting and always tell your physician before labor if you are on any drugs , particularly aspirin like!

If you are obese or overweight continue a lifestyle program of nutritional support and exercise while pregnant until told not to do so. Keep your cholesterol and blood sugar in its normal limits. chart your baby's weight gain as you take on more weight, watch your hunger craves and document which foods may make you hungrier or those that you crave more often and chart when you eat them and their caloric amount. Report patterns to your nutritionist.

If you smoke try stopping and realize you may need a non-pharmaceutical means to quit so no cross over of drugs affects your baby!

IF YOU ARE AT RISK AFTER A PROCEDURE OR BECOME SEDENTARY
Becoming sedentary after an invasive procedure is a risk for the thrombo-embolic event to occur. Ask your doctor for pulsatile or jobe hose stockings while being hospitalized. Sometimes wiggling the toes help. When a person can tolerate it , physical therapy in-house can perform some passive exercises for you.

Your medical staff should be aware of your clotting factors and bleeding times and PT/PTT as well as your liver function ; if they are not you should ask what they are!

Try to avoid having induced labor or C-sections as much as possible and always use prevention.

Dr. Marcus Wells, MD, MPH is a past clinical associate at the National Institutes of Health at the National Heart , Lung & Blood Institute(NIH/NHLBI) and has a Master's in Public Health from Emory University. He has also worked at the Health and Human Services(HHS), Public Health Service(PHS), and Commissioned Corp.

Learn more about prevention of obesity and developing a healthier lifestyle at http://www.tgx360.com/

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