It’s nice to discuss bread-and-butter normal pregnancy sometimes. Please check-out my article on eMediHealth.com (link below). Thanks for the opportunity! #PregnancypearlswithDrPlenty
Wheeww… chiiillld!!! It’s been a while since I’ve posted. There are a few reasons for this. In all honesty, I have avoided writing partly because I’ve been scared. As a physician, I’m supposed to be a healthcare leader. I must keep it together, right! But it’s hard to keep everything together when I’m walking into the unknown everyday. I don’t know who has the virus and who doesn’t. It’s June… 5 months into the pandemic… and I still have to re-use masks. I’ve received 3 KN95 masks from my job, and I finally received the 10 I ordered from Amazon. Some patients refuse to wear masks, which means I have to deal with the drama of refusing to have them seen in clinic. The other reason I haven’t posted in a while is that I’m completely overwhelmed. In light of the death of Ahmaud Arbery, Breonna Taylor, George Floyd, and all those in between and after, it has been emotionally draining. One positive thing the two pandemics (COVID-19 and racism) have done is highlight racial injustices and health disparities and given the majority and large cooperations the opportunity to become allies and for us, as people of many races and ages, to be a part of the solution. As a Black mom and high risk pregnancy physician, doing my part is striving to reduce maternal deaths related to pregnancy.
Since forever ago, the pregnancy-related mortality rate, or the rate of death related to pregnancy issues, is highest amongst Black women. Some would like to blame it on “lower socio-economic status” or a lack of education. NOPE! According to the CDC, The pregnancy-related mortality ratio (abbreviated as PRMR) of Black women with at least a college degree was 5.2 times that of our White counterparts1. Some may say that these deaths weren’t preventable. Well, studies show that Black are more likely to experience preventable maternal deaths compared to White women 2. Although people jokingly say “Black don’t crack”, it has been long known that Black women, in fact, experience “weathering”, meaning our bodies actually age faster than White women’s due to chronic exposures to environmental stresses related to socioeconomic disadvantage and discrimination3. This is thought to account for riskier pregnancies at earlier gestational ages.
Because being Black is an independent risk factor for poor maternal outcomes, here are some things you can do and/or discuss with your provider before, during, and after your pregnancy that will help you get safely through it.
- Exercise and drop some pounds. Obesity increases the risk of high blood pressure issues in pregnancy, gestational diabetes, having a small baby, stillbirth, and C-section delivery. Being at a healthy weight will reduce these risks. If you already have high blood pressure, you could potentially come off of blood pressure medications before pregnancy. If you’re diabetic, healthy eating and exercise will lower your A1C.
- Get a pre-conception visit. This visit will help you know if you’re healthy enough to get pregnant. The OB/GYN or Maternal-Fetal Medicine physician will also review all medicines to make sure they won’t cause birth defects. Make sure to mention even over-the-counter medications during your visit.
- Get a well-woman exam. Make sure you’re wellness checklist is up-to-date. If you’re over the age of 40yrs or have a strong family history of breast cancer, make sure you have had a breast exam and mammogram. Make sure your most recent pap smear is normal. You don’t want to deal with a cancer work-up during pregnancy if you can avoid it.
- Start prenatal vitamins. Starting vitamins early will make sure your growing baby has all it needs during early development before you even know you’re pregnant. Folate is in your prenatal vitamin. If you have a seizure disorder, a personal or family history of spina bifida, or diabetes, you need to take extra folate beyond what’s in your prenatal vitamins.
During the pregnancy:
- Ask about starting Aspirin (81mg) to reduce your risk of pre-eclampsia. If you’re Black AND obese, you should be on this unless you have issues with bleeding. If you have type 1 or 2 diabetes, high blood pressure/hypertension, lupus, thyroid disease, an autoimmune disease, or have an IVF pregnancy, aspirin is also recommended for you (unless there are reasons that would make it harmful). Discuss with your provider.
- Attend all prenatal visits. If you have to miss one, then call before the appointment to reschedule.
- Take notes and ask questions. Bring a notebook with all questions you can think of. Jot down the answers during your visit. It’s your provider’s job to make sure all your questions are answered.
- Do not avoid the hospital or delivery. Some people think doctors want to deliver patients for convenience. Ask why you need to go to the hospital. If the reason is your health or baby’s health, then go!
- Eats lots of vegetables. This is cliche, but nothing substitutes being healthy… it’ll help you avoid a ton of issues later on.
- Drink 5 bottles of water a day. This will help you stay hydrated and reduce your risk of preterm contractions.
- Monitor your symptoms. A headache, shortness of breath, or pain near your liver should prompt you to go back to the hospital. Vaginal bleeding with more than 2 pads an hour should also be evaluated.
- Make sure to keep your postpartum appointments. You’re not out of the woods for 6 weeks… really up to a year. So, it’s important to get everything checked out. If you had blood pressure issues during the pregnancy, you should be seen within a week of delivery by your OB/GYN or Maternal-Fetal Medicine physician.
- Breastfeed if you can. This helps with getting you back to a healthy weight. It’s also extremely helpful for the baby as well.
- Wait a year before trying conceive again. This allows your body to heal and get back to its pre-pregnant state. During this year, you should take steps to avoid getting pregnant by using some type of contraception or family planning method.
- 2. Louis, J. M., Menard, M. K., & Gee, R. E. (2015). Racial and ethnic disparities in maternal morbidity and mortality. Obstetrics & Gynecology, 125(3), 690-694.
- Geronimus, A. T. (1992). The weathering hypothesis and the health of African-American women and infants: evidence and speculations. Ethnicity & Disease, 2(3), 207-221.
Unless you’ve been living under a rock, you already know that the U.S., and the rest of the world, has been hit hard by COVID-19 (coronavirus disease 2019). COVID-19 is caused by SARS-CoV2 strain of coronavirus and primarily affects the lungs, leading to pulmonary fibrosis. This respiratory illness can cause symptoms, such as fever, shortness of breath, headache, diarrhea, etc. In some cases, these symptoms can be severe and life threatening. Here’s the link to my first video on COVID-19 and pregnancy for more back ground info:
Since the first U.S. case, we now have almost 800,000 cases and 40,000 deaths in the U.S. alone (CDC.gov). Some states are starting to re-open retail businesses. Texas, the state in which I live, is one of them. As an MFM provider, I want you to take steps to continue to protect yourself and your unborn baby or future pregnancy. Data is limited on the effects of COVID-19 in the first trimester and throughout pregnancy. However, so far, studies do not show an increase in birth defects. The biggest issues with COVID-19 in pregnancy, besides the risk of respiratory disease, is the association with hypertensive disorders of pregnancy, thrombosis (blood clots in the legs or lungs), and preterm labor (which is common with respiratory illnesses). A lot of OB/GYN are spacing in-person visits and doing more virtual visits. Therefore, if you are experiencing any of the following, seek help:
- headaches that are unrelieved with Tylenol
- shortness of breath
- change in your vision
- frequent contractions (meaning contractions for 10min for at least an hour)
- Pain near your liver (on the right side, at the top of your stomach/abdomen)
- Leakage of fluid from the vagina
- Vaginal bleeding
Not all of these are symptoms of COVID-19, but these symptoms can signify more common complications which require medical attention, such as preterm labor, infection in other parts of the body, and preeclampsia (high blood pressure and protein in your urine).
Since the pandemic, wearing masks in public and practicing social distancing are now the new norm. Zoom meetings all day are exhausting! A car ride is considered a “day out”. To stay connected, we have virtual family meet-ups. Thankfully, we live at the time of social media and and internet. If this were to happen when I was younger, I would probably not see any family members for months (and might not talk with people too often since I didn’t have a cellphone growing up)! Here’s my medical take on life since COVID-19. Feel free to share your pandemic stories!
A ton of people always ask questions about exercise during pregnancy with most questions being related to the safety of exercise in pregnancy. You’ve probably heard someone in your family tell you to “sit down and put your feet up,” or tell you that “you’re doing too much”. Although family members mean well, staying active during pregnancy is typically very beneficial unless you have particular complications and have been instructed to avoid it by your OB/GYN. Watch my video on exercise in pregnancy to delve into this topic a bit further.
Approximately 1:4 people in the U.S. experience symptoms or depression or anxiety in their lifetime. Therefore, it comes at no surprise that depression and anxiety are fairly common in pregnancy. Changes that occur during pregnancy can influence symptoms of depression or anxiety. Some patients might have issues due to changes in body image due to weight gain or feel more depressed because they are now dealing with being nauseated or vomiting. Not getting enough rest due to fetal movement or limited sleeping positions because of your growing belly can also alter your mood. Watch the video for more information on how depression or anxiety can affect your pregnancy and ways to improve your pregnancy outcome!
Diabetes in pregnancy can cause serious problems if uncontrolled. However, if you have pre-existing (type 1 or 2 diabetes) or have gestational diabetes, there’s no reason to be afraid. The key to maintaining a complication-free pregnancy is to obtain tight control of your blood sugar. If you have type 1 or type 2 diabetes, make sure you are as healthy as possible before pregnancy. If you have high blood pressure in addition to diabetes, make sure your blood pressure is normal. Your hemoglobin A1C value (the value that tells doctors how controlled your diabetes is) should be <7% (ideally 6%) before pregnancy. You should also start prenatal vitamins and folic acid supplements prior to pregnancy to reduce your risk of having a baby with birth defects.
If you are diagnosed with gestational diabetes, that means that you failed your glucose challenge test… you know, that orange tang or cherry flavored juice you had to drink at 26-28 weeks of pregnancy. For you, you already already more than half way through the pregnancy. So, you only have a few weeks of sacrificing your normal diet for a diabetic diet. That’s not too bad. You can do it!
For pregnancy, regardless of the type of diabetes you have, the goal is to maintain a fasting blood glucose (meaning fingerstick value when you first wake up, before eating) of less than 95mg/dl and well-controlled levels 1 or 2 hrs after eating meals. If you check your fingersticks 1hr after meals, your goal is to have your value less than 140mg/dl; if you check your fingersticks 2hrs after meals, the goal is 120mg/dl or less. Making sure you are well-controlled during pregnancy will make sure your baby remains safe! Watch my YouTube video below to learn more.
Vaginal bleeding in pregnancy is very common, but not necessarily considered normal. However, there are times in the pregnancy, especially early on, when one can anticipate vaginal bleeding. Implantation spotting typically happens very early (usually days 10-14 after fertilization) in the pregnancy. This is considered a normal finding. This occurs as the egg (aka, the tiny baby) disrupts the lining of your uterus to implant. Because there are several other reasons for bleeding in pregnancy, some of which need immediate attention, vaginal bleeding should always prompt you to contact your doctor or go to the nearest hospital (if heavy). Watch the VLOG post to find out more information.
Did you decide to wait to have a baby, and now you’re wondering if you should still have one? If so, this is the video for you. Watch this video to know the risk of being “older” and having a baby.
I am an OB/GYN, but many people, including other doctors, don’t really know about my subspecialty. To find out more about what I do or why you or someone you know might see me during pregnancy, see the VLOG below. Also, make sure to subscribe to the blog and my YouTube channel for more content related to pregnancy!
Things to think about before pregnancy.
Dr. Nicole Lee Plenty, MD, MPH, MS, FACOG
One of the reasons I became a high risk pregnancy specialist was to improve pregnancy outcomes… meaning I want to make sure mom and baby both get through the pregnancy safely. Let’s be completely real for a second. Some of us should not get pregnant… at least not yet! A lot can happen during a pregnancy, but most maternal complications (meaning badness with the mother) can be prevented by making sure we are healthy before the pregnancy starts.
Here are a few things you should do before you get pregnant to improve your chances of getting pregnant and safely delivering a healthy baby.
Maximize your health
One of the biggest concerns in pregnancy and the reason that some women die in pregnancy or shortly after is due to heart disease and what’s called preeclampsia. Preeclampsia is a fancy name for high blood pressure and vascular damage in pregnancy. Things like being obese, having high blood pressure or uncontrolled diabetes greatly increase your risk of these complications. Incorporate daily brisk walking to shred a few pounds. This will help get your blood pressure and get your diabetes under control.
Diabetics in general should talk with their primary care doctors to make sure their hemoglobin A1C is under 7%. If you’re a diabetic, you know that this number is your average fingerstick value over a three month period. This number being under 7% decreases your risk of complications for yourself and the chances of your baby having a birth defect.
Get your teeth checked
Yep! I said it. Make sure to see your dentist to make sure you don’t have gum disease. We should all be getting regular cleanings anyway. If you haven’t, go ahead and find a local dentist. Women with gum disease have a higher risk of having babies preterm. So, healthy gums theoretically can reduce this risk.
Make sure you’re in a healthy relationship
Now, this suggestion is not for everyone. I recognize that people are getting pregnant independently now. However, if you have a partner and want to have a baby together, make sure you’re on the same page before moving forward. Pregnancy is the number one time for domestic abuse. It’s sad to think about, but it’s true. So, if you’re trying to get pregnant to keep your man, don’t do it. Pregnancy and a new baby can put a strain on a relationship, especially one that is shaky. If your spouse is not sure he/she wants a baby or if your relationship is on the brink of ending, make sure your relationship bounces back first.
Visit your OB/GYN for a preconception visit
You might think you’re healthy because you feel fine, but you want to make sure your pregnancy provider checks all the details. When I say details, I mean the numbers that tell us you’re body is ready for stress caused by a pregnancy. If you have diabetes, you can’t feel that you have kidney disease. The details tell us that. A physical exam plus details can tell your provider if your high blood pressure has caused heart disease or if your asthma is controlled enough to withstand heavier breathing in pregnancy. I’m not trying to scare anyone. Most of you are completely healthy… it just makes more sense to be sure first. No one likes unpleasant surprises.