Bedrest Fitness
Gestational Diabetes: A Particular Problem for Mamas on Bed Rest
January 29th, 2010
Gestational Diabetes (GD) can be particularly problematic for mamas on prescribed bed rest. Previously a common indication for bed rest, with all of the medical advances and therapies most pregnant women who develop GD are easily managed as out patients. Unfortunately, women who are prescribed bed rest for another medical condition are at increased risk for developing GD as a result of inactivity and weight gain. Women who develop GD are at increased risk of developing Type II diabetes later in life as well as Metabolic Syndrome.*
Gestational Diabetes is defined as impaired (improper) glucose metabolism during pregnancy. Some women become insulin resistant, meaning that the insulin their bodies produce does not properly carry glucose from the bloodstream into the body’s cells as it should. Sometimes GD develops because a woman has gained too much weight, a common cause of insulin resistance. Other times the increased hormones of pregnancy interfere with glucose metabolism. Finally, a woman with a genetic predisposition to diabetes may manifest her first symptoms during her pregnancy. This woman is at increased risk of developing Type II diabetes later in her life.
Testing for gestational diabetes is typically done between 20 and 28 weeks of pregnancy. The normal ranges of blood glucose are:
- 70-95 mg/dL Before breakfast (fasting)
- 70-140 mg/dL 1 hour after eating a meal
- 70-120 mg/dL 2 hours after eating a meal
Women who have blood sugars that fall above these ranges during testing will be diagnosed with GD. It is essential that women diagnosed with Gestational Diabetes are treated aggressively and that they achieve and maintain tight blood sugar control. Blood sugar control is essential to ensure the health of both mother and baby. When blood sugars are not controlled during pregnancy, Some unfortunate complications can result such as:
- High blood pressure in the mother caused by preeclampsia
- Excessive birth weight (exceeding 9 pounds, 14 ounces)or Macrosomia
- C-section delivery
- Hypoglycemia (low blood sugar) in the baby at birth
- Jaundice (yellow skin) in the baby at birth
- Respiratory distress syndrome (breathing difficulties) in the baby at birth
- Low blood calcium levels in the baby at birth
- Red blood cell disorders in the baby at birth
- In very rare cases, stillbirth of the baby at 28+ of pregnancy
- In very rare cases, death of the baby in infancy
- Increased risk for type 2 diabetes in both mother and baby later in life
Treatment of Gestational Diabetes is actually quite simple. From many women, adherence to a “diabetic diet”, a regular exercise regimen and regular blood sugar testing are all that is needed. However, for many other women, blood sugar cannot be adequately regulated and controlled with diet and exercise alone, so they are prescribed oral medications or Insulin injections.
Unfortunately most pregnant women on prescribed bed aren’t able to exercise enough reduce insulin resistance with diet and exercise alone. However it is still very important, perhaps even more so, that they follow the dietary instructions from their OB or a nutritionist and that they stretch and do some muscle strengthening and toning while in bed. If women on bed rest are diagnosed with gestational diabetes, they should request a referral to a physical therapist or exercise specialist** so that they can learn safe exercises that they can do while on bed rest.
It may seem unfair to be diagnosed with gestational diabetes while on bed rest for another condition. Try not to become too discouraged. Gestational Diabetes is easily managed and with careful adherence to your obstetrician’s directions, you and your baby can be just fine.
*Metabolic Syndrome is a group of symptoms that occur together and promote the development of coronary artery disease, stroke, and type 2 diabetes. An individual is diagnosed with Metabolic syndrome if they have:
- Extra weight around the waist (central or abdominal obesity)
- High blood pressure
- High triglycerides
- Insulin resistance
- Low HDL (“good”) cholesterol
**Bedrest Fitness is a set of simple yet effective modified prenatal exercises that a pregnant woman on prescribed bed rest can do from her bed with her obstetrician’s approval. Order Bedrest Fitness here.
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Weight Management on Bed Rest: An Interview with Kathryn Flynn
November 19th, 2009The holidays are fast approaching and I for one am going to try to monitor my eating this year. With all of the holiday parties, candies, sweets and good cheer, it’s not hard to wake up in the new year with more than a little “new you”. So I am upping my exercise and doing my best to monitor my caloric intake.
Now from your vantage point of bed rest, you may be saying, “That’s easy for you to do/say. You can actually exercise and move around. I’m stuck in this bed! I deserve these (cookies, candies, etc…)! But the reality is that it is very important for pregnant women on prescribed bed rest, just as it is for all other pregnant women, to make wise food choices.
Since I am no nutrition expert, I have asked Kathryn Flynn to “weigh in” on the best ways for mamas on bed rest to manage their weight-especially during the holiday season.
Kathryn Flynn, BEd. is the founder of FertileFoods.com a website intended to educate men and women about food and lifestyle habits to support a healthy pregnancy. She studied with PaulPitchford, author of Healing with Whole Foods and has worked extensively with Dr. Randine Lewis, author of The Infertility Cure and The Way of the Fertile Soul, to develop the Fertile Soul’s integrative nutrition program for reproductive health. For the past four years, she has led group lectures in nutrition education, five-element phase diagnosis, self-treatment through acupressure and fertility yoga. She provides individual nutritional counseling to men and women worldwide, with the intention of enhancing reproductive capacity naturally through a holistic approach that includes lifestyle changes, relaxation techniques, exercise and healing foods. Kathryn is the author of Cooking for Fertility: Foods to Nourish Your Fertile Soul and is currently developing a line of Moontime Tea’s to help women balance their menstrual cycles.
DTL: Karen, We hear so much about “acceptable” weight gain during pregnancy; 25-35 lbs for normal weight women, up to 45lbs for underweight women and just 15-25 lbs for overweight women. How can a woman on prescribed bed rest manage her weight?
KF: Managing your weight on bed rest is a three fold process that involves a close look at your relaxation habits, physical activity and what you are eating.
1. Though it may seem like bed rest would imply restfulness and relaxation, the true experience can be anything but stress relieving. Many women feel contained, restless and impatient when they are unable to go about their daily activities. Training oneself to consciously relax involves introducing activities that truly bring you a sense of peace and calm such as meditation, deep belly breathing, uplifting reading and getting adequate rest. When the nervous system is able to relax, we can manage our weight with greater ease by becoming more mindful of our cravings. Emotions play a big role in directing what we put in our mouths, so relaxation is a great place to start to set the stage for moderating weight gain.
2. Physical activity may also seem contradictory when one talks about bed rest, but there are in fact many stretches and gentle movements that can be incorporated. Changing your concept of exercise is important and you may consider trying different yoga, tai chi and qi gong videos and zoning in on the floor postures. Of course videos that specialize in bed rest like The Bedrest Fitness DVD* are ideal because all of the exercises are streamlined so you won’t have to improvise. The key here is to get fresh blood flow and oxygen through all the organs which is essential for preventing blood clots, maintaining weight and managing your mood. The feel good endorphins are essential for every aspect of our well being and especially keeping your spirits up.
3. Finally, it is important to eat a colorful nutrient rich diet. So often, I talk to women who are feeling a little down about being on bed rest and the first thing they reach for are “treats” usually in the form of simple carbohydrates and sugary sweets. While this may solve the blues temporarily, it creates a vicious cycle where you need more and more “treats” to boost your serotonin. They key here is to eat small and frequent protein, carbohydrate balanced meals and snacks throughout the day to moderate your blood sugar levels, keeping your insulin levels, mood and weight gain stable. By choosing colorful fruits and vegetables, whole grains and organic protein sources you are giving your body the nutrients it needs. It’s also important to treat yourself from time to time to avoid the feeling of restriction and the potential of bingeing. I would recommend stocking your fridge full of healthy foods to avoid too much temptation and focusing on the delicious healthful alternatives.
DTL: What dietary tips would you recommend for women on prescribed bed rest?
KF:
1. Eat small frequent meals and snacks throughout the day to stabilize energy levels
2. Combine a protein, carbohydrate and healthy fat at every meal and snack for blood sugar balance
3. Eat a colorful organic diet of predominantly of fruits and vegetables with some grains and hormone free proteins
4. Avoid simple white carbohydrates and sugars that have little nutritional value
5. Practice mindful eating: turn the tv off while you eat, chewing slowly to taste each bite
6. Continue to take a quality prenatal and add fish oil if you haven’t already to support the neural development of your baby and your mood
7. Stock your fridge with delicious healthy foods and get rid of any “junk food”
8. Indulge in decadent healthful treats from time to time to avoid feeling restricted, but don’t make them a staple
I’d like to thank Kathryn for her insight into healthy eating and nutrition. Talk to your doctor or midwife about incorporating Kathryn’s expert nutrition tips into your own diet.
*Order your copy of The Bedrest Fitness DVD here
Is Complete Bed Rest Best?
October 16th, 2009Recently someone made the comment that high risk pregnant women should not engage in any sort of physical activity while on prescribed bed rest. I cannot disagree more vehemently! When a pregnant woman is placed on bed rest, not only is she at risk for the usual complications of pregnancy (in addition to the particular risks that landed her on bed rest in the first place!) she then adds an increased risk for deep venous thrombosis (DVT) and embolism, pulmonary complications an muscle atrophy (wasting and loss of strength). This is why I produced Bedrest Fitness, a series of exercises pregnant women can do while on prescribed bed rest.
Numerous research studies have documented that prolonged inactivity is detrimental to health. For this reason, when a person has heart bypass surgery, as soon as they are taken off the ventilator and are breathing on their own, nurses are instructed to get them out of bed and into a chair. This sometimes occurs within in hours of open heart surgery! But the sooner patients sit in an upright position, the sooner they will begin reusing their muscles, taking deep breaths and recovering. The same thing happens for orthopedic patients. Once a hip or knee is replaced, within hours to days, physical therapists begin moving the new joint to aid in healing, range of motion and optimum utilization. Early movemtner lowers the risk of venous blood pooling in the legs , blood clot formation, embolisms (blood clots that dislodge and travel to other areas of the body), pulmonary (lung) collapse, fluid in the lungs and the development of pneumonia. So given these examples (and there are many more such as cancer patients and other surgical patients) doesn’t it seem strange that we tell pregnant women to go sit/lie down for weeks to months at a time???
I am sure that opponents and naysayers will chide me by saying, “Well then YOU take responsibility when a woman loses her baby!” I think that we can all agree that no one wants a pregnant woman to lose her baby (or babies as the the case may be). But I think that it behooves all of us, especially in this era of health care reform, to re-examine how we manage high risk pregnant women and to really ask ourselves, is complete bed rest really best?
In some cases, bed rest really is the answer. If a woman is actively bleeding from her vagina, experiencing contractions indicative of preterm labor or has severe high blood pressure and is at risk of pre-eclampsia then yes, bed rest is indicated and I think that inpatient hospital care is best in these settings. But once the bleeding stops, the contractions stop and her blood pressure is closer to the normal range is it still necessary to completely restrict a woman’s activities? Is it best to send her home without medical supervision? Is it in her and her baby’s best interest for her to remain immobile and inactive?
Researchers are just beginning to look at how high risk pregnant women are managed and are beginning to realize that perhaps restricted activity and modified bed rest are better options. If a woman is able to be up out of bed but sitting with her feet up she can work from home and engage in family activities. But some people still argue this isn’t enough, especially in the case of the incompetent cervix. They argue that the gravitational pull downward requires that a women stay reclined in bed. Again, this may not be the case.
The September 2009 American Journal of Obstetrics and Gynecology published a study, “Prediction of spontaneous preterm birth in asymptomatic twin pregnancies with the use of combined fetal fibronectin (fFn) test and cervical length”. Now first let’s qualify their findings by saying that the mothers in this study were in fact having twins but they were not otherwise high risk, i.e. they didn’t have incompetent cervices. The researchers found that in 155 twin pregnancies examined between 22 and 32 weeks gestation,
- A positive fFN test or a cervical length of <20mm increased the risk of spontaneous preterm birth at <37,<34,<32, <30 and <28 weeks gestation.
- The combination of a positive fFN test result and cervical length <20mm had a significantly higher positive predictive value for delivery at all gestational ages than either test alone.
- A positive fFN test result was a stronger predictor of spontaneous preterm birth than a short cervical length alone.
Although this is one test and on a fairly small, very specific population, we can’t ignore the potential indications. To date many women with multiple pregnancies are placed on bed rest to prolong gestation-regardless if they are having symptoms of preterm labor or other complications. While most mothers of multiples often lower their activity levels later in pregnancy out of necessity, those who wish to remain “restricted” but not “bedridden” may now have a way to determine their risk and potentially avoid bed rest.
Likewise, incompetent cervix is one of the most common reasons women are placed on prescribed bed rest. If a pregnant woman with an incompetent cervix can have a cerclage (sugical stitch placed around the cervix) and if the cervix is not effacing (thinning and shrinking), the fFN test may be used to establish which mothers actually need to be on bed rest because preterm labor is highly probable and which mothers may be able to be on modified bed rest, “house arrest” or simple modified/restricted activity.
Truly more research must be done in this area, but it is exciting to see that people are actually doing work for us high risk mamas. Maybe one day, we’ll be better able to tell who really needs to be on bed rest and who does not.
Mamas on bed rest, if you want to keep moving, try Bedrest Fitness! It’s simple yet effective at helping maintain muscle strength and mobililty. see a clip at www.mamasonbedrest.com.
