Case Study: Improving Your Pregnancy Odds with Pre-Existing Conditions
On becoming a client, Sara (not her real name) presented with four major pre-existing conditions but we were able to improve her lab values, reverse gestational diabetes and iron deficiency during pregnancy, and enhance her overall health and well-being. She was induced to avoid complications and had an excellent outcome: a healthy vaginal delivery and a healthy baby.
What’s My Health Status Got To Do With Pregnancy?
Being pregnant is a really exciting time. We’re so pleased to finally have that baby growing inside! Yet, many of us come to the table with health conditions that suddenly have our attention because they can contribute to complications of pregnancy if unmanaged. This can be something as simple as being prone to anemia (having low iron levels) or can be an autoimmune, blood sugar, skin, or blood pressure problem.
While the changes in each trimester (see below) are bound to happen, how you respond to them is partly determined by your health status. And the good news is that with good nutrition, preventive care can improve your outcomes and also how you feel during pregnancy. This case study discusses early pregnancy complications and how to reduce your risk.
How The Body Naturally Changes During Pregnancy
The growth of an embryo to a baby means the entire body needs to adjust over the full term of pregnancy. Every organ in your body has to adjust and also many move to make room for a growing baby. The amazing thing is every week has a new milestone for your baby’s growth and development.
First-Trimester body changes
During the first trimester, it’s normal for your heart rate and breathing rate to be faster. You might feel moody as your hormones change rapidly to adjust. Your breasts will become large and tender. You may suddenly feel unusually tired as your body works to grow the baby’s placenta.
If you are prone to experience morning sickness, this usually is most prominent in the first trimester. Another common symptom is having to pee frequently as the growing uterus puts pressure on your bladder. Night waking to go to the bathroom is common. Get used to frequent bathroom trips as it becomes a new normal—but don’t reduce your water consumption as you need to hydrate.
Second Trimester body changes
Many women love the second trimester. The baby is not so big that it hinders your sleep and movement, and the morning sickness and moodiness of the first trimester often wane. You will gain weight—close to 12 to 15 pounds at this point—and a very visible bump. Your hair and fingernails may become stronger (thank you extra hormones!) as many women experience “pregnancy hair” or the “pregnancy glow.” Cravings can really kick-in at this time as your body has increased nutrient demands that actually change with the trimester and depending on what the baby is doing at that moment.
Third Trimester Body changes
In the third trimester, you feel “full pregnant.” This means sleep and movement are distrubed and even sitting requires constant adjusting as there is new pressure on your back. You will continue to gain weight—around 10 to12 pounds can be normal. Much of this is the weight of your baby, but also the weight gain comes from amniotic fluid, the placenta, your breasts, your blood and your uterus. The baby also grows upward; you can feel this with pressure on your lungs, and your breath may be shortened. The uterus muscles tighten (called Braxton Hicks), but this is not to be confused with labor.
How Do You Evaluate A Woman’s Health Status During Pregnancy?
My client, Sara (not her real name), came to see me at 16 weeks pregnant at age 41. She had iron deficiency, hypertension, rheumatoid arthritis, hypothyroidism and gestational diabetes. The first thing I did was look at Sara’s lab work history to see if I could identify patterns and then I listened carefully to her health history.
As I have learned, so much can be pulled from looking at lab test results and medical records, and listening to a client’s story.
When did a condition start? What happened around that time? Has it gotten better or worse, and why?
Clients know their own health better than anyone—any doctor, any practitioner and even a family member. Your healthcare provider should be asking you questions and listening thoughtfully to your responses before determining any course of treatment.
The Role of Iron in Pregnancy
Sara said she had always been anemic, but had she been ruled out for the hereditary form of anemia? Low iron in pregnancy is problematic. Some low iron in pregnancy symptoms include fatigue, weakness, pale skin, irregular heartbeat and shortness of breath. We don’t want to over supplement iron with someone who has thalassemia minor. We reviewed her existing lab tests, determined she did not have hereditary anemia, and concluded instead that Sara was iron-deficient. The fact that she’s vegetarian and hadn’t been taking a prenatal multivitamin helped explain her condition.
Iron is very important in pregnancy as the body expands its blood volume to support both the new baby and mom. It also helps hemoglobin carry oxygen from the lungs to the rest of the body.
Pregnant women are prone to anemia, but you don’t want this to be exacerbated by lack of iron-containing foods and a good prenatal supplement. Having good iron stores can also help you recover from the blood loss that occurs during labor.
Iron status is one of the first things I check in all my pregnant clients.
Several helpful things you’ll want to know about iron:
Choose a supplement containing a bioavailable form of iron.
Eat iron-rich foods such as red meat, especially organ meat such as liver. (I know! Not the tastiest meat, but a phenomenal source of iron.) Also, nettle root tea, lentils, beans, and spinach.
Vitamin C is important for the uptake of iron, which is why you may have heard that you should drink orange juice with your iron supplement. You can also have fresh fruit right after a steak dinner. Fruits high in vitamin C include citrus, papaya, kiwi, mango and berries. Berries must be organic as they are high in pesticides and often found on the Environmental Working Group’s (EWG) annual Dirty Dozen List of the most pesticide-laden produce.
Using this approach with my client Sara, we were able to elevate her iron levels back within normal range in the course of 4 weeks.
Pregnancy and Blood Pressure
High blood pressure can occur during pregnancy especially if you are predisposed to it. It can be serious and should be monitored closely.
High blood pressure or low blood pressure in pregnancy is a risk factor for preeclampsia.I recommend having an at-home blood pressure cuff if you are screened and identified as having high blood pressure or have a history of it before pregnancy. Blood pressure changes with stress, exercise, and diet so make sure you monitor your blood pressure correctly and at the same time everyday to make sure you are comparing apples to apples.
Foods and supplements that can help with blood pressure are magnesium, potassium, and calcium. That is your leafy greens, dairy and fruits. Sound familiar? Also, foods that help produce Nitric Oxide like Coenzyme Cq10, cocoa and garlic can be helpful. Fatty fish, salmon and sardines are good, too.
In her case, we gave Sara a special electrolyte cocktail that had calcium in addition to magnesium, sodium, and potassium at the right ratio. We added fish twice a week, leafy greens with lunch and dinner, and continued the fresh fruit for potassium.
In addition, I gave Sara simple deep breathing exercises to do daily and when under stress. Her blood pressure moved within normal range, but was variable. She monitored daily and checked in with her physician, who encouraged her to maintain the dietary changes given the positive impact she was experiencing, and decided to hold off on blood pressure medication.
Her blood pressure did rise in the last weeks of her pregnancy and she was induced early to avoid any unnecessary risk.
Rheumatoid Arthritis and Pregnancy
Autoimmune conditions, which may behave differently in pregnancy, can frequently be effectively managed.
Autoimmunity during pregnancy has fewer published studies than iron-deficiency anemia, for example. It is very important to keep in touch with your physician who monitors this condition.
Sara was taking a strong medication to manage her condition that she was concerned about during pregnancy. Her doctor was worried about switching and recommended continuing on her current drug regime while pregnant.
We focused on Sara reducing sugar and caffeine (two known triggers for autoimmunity) as well as on adding anti-inflammatory foods and supplements, specifically gamma-linoleic acid (GLA) and an Omega-6 and Omega-3 fish oil at a specific ratio, to reduce inflammation.
Sara noticed a discernible difference in her joint pain. We also added epsom salt foot soaks and hand soaks to reduce her discomfort. Epsom salts are a source of magnesium and can reduce muscle tension and ache.
I also checked Sara’s vitamin D3. She was borderline deficient and we supplemented. Vitamin D3 is an important immune modulator. Sara actually was able to stop her medication, under the guidance of her physician, for her second and third trimesters. Her joint pain was reduced and bearable.
I will note that clients ask if pregnancy can cause rheumatoid arthritis. The additional weight on the body can put pressure on the joints, but this is different than having rheumatoid arthritis.
Hypothyroidism and Pregnancy
As your OB-GYN may have told you, thyroid hormones are important and should be monitored throughout your pregnancy. There are several risk factors associated with the thyroid. These include an under-active thyroid in pregnancy or an over-active thyroid in pregnancy. Hypothyroidism can make it harder to conceive and hold a pregnancy. Even if you are pregnant, hypothyroidism has risks and it is important to get the medical care you need to closely monitor that condition. Sara had a history of hypothyroidism, and under the care of her endocrinologist, she was taking thyroid medication to address this long-standing issue.
I did not change anything other than make her aware of foods that can interact with thyroid medication if taken at the same time.
A common example that is often frequently overlooked is calcium/magnesium. Often people take thyroid medication with breakfast cereal and milk. Or with green tea, which is a natural source of fluoride that can bind the thyroid hormone.
Thyroid medication should be taken a full hour before breakfast. In fact, I suggest holding off on all supplements that contain magnesium and calcium, such as prenatal vitamins, until lunch time.
Also, uncooked cruciferous vegetables can interfere with thyroid hormones and should instead be cooked and not consumed around the same time.
Excess use of fiber and coffee can interact with thyroid supplements if taken around the same time. Also iron deficiency can play a role in thyroxine’s (thyroid hormone) ability to be utilized by the cells. Checking iron status, which we already did with Sara, is important when checking thyroid levels.
These simple food tips are good management for hypothyroidism during pregnancy.
Gestational diabetes
Gestational diabetes can occur during pregnancy. Gestational diabetes can not have any obvious symptoms or symptoms can include increased thirst and urination (two things you will have even if you don’t have gestational diabetes). In the case of my client, Sara's fasting blood sugar was elevated as was her HbA1c. Her doctor told her “It’s a permanent condition that can’t be reversed.”
We added exercises daily with walking and resistance bands (so as not to inflame her arthritis), low-glycemic foods and snacks, timed meals, and chromium supplementation. Her HbA1c and fasting blood glucose went from abnormal to normal in 4 weeks and maintained at a normal level, with some fluctuation. Her OGTT came back normal!
You can absolutely alter blood glucose and this reduces risk for a series of complications for baby and mom in pregnancy and labor.
She stopped her low-glycemic food plan and chromium post pregnancy and her blood sugar rose accordingly. We now have her back on it.
Sara’s Outcomes
Sara delivered a healthy baby boy at 32 weeks. She was induced because at 31 weeks her blood pressure rose and her physicians felt it was the best thing to do. With her urging, she had a vaginal delivery and now has a healthy baby boy.
As it can be seen with this case study of Sara, you can have pre-existing conditions that can be helped by consulting with a functional medicine nutritionist.
You do not need to accept that you will permanently have these conditions and that they will not improve. At the very least, nutrition can make you feel better. At best, you can reduce the symptoms and address the underlying issues to have a better outcome for your pregnancy, labor, and ultimately a healthier baby and a healthier you.
If you are pregnant and want the help of a functional nutritionist, you can book here to get your full evaluation. Our health isn’t a permanent condition. It’s fluid; it can be changed and improved. The beauty of functional medicine is that we are not only looking to treat the root causes of disease, but to prevent disease in the first place, and to help you find your place of greatest well-being.
I am always looking to provide guidance for optimum health, so you feel like your very best.
Would you like to talk?
Annina is a PhD, Registered Dietitian, Licensed Dietitian Nutritionist and Board Certified in Functional Medicine specializing in nutrition and functional medicine for fertility, pregnancy and new mom and baby. She has 7 years of practice experience and has co-authored several books on infant, child nutrition and obesity prevention.