Early obesity in women may be linked with difficulty in becoming pregnant. Women who became obese by age 18 and participated in a weight-loss surgery study showed higher rates of infertility and polycystic ovarian syndrome (PCOS).

Forty-two percent of the women in the study trying to conceive experienced infertility, but pregnancy was more likely for women who became obese after age 18. The good news is, surgical weight loss may increase fertility.

The study, the Longitudinal Assessment of Bariatric Surgery (LABS), provided information on the fertility of obese women considering surgical weight loss procedures.

Obesity can interfere with a woman’s hormone levels, making it difficult to become pregnant. This also makes vitro procedures less likely to work. Even in the event of conception, there are major health risks to both mother and child. Not only are miscarriage rates higher, but there are also a higher rates of premature and still-births.

Weight loss surgery, also known as bariatric or metabolic surgery, which includes gastric bypass surgery and lap banding, may help obese women trying to conceive. Many women don't know that having such a procedure is an option.

Research shows that bariatric surgery can reduce pregnancy complications for obese women, and LABS participants were no exception. Roughly 62 percent of LABS participants who underwent surgery who hoped to conceive experienced at least one live birth after infertility.

After weight loss surgery, doctors advise women to wait at least 18 months after surgery (6 months after banding) before trying to become pregnant. They also suggest using contraceptives while waiting for the body to become more stable.

“As the incidence of obesity increases in the United States, women’s health care practitioners are likely to care for a substantial number of patients who will undergo bariatric surgery,” says Dr. William Gibbons of the American Society for Reproductive Medicine. “Studies like this one are extremely useful to help us determine how to advise these patients and best meet their needs.”

Find more information about pregnancy after bariatric surgery, or test your knowledge with Healia’s Pregnancy Quiz.

Glucose intolerance during pregnancy may put women at greater risk for heart disease. According to Baiju Shah, MD, PhD, FRCP, of the Institute for Clinical and Evaluative Sciences in Toronto, co-author of a recent study on women with gestational diabetes, even mild glucose intolerance—below the threshold for gestational diabetes—increases the chances of later cardiovascular disease. 
Gestational diabetes had been connected to cardiovascular disease prior to this study, but little was known of the links between minor glucose intolerance and heart disease. Type 2 diabetes and cardiovascular disease share several characteristics including obesity, insulin resistance and cholesterol problems. Oftentimes, individuals with one condition will develop the other. Women with gestational diabetes may experience similar metabolic complications as soon as 3 months after giving birth.

Researchers analyzed the medical records of all Ontario women between the ages of 20 and 49 who had given birth between April 1994 and March 1998.  Participants were divided into three groups: those who were diagnosed with gestational diabetes, those who received an oral glucose tolerance test, and those who were not screened using oral glucose testing. One birth was selected at random for women with multiple deliveries; the median ages were between 29.2 and 31.1.

Women are tested for gestational diabetes (a type of diabetes that develops when women experience unusually high glucose levels during pregnancy) during the second trimester of pregnancy (13-27 weeks). The first step is a glucose challenge test, taken by measuring glucose levels one hour after ingesting a sugary substance such as glucola. If results are abnormal (≥7.8 mmol/L), a second oral glucose tolerance test (OGGT) is taken.

Participants in the study were followed up until March 31, 2008, providing information reflecting cardiovascular disease development for a median of 12.3 years after childbirth. “If you followed 10,000 people for one year, 4.2 of them would have an event,” Dr. Shah explains. “If you followed those 10,000 people for 10 years, 42 of them would have an event…In other words, these are extremely rare events.”

Although the differences were minor—absolute risk was 0.16% and 0.05% for women with gestational diabetes and women who received an OGGT, respectively—the results indicate a need for further research. "We shouldn't be ignoring these mild abnormalities during pregnancy,” Dr. Shah says. “(They) may benefit from extra surveillance and/or cardiovascular disease screening.”

More information is needed to establish the exact relationship between glucose intolerance and cardiovascular disease. In the meantime, proper nutrition and exercise may reduce your risk for both gestational diabetes and cardiovascular disease.

Read more about gestational diabetes and cardiovascular disease.

 The air quality in and around your home may have negative effects on your child’s intelligence, according to a study by Columbia University Center for Children’s Environmental Health (CCCEH).

The study, released a week ago by the National Institute of Environmental Health Sciences (NIEHS), found that children exposed to chemical pollutants called polycyclic aromatic hydrocarbons found in the air, water, and soil scored lower on IQ tests than children with lower exposure.

Polycyclic aromatic hydrocarbons, or PAHs, are chemical pollutants that can be found in the air, water, and soil. PAHs are typically released from the burning of fossil fuels (coal, diesel, oil, gas, etc.), tobacco and other natural substances. Auto emissions are a major source of PAHs in the United States, especially in heavily trafficked urban areas.

Doctor Frederica Perera, lead author and professor of Environmental Health Sciences at Columbia University Mailman School of Public Health, compares the exposure to such pollutants to low-level lead exposure. “These findings are of concern because these decreases in IQ could be educationally meaningful in terms of school performance,” she says. “IQ is an important predictor of future academic performance.”

A child’s developing fetal and nervous system is more vulnerable than an adult’s, and PAHs have been associated with higher cancer risk, asthma, allergies, low birth weight, and a reduced head circumference. Reduced head circumference, according to CCCEH, is connected with lower cognitive functioning and academic performance. In this study, the first of its kind, researchers hoped to study the relationship of in utero PAH exposure on a child’s intelligence.
 
Participants were non-smoking black and Dominican-American women, aged 18-35, residing in Washington Heights, Harlem and South Bronx, N.Y.—areas with higher pollutant exposure. During pregnancy participants regularly completed questionnaires and were asked to wear monitors that measured PAH levels.

Researchers followed the children, measuring IQ levels at age three and again at age five using the Wechsler Preschool and Primary Scale of the Intelligence. Of the 249 children, 140 had higher than the average 2.26 n/m3 level of exposure. The mean score for all children was 98.72, with a mean score of 96.6 for children whose exposure was classified as “high” and 101.6 for children with lower exposure. Scores differed by 4.67 on the verbal and 4.31 points on the full-scale test.

Researchers will continue to follow children to age 11 to learn more about the effects of PAHs on intelligence and child development. “It should serve as a warning bell to us all,” says Linda Birnbaum, Ph.D., director of NIEHS. “We need to do more to prevent environmental exposures from harming our children.”

Want more information about health during pregnancy? Visit Healia's Pregnancy Community or take the Healia Pregnancy Quiz!

Obese women should limit weight gain to between 11 and 20 pounds during gestation, according to an updated set of pregnancy weight gain guidelines released Thursday by the Institute of Medicine. Previously, the Institute did not recommend a specific gestational weight gain range for obese women, but the section was added in response to increasing obesity rates and high weight gain trends in pregnant women. This is the first time the Institute has issued new pregnancy weight gain guidelines in nearly 20 years.

The Institute of Medicine also reevaluated the weight gain recommendations for overweight, normal weight, and underweight women, though the alterations in these weight groups were minute. The Institute now suggests overweight women gain between 15 and 25 pounds, normal weight women gain 25 to 35 pounds, and underweight women gain 28 to 40 pounds during gestation.

These guidelines are based on multiple factors affecting the health of the mother and embryo. Most central to the Institute’s recommendations is the body mass index (BMI) of the expectant mother, a measurement based on acceptable weight to height ratios. Women with a BMI of 30 or greater are considered obese, while a BMI of 25 to 29.9 is considered overweight. Normal weight women have BMIs between 18.5 and 24.9 and a BMI below 18.5 falls in the underweight range.

To measure your BMI, visit the National Institute of Health’s body mass index calculator.

Test your pregnancy knowledge on the Healia Pregnancy Quiz and challenge yourself on the Weight Management Quiz. After taking the quizzes, visit the Healia Pregnancy Health Guide for more pregnancy information and check out the Healia Obesity and Overweight Health Guide to learn more about weight gain.

^{Photo: Crystal_1979, Flickr, Creative Commons}

While some in the government expressed alarm after the National Center for Health Statistics, a part of the Center for Disease Control and Prevention, released a document in March stating births to unwed mother reached an all-time high of nearly 40 percent, the rate of births out of wedlock remains low in many states. The National Vital Statistics Report entitled "Births: Preliminary data for 2007"  provides data on all births in United States in 2007 and includes information on the rate of births to unwed mothers in each state. Below is a list of the states with the lowest unwed mother birth rates; each state is followed in parentheses by the percentage of all live births in that state to unwed mothers.


The top 10 states with the lowest rate of births to unwed mothers are:

Utah (19.6%)
Colorado (25.4%)
Idaho (25.5%)
New Hampshire (31.4%)
North Dakota (32.6%)
Minnesota (32.7%)
Washington (33.2%)
Massachusetts (33.4%)
Nebraska (33.4%)
Iowa (34.3%)

For more information about birth, join the Healia Online Community for Pregnancy or the Healia Online Support Group for Childbirth. Find out more about pregnancy by reading the Healia Health Guide to Pregnancy.

Source: National Center for Health Statistics, National vital statistics reports, Births: Preliminary data for 2007, Web release 03/09; vol 57 no 12. http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf

While the percentage of babies born prematurely has risen by one-third since the 1980s, the rate dropped by 1 percent in 2007 compared to the previous year to a rate of 12.7 percent. Premature or preterm babies are defined as those born before the 37th week of pregnancy. Babies born between the 37th and 40th week are considered full-term. This data comes from a recent national vital statistics report from the National Center for Health Statistics, a part of the CDC, called Births: Preliminary data for 2007. The report contains data on all births in the U.S. during 2007, including information on the rates of premature in each state. Several states still have relatively high rate of premature births and the top 10 are listed below, with the percentage of all live births that were premature appearing in parentheses.

The top 10 states with the highest rates of preterm births are:

Mississippi (18.3%)
Alabama (16.6%)
Louisiana (16.5%)
South Carolina (15.5%)
Kentucky (15.2%)
Delaware (14.3%)
Nevada (14.3%)
Tennessee (14.2%)
Arkansas (13.9%)
West Virginia (13.9%)


For more information about birth, join the Healia Online Community for Pregnancy or the Healia Online Support Group for Childbirth. Find out more about pregnancy by reading the Healia Health Guide to Pregnancy.

Source: National Center for Health Statistics, National vital statistics reports, Births: Preliminary data for 2007, Web release 03/09; vol 57 no 12. http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf

_{Photo: César Rincón, Flickr, Creative Commons}

While cheese and other dairy products can be a great source of calcium and other nutrients during pregnancy, there are some you avoid completely. Specifically, you should avoid any product that contains unpasteurized milk. Unpasteurized milk may contain Listeria bacteria that can cause miscarriage. That means no unpasteurized or "raw" milk and no imported soft cheeses unless they are clearly labeled as being pasteurized. While the former is pretty easy to avoid (you have to go out of your way to find unpasteurized milk), you may not even realize when you are eating unpasteurized cheese. If you are at a restaurant, ask to make sure that any soft cheese you are served is pasteurized, or just ask them to substitute a hard cheese such as mozzarella instead.

Unless these soft cheeses are clearly labeled as being made with pasteurized milk, do not eat them while pregnant:

• Roquefort
• Feta
• Gorgonzola
• Brie
• Camembert
• Blue cheese
• Mexican-style cheeses, such as queso blanco, queso fresco, queso de hoja, queso de crema and queso asadero

For more information on proper nutrition during pregnancy, see the Healia Health Guide on Pregnancy. If you have questions about whether a certain food is OK to eat, ask the people in the Healia Health Community for Pregnancy.

Related blog posts: Tips for Eating Healthy During Pregnancy: what to eat when you are pregnant
Tips for Eating Healthy During Pregnancy Part 2: 13 foods and beverages to avoid when you are pregnant
Tips for Eating Healthy During Pregnancy Part 3: fish with the highest and lowest levels of mercury

_{Source: American Pregnancy Association, Foods to Avoid During Pregnancy, Updated 11/07 http://www.americanpregnancy.org/pregnancyhealth/foodstoavoid.html}

_{Photo: JacobEnos, Flickr, Creatvie Commons}

Fish is a very healthy food with lots of omega-3 fatty acids that are necessary for the brain development of a growing fetus. Unfortunately, some types of fish contain high levels of mercury, a highly toxic chemical that can cause serious birth defects if a pregnant woman consumes too much of it. Fish with the highest levels of mercury should not be consumed at all during pregnancy, while those with the lowest levels can be safely consumed twice a week. Fish with intermediate levels of mercury should be eaten in moderation during pregnancy. The following is a grouping of the most common types of fish based on their mercury content.

Fish with the highest mercury levels
Avoid these fish entirely during pregnancy

• Grouper
• Marlin
• Orange roughy
• Tilefish
• Swordfish
• Shark
• Mackerel (king)

Fish with medium to high mercury levels
Eat no more than three, 6-oz servings per month

• Saltwater Bass
• Croaker
• Halibut
• Tuna (canned, white albacore, fresh bluefin, ahi)
• Sea trout
• Bluefish
• Lobster (American/Maine)

Fish with low to medium levels of mercury
Eat no more than six, 6-oz servings per month

• Carp
• Mahi Mahi
• Crab (Dungeness, blue, snow)
• Snapper
• Herring
• Monkfish
• Perch (freshwater)
• Skate
• Cod
• Tuna (chunk light canned, fresh Pacific albacore)

Fish with the lowest levels of mercury
Eat up to two, 6-oz servings per week

• Anchovies
• Butterfish
• Calamari (squid)
• Caviar (farmed)
• Crab (king)
• Pollock
• Catfish
• Whitefish
• Perch (ocean)
• Scallops
• Flounder
• Haddock
• Hake
• Herring
• Lobster (spiny/rock)
• Shad
• Sole
• Crawfish
• Salmon
• Shrimp
• Clams
• Tilapia
• Oysters
• Sardines
• Sturgeon (farmed)
• Trout (freshwater)

For more information on proper nutrition during pregnancy, see the Healia Health Guide on Pregnancy. If you have questions about whether a certain food is OK to eat, ask the people in the Healia Health Community for Pregnancy.

Related blog posts: Tips for Eating Healthy During Pregnancy: what to eat when you are pregnant
Tips for Eating Healthy During Pregnancy Part 2: 13 foods and beverages to avoid when you are pregnant

_{Source: American Pregnancy Association, Mercury Levels in Fish, updated 3/07. http://www.americanpregnancy.org/pregnancyhealth/fishmercury.htm}

_{Photo: hyku, Flickr, Creative Commons}

Good nutrition is especially important during pregnancy, which means eating a well-balanced and varied diet. This will ensure that your developing baby gets all essential vitamins and minerals that he or she needs. Healthy nutrition during pregnancy also means avoiding foods that could put your pregnancy at risk or that might threaten the health of your unborn child. While most foods are safe to eat while pregnant, there are some foods and beverages that you should avoid during pregnancy.

13 foods and beverages to avoid during pregnancy are:

Undercooked Meat
Raw or undercooked seafood, beef, and poultry should be avoided during pregnancy because of the risk of contamination with coliform bacteria such as E. Coli, toxoplasmosis, and Salmonella. This means no sushi, medium rare prime rib, or pink hamburgers.

Deli Meat
Deli meats and cold cuts are sometimes contaminated with a bacterium called Listeria, which can cause miscarriage. Even though such contamination is rare, it is best not to take the chance. However, you can eat deli meats if you make certain that you heat the meat until it is steaming, then consume it before it cools down again.

Certain Types of Fish
While some types of fish are OK to eat in moderation during pregnancy, fish that contains high levels of mercury should be avoided altogether. Mercury is a highly toxic poison that, when consumed during pregnancy, can cause developmental delays and brain damage. The fish with some of the highest levels of mercury include shark, swordfish, king mackerel, and marlin.

Smoked Seafood
Fresh smoked seafood is often labeled as lox, nova style, kippered, or jerky and should be avoided because it may be contaminated with Listeria. However, it is usually alright to eat smoked fish if it has been cooked, such as if it is part of a pasta dish, or if it is canned.

Fish Exposed to Industrial Pollutants
Avoid fish caught in local lakes and rivers that may be contaminated with high levels of polychlorinated biphenyls (PCBs). These fish include: bluefish, striped bass, salmon, pike, trout, and walleye. Contact the local health department or Environmental Protection Agency to determine which fish are safe to eat in your area.

Raw Shellfish
Raw or undercooked shellfish, such as oysters, clams, and mussels may harbor bacteria that can make you sick. While cooking helps prevent this problem, it does not prevent the algae-related infections that are associated with red tides (a seasonal toxic infection of shellfish). Only eat shellfish that has been fully cooked and that has no risk of red tide poisoning.

Raw or Undercooked Eggs
Raw eggs or foods that contain raw eggs should be avoided because of the potential exposure to salmonella. Most commercial products available in stores do not contain raw eggs, but restaurants sometimes use raw or undercooked eggs in Caesar salad dressings, custards, or Hollandaise sauces; make sure to ask before ordering these at a restaurant.

Soft Cheeses
Imported soft cheeses may contain bacteria called Listeria, which can cause miscarriage. Avoid soft cheeses unless they clearly state that they are made from pasteurized milk. All soft non-imported cheeses made with pasteurized milk are safe to eat.

Unpasteurized Milk
Unpasteurized or "raw" milk may contain Listeria, which can cause miscarriage. Make sure that any milk you drink is pasteurized.

Pate
Refrigerated pate or meat spreads should be avoided because they may contain the bacteria Listeria, but canned pate, or shelf-safe meat spreads can be eaten.

Caffeine
Avoid caffeine during the first trimester to reduce the likelihood of a miscarriage. Later on during pregnancy, caffeine should be limited to less than 200 - 300 mg per day, which is equal to about a 16 ounce coffee from a national coffee chain. Caffeine is a diuretic, which can cause you to lose fluids along with needed calcium. The safest thing is to avoid caffeine completely.

Alcohol
Avoid alcohol completely as there is no amount of alcohol that is known to be safe during pregnancy. Repeat: NO AMOUNT of alcohol is safe during pregnancy. Prenatal exposure to alcohol can interfere with development and can lead to Fetal Alcohol Syndrome or other developmental disorders. If you consumed alcohol before you knew you were pregnant, stop drinking now. If you are breastfeeding, you should continue to avoid alcohol until you are done breastfeeding.

Unwashed Vegetables
Even vegetables can be contaminated with bacteria or parasites. While you should certainly be eating plenty of vegetables while you are pregnant, make sure they are thoroughly washed to avoid possible exposure to coliform bacteria or toxoplasmosis, which may contaminate the soil where the vegetables were grown.

Related blog post: Tips for Eating Healthy During Pregnancy: what to eat when you are pregnant

For more information on proper nutrition during pregnancy, see the Healia Health Guide on Pregnancy. If you have questions about whether a certain food is OK to eat, ask the people in the Healia Health Community for Pregnancy.

_{Source: American Pregnancy Association, Foods to Avoid During Pregnancy, 11/07. http://www.americanpregnancy.org/pregnancyhealth/foodstoavoid.html}

_{Photo: Mercury47, Flickr, Creative Commons}

Wondering what to eat to ensure a healthy pregnancy? Good nutrition is especially important during pregnancy, and you need to be taking in more calories than you usually would since you are "eating for two." However, being pregnant is not a license to eat as much as you want. Experts estimate that most women only need about 300 extra calories per day to support a baby’s growth and development. So instead of concentrating on eating more, you just need to think about eating smart and making sure that most of your choices are healthy ones. Maintain control over your portions; it can be very easy to eat too much without even realizing it. Try to eat foods from each of the five food groups every day. You should also limit sugar and fat intake, which is good advice for any time in your life.

To ensure healthy nutrition during pregnancy, consume the following:

Grains: 6 Ounces per Day
1 ounce of grains is equal to:

• 1 slice bread
• 1 cup ready-to-eat cereal
• ½ cup cooked rice, pasta or cereal
• 1 small pancake (4 ½" in diameter)
• 1 small tortilla (6" in diameter)

Vegetables: 2 ½ Cups per Day
1 cup of vegetables is equal to:

• 1 cup raw or cooked vegetables
• 1 cup vegetable juice
• 2 cups raw, leafy greens
• 1 medium baked potato (2 ½" to 3" in diameter; go easy on the butter, bacon bits and sour cream)

Fruits: 1 ½ to 2 Cups per Day
½ cup of fruit is equal to:

• ½ cup 100% fruit juice
• ½ cup fresh, frozen or canned fruit
• ½ a fruit (small orange, apple or banana)
• ¼ cup dried fruit
• 16 grapes

Milk Products: 3 Cups per Day
1 cup of milk products is equal to:

• 1 cup milk
• 1 cup yogurt
• 1 ½ ounces natural cheese (examples: cheddar, parmesan)
• 2 ounces processed cheese (example: American)

Proteins: 5 to 5 ½ Ounces per Day
1 ounce of protein is equal to:

• 1 tablespoon peanut butter
• ¼ cup cooked dried beans
• 1 ounce lean meat, poultry or fish
• 1 egg
• ½ cup nuts (12 almonds, 24 pistachios)

Folic Acid
Folic acid (also called folate) is a B vitamin that helps prevent birth defects of the developing brain and spinal cord (the neural tube). The critical time that folate is needed to prevent neural tube defects is during the first month of embryonic development. Because women may not even realize they are pregnant until after this period had passed, experts recommend that all women of childbearing age should take a multivitamin with 400 micrograms of folic acid every day before pregnancy and during early pregnancy, as part of a healthy diet.
Good food sources of folale include:

• Fortified breakfast cereals
• Enriched grain products
• Beans
• Leafy green vegetables
• Orange juice

Other Healthy Eating Tips

• Meals: Eat frequent small meals instead of three large ones. This can help relieve heartburn and abdominal discomfort that may accompany eating in the middle and late stages of pregnancy.
• Snacks: Chose healthy snacks, such as cheese, yogurt, fruit, nuts, and vegetables.
• Fluids: Drink at least six to eight glasses of water, juice, or milk every day.
• Vitamins: Take a prenatal vitamin every day. Ask your health care provider if you need to take an additional supplement such as iron or calcium, as well.
• Caffeine: Limit your caffeine intake, especially during the first trimester. Even small amounts of caffeine may increase the risk of miscarriage in early pregnancy.

For more information on proper nutrition during pregnancy, see the Healia Health Guide on Pregnancy. If you have questions about whether a certain food is OK to eat, ask the people in the Healia Health Community for Pregnancy.

_{Source: March of Dimes Pregnancy and Newborn Health Education Center, Eating Healthy, 2009. http://www.marchofdimes.com/pnhec/159_823.asp}

_{Photo: molly_darling, Flickr, Creative Commons}