July 16, 2012
A 33-year-old pregnant woman at 20 weeks collapses while attending a church function and a physician at the scene began receives CPR (cardiopulmonary resuscitation). According to a recent article in the Annals of Emergency Medicine, emergency workers arrive and shock her heart out of a life-threatening irregular heart rhythm and 25 minutes later, it beats in a normal pattern. The patient however, appears to be in a coma which occurs when the brain doesn’t receive enough oxygen. The hospital physicians enter unchartered water and perform a procedure that has rarely been done in pregnant women. They cooled her body temperature to 90 degrees, a procedure known as hypothermia for an hour in an attempt to improve her condition and then slowly rewarmed her body back to its normal temperature in order to save her life. It worked and during the procedure an ultrasound showed the fetus shivering.
Heart conditions during pregnancy are rare, affecting only 1 to 4% of patients. This particularly patient had a condition called cardiomyopathy which is an enlargement of the heart, causes heart failure and is often fatal. It is a disease that hits close to home because it killed my grandmother six months after she delivered my aunt. The heart is considered a pump that helps circulate blood throughout the body and heart failure means the “pump” is not working properly. No one knows exactly why cardiomyopathy occurs but it tends to affect
- women over 30
- African American women and
- women who have several children
Fortunately, the patient had a device implanted 8 days after her heart attack that helped her heart beat in a normal pattern. The patient was discharged home from the hospital after 10 days, returned to work in 4 weeks and then delivered a normal baby boy at 39 weeks who weighed 5 lbs. 15 oz. The baby was evaluated at 1, 2, 3, 6, 12 and 36 months of age and is completely normal.
Although hypothermia has been used as a treatment for heart attack victims since 2005, pregnant women were previously excluded. However as a result of this case, I suspect they won’t be excluded anymore.
December 18, 2009
While we’re aware that obesity in developed countries is approaching epidemic levels, I’m not certain whether the strategy in the Healthy Moms study is the correct approach.
The federal government is paying researchers $2.2 million dollars over a 4-year period in an attempt to prevent obese pregnant women from gaining any weight during the course of their pregnancy. If the participants gain weight, it is to be limited to 3 percent of their baseline weight. While this appears to be a noble endeavor, the goal of zero weight gain during pregnancy is unrealistic. The average pregnancy requires 80,000 additional calories over pre-pregnancy requirement which amounts to approximately 300 additional calories per day. The study recommends an intake of 100 to 300. If we take the lower recommendation of 100 additional calories per day, that would amount to an 8 pound weight gain during pregnancy because 3500 calories equals one pound. The Institute of Medicine’s recommendation is a total weight gain of eleven pounds for obese pregnant moms. This appears to be more practical.
The greater concern is what effect will calorie restrictions have on the fetus and newborn? The additional 300 calories is needed for proper fetal development and growth. Will there be risks of fetal growth restriction (the baby not growing properly)? Nutritional deficits based upon increased fetal demands and less calories? The majority of pregnant women complain of having an increased appetite when taking prenatal vitamins which is necessary for proper fetal development. How will that issue be addressed?
We are well aware of the adverse consequences that obesity can have on pregnancy outcomes. However, zero prenatal weight gain is pushing the envelope. What long-term neurological or developmental effects will this diet have on babies? Let’s keep a close eye on the developments of this study as they unfold.