My patients are often surprised when I mention breastfeeding can safeguard a woman’s heart health.

Here’s what we know

Several studies have found breastfeeding lowers a woman’s risk of both heart attack and stroke. This is pretty significant: the Heart and Stroke Foundation of Canada estimates 31,000 women in Canada die every year from heart disease and stroke. The studies published in the Journal of the American Heart Association and show a link between breastfeeding and a lower risk of developing diabetes, high cholesterol, high blood pressure, heart disease and stroke far beyond a woman’s breastfeeding years. (The studies can be viewed here and here)

This is compelling support. I strongly recommend breastfeeding to my patients, especially those who may have developed preeclampsia or gestational diabetes during their pregnancy. The protective benefits of breastfeeding stretch to your post-menopausal years.

What we don’t know yet is why breastfeeding is so helpful for mother’s heart health. Some suggest it could be that breastfeeding releases the hormone oxytocin which relaxes blood vessels. Or that the impact of breastfeeding on helping to lose pregnancy-related weight may change a woman’s metabolism and lower risk of heart disease and stroke.

During your doctors’ appointments (during pregnancy and beyond)

There are some common complications in pregnancy — like gestational diabetes and preeclampsia — that are associated with an increased risk of heart disease. Be sure to share your pregnancy history with your family doctor.

The great news is that your heart health is linked to many factors in your control, like the foods you eat, your activity level and whether you smoke. There is a lot to do to help lower your risk for developing heart disease.

Getting help breastfeeding

If you’re having problems with breastfeeding, there is a lot of help out there. Visit sunnybrook.ca/womenandbabies for tips and information.

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If you’re thinking of having a child, a preconception visit with a health-care professional is a good way to start. Surprisingly, many women are not aware of this.

Good health for mom and baby starts before pregnancy. Ideally, I like to sit down with women before they’ve gone to the drug store to buy a pregnancy test kit to confirm they are pregnant.

There are lots of things to consider and discuss before you get pregnant. It’s much more than taking a prenatal vitamin, and it may be a little overwhelming at the start, but planning ahead is key. It’s similar to a marathon: you would never attempt to run one without training for it!

What to expect at a preconception appointment

I suggest my patients bring a list of questions they might have about conceiving. For example, topics such as travel, genetic carrier screening, drugs, healthy weight, exercise and an immunization update should be part of the preconception discussion. We know so much more today about pregnancy than when our parents were having babies and information changes!

A full review of your medical history (family and personal) is also an important point of discussion. It’s key that any potential risks are addressed with your doctor, and any pre-existing medical issues are covered. This includes diabetes, high blood pressure, epilepsy or heart disease.

Pregnancy and birth involve many physical and emotional changes, and preparing your body (and a healthy start) is just as important as your overall health during and after pregnancy.

Family physicians provide personalized care that builds upon the long-term relationships they have with women and their families across the lifespan. We promote good health before, during and after pregnancy. In essence, we look after the whole person: the mother as well as the health of the baby.

Did you know? There’s a profound link between a woman’s health pre-pregnancy, during pregnancy, and her future health.

Want to learn more about good health before, during and after pregnancy? Looking for a family physician who can guide you through the pregnancy journey and delivers at Sunnybrook? You’re invited to attend Sunnybrook’s Family Medicine Obstetrics Community Open House! Learn more and register.

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Here are my tips for pregnant women:

1. You’re protecting yourself and your baby: Whatever stage of pregnancy you’re at, the flu vaccine keeps you and your baby healthy. Pregnant women are at a much higher risk of hospitalization from influenza – four times more likely to land in a hospital ward than a non-pregnant person. When you’re vaccinated, you develop antibodies to protect your body from the virus. In turn, you also pass along these antibodies to your baby, so she will be protected during her most vulnerable months after birth.
2. Don’t delay (it’s free and easy to access): There are so many places to receive the flu vaccination. From local pharmacies, to your doctor’s office, to public health flu clinics, it is free and easily available. Add it to your list of errands.
3. “But I’m really healthy”: Even if you have a healthy diet, exercise, take your vitamins and get lots of rest, changes in your immune, heart and lung functions during pregnancy make you more likely to get seriously ill from the flu.
4. No link between flu vaccine and autism: Some of my patients are determined to have a “natural” pregnancy and feel anxious about being vaccinated. There is no link between vaccines and autism, in fact there have been several scientific studies refuting this claim. Speak with your doctor if this is a concern.
5. Don’t take a chance: Severe illness in a pregnant mother can be dangerous to your fetus, and increases the chance for serious problems such as premature labour and delivery.

What if…you get the flu when you’re pregnant?

If you do find yourself with the telltale symptoms – fever, chills, cough, sore throat, headaches, muscle and body aches and fatigue – call your doctor right away. There are antiviral drugs that can treat the flu and help prevent serious flu complications. These drugs are safe for pregnant women. Your fever can cause problems with your unborn baby, speak to your doctor about reducing your fever with Tylenol.

Every day, I see mothers agonize over decisions related to their pregnancy. Receiving the flu vaccination should not be one of them. It’s a no-brainer: get vaccinated to protect yourself and your baby. And don’t forget the usual steps you should take every year, like cleaning your hands regularly to combat any viruses you may come into contact with.

Stay healthy and enjoy your pregnancy!

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Exercise plays an important role in our lives and helps to improve fitness and reduce the risk of many chronic diseases like diabetes, heart disease and cancer. With planning, new moms can fit exercise in with the demands of a new baby. Walking is an excellent form of exercise which can include baby in the stroller as well as enjoying the benefits afforded by group support. Many choose to walk with friends or join a walking mother’s group in their area. Moms may enjoy time walking with their partner and children to improve the health of the entire family. Public health units and local Community Health Centres can also help women connect with exercise options in their area.

That said, many breastfeeding mothers worry about whether exercise can affect breastfeeding, milk supply, and baby’s growth.

Exercise and the new mother 

Exercise improves wellbeing in so many ways. Exercise is good medicine across the lifespan and an opportunity to role model healthy lifestyle for the entire family while improving your health. Exercise improves heart health, fitness, energy, bone strength, facilitates return to pre-pregnancy weight and reduces rates of postpartum depression and anxiety.

Exercise and breast milk supply

Exercise at high intensity does lead to accumulations of lactic acid as most of us have experienced. Lactic acid does increase in breast milk following intense exercise however mild to moderate exercise in keeping with our current guidelines does not increase lactic acid significantly. Even if you are an elite athlete, there is no evidence increased lactic acid levels in breast milk is a concern for your baby. The bottom line is that quality of breast milk is not impacted and moderate exercise does not impact your baby’s growth.

Tips for success

1. Breastfeed prior to exercising (empty breasts are more comfortable)
2. Wear a supportive bra for increased comfort especially with higher impact exercise
3. Focus on hydration and drink water. Remember, you’re hydrating for two
4. Look for options to exercise together as a family or with a group for support
5. Talk to your physician, midwife or breastfeeding clinic for further advice

For more info, visit the Society of Obstetricians and Gynaecologists of Canada website.

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Here are my tips for pregnant women:

1. Stay active: Physical activity in pregnancy has minimal risks and has been shown to benefit most women.  Of course, your body is changing with a little one on board, so you may need to modify your exercise routine.  I recommend my pregnant patients with uncomplicated pregnancies do aerobic and strength-conditioning exercises before, during, and after pregnancy.  The impact of exercise on reducing your risk of gestational diabetes, and on maintaining a healthy weight, have positive implications for both you and your baby. Exercising for two helps both of you to be heart healthy for life!
2. Keep an eye on the scale: There are guidelines for recommended weight gain during pregnancy, and for good reason: women who gain more than the recommended weight are at risk of complications for both themselves and their unborn children even if their pre-pregnancy weight is in the normal range. When eating for two you are not eating as if you are two! Pop culture, including TV and movies, can play into the idea that pregnant women can or should eat whatever they like (tub of Ben and Jerry’s anyone)! The reality is that currently almost half of Canadian women of childbearing age are overweight or obese, which is associated with an increased risk of gestational diabetes, hypertensive disorders in pregnancy, thromboembolic disease (blood clots formed in blood vessels) and operative deliveries.  A healthy diet and staying within the guidelines of recommended weight gain goes a long way in setting you and your baby up for good health both now and in the future!
3. Share your pregnancy history with your family doctor: After your baby is born, be sure to fill in your family doctor about your pregnancy.  You may have seen an obstetrician, midwife, or family physician for your pregnancy but your family doctor may not be aware of your pregnancy history or complications. What happens in pregnancy is important for your future health as well as for planning for next time. If you developed gestational diabetes, you have a 10 to 20 per cent risk of developing type 2 diabetes over the next 10 years.  Knowing this can help you and your primary care doctor develop a plan together to reduce that risk. Women with a hypertensive disorder in pregnancy are at higher risk of developing earlier high blood pressure, heart disease and stroke but knowing this history helps you and your family physician make the changes together to change that future. Take advantage of the opportunity provided by pregnancy to change the future.

Pregnancy is a wonderful opportunity to embrace lifestyle changes with support that benefit both you and your family, “when it matters most”

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