Dr. Noor Ladhani is Maternal-Fetal Medicine (MFM) Specialist in Sunnybrook’s DAN Women & Babies Program. MFMs are part of a team providing high-quality care during labor and childbirth.

You really are living your work right now.

Yes, I’m a pregnant obstetrician! My first daughter is almost 3, so this will be my second child.

Is it hard changing your hat from caregiver to patient?

No, I just let my amazing team take care of me. I delivered my daughter at Sunnybrook and plan to do the same with this baby. I trust everybody and we have a great centre so I wouldn’t dream of delivering anywhere else.

Knowing what you know, does that make pregnancy and labour easier or harder?

It probably does both, so I try to focus on the positive. I know what people can do in pregnancy and what helps them feel “normal” and healthy – like staying active – so I try to focus on that. Of course, there are risks and sometimes things don’t go as planned.

Are you able to bond with your patients differently being pregnant?

I think it’s fun, but I try not to get too personal because everybody’s path is different. For example, even though I’m having a pregnancy where I’m able to work and be active, not everyone is on that same path.

What are your thoughts on giving personal advice?

I think if people ask for advice, then that’s fine. But unsolicited advice is always tricky. The thing we have to remember with advice is that not everything applies to everybody, and that’s why we do research studies. We also shouldn’t give advice we can’t follow ourselves.

Is there any professional advice you give to patients that you find hard to follow yourself?

We always say to have a healthy well-balanced diet, but sometimes our pregnancy appetite doesn’t allow us to follow those Health Canada nutrition guidelines completely! I do my best, but once in a while I’ll have ice cream and some salty snack foods.

Are people extra judgy during your pregnancy because you’re a doctor too?

Generally, no, but sometimes I wonder what people are thinking when I get my coffee order in the morning.

What’s the hardest part of being pregnant for you?

Just the anticipation of what this person is going to be like, when are they going to come and how our family will look afterwards.

And the best?

It’s fun to have a buddy with you all the time. I love the baby’s movement and reassurance of that.

What attracted you to this line of work?

I’m the first doctor in my family. I always had an interest in public health so after medical school I wanted to do something that was a normal part of a person’s life. That’s why obstetrics was interesting, but I also really liked the surgery and the medical specialization.

It will be quite the moment when you are delivering the babies of the babies you helped deliver.

That’s when I know it will be time to retire!

The post How to live like the experts: Maternal-Fetal Medicine Specialist Dr. Noor Ladhani shares her approach to pregnancy appeared first on Your Health Matters.

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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1. Spot the problem
2. Get the facts
3. Seek support

As a pregnant woman, you are likely receiving lots of advice about what to do, including what to eat. There is an overwhelming amount of information from friends, family, television, magazines, websites, and more. No wonder it can be a struggle to figure out what you should be eating for a healthy pregnancy. One common question is whether fish is safe to eat during pregnancy.

1. Spot the problem:

There is confusion about fish in pregnancy. Is it safe to eat fish while pregnant? How much, and what types of fish are recommended?

2. Get the facts:

Fish can be a healthy source of protein, fat, and omega-3 fats for mom and baby. Omega-3 fats such as EPA and DHA are important for the healthy development of baby’s brain, nerves and eyes. Pregnant women are recommended to eat two servings of low mercury fish per week. One serving of fish is about 75g (2.5 oz), ½ cup, or the size of the palm of your hand.

Pregnant women should choose low mercury fish such as basa, arctic char, herring, salmon, sardines, trout, or canned light tuna. Clams, mussels, scallops and shrimp are low in mercury too. Avoid large predator fish such as shark, marlin, pickerel, and tuna steak as they contain high mercury levels.

Some people also wonder if raw fish is safe in pregnancy. The main concern about raw fish is the risk of food-borne illness. Raw fish can be safe to eat in moderation as long as it is coming from a reputable source, stored and handled safely, and eaten within a few days. It is still important to choose a low mercury fish whether raw or cooked.

3. Seek support:

To learn more about mercury levels in fish, take a look at this information sheet from Toronto Public Health.

For more information about food-borne illness, read this statement from Motherisk.

To speak to a registered dietitian for trusted advice on nutrition, you can contact Eat Right Ontario at 1-877-510-510-2, or visit their website at eatrightontario.ca

Want more information about nutrition and pregnancy? Nutrition is one of the topics that will be covered at Sunnybrook’s Family Medicine Obstetrics Community Open House on Saturday, June 10. Learn more and register.

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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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As incredible as her professional achievements have been though, she says her greatest moment yet was becoming a mom one year ago. So who better to speak to the importance of exercise in pregnancy? Here is part of my conversation with Karen, talking about her leap from the Olympics to motherhood and back again.

Q: When you were training for the Olympics, what did your average week entail?

A: When I was training for the Games, it was six days a week up to six hours a day and it included trampoline sessions, weight training, cardio, Pilates, flexibility work. Lots of different things to be in peak form.

Q: Then along comes baby!

A: As an athlete, you’re always planning everything. So after the Olympics, I planned to get pregnant. I was in great shape and already taking prenatal vitamins at the Olympics. It took about three months and I was ecstatic that it happened so quickly. Then there was a complete change of pace. You can usually continue to exercise when you’re pregnant, but with trampoline, you have to stop because of the impact. I had to find other things to stay in shape, so biking, swimming.

Q: Did you plan out your exercise strategy with your doctor?

A: My doctor advised me on what I could do when I was pregnant and of course I followed those guidelines. I had to be very careful during my pregnancy because I had gestational diabetes. I’m an elite athlete with a healthy diet and have no family history, so I was shocked when I got the diagnosis, but these things can happen to anybody. I only gained about 35 pounds during my pregnancy and had to stay active throughout because of my condition.

Q: Did staying active help keep you in a positive mood?

A: It was a huge change with my body, but you’re growing a life and that’s such a magical thing! It was more about staying healthy and being in shape to last through the labor, which mine was 27 hours, so being in shape really helped with that. I had morning sickness for 19 weeks, 24 hours a day and it’s tough to exercise when you’re feeling like that, but I tried to do as much as I physically could and I think it made me feel better actually. My second and third trimesters were great.

Q: What was your training schedule like after the birth of your daughter?

A: After her birth, I had about 5 weeks of just baby time and rest. Then I started jogging again and my body was feeling better. About two months later I started in a gym with body weight exercises, just getting fit. I didn’t come back to trampoline until 5 months after having her. I had a good three months of weight training, cardio, just to have that strong base before trying to jump 20 feet in the air!

Q: What advice to you have for other women?

A: It’s really important to talk to your doctor about what you’re going to do. It’s good to be in shape before you get pregnant. And doing some form of exercise in pregnancy and after. But enjoy your baby! I wasn’t rushing back into training. It’s a special moment when your baby arrives and that’s your focus. Then you just slowly fit exercise back in when you can. It gives you more energy to be with your baby.

Q: How does motherhood compare to the Olympics?

I always thought achieving Olympic medals and standing on the podium were those moments, but nothing can compare to my daughter being born. That’s the most amazing moment so far for me.

For more information on exercise in pregnancy, check out these resources:

• Exercise+Pregnancy Hotline: 1-800-363-9353
• Health Canada
• PARmed X for Pregnancy
• Motherisk 
• Society of Obstetricians and Gynaecologists of Canada

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Dos and Don’ts

Exercise in Pregnancy:

Advised:
• talk to your doctor
• determine safe levels of activity for you
• switch to low-impact activities
• eat proper nutrients and stay hydrated
• be aware of the guidelines

Not Advised:
• starting an exercise program without physician consent
• participating in high-risk activities
• being sedentary unless so advised
• cutting back on necessary nutrients
• continuing activity if pain or bleeding occur

Exercise May
• lower the risk of gestational diabetes
• reduce the need for interventions in labour
• help mothers maintain a healthy weight
• reduce some aches and pains of pregnancy, like back pain

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