PRAKASH MURTHY'S BEST BLOG: March 2009

Sunday, March 15, 2009

DO U DRINK? THEN READ THIS FIRST

do u drink? then read this first
LIVER...

it is the principal organ which is affected due to ALCOHOL consumption{BEER drinking also}.

you may kow this but do u know that BRAIN IS DESTROYED..

do u know that indians are more prone to attack by ALCOHOLISM..continue reading...

WERNICKES DISEASE..BRAIN DAMAGE

due to BEER DRINKING , the neurons of the brain are damaged..this results in loss of memory..

{can u realise that there is loss of memory in u..then its due to drinking only..its prime time to stop it ya

before it stops you}

FATTY LIVER...

normally alcohol is deposited on the LIVER makes it tough to work..in progress of time LIVER FUNCTION IS LOST

INDIANS ARE MORE PRONE TO ATTACK BY ALCOHOL! WHY?

normally alcohol is converted to aldehyde and then to acid..to do so an enzyme ALDEHYDE DEHYDROGENASE is needed

but ASIANS lack this enzyme..so FASTER DEATH RATES compared to other countries...

DRINKING IS IMMORAL TOO NA?

dont start it..if u have , then stop it!

BREAST FEEDING REDUCES RISK OF DIABETES MELLITEUS

Breastfeeding and risk reduction
in type-2 diabetes
Breastfeeding may provide a degree of
long-term protection against the deve-
lopment of type-2 diabetes, which could
be of public health importance. Longer
duration of breastfeeding was associated
with reduced incidence of type-2 diabe-
tes mellitus in two large US cohorts of young and middle-aged women
16
, the
Nurses’ Health Studies I and II. In sup-
port of this, the Shanghai Women’s
Health Study also demonstrated that
longer duration of breastfeeding was as-
sociated with a reduced risk of type-2
diabetes mellitus, independently of known
risk factors for type-2 diabetes mellitus
17
.
Previous studies have documented a
lower prevalence of breastfeeding among
African–American infants than among
infants of other races/ethnicities
18
. There-
fore, it is advised that targeting popu-
lation subgroups at relatively high risk
both for type-2 diabetes and low preva-
lence of breastfeeding, may offer an im-
portant opportunity for primary prevention
of type-2 diabetes through promotion of
breastfeeding.
In our fast-paced and pre-packaged
world, it is easy to stay away from natu-
ral foods. However, when life is just
starting out, nothing is better for baby
than the most natural food of all –
breastfeeding. Breastfeeding has been a
part of our culture since ancient times.
But with modernization, breastfeeding
practices have gradually declined. This
has resulted in activities for increasing
awareness and promotion of breastfeeding.
According to the Indian Academy of Pe-
diatrics Policy on Infant Feeding, ‘an
ideal infant feeding comprises exclusive
breastfeeding for 6 months followed by
sequential addition of semi-solid and
solid foods to complement (not replace)
breast milk till the child is gradually able
to eat normal family food (around one
year)’. The latter period is also referred
to as weaning. The term ‘weaning’ does
not denote termination of breastfeeding.

ADIPO NECTIN IN HUMAN MILK

Adiponectin in human milk!
High concentrations of circulating adipo-
nectin have positive health effects through the reduction of proinflammatory cyto-
kines, improvement of insulin sensitivity,
and increase in fatty-acid metabolism.
Recently, Martin et al.
12
reported that adi-
ponectin is present in human milk and is
associated with maternal factors. The
concentration of adiponectin in milk is
much lower than in the serum, but ap-
pears to have biological significance for
breastfeeding infants. Previous studies
have shown that milk components are not
often degraded in the stomach, in part
because the composition of human milk
forms a protective environment for pro-
teins and in part because of the reduced
acidity of the infant stomach and limited
gastric proteolysis. Second, physiologi-
cal actions of adiponectin could be im-
portant in developing infants. Because
adiponectin has been shown to increase
insulin sensitivity, it may also augment
the action of insulin in the gut of infants.
Adiponectin may also have direct effect
on the gut of infants, because previous
studies have documented that adiponectin
receptor 1 is expressed in foetal small in-
testine
13
. Bronsky et al.
14
have reported
that concentrations of adiponectin, adipo-
cyte fatty acid-binding protein, and epi-
dermal fatty acid-binding protein in human
breast milk are related to nutritional
variables of mothers and newborns, and
thus may play a role in the protective ef-
fects of breastfeeding. Since circulatory
adiponectin levels were demonstrated to
be lower in Asian Indians with metabolic
syndrome
15
, it would be interesting to
know the milk adiponectin levels and
their physiological role in Indians. In this
context, long-term follow-up studies are
needed to assess the development of
symptoms of metabolic diseases in rela-
tionship to adiponectin breast-milk con-
centrations

BIOLOGICAL EFFECTS OF BREAST FEEDING

What would be the biological
effects of breastfeeding?
It is suggested that potential causal mecha-
nisms for an association of breastfeeding
with a reduction in childhood obesity in-
clude satiety signalling in response to nu-
tritional composition of breast milk
5
and
overfeeding among bottle-fed infants,
who exhibit significantly higher plasma
insulin levels and a prolonged insulin re-
sponse
6
compared with breastfed infants.
There might be many mechanisms other
than weight status that could account for
a protective association between breast-
feeding and type-2 diabetes. Studies
conducted in infants in contrast to those
conducted in children and adults, showed
consistent associations between breast-
feeding and lower glucose and insulin
concentrations. These differences could
reflect lower energy intake in breastfeed-
ing infants than in formula-fed infants
7
,
differences between breast-milk compo-
sition and formulas (particularly the amino
acid and protein contents), or hormonal
differences that result in lower levels of
fat deposition in breastfed infants
4,8
. An-
other possible mechanism is that breast-
feeding may improve insulin sensitivity
and glucose intolerance. In a study of
both breastfeeding and non-breastfeeding
nondiabetic women, insulin levels and
insulin/glucose ratios were lower, while
carbohydrate use and total energy expen-
diture were higher in the breastfeeding
group
9
. Various environmental toxins,
particularly endocrine-disrupting chemi-
cals, have recently been postulated as
contributors to obesity and related meta-
bolic disorders. These include bisphenol-
A, which has been widely incorporated
into plastic products, including infant
feeding bottles
10
and which has been as-
sociated with both reduced pancreatic b-
cell function and insulin resistanc

BREAST FEEDING

There is an intense interest in the effects
of breastfeeding on the health of an off-
spring and in understanding the mecha-
nisms behind these effects. It is widely
known that breastfeeding is the most nu-
tritious way to feed an infant, but it is
less known that the benefits that a child
and mother receive from breastfeeding
continue throughout life, even after
breastfeeding has stopped. The most im-
portant short-term immunological benefit
of breastfeeding is protection against in-
fectious diseases. There is also some evi-
dence of lower prevalence of inflammatory
bowel diseases, childhood cancers, and
type-I diabetes in breast-fed infants, sug-
gesting that breastfeeding influences de-
velopment of the own immune system of
an infant
1
. One of the most consistent
findings of breastfeeding is also a posi-
tive effect on later intelligence tests, with
a few test points advantage for breast-fed
infants

Is breastfeeding a best lifestyle
approach to prevent and reduce
non-communicable diseases?
In the last few years, several systematic
reviews and meta-analyses have exam-
ined the effect of breastfeeding on non-
communicable diseases
2
. There seems to
be a protective effect against later over-
weight and obesity. Blood pressure and
blood cholesterol seem to be slightly lower
in individuals who were breastfed as in-
fants. Identification of lifestyle approaches,
including breastfeeding practices are now
considered an ideal way to decrease the
dramatic increases in childhood obesity
and the emergence of type-2 diabetes in
youth, and to primary prevention of both
conditions. Among adults, breastfeeding
in infancy has been associated with re-
duced risk of type-2 diabetes
3
, but little
is known regarding the potential benefi-
cial effect of breastfeeding on the deve-
lopment of type-2 diabetes in adolescence.
Mayer-Davis et al.
4
have recently re-
ported a protective association of breast-
feeding against the development of type-
2 diabetes in youth in a dose-response
fashion, independent of other potentially
confounding variables. Attenuation of
the odds ratios when body mass index
score was added to the models was consistent with a causal pathway in which
breastfeeding may lower the risk for
childhood overweight, which may in turn
reduce risk for type-2 diabetes

REMEMBER THESE IN PREGNANCY

Remember…
•
Talk to your health care provider
about how much weight you should
gain during your pregnancy .
•
Eat foods rich in folate, iron, calcium,
and protein, or get these nutrients
through a prenatal supplement .
•
Talk to your health care provider
before taking any supplements .
•
Eat breakfast every day .
•
Eat high-fiber foods and drink plenty of water to
avoid constipation .
•
Avoid alcohol, raw fish, fish high in mercury, soft
cheeses, and anything that is not food .
•
Aim to do at least 30 minutes of moderate-inten-
sity physical activity on most, if not all, days of the
week during your pregnancy . Talk to your health
care provider before you begin if you have not
previously been physically active .
•
After pregnancy, slowly get back to your routine of
regular, moderate-intensity physical activity . Make
sure you feel able and your health care provider
says it is safe to be physically active .
•
Take pleasure in the miracles of pregnancy and
birth

What habits should I keep up after my baby is born?

What habits should I keep up after my
baby is born?
Following healthy eating and physical activity hab-
its after your baby is born may help you return to a
healthy weight more quickly, provide you with good
nutrition (which you especially need if you are breast-
feeding), and give you the energy you need .You can
also be a good role model for your growing child . After
your baby is born:
•
Continue eating well . Eat a variety of foods from
all of the food groups . If you are not breastfeeding,
you will need about 300 fewer calories per day
than you did while you were pregnant .
•
If you are breastfeeding, you will need to eat
about 200 more calories per day than you did
while you were pregnant . Breastfeeding may
help you return to a healthy weight more easily
because it requires a great deal of energy . Breast-
feeding may also protect your baby from illnesses,
such as ear infections, colds, and allergies, and
may help lower your risk for breast and ovarian
cancer . If you had gestational diabetes, breast-
feeding for more than 3 months may help prevent
your baby from becoming overweight .
•
When you feel able and your health care provider
says it is safe, slowly get back to your routine of
regular, moderate-intensity physical activity . Wait
for 4 to 6 weeks after you have your baby to begindoing higher levels of physical activity . Doing
physical activity that is too hard, too soon after
delivery, can slow your healing process . Regular,
moderate-intensity physical activity will not affect
your milk supply if you are breastfeeding .
•
Return to a healthy weight gradually . Lose no
more than 1 pound per week through a sound
eating plan and regular physical activity after you
deliver your baby

Tips for Getting Physically Active

Tips for Getting Physically Active
Get physically active for your health and the health of
your baby by using the tips below:
•
Go for a walk around the block or through a
shopping mall with your spouse or a friend .
•
Sign up for a prenatal yoga, aqua aerobics, or
fitness class . Make sure you let the instructor
know that you are pregnant before beginning .
•
Rent or buy an exercise video for pregnant
women . Look for videos at your local library,
video store, health care provider’s office, hos-
pital, or maternity clothing store .
•
At your gym, community center, YMCA, or
YWCA, sign up for a session with a fitness
trainer who knows about physical activity during
pregnancy .
•
Get up and move around at least once an hour if
you sit in a chair most of the day; get up and move
around during commercials when watching TV

What physical activities should I avoid during pregnancy?

What physical activities should I avoid
during pregnancy?
For your health and safety, and for the health of your
baby, there are certain physical activities that you
should not do while you are pregnant . Some are listed
below . Talk to your health care provider about other
physical activities that you should avoid during your
pregnancy .
•
Avoid being active outside during hot weather .
•
Avoid steam rooms, hot tubs, and saunas .
•
Avoid physical activities, such as certain yoga
poses, that call for you to lie flat on your back after
20 weeks of pregnancy .
•
Avoid contact sports, such as football and boxing,
and other activities that might injure you, such as
horseback riding .
•
Avoid activities that make you jump or change
directions quickly, such as tennis or basketball .
During pregnancy, your joints loosen and you
are more likely to hurt yourself when doing these
activities .
•
Avoid activities that can result in a fall, such as
in-line skating or downhill skiing

SHOULD I BE PHYSICALLY ACTIVE DURING PREGNANCY

Should I be physically active during my
pregnancy?
Almost all women can and should be physically active
during pregnancy . Talk to your health care provider
first, particularly if you have high blood pressure,
diabetes, anemia, bleeding, or other disorders, or if
you are obese or underweight .
Whether or not you were active before you were
pregnant, ask your health care provider about a level
of exercise that is safe for you . Aim to do at least 30
minutes of moderate-intensity physical activity (one
that makes you breathe harder but does not overwork
or overheat you) on most, if not all, days of the week .
Regular, moderate-intensity physical activity
during pregnancy may:
•
Help you and your baby to gain the proper
amounts of weight .
•
Reduce the discomforts of pregnancy, such as
backaches, leg cramps, constipation, bloating,
and swelling .
•
Reduce your risk for gestational diabetes (dia-
betes found for the first time when a woman is
pregnant) .
•
Improve your mood and energy level

WHAT FOODS SHOULD I AVOID DURING PREGNANCY

What foods should I avoid during
pregnancy?
There are certain foods and beverages that can harm
your baby if you eat or drink them while you are preg-
nant . Here is a general list of foods and beverages
that you should avoid:
•
Alcohol. Instead of wine, beer, or a mixed
drink, enjoy apple cider, tomato juice,
sparkling water, or other nonalcoholic
beverages .
•
Fish that may have high levels of
methylmercury (a substance that can build
up in fish and harm an unborn baby) . Do not
eat shark, swordfish, king mackerel, and
tilefish during pregnancy . Eat no more than
12 ounces of any fish per week (equal to four
3-ounce servings—each about the size of a
deck of cards) .
•
Soft cheeses such as feta, Brie, and goat
cheese and ready-to-eat meats including
lunch meats, hot dogs, and deli meats . These
foods may contain bacteria called listeria
that are harmful to unborn babies . Cooking
lunch meats, hot dogs, and deli meats until
steaming hot can kill the bacteria and make
these meats safe to eat

Raw fish such as sushi, sashimi, or ceviche
and raw or undercooked meat and poultry.
These foods can contain harmful bacteria .
Cook fish, meat, and poultry thoroughly
before eating .
.
•
Large amounts of caffeine-containing
beverages.
.
If you are a heavy coffee, tea,
or soda drinker, talk to your health care
provider about whether you should cut back
on caffeine . Try a decaffeinated version of your
favorite beverage, a mug of warm low-fat or
fat-free milk, or sparkling mineral water .
•
?
f
Anything that is not food. Some pregnant
women may crave something that is not
ood, such as laundry starch or clay . Talk to
your health care provider if you crave
something that is not food .
Ask your health care
provider for a complete
list of foods and
beverages that you
should avoid .

TIPS FOR HEALTHY EATING IN PREGNANCY

Tips for Healthy Eating
.
.
VISIT http://www.indiareviewchannel.com/products/Health-Beauty-reviews-52.aspx for the best health products....
Meet the needs of your body and help avoid common
discomforts of pregnancy by following these tips:
Eat breakfast every day. If you feel sick to your
stomach in the morning, choose dry whole-wheat
toast or whole-grain crackers when you first wake
up—even before you get out of bed . Eat the rest of
your breakfast (fruit, oatmeal, cereal, milk, yogurt,
or other foods) later in the morning .
•
3
Eat high-fiber foods. Eating whole-grain cereals,
vegetables, fruits, beans, whole-wheat breads,
and brown rice, along with drinking plenty of water
and getting daily physical activity, can help you
prevent the constipation that many women have
during pregnancy .
•
3
Keep healthy foods on hand. A fruit bowl filled
with apples, bananas, peaches, oranges, and
grapes makes it easy to grab a healthy snack .
Fresh, frozen, and canned fruits and vegetables
make healthy and quick additions to meals, as do
canned beans .
•
3
If you have heartburn during your pregnancy,
eat small meals more often, eat slowly, avoid
spicy and fatty foods (such as hot peppers or fried
chicken), drink beverages between meals instead
of with meals, and do not lie down right after eating

Do I have any special nutrition needs now that I am pregnant?

Do I have any special nutrition needs
now that I am pregnant?
Yes. During pregnancy, you and your growing baby
need more of several nutrients . By eating the recom-
mended number of daily servings from each of the
five food groups, you should get most of the nutrients
you need .
Be sure to include foods high in folate, such as or-
ange juice, strawberries, spinach, broc-
coli, beans, and fortified breads
and breakfast cereals . Or get
it in a vitamin/mineral supple-
ment .
To help prevent birth defects, you must get enough
daily folate before as well as during pregnancy .
Prenatal supplements contain folic acid (another form
of folate) . Look for a supplement that has at least 400
micrograms (0 .4 milligrams) of folic acid .
Although most health care providers recommend
taking a multi-vitamin/mineral “prenatal” supple-
ment before becoming pregnant, during pregnan-
cy, and while breastfeeding, always talk to your
health care provider before taking any supple-
ments.

Can I continue to
follow my vegetarian
diet during
pregnancy?
Yes, you can continue a
vegetarian eating plan during
pregnancy, but talk to your
health care provider first .
To make sure you are getting
enough important nutrients,
including protein, iron, vita-
min B12, and vitamin D, your
health care provider may ask
you to meet with a registered
dietitian who can help you
plan meals, and may also
recommend that you take
supplements

Saturday, March 14, 2009

HEALTHY EATING IN PREGNANCY

What is a healthy eating plan for
pregnancy?
A healthy eating plan for pregnancy includes a vari-
ety of nutrient-rich foods . In January 2005, the U .S .
Department of Health and Human Services and the
U .S . Department of Agriculture jointly released the
2005 Dietary Guidelines for Americans . These new
guidelines outline recommendations
to promote health and reduce the
risk of chronic disease through
nutritious eating and physical
activity . The recommendations
include some of the nutritional
needs of pregnancy

How many calories should I eat?
Eating a variety of foods that provide enough calories
helps you and your baby gain the proper amount of
weight . During the first 3 months of your pregnancy,
you do not need to change the number of calories you
get from the foods you eat .
Normal-weight women need an extra 300 calories
each day during the last 6 months of pregnancy .
This totals about 1,900 to 2,500 calories a day . If you
were underweight, overweight, or obese before you
became pregnant, or if you are pregnant with more
than one baby, you may need a different number of
calories . Talk to your health care provider about how
much weight you should gain and how many calories
you need

Page 1
TIPS FOR PREGNANCY
Healthy Eating & Physical
Activity Across Your Lifespan
Fit for Two
WIN
Weight-control Information Network
Page 2
Page 3
Index
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Healthy Eating
What is a healthy eating plan for pregnancy? . . . . . . . . 2
How many calories should I eat? . . . . . . . . . . . . . . . . . . 2
Why is gaining a healthy amount of
weight important? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
How much weight should I gain during
my pregnancy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Do I have any special nutrition needs
now that I am pregnant? . . . . . . . . . . . . . . . . . . . . . . . . 6
Can I continue to follow my vegetarian diet
during pregnancy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Tips for Healthy Eating . . . . . . . . . . . . . . . . . . . . . . . . . 8
What foods should I avoid during pregnancy? . . . . . . . 10
Physical Activity
Should I be physically active during
my pregnancy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
What physical activities should I avoid
during pregnancy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Tips for Getting Physically Active . . . . . . . . . . . . . . . . 15
What habits should I keep up after
my baby is born? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Why should I try to return to a healthy
weight after delivery? . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Be Good to Yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Fit for Two
Page 4
Page 5
Introduction
Eating well can help you have a healthy pregnancy
and a healthy newborn . Being physically active may
help you have a more comfortable 9 months and
an easier delivery . Use the ideas and tips in this
booklet to improve your eating plan and become
more physically active before, during, and after your
pregnancy . Make changes now, and be
a healthy example for your family for a lifetime .
Fit for Two
1
Page 6
Healthy Eating
What is a healthy eating plan for
pregnancy?
A healthy eating plan for pregnancy includes a vari-
ety of nutrient-rich foods . In January 2005, the U .S .
Department of Health and Human Services and the
U .S . Department of Agriculture jointly released the
2005 Dietary Guidelines for Americans . These new
guidelines outline recommendations
to promote health and reduce the
risk of chronic disease through
nutritious eating and physical
activity . The recommendations
include some of the nutritional
needs of pregnancy . For more
information about food groups and
nutrition values, visit:
http://www.healthierus.gov/dietaryguidelines.
How many calories should I eat?
Eating a variety of foods that provide enough calories
helps you and your baby gain the proper amount of
weight . During the first 3 months of your pregnancy,
you do not need to change the number of calories you
get from the foods you eat .
Normal-weight women need an extra 300 calories
each day during the last 6 months of pregnancy .
This totals about 1,900 to 2,500 calories a day . If you
were underweight, overweight, or obese before youHEalthy Eating
became pregnant, or if you are pregnant with more
than one baby, you may need a different number of
calories . Talk to your health care provider about how
much weight you should gain and how many calories
you need .
Fit for Two
3
Each of these healthy choices has about 300
calories:
•
1 cup of fat-free fruit yogurt and a
medium apple
•
1 piece of whole-wheat toast spread with
2 tablespoons of peanut butter
•
1 cup of beef and bean chili sprinkled
with 1/2 ounce of cheddar cheese (You
can also substitute various vegetables for
the beef .)
•
1 cup of raisin bran cereal with 1/2 cup of
fat-free milk and a small banana
•
3 ounces of roasted lean ham or chicken
breast and 1/2 cup of sweet potatoes
•
1 flour tortilla (7-inch), 1/2 cup of refried
beans, 1/2 cup of cooked broccoli, and
1/2 cup of cooked red peppeR

HEALTHY EATING IN PREGNANCY

What is a healthy eating plan for
pregnancy?
A healthy eating plan for pregnancy includes a vari-
ety of nutrient-rich foods . In January 2005, the U .S .
Department of Health and Human Services and the
U .S . Department of Agriculture jointly released the
2005 Dietary Guidelines for Americans . These new
guidelines outline recommendations
to promote health and reduce the
risk of chronic disease through
nutritious eating and physical
activity . The recommendations
include some of the nutritional
needs of pregnancy

How many calories should I eat?
Eating a variety of foods that provide enough calories
helps you and your baby gain the proper amount of
weight . During the first 3 months of your pregnancy,
you do not need to change the number of calories you
get from the foods you eat .
Normal-weight women need an extra 300 calories
each day during the last 6 months of pregnancy .
This totals about 1,900 to 2,500 calories a day . If you
were underweight, overweight, or obese before you
became pregnant, or if you are pregnant with more
than one baby, you may need a different number of
calories . Talk to your health care provider about how
much weight you should gain and how many calories
you need

Page 1
TIPS FOR PREGNANCY
Healthy Eating & Physical
Activity Across Your Lifespan
Fit for Two
WIN
Weight-control Information Network
Page 2
Page 3
Index
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Healthy Eating
What is a healthy eating plan for pregnancy? . . . . . . . . 2
How many calories should I eat? . . . . . . . . . . . . . . . . . . 2
Why is gaining a healthy amount of
weight important? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
How much weight should I gain during
my pregnancy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Do I have any special nutrition needs
now that I am pregnant? . . . . . . . . . . . . . . . . . . . . . . . . 6
Can I continue to follow my vegetarian diet
during pregnancy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Tips for Healthy Eating . . . . . . . . . . . . . . . . . . . . . . . . . 8
What foods should I avoid during pregnancy? . . . . . . . 10
Physical Activity
Should I be physically active during
my pregnancy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
What physical activities should I avoid
during pregnancy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Tips for Getting Physically Active . . . . . . . . . . . . . . . . 15
What habits should I keep up after
my baby is born? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Why should I try to return to a healthy
weight after delivery? . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Be Good to Yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Fit for Two
Page 4
Page 5
Introduction
Eating well can help you have a healthy pregnancy
and a healthy newborn . Being physically active may
help you have a more comfortable 9 months and
an easier delivery . Use the ideas and tips in this
booklet to improve your eating plan and become
more physically active before, during, and after your
pregnancy . Make changes now, and be
a healthy example for your family for a lifetime .
Fit for Two
1
Page 6
Healthy Eating
What is a healthy eating plan for
pregnancy?
A healthy eating plan for pregnancy includes a vari-
ety of nutrient-rich foods . In January 2005, the U .S .
Department of Health and Human Services and the
U .S . Department of Agriculture jointly released the
2005 Dietary Guidelines for Americans . These new
guidelines outline recommendations
to promote health and reduce the
risk of chronic disease through
nutritious eating and physical
activity . The recommendations
include some of the nutritional
needs of pregnancy . For more
information about food groups and
nutrition values, visit:
http://www.healthierus.gov/dietaryguidelines.
How many calories should I eat?
Eating a variety of foods that provide enough calories
helps you and your baby gain the proper amount of
weight . During the first 3 months of your pregnancy,
you do not need to change the number of calories you
get from the foods you eat .
Normal-weight women need an extra 300 calories
each day during the last 6 months of pregnancy .
This totals about 1,900 to 2,500 calories a day . If you
were underweight, overweight, or obese before you
2
Fit for Two
Page 7
Healthy Eating
became pregnant, or if you are pregnant with more
than one baby, you may need a different number of
calories . Talk to your health care provider about how
much weight you should gain and how many calories
you need .
Fit for Two
3
Each of these healthy choices has about 300
calories:
•
1 cup of fat-free fruit yogurt and a
medium apple
•
1 piece of whole-wheat toast spread with
2 tablespoons of peanut butter
•
1 cup of beef and bean chili sprinkled
with 1/2 ounce of cheddar cheese (You
can also substitute various vegetables for
the beef .)
•
1 cup of raisin bran cereal with 1/2 cup of
fat-free milk and a small banana
•
3 ounces of roasted lean ham or chicken
breast and 1/2 cup of sweet potatoes
•
1 flour tortilla (7-inch), 1/2 cup of refried
beans, 1/2 cup of cooked broccoli, and
1/2 cup of cooked red peppeR

TIPS FOR A HEALTHY PREGNANCY PART 1

Prevent falls at home
Each year, more than one-third of U.S. adults 65 and
older experience a fall, according to the federal Centers
for Disease Control and Prevention (CDC).
A fall might not sound like a big deal, but among
older adults, falls are the leading cause of death due to
injury (vs. disease). In 2005, 15,800 people 65 and older
died from fall-related injuries, according to the CDC.
There are a variety of reasons older adults have a
greater fall risk, says Evelyn McKay, director of rehabili-
tation services for the Southington Care Center.These
include vision problems, certain medications, weak and
inflexible joints and muscles, arthritis, osteoporosis, diabetes, stroke and
other conditions.
People at high fall risk — in fact, all of us — can take some easy steps to
help prevent falls at home*:
Stairs: Attach non-slip treads and mark stair edges to prevent tripping.
Stairs should be in good repair, and staircases should have handrails on
both sides.
Kitchen: Be sure floors aren’t slippery; storage areas are easy to reach
(without having to stand on tiptoe or a chair); and a non-slip mat is near
the sink to soak up spilled water.
Bathroom: Be sure doors are wide enough to accommodate walkers and
other devices; thresholds aren’t too high; tubs have skid-proof mats or
strips; tub and toilet grab bars are available; and toilet seats aren’t too low.
Bedroom: Keep lamps on a night table beside the bed; maintain a clear,
uncluttered path from the bed to the bathroom; and ensure the bed is at an
appropriate height.
General: Ensure adequate lighting throughout the house; secure throw
rugs and carpets; remove clutter to prevent tripping; keep phones and light
switches accessible; ensure chairs are strong enough (particularly arm rests)
to support you when you’re sitting down and getting up

FREQUENTLY ASKED QUESTIONS ABOUT PREGNANCY PART 3

Q: Which brand of pregnancy test
is the most accurate?
A:
Some brands of tests can pick up lower
levels of hCG than others. But limited
research makes it impossible to say for
sure which one is the best. Even so,
two studies suggest that First Response,
Early Result Pregnancy Test may be
more sensitive than others. So for
women who want test early, this is
probably the best product.
Q: How soon after a missed period
can I take a home pregnancy
test and get accurate results?
A:
Many home pregnancy tests (HPTs)
claim to be 99% accurate on the day
you miss your period. But research sug-
gests that most HPTs do not consis-
tently spot pregnancy that early. And
when they do, the results are often so
faint they are misunderstood. If you can
wait one week after your missed peri-
od, most home pregnancy tests will
give you an accurate answer. Ask your
doctor for a more sensitive test if you
need to know earlier.
When a home pregnancy test will give
an accurate result depends on many
things. These include:
●
How long it takes for the fertilized
egg to implant in the uterus after
ovulation. Pregnancy tests look for
the hormone human chorionic
gonadotropin (hCG) that is only
produced once the fertilized egg has
implanted in the uterine wall. In
most cases, this happens about 6 days
after conception. But studies show
that in up to 10 percent of women,
the embryo doesn’t implant until
much later, after the first day of the
missed period. So, home pregnancy
tests will be accurate as soon as one
day after a missed period for some
women but not for others.
●
How you use them - Be sure to fol-
low the directions and check the
expiration date.
●
When you use them - The amount
of hCG in a pregnant woman’s
urine increases with time. So, the
earlier after a missed period you take
a HPT, the harder it is to spot the
hCG. If you wait one week after a
missed period to test, you are more
apt to have an accurate result. Also,
testing your urine first thing in the
morning may boost the accuracy.
●
Who uses them - The amount of
hCG in the urine at different points
in early pregnancy is different for
every woman. So, some women will
have accurate results on the day of
the missed period while others will
need to wait longer.
●
The brand of test - Some home
pregnancy tests are more sensitive
than others. So, some tests are better
than others at spotting hCG early
on.
Q: I got a negative result on a
home pregnancy test. Might I
still be pregnant?
A:
Yes. So, most HPTs suggest women
take the test again in a few days or a
weeK Every woman ovulates at different times
Q: Can anything interfere with
in her menstrual cycle. Plus, embryos
home pregnancy test results?
implant in the uterus at different times.
A:
Most medicines, over-the-counter and
So, the accuracy of HPT results varies
prescription, including birth control
from woman to woman. Other things
can also affect the accuracy.
Sometimes women get false negative
results (when the test says you are not
pregnant and you are) when they test
too early in the pregnancy. Other
times, problems with the pregnancy can
affect the amount of hCG in the urine.
pills and antibiotics, should not affect
the results of a home pregnancy test.
Only medicines that have the pregnan-
cy hormone hCG in them can give a
false positive test result. A false positive
is when a test says you are pregnant
when you’re not.
Sometimes medicines containing hCG
If your HPT is negative, test yourself
again in a few days or 1 week. If you
keep getting a negative result but think
you are pregnant, talk with your doctor
right away.
are used to treat infertility (not being
able to get pregnant). Alcohol and ille-
gal drugs do not affect HPT results.
But women who may become pregnant
should not use these substances.

FREQUENTLY ASKED QUESTIONS ABOUT PREGNANCY PART 2

How do you do a home preg-
Q: How accurate are home preg-
nancy test?
nancy tests?
A:
There are many different types of home
pregnancy tests, or HPTs. Most drug-
stores sell HPTs over-the-counter.
They cost between $8 and $20 depend-
ing on the brand and how many tests
A:
Home pregnancy tests (HPTs) can be
quite accurate. But the accuracy
depends on many things. These
include:
●
How you use them – Be sure to fol-
come in the box.
Most popular HPTs work in a similar
way. The majority tell the user to hold
a stick in the urine stream. Others
low the directions and check the
expiration date.
●
When you use them – The amount
of hCG or pregnancy hormone in
involve collecting urine in a cup and
your urine increases with time. So,
then dipping the stick into it. At least
the earlier after a missed period you
one brand tells the woman to collect
take the test the harder it is to spot
urine in a cup and then put a few drops
the hCG. If you wait one week after
into a special container with a dropper.
a missed period to test, you are more
Testing the urine first thing in the
morning may help boost accuracy.
Then the woman needs to wait a few
minutes. Different brands instruct the
apt to have an accurate result. Also,
testing your urine first thing in the
morning may boost the accuracy.
●
Who uses them – The amount of
woman to wait different amounts of
hCG in the urine is different for
time. Once the time has passed, the user
every pregnant woman. So, some
should inspect the “result window.” If a
women will have accurate results on
line or plus symbol appears, you are
pregnant. It does not matter how faint
the line is. A line, whether bold or faint,
means the result is positive.
the day of the missed period while
others will need to wait longer.
●
The brand of test – Some home
Most tests also have a “control indica -
tor” in the result window. This line or
symbol shows whether the test is work -
ing or not. If the control indicator does
not appear, the test is not working
properly. You should not rely on any
results from a HPT that may be faulty.
pregnancy tests are more sensitive
than others. So, some tests are better
than others at spotting hCG early
on.
Many HPTs claim to be 99% accurate
on the day you miss your period. But
research suggests that most HPTs do
Most brands tell users to repeat the test
not consistently spot pregnancy that
in a few days, no matter what the
early. And when they do, the results are
results. One negative result (especially
soon after a missed period) does not
always mean you’re not pregnant. All
HPTs come with written instructions.
Most tests also have toll-free phone
numbers to call incase of questions
about use or results.
often very faint.
In a 2004 study, researchers tested the
accuracy of 18 HPTs sold in retail
stores. They found that only one brand
consistently detected the low levels of
hCG usually present on the first day of
the missed period.

FREQUENTLY ASKED QUESTIONS ABOUT PREGNANCY

Q: What’s the difference between
pregnancy tests that check urine
Pregnancy
and those that test blood?
Which one is better?
A:
There are two types of pregnancy tests.
Tests
One tests the blood for the pregnancy
hormone, hCG. The other checks the
urine for this hormone. You can do a
urine test at home with a home preg-
nancy test. You need to see a doctor to
have blood tests.
These days, most women first use
home pregnancy tests (HPT) to find
out if they are pregnant. HPTs are
inexpensive, private, and easy to use.
Urine tests will be able to tell if you’re
pregnant about 2 weeks after ovulation.
Am I Pregnant?
Some more sensitive urine tests claim
that they can tell if you are pregnant as
Q: How do pregnancy tests work?
early as one day after a missed period.
A:
Pregnancy tests look for a special
If a HPT says you are pregnant, you
hormone in the urine or blood that is
should call your doctor right away. You
only there when a woman is pregnant.
This hormone, human chorionic
gonadotropin (hCG), can also be
called the pregnancy hormone.
doctor can use a more sensitive test
along with a pelvic exam to tell for sure
if you’re pregnant. Seeing your doctor
early on in your pregnancy will help
you and your baby stay healthy.
The pregnancy hormone, hCG, is
made in your body when a fertilized
Doctors use two types of blood tests to
egg implants in the uterus. This usually
check for pregnancy. Blood tests can
happens about 6 days after conception.
pick up hCG earlier in a pregnancy
But studies show that the embryo does-
than urine tests can. Blood tests can tell
n't implant until later in some women.
The amount of hCG increases drasti -
cally with each passing day you are
pregnant.
if you are pregnant about 6 to 8 days
after you ovulate (or release an egg
from an ovary). A quantitative blood
test (or the beta hCG test) measures the
exact amount of hCG in your blood.
Many home pregnancy tests claim they
So it can find even tiny amounts of
can tell if you’re pregnant on the day
hCG. This makes it very accurate.
you expect your period. But a recent
Qualitative hCG blood tests just check
study shows that most don’t give accu-
to see if the pregnancy hormone is
rate results this early in pregnancy.
present or not. So it gives a yes or no
Waiting one week after a missed period
answer. The qualitative hCG blood test
will usually give a more accurate
is about as accurate as a urine test

FREQUENTLY ASKED QUESTIONS ABOUT PREGNANCY

VERY VERY VALUABLE TIPS FOR PREGNANCY

Prenatal Precautions
Vitamins and minerals are important during pregnancy but some need special attention, especially
those that promote cell division and the formation of new life. A varied and balanced approach to
eating is the best way to get the vitamins and minerals you and your baby need.
•
Folate is important before conception and during the first three months. It is especially
critical for lowering a newborn’s risk for neural tube, or spinal cord, damage.
•
Iron needs increase during pregnancy by about 50 percent because iron is essential in
making the component of blood that carries oxygen throughout your body, including to the
placenta for your baby.
•
Vitamin C helps your body absorb the needed iron.
•
Calcium is needs for two reasons: your baby’s developing bones and preserving your own
bone mass. Without enough calcium, your body will draw calcium from your bones to build
your baby’s bones.
•
Vitamin D helps your body absorb the calcium you need during pregnancy.
Weight Gain
There is no set amount for all women.
Because every pregnant woman is
unique, your doctor will advise you
about the weight-gain range that’s right
for you. That advice depends on:
·
Your weight before pregnancy
·
Your height
·
Your age
·
If you’re expecting multiples.
Excessive weight gain during
pregnancy can lead to a difficult
delivery, back and joint problems,
gestational diabetes and postpartum
weight gain.
Food Safety
When women are pregnant, their risk of developing food borne illness increases and even a mild
case of food poisoning can have serious consequences. Protect yourself and your unborn infant
from food borne illness by practicing good food safety habits.
Do not eat meats, poultry, seafood and eggs that are raw or undercooked. Also, unpasteurized
dairy products like raw milk and some imported cheeses can pose safety threats to pregnant
women.
Pregnant and nursing women can eat fish, but not long-lived fish — such as swordfish, shark, king
mackerel and tilefish — because of the methyl mercury they may contain. Pregnant women should
also pass on raw seafood.
Gestational Diabetes
Gestational diabetes is a health problem for
approximately 4% of pregnant women, though its
cause is unknown.
Risk factors include a family history of diabetes,
being obese, a problem pregnancy and being over
age 40. Most pregnant women are routinely tested
for gestational diabetes at about 24 to 28 weeks.
The risk for developing diabetes later in life is
higher among women who have had gestational
diabetes.
But don’t fear: Even if you have gestational
diabetes, you can deliver a healthy baby. It’s
important for you and your doctor to monitor it
carefully.

VERY VERY VALUABLE TIPS FOR PREGNANCY

STUDY OF PREGNANCY INTENTIONS AND MENTAL HEALTH

Researchers at the University of California, San Francisco Bixby Center for Global Reproductive Health are conducting a
study to understand and document the mental health consequences of unintended pregnancy. This study explores the
experiences and outcomes of women who suspect pregnancy and seek a pregnancy test. We will follow women who have
a positive pregnancy test as well as those who have a negative result to examine the effect of pregnancy and pregnancy
intentions on women’s mood, mental health, and decision-making. Although our primary focus is on women’s
experiences, we will also gather information about the health and wellbeing of children born to women who have a
positive test result and continue their pregnancies.
The Study of Pregnancy Intentions and Mental Health has four major aims:
1. To understand the effects of women’s mental health, including mood, anxiety and depression, on their desire for
and ability to make decisions about pregnancy and contraception.
2. To assess the impact of unintended pregnancy on women’s mental health.
3. To evaluate the relationship, if any, between mental health status and decisions to continue or terminate
unintended pregnancies.
4. To document the physical and psychological responses to abortion compared to carrying an unintended pregnancy
to term.
Why is this study important?
Approximately half of pregnancies and a fifth of pregnancies leading to birth were unintended at the time of conception.
Although there is a substantial literature on psychological responses to pregnancy and abortion, there are few studies
which examine the effect of pregnancy intentions on gestational and postpartum mental health and pregnancy outcomes.
The National Institute of Health has announced the availability of R21 grant money to study Women’s Mental Health in
Pregnancy and the Postpartum Period. This is an excellent opportunity to design a study to examine the effects of
unintended pregnancy on mental health.
A pregnancy test at a clinic or center is an opportunity to examine women’s reproductive intentions and mental health.
Many women experience a ‘pregnancy scare’ when their menstrual period is late and they believe that that they could be
pregnant. The full effect of unintended pregnancy on mental health can be ascertained by comparing women who have a
positive test result with women with negative test results. Since fertilization and implantation are complex events, largely
unrelated to women’s characteristics, the result may be similar to randomization to unintended pregnancy and control
groups.
A 1989 study by Zabin followed 360 teenage African American women seeking pregnancy tests and followed three
groups – those with a negative test result, those with a positive result who sought an abortion and those with a positive
result who chose to carry the pregnancy to term. This study found that teenagers who obtained an abortion experienced
similar levels of psychological stress compared to the two other groups over the two year period. This study, now two
decades old, only followed teenagers. This R21 is a great opportunity to test the feasibility of repeating this study with a
diverse population of women including both teenagers and adults.

PREGNANCY TEST-ULTRA SOUND

Pregnancy tests - ultrasound

Ultrasound is a scan that uses high frequency sound waves to study internal body structures. The
sound waves are emitted from a vibrating crystal in a handheld scanner. The reflected sound
waves or ‘echoes’ are then translated into a grainy, two-dimensional (or sometimes three-
dimensional) image on a monitor.
Ultrasound is used during pregnancy to check the baby’s development and to help pick up any
abnormalities such as Down syndrome. Since the procedure can’t produce high quality images, any
suspected abnormalities need to be confirmed with other tests. The ultrasound scan isn’t 100 per
cent accurate, but the advantages of the test are that it’s non-invasive, painless and safe for both
mother and unborn baby.
Uses of the ultrasound
Ultrasound may be used at various points during pregnancy, including:
•
First trimester - ultrasound performed within the first three months of pregnancy is used
to check that the embryo is developing inside the womb (rather than inside a fallopian
tube, for example), confirm the number of embryos, and calculate the gestational age and
the baby’s due date.
•
Second trimester - ultrasound performed between weeks 18 and 20 is used to check the
development of foetal structures such as the spine, limbs, brain and internal organs. The
size and location of the placenta is also checked. The baby’s sex can be established, if the
parents wish to know.
•
Third trimester - ultrasound performed after 30 weeks is used to check that the baby is
continuing to grow at a normal rate. The location of the placenta is checked to make sure it
isn’t blocking the cervix

Medical issues to consider
Ultrasound is a safe, painless and non-invasive procedure. Many parents consider the ultrasound as
an opportunity to see their unborn child, and perhaps discover its sex. However, you should
remember that the ultrasound is a diagnostic procedure and, in some cases, it may suggest that a
foetus has an abnormality. Further tests are usually needed to confirm the diagnosis.
Ultrasound procedure
The procedure depends on the type of ultrasound used, but may include:
•
Transabdominal ultrasound - sound waves pass very well through water. The
sonographer uses your full bladder as a ‘porthole’ to your uterus, so you will have to drink
plenty of water before the test. You lie down on an examination table or bed. Gel is applied
to your abdomen (to provide better contact between your skin and the scanner) and the
sonographer moves the scanner in various positions. Pictures are sent instantly to a nearby
monitor. The sonographer may have to push quite firmly at times in order to see the
deeper structures. The scan usually takes about 30 minutes.
•
Vaginal ultrasound - in some cases, a transabdominal ultrasound can’t produce clear
enough pictures. There may be too much air in your bowel, for instance, and air is a poor
conductor of sound waves. In these cases, a slender scanner is inserted into your vagina.
The scan usually takes about 30 minutes.
Immediately after the ultrasound
Once the ultrasound is finished, you are given tissues to wipe away the gel, and you can go to the
toilet. The report is sent to your doctor, so you will have to make an appointment to get the result.
Possible complications
There are no known risks, complications or side effects for either the mother or her unborn babY
An ultrasound scan is safe, painless and non-invasive, so there is no need to take any special
precautions afterward. You are free to go about your normal business.
Long term outlook
What happens next depends on the results of your ultrasound. Note that a normal result doesn’t
guarantee that your baby is normal, because some abnormalities cannot be found using this test. If
foetal abnormalities were detected, you may need further tests to confirm the diagnosis. These
tests, including amniocentesis and chorionic villus sampling, are optional. Discuss the benefits,
risks and complications of these tests with your doctor before deciding whether or not to go ahead.
Other types of pregnancy tests
Other types of pregnancy tests you may be offered could include:
•
Amniocentesis - a small amount of amniotic fluid is taken using a slender needle inserted
through the abdomen. The needle is guided with the help of ultrasound. The fluid sample
contains cells, which are then examined in a laboratory for chromosomal abnormalities.
The risk of miscarriage following amniocentesis is around one in 250.
•
Chorionic villus sampling - a slender needle is inserted through the abdomen or cervix
to take a small sample of placenta. The needle is guided with the help of ultrasound. The
chorionic villi are then tested in the laboratory for chromosomal abnormalities. The risk of
miscarriage following chorionic villus sampling is one in 100.
Where to get help
•
Your doctor
Things to remember
•
Ultrasound is used during pregnancy to check the baby’s development, the presence of a
multiple pregnancy and to help pick up any abnormalities.
•
The ultrasound scan isn’t 100 per cent accurate, but the advantages of the test are that it’s
non-invasive, painless and safe for both mother and unborn baby.
•
If foetal abnormalities are detected, you may be offered further tests to confirm the
diagnosis, such as amniocentesis and chorionic villus sampling

ENDOCRINE CHANGES IN PREGNANCY

Endocrine
In the non-diabetic pregnant woman carbohydrate loads
will cause a greater than normal increase in plasma glucose
levels facilitating placental glucose transfer. This is due to
increased insulin resistance caused by placental hormones
(mainly human placental lactogen). Insulin production is
also increased during pregnancy.
Maternal hyperglycaemia in diabetic pregnant women
induces an increase in fetal insulin production, as insulin
does not cross the placenta. Neonatal hypoglycaemia may
follow as the carbohydrate load falls immediately after
birth. Since insulin also acts as a growth hormone maternal
diabetes is associated with fetal macrosomia

GASTRO INTESTINAL SYSTEM IN PREGNANCY

Increased intra-abdominal pressure by the gravid uterus,
displacement of the gastric axis and progesterone mediated
reduction in lower oesophageal sphincter tone cause gastro-
oesophageal reflux in as many as 80% of term parturients.
Whilst pregnancy does not seem to cause increased gastric
volumes and delayed gastric emptying, both of these are
features of labour. The administraion of opioids for labour
analgesia further accentuates this. Pregnant women are
therefore at risk of developing Mendelson’s syndrome
(aspiration pneumonitis) especially on induction of general
anaesthesia, which reduces upper oesophageal sphincter
pressure. Strategies for the prevention of this may include
the administration of H
2
blocking drugs, neutralization of
gastric contents with non-particulate antacids, e.g. sodium
citrate, and the use of a rapid sequence induction with
cricoid pressure, when administering general anaesthesia
to pregnant women. At 24 - 48 hours postpartum the
changes in the gastro-intestinal system are thought to have
reverted to norma

HEPATIC CHANGES IN PREGNANCY

Plasma concentrations of g-GT, ALT, AST, and LDH are
high normal or slightly elevated and clinical signs of liver Disease like spider naevi and palmar erythema may occur
during normal pregnancy making diagnosis of liver disease
during pregnancy more difficult. Plasma concentrations
of alkaline phosphatase are increased 3-fold as a result
of placental production. Pregnant patients are more
likely to develop gall-stones as increased progesterone
concentrations cause a decrease in cholecystokinin
release and a reduction of the contractile response to
cholecystokinin. Succinylcholine may lead to prolonged
neuromuscular blockade secondary to a 25% fall in plasma
cholinesterase concentrations at term and a further 8% fall
three days postpartum (post delivery). This is compounded
by an increased volume of distribution at term but not
usually clinically significant. Never the less, standard or
increased doses of succinylcholine are recommended in
pregnancy. Succinylcholine sensitivity in females who are
heterozygote for an abnormal cholinesterase gene may
be unmasked due to a 25% decrease in hepatic protein
synthesis in pregnancy

ACID BASE REGULATION IN PREGNANCY

Acid Base regulation
Increased minute ventilation leads to a decrease in PaCO
2
producing a respiratory alkalosis and a left shift of thoxyhaemoglobin dissociation curve. A 30% increase in
2-3 DPG has the opposite effect on the oxyhaemoglobin
dissociation curve with an increase of the P50 from 3.5
kPa to 4 kPa (26-30mmHg). The respiratory alkalosis is
compensated by increased renal bicarbonate excretion so
that plasma hydrogen ion concentrations remain essentially
unchanged.
Pain in labour causes maternal hyperventilation associated
with an acute left shift of the oxyhaemoglobin dissociation
curve. This increases the affinity of maternal haemoglobin
for oxygen and consequently oxygen delivery to the
fetus decreases. If labour becomes prolonged and is also
painful, basic metabolic rate increases and O
2
extraction
does as well. Under these circumstance there will be
less O
2
available to the fetus, as cardiac output cannot be
further increased to match the increased O
2
demand. In
this situation regional analgesia is useful as it prevents the
increase in BMR and further hyperventilation secondary
to the pain. Effective regional analgesia largely abolishes
the detrimental effects of a painful labour on the fetus

RENAL CHANGES IN PREGNANCY

As a result of the changes in the cardiovascular system,
renal plasma flow and glomerular filtration rate increase
in pregnancy. This results in an increase in urea, creatinine
and urate clearance and excretion of bicarbonate causing
plasma concentrations to be less than in the non-pregnant
population. The activities of renin-angiotensin, aldosterone and progesterone are increased leading to increased water
retention and a decreased plasma osmolality. Glycosuria
can be observed in 40% of parturients secondary to
reduced reabsorption of glucose. Urinary tract infections
are more common in pregnant patients due to urinary
stasis from progesterone mediated ureteric smooth muscle
relaxation.
The changes in renal physiology increase the volume of
distribution for drugs and those that are renally excreted
may have to be given in higher than normal dosages and
may have prolonged action

COAGULATION IN PREGNANCY

Plasma levels of fibrinogen and all clotting factors, except
XI and XIII, gradually increase during pregnancy inducing
a hypercoagulable state. An increase in fibrinolysis is
reflected in increased concentrations of antithrombin III,
plasminogen, and fibrin degradation products. Platelet
activity and consumption are both increased but platelet
function remains normal in pregnancy. None of these
changes are reflected in a routine clotting screen, which
will show values around normal. Platelet function, as
assessed by thromboelastography, remains normal while
the platelet count is greater than 100 x 10
9
per litre. A
platelet count of greater than 80 x 10
9
per litre is regarded
as safe for the use of neuroaxial blockade by many.
Thromboembolic complications remain a common source
of morbidity and mortality associated with pregnancy

CARDIOVASCULAR CHANGES IN PREGNANCY

Oestrogen and progesterone mediated relaxation of
vascular smooth muscle in pregnancy cause vasodilatation
reducing the peripheral vascular resistance by 20%.
Consequently systolic and diastolic blood pressures fall.
Areflex increase in heart rate by 25% together with a 25%
increase in stroke volume, results in a 50% increase in
cardiac output. During labour cardiac output may increase
further by up to 45%. Cardiac contractility remains
unchanged. The rise in cardiac output is facilitated by
anatomical changes, namely left ventricular hypertrophy
and dilatation.
In the supine position the gravid uterus can compress the
inferior vena cava. This will reduce venous return to the
heart resulting in a decrease of cardiac output, maternal
blood pressure and placental perfusion. The descending
aorta can also be compressed by the uterus causing a
reduction in uterine blood flow. Aortocaval compression
must be considered as a cause of maternal hypotension
from the end of the 1st trimester onwards, though it
typically occurs after 20 weeks gestation

RESPIRATORY CHANGES IN PREGNANCY

Changes in the respiratory system may be categorised as
anatomical and physiological. The anatomical changes
make upper airway obstruction and bleeding more likely
during mask anaesthesia and may make tracheal intubation
more difficult. There is approximately a 7-fold increase in
failed intubations in parturients at term. The anatomical
changes include capillary engorgement and oedema of the
upper airway, pharynx, false cords, glottis and arytenoids.
There is also an increase in chest diameter, to allow
increased minute ventilation, and an enlargement of the
breasts, which can make laryngoscopy with a standard
Macintosh blade more difficult.
The gravid uterus progressively displaces the diaphragm
cranially reducing diaphragmatic movement in late
pregnancy, particularly in the supine position. Inspiratory
reserve volume is increased but vital capacity, total lung
volume and FEV1 remain unchanged. A decrease in both
residual and expiratory reserve volumes causes a 20%
reduction in functional residual capacity, which in turn
causes airway closure in 50% of parturients at term in the
supine position. Thus, pre-oxygenation is less effective in
the term parturient and desaturation is likely to occur much
faster than in the non-pregnant patient. A pre-oxygenation
period of 3 - 5min is the standard recommendation. Some
of the changes to respiratory physiology are illustrated in
Figure 2.
Bronchial and tracheal smooth muscle relaxation are a
result of increased progesterone concentrations. This often
causes the symptoms of asthma to lessen in pregnancy.
PaCO
2
falls and then levels off at 4.1kPa (31mmHg) by
the end of the first trimester. This is caused by a 10%
increase in the respiratory rate, secondary to progesterone
mediated hypersensitivity to CO
2
, and an increase in
alveolar and minute ventilation, secondary to increased
respiratory rate and tidal volume. PaO
2
rises to 14 kPa
(105mmHg) during the 3rd trimester but then falls to
less than 13.5 kPa (101mmHg) at term because increased
oxygen consumption is no longer fully compensated for
by the rise in cardiac output. Thus, the alveolar arterial
oxygen gradient increases. In some parturients this may
be worsened by aortocaval compression and closure of
dependant airways. At term (40 weeks gestation), oxygen
consumption and carbon dioxide production are increased
by 60% above non-pregnant values

PREGNANCY-CHANGES IN MOTHER DURING PREGNANCY

CHANGES IN MATERNAL PHYSIOLOGY DURING PREGNANCY

Gestation
Period between conception and birth
Pregesterone/Oestrogen
Female hormones
Erythropoietin
Hormone secreted to increase the numbers of red blood cells
Trimester
A period of 3 months - during pregnancy there are three trimesters
Gravid
Pregnant - “Gravid uterus” means pregnant uterus
FEV
1
Forced Expiratory Volume in 1 minute
FRC
Functional Residual Capacity -
see Update in Anaesthesia (2000) 12;42
Parturient
A patient who is about to or is giving birth
Palmar erythema
Reddening of the palm of the hand

Maternal physiology undergoes many changes during
pregnancy. These changes, which are largely secondary to
the effects of progesterone and oestrogen, begin as early as
4 weeks gestation and are progressive. In the first 12 weeks
of pregnancy progesterone and oestrogen are produced
predominately by the ovary and thereafter by the placenta.
These changes both enable the fetus and placenta to grow
and prepare the mother and baby for childbirth.
Haematological
Red cell mass, white cell count and platelet production
are all increased during pregnancy. The rising white cell
count during pregnancy, which peaks after delivery, can
make diagnosis of infection difficult. Platelet production
is increased, but platelet consumption increases more,
causing the platelet count to fall to low normal values.
Renal erythropoietin production increases leading to a
20% increase in red cell mass.
Increased concentrations of progesterone and oestrogen
directly act on the kidney causing the release of renin. This
activates the aldosterone-renin-angiotensin mechanism
leading to renal sodium retention and an increase in total
body water. Plasma volume increases by 45% and as this
increase is relatively greater than the increase in red cell
mass, maternal haemoglobin concentrations falls from 150
g per litre pre-pregnancy to 120 g per litre during the 3rd
trimester (Figue 1). This is termed physiological anaemia
of pregnancy.
The increased circulating volume offers protection
for mother and fetus from the effects of haemorrhage
at delivery. Knowledge of this is important for the
anaesthetist as it can delay the onset of classic signs and
symptoms of hypovolaemia. It is very easy to be misled
into thinking that, even in the presence of considerable
volume loss, it does not need replacement. This is wrong,
it being essential to replace the measured loss, and to be
aware that more volume may have been lost than the blood
pressure and pulse might indicate. By two weeks post
partum the haematological changes have mostly reverted
to pre-pregnancy status

Monday, March 9, 2009

BREAST CANCER

BREAST the mammary gland is more prone to b attacked by cancer..
breast cancer attacks the lymph nodes of the breast mailnly the axillary group of lymph nodes
breast cancer over the skin appears like PEAU DE ORANGE.
surgically breast cancer is of 3 types
1.due to infection

2.a beningn tumour which is treated by EXISION

3.a malignant tumour which needs mastectomy ( recently i did an MRM{MODIFIED RADICAL MASTECTOMY}

other important method is PATTYs mastectomy

BREAST CANCER CAN BE IDENTIFIED BY A MAMMOGRAPHY..

it is a must needed investigation for present day women to do this test and safe guard themselves from BREAST CANCER

DNA MICRO ARRAY AND BREAST CANCER

DNA Microarray and Breast Cancer

Microarray is a powerful tool used widely to characterize tumors and has greatly improved
the ability to subclassify tumors according to shared molecular characteristics and clinical behavior.
It is a method to measure the expression of a large number of genes in any specimen simultaneously.
Researchers at Stanford University were the first to describe and use DNA microarray to study gene
expression in various diseases including cancer. Breast cancer is the second most common cancer
among Indian women. Multiple factors like age, diet, obesity, parity, age at first childbirth, oral
contraceptives, exogenous estrogens, genetics, environment, geographic location influence the
development of this heterogeneous disease. Gene expression in these cancers by microarray is fast
gaining in popularity in providing better prognostic and predictive information on the disease. This
review is an attempt to look at the recent advances in breast cancer research with DNA microarray TECHNOLOGY

WHOLE GENOMIC APPROACH IN BREAST CANCER

current methods of classification of breast cancer are based
on clinical stage, histopathological characteristics and few
immunohistochemical markers. These traditional methods
are often subjective, inconsistent and do not have the ability to differentiate subtle differences that may be of importance
for developing a better understanding of the tumor and
advancing therapeutic strategies for treatment. For example,
to identify breast cancer patients who need to be
administered adjuvant systemic therapy, the criteria
followed are a combination of age, tumor size, axillary node
status, and histopathological grade and hormonal status of
the tumor. However, these criteria do not predict disease
progression and clinical outcome precisely. This uncertainty
sometimes results in patients who need adjuvant therapy
not receiving it, while some are treated unnecessarily,
thereby being exposed to the risk of side effects. Expression
profiling of thousands of genes simultaneously using DNA
microarrays has a great potential to sub-classify tumors,
which are indistinguishable with current criteria, to different
groups so that the outcome to therapy can be predicted
more precisely [39••]. Although individual gene variations
may exert major effects on drug response, this response is
often a complex trait with several polymorphic genes and
other environmental factors contributing to different
degrees to overall treatment outcome. A number of studies
have reported the gene expression profiling of breast cancer,
and those of particular relevance to pharmacogenomics are
discussed below [40••,41-46,47••,48,49••,50••,51••].
Expression profiling can be used to define subtypes of breast
cancer more precisely. Approximately 60% of breast cancer
cases are ER positive (ER+), which is a well recognized
prognostic and predictive factor in early breast cancer.
Women with ER+ status respond better to hormonal or anti-
estrogen (such as tamoxifen) therapy. However, the
immunohistochemical method for determining ER status
often produces false results. For example, alterations in the
genes involved in ER signaling pathways leading to
defective ER pathways cannot be differentiated by the above
method. Gruvberger et al have identified the 100 most
important ER discriminator genes to demonstrate that ER+
and ER negative (ER-) tumors display remarkably different
phenotypes, which they attributed to their evolution from
distinct cell lineages [40••]. Unexpectedly, only a few of the
ER discriminator genes appear to be part of the ER signaling
pathway, suggesting that the difference in gene expression
profile between ER+ and ER- tumors can only partly be
explained by the activity of a functional ER pathway in ER+
tumors. Another independent study by West et al identified
a specific expression of a set of genes, which included not
only ER and ER pathway genes, but also genes that encode
proteins that synergize with ER, such as HNF3α and the
androgen receptor, to identify the ER status [51••]. This
study also identified a gene expression pattern to categorize
lymph node status. A study by Sørlie et al [47••] refined the
previously defined subtypes of breast tumors [44,46]. A total
of 115 malignant breast tumors were analyzed by
hierarchical clustering based on patterns of expression of 534
'intrinsic' genes and were subdivided into five subgroups,
some of which were previously known and some of which
are new entities.
Microarray-based expression profiling can also identify
expression patterns of a small set of markers that can predict
the outcome in a patient with a tumor or response of a
patient to a specific therapy. Landmark studies by van de vijvar et al revealed two genetic signatures, one correlated
with a good prognosis and the other with a poor prognosis,
based on the overall survival and development of distant
metastasis [50••,49••]. In their first study, oligonucleotide
microarrays containing 25,000 genes were used to study the
expression patterns of 98 primary tumors from young
patients under the age of 55 years with lymph node-negative
type cancer [49••]. Supervised clustering using information
about the clinical outcome in these patients identified a set
of 70 genes with an expression pattern that allowed highly
accurate classification of the patients into those with a poor
prognosis and those with good prognosis. A limitation of
this study was that patients with a known outcome were
used. To provide a more accurate estimate of the risks of
metastasis associated with the two gene expression patterns,
and to substantiate that the gene expression profile of breast
cancer is a clinically meaningful tool, van de Vijver et al
studied a cohort of 295 patients with either lymph node-
negative or lymph node-positive breast cancer [50••].
Examination of the expression levels of the previously
identified 70 predictor genes allowed the classification of 115
patients to the good-prognosis category and 180 patients to
the poor-prognosis category. Interestingly, the prognosis
profile did not appear to depend on lymph node status, as
patients with node-negative and node-positive status were
uniformly present in both categories. However, the
molecular profiling-based classification correlated well with
the age of the patient, histological grade and ER status of the
tumor. The prognosis profile predicted both the survival
and the risk of distant metastases. The overall ten-year
survival rate was 94.5% in the good-prognosis group and
54.6% in the poor-prognosis group. The probability of
remaining free of distant metastases at ten years was 85.2%
in the good-prognosis group and 50.6% in the poor-
prognosis group. A major implication of this study is that
molecular signature-based prediction of clinical outcome is
better than any of the currently used criteria

PHARMACOGENETICS AND BREAST PART 2

mutation in the cell cycle-checkpoint kinase gene (CHEK2) confer a small but
appreciably enhanced risk of breast cancer [16••]. CHEK2
encodes a cell-cycle checkpoint kinase and is implicated in
DNA repair processes involving BRCA1 and p53. The
1100delC mutation, a truncating variant of CHEK2 that
abrogates the kinase activity, occurs at a frequency of 1.1%
in healthy individuals. However, this variant is present in
5.1% of individuals with breast cancer families that do not
carry mutations in BRCA1 or BRCA2. This mutation results
in an approximately 2-fold increase of breast cancer risk in
women and a 10-fold increase of risk in men. In contrast, the
variant confers no increased cancer risk in carriers of BRCA1
or BRCA2 mutations.
The penetrance of BRCA1/BRCA2 mutations is modified by
other genetic and/or environmental factors. Identification of
such modifiers would help in facilitating more accurate risk
assessment in carriers who face difficult clinical choices
regarding prophylactic mastectomy and oophorectomy.
Candidate modifiers include genes with products that are
known to interact with BRCA1 and BRCA2 [17]. RAD51 is a
homolog of bacterial RecA, which is required for meiotic
and mitotic recombination and for recombinational repair of
double-strand DNA breaks. Both BRCA1 and BRCA2
interact with RAD51 [18,19]. The presence of an SNP in the
5'-untranslated region of RAD51 (135 G-C) increased breast
cancer risk by 4-fold among BRCA2 but not BRCA1 mutation
carriers [20•,21•]. It is possible that this SNP could affect the
mRNA stability and/or translation efficiency, leading to
altered RAD51 protein levels. The differential effect of
RAD51 polymorphism on BRCA1 versus BRCA2 mutation
carriers may relate to the different pathways by which
BRCA proteins function.
Predicting drug efficacy and toxicity
The study of large numbers of genes that influence drug
activity, toxicity and metabolism provides the opportunity
to customize drug treatments, thereby eliminating the
uncertainties of current cancer chemotherapy. Specifically,
genetic polymorphisms in genes responsible for metabolism
and disposition of drugs, transporters and targets of drugs
are being explored [22••].
The cytochrome P450 (CYP) system has been under study
for a considerable period of time for predicting drug
efficacy. CYP enzymes are members of a multiple gene
'superfamily'. These enzymes play an important role in
steroidogenesis and detoxification of xenobiotics, such as
polycyclic aromatic hydrocarbons, benzopyrene, arylamines
and heterocyclic amines. One CYP gene, CYP2D6, appears to
contribute to metabolism of many anticancer agents [23]. It
is believed that common SNPs in CYP2D6 impair the
activity of CYP2D6 and perhaps alter the pharmacokinetics
of anticancer drugs.
Glutathione S-transferases (GSTs) detoxify a variety of
carcinogens and cytotoxic drugs by catalyzing the
conjugation of a glutathione moiety to the substrate.
Individuals who are homozygous carriers of deletions in the
GSTM1, GSTT1 or GSTP1 genes may have a higher risk of
cancer of the breast and other sites due to their impaired
ability to metabolize and eliminate carcinogens
Most drugs interact with specific target proteins, such as
receptors, enzymes or proteins involved in, for example,
signal transduction and cell cycle control, for exerting their
effects. Polymorphisms in thee target genes can alter
sensitivity to the drugs. This interaction has been exploited
in the analysis of breast cancers to determine their suitability
for treatment with the recombinant humanized monoclonal
antibody trastuzumab (Herceptin) [27••], which brings
about the death of breast cancer cells by binding to HER2
receptors on their surface. The HER2 proto-oncogene
encodes a 185-kDa cell surface human epidermal growth
receptor 2 protein known as the HER2 protein or receptor
[28]. The gene is also known as HER2/neu, as it has
homology to the rat gene neu. Normal cells express a small
amount of HER2 protein, which is activated by
heterodimerization with HER1, HER3 and HER4 in a
complex with their ligands [29]. The HER2 gene is amplified
in 25 to 30% of breast cancers, leading to the expression of
HER2 proteins at abnormally high levels in cancer cells [30].
Women with breast cancers that overexpress HER2 have an
aggressive form of the disease with significantly shortened
disease-free survival and overall survival [29,31-33].
Treatment with trastuzumab is successful only in breast
cancers that overexpress HER2 receptor.
Fluoropyrimidine prodrugs (eg, capecitabine) are widely
used to treat solid tumors such as colorectal, breast, and
head and neck cancer. This drug needs to be activated in the
tumor to the active drug 5-fluorouracil (5-FU) by the enzyme
thymidine phosphorylase (TP), which is usually expressed
in higher amounts in tumors than in healthy tissue.
Normally,
85%
of
5-FU
is
broken
down
by
dihydropyrimidine dehydrogenase (DPD) in the liver, but
between 3 to 5% of the population have reduced DPD
activity and manifest more severe gastrointestinal and
hematological toxicity when treated with 5-FU. Reduced
DPD activity has been correlated to mutational inactivation
[34]. The ratio of TP to DPD expression (TP/DPD ratio)
appears to determine the level of 5-FU in the tumor, in
addition to its effectiveness. 5-FU inhibits tumor cell
proliferation by targeting thymidylate synthase (TS), an
enzyme that is required for de novo pyrimidine synthesis.
Multiple studies have demonstrated that TS mRNA and
protein levels are inversely related to clinical antitumor
response [35,36]. The expression of TS is controlled in part
by a polymorphism characterized by a multiple number of
tandem repeats of a 29-base pair sequence in the 5'-promoter
enhancer region (TSER) of the gene. Multiple in vivo studies
have demonstrated that increasing the number of repeats
leads to an increase in TS mRNA and protein levels
[37•,38•]. Together, these studies suggest that combined
genotyping and protein level estimation of TP, DPD and TS
genes might be useful in selecting patients who are likely to
tolerate and respond to 5-FU therapy.

PHARMACOGENETICS AND BREAST PART 1

PHARMACOGENETICS AND BREAST PART 1

Pharmacogenomics is the study of genetic variations between
individuals to predict the risk of toxic side effects and the probability
that a patient will respond to single- or multidrug chemotherapy.
Breast cancer remains one of the most common cancers among
women worldwide and is second only to lung cancer in cancer-
related death. A better understanding of the mechanisms of
initiation and progression of breast cancer is needed for early
diagnosis and development of better therapeutic methodologies.
Differences in cancer patients' responses to chemotherapy have often
been attributed to pathogenesis and severity of the disease, drug
interactions, patient's age, gender, nutritional status, organ
functions and tumor biology. It is now well recognized that genetic
variations in drug target genes, disease pathway genes and drug
metabolizing enzymes can have greater influence on drug efficacy
and toxicity. In addition, germline variants can be used to study
breast cancer susceptibility, as well as the variable response to both
drug and radiation therapy used in the treatment of breast cancer.
This review discusses clinically relevant individual gene variations
that influence breast cancer susceptibility and cancer therapy, as
well as the microarray-based expression profiling studies that have
great potential in cancer pharmacogenomics in terms of tumor
classification, drug and biomarker discovery and drug efficacY

Pharmacogenomics and single nucleotide
polymorphisms
Pharmacogenomics is the study of how genetic variations
influence responses to drugs. Genetic variations in drug-
metabolizing enzymes, transporters, receptors and other
drug targets have significant effects on the efficacy and
toxicity of many drugs. Pharmacogenomics combines
traditional pharmaceutical sciences such as biochemistry
with annotated knowledge of genes, proteins and single
nucleotide polymorphisms (SNPs). It is believed that drugs
might one day be tailor-made and adapted to each
individual's genetic makeup. Although factors such as
environment, diet, age, lifestyle and state of health can
influence an individual's response to medicines, their
genetic make-up is the key to creating personalized drugs
with greater efficacy and safety.
SNPs are the most frequently found DNA sequence
variations in the human genome, compared with infrequent
variants (mutations), the primary cause of genetic disorders.
It is believed that SNPs may contribute significantly to
genetic risk for common diseases [4••]. It is estimated that
the average nucleotide diversity is 1 difference/1200
basepairs. Approximately 1 million SNPs are likely to occur
in human genes, with approximately 500,000 being non-
coding SNPs, 200,000 being silent coding SNPs and 200,000
being replacement coding SNPs [5]. SNPs found in the
coding and regulatory regions of genes are likely to be the
most relevant variants. Efforts to identify all SNPs and their
relevance to disease (cancer) susceptibility and treatment
outcome are continuous, and may take several more years.
However, the approach taken by many scientists at present
is the candidate gene approach in which one examines the
SNPs of the chosen gene that are likely to have an effect.
Single gene variations in pharmacogenomics
Single gene variation studies of both SNPs and mutations
are of use in predicting the risk of cancer development and
predicting drug efficacy and toxicity.
Predicting the risk of developing breast cancer
The lifetime risk of a woman developing breast cancer is
approximately 10% [1]. Approximately, 5 to 10% of breast
cancers are of hereditary origin and two major genes
associated with hereditary breast and ovarian cancer, breast
cancer susceptibility gene 1 (BRCA1) and breast cancer
susceptibility gene 2 (BRCA2), have been identified [6••,7••].
Mutations in either of these genes confer a lifetime risk of
developing breast cancer of between 60 and 85% [8].
However, mutations in these genes account for
approximately 40% of hereditary breast cancer and only 2 to
3% of all breast cancer. Additional breast cancer
susceptibility genes with high-penetrance alleles are
believed to exist [9,10•]. Breast cancer also occurs in a
number of multicancer syndromes, such as Li-Fraumeni
syndrome, Li-Fraumeni-like syndrome, Cowdens syndrome,
Peutz-Jeghers syndrome and Muir-Torre syndrome, in
which affected individuals inherit mutations in p53, hCHK2,
PTEN, STK11/LKB1 and MSH2/MLH1, respectively [11-15].
Studies of BRCA1 and BRCA2 signaling pathways are
discovering newer genes that also appear to play important
roles in breast cancer susceptibility.

MILK EJECTION

ejection is critical for successful lactation, because
only small volumes of milk (1–10 mL) can be either
expressed
46
or removed by the breastfeeding infant
40
before milk ejection. Failure to remove sufficient quan-
tities of milk results in a decrease in milk production
because of local control mechanisms.
47
Stimulation of
the nipple initiates milk ejection via initiation of nervous
impulses to the hypothalamus, which stimulates the
posterior pituitary gland to release oxytocin into the
bloodstream.
48
Oxytocin causes the myoepithelial cells
surrounding the alveoli to contract, forcing milk into the
ducts. This results in increased intraductal pressure,
49
duct dilation
40,50
(measured by ultrasound), and conse-
quently increased milk flow rate
50
(measured by contin-
uous weigh balance during breast expression). Multiple
milk ejections almost always occur during breastfeed-
ing
40
(mean, 2.5; range, 0–9) and breast expression
50
(mean, 3–6 for 15-minute expression period), and alhough many women are able to sense the first milk
ejection, few are able to sense subsequent ones.
While it is well known that stress can influence milk
ejection—resulting in diminished amounts of milk re-
moved by both the infant
48
and breast pump
51
—it is
often the subtle stress which affects maternal confidence
and subsequently milk ejection that is overlooked. There-
fore, it is important to provide positive support to the
mother during both breastfeeding and pumping. Another
factor that may influence milk ejection and milk removal
is the ductal anatomy of the breast. In a study of mothers
expressing with an electric breast pump, ultrasound was
used to image duct dilation in the breast that was not
pumped. It was found that mothers with larger ducts
expressed more milk during milk ejection and had longer
milk ejections than mothers with smaller ducts.
50
There-
fore, the rate of milk removal for a mother may be
influenced in part by her ductal anatomy

Sunday, March 15, 2009

Saturday, March 14, 2009

Monday, March 9, 2009

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