Pregnancy

  Pregnancy is a transformative journey marked by the conception, growth,  and nurturing of a new life within a woman's body. It begins with the  fertilization of an egg by sperm, leading to the formation of a zygote  that implants in the uterine lining. Over the course of approximately 40  weeks, the developing embryo undergoes rapid cell division and  differentiation, eventually becoming a fetus with recognizable features  and organs. Throughout pregnancy, the mother experiences profound  physical and hormonal changes to support the developing fetus, including  increased blood volume, hormonal fluctuations, and alterations in organ  function. Pregnancy is divided into three trimesters, each  characterized by unique milestones and developmental stages. As the  pregnancy progresses, the fetus grows and matures, gaining the ability  to move, hear, and respond to stimuli. Towards the end of pregnancy, the  mother may experience labor, characterized by rhythmic uterine  contractions leading to the delivery of the baby. Pregnancy is a  remarkable and awe-inspiring process, culminating in the birth of a new  life and the beginning of a profound bond between parent and child. 

Ectopic Pregnancy: This occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tube. It can lead to life-threatening complications if not detected and treated promptly.

Gestational Diabetes: This condition develops during pregnancy when blood sugar levels become elevated. It increases the risk of complications for both the mother and the baby, including macrosomia (large birth weight), birth injuries, and cesarean delivery.

Hypertensive Disorders: These include gestational hypertension, preeclampsia, and eclampsia, which are characterized by high blood pressure during pregnancy. They can lead to complications such as placental abruption, preterm birth, and organ damage if not managed properly.

Miscarriage: Also known as spontaneous abortion, this refers to the loss of a pregnancy before 20 weeks of gestation. It can occur due to genetic abnormalities, hormonal imbalances, or maternal health conditions.

Placenta Previa: This occurs when the placenta partially or completely covers the cervix, leading to vaginal bleeding during pregnancy. It may require cesarean delivery to avoid complications such as hemorrhage and fetal distress.

Preterm Birth: This refers to the birth of a baby before 37 weeks of gestation. It increases the risk of complications such as respiratory distress syndrome, neurological problems, and developmental delays.

Preeclampsia: This is a hypertensive disorder characterized by high blood pressure and organ damage, typically affecting the kidneys and liver. It can lead to serious complications for both the mother and the baby if not managed promptly.

Rh Incompatibility: This occurs when the mother's Rh factor is negative, and the baby's Rh factor is positive, leading to a potential immune response that can harm the baby's red blood cells. It may require treatment with Rh immunoglobulin injections to prevent complications such as hemolytic disease of the newborn.

Stillbirth: This refers to the loss of a baby after 20 weeks of gestation but before birth. It can occur due to various factors, including placental abnormalities, infections, and umbilical cord accidents.

Uterine Rupture: This is a rare but serious complication in which the uterine wall tears during labor, potentially leading to severe bleeding and fetal distress. It often requires emergency medical intervention, including cesarean delivery.

Ectopic Pregnancy: 

Hyperinsulinemia and insulin resistance may affect tubal motility and increase the risk of impaired embryo transport, leading to ectopic implantation.

Metabolic syndrome, particularly obesity, can disrupt hormonal balance and impair fallopian tube function, contributing to ectopic pregnancies.

Gestational Diabetes: 

Hyperinsulinemia and insulin resistance are central to the development of gestational diabetes, leading to elevated blood sugar levels during pregnancy.

Metabolic syndrome, characterized by insulin resistance and dyslipidemia, increases the risk of developing gestational diabetes due to impaired glucose metabolism.

Hypertensive Disorders: 

Hyperinsulinemia and insulin resistance may contribute to endothelial dysfunction and vascular inflammation, increasing the risk of hypertensive disorders such as gestational hypertension and preeclampsia.

Metabolic syndrome, particularly abdominal obesity and dyslipidemia, is associated with increased blood pressure and endothelial dysfunction, further predisposing women to hypertensive complications during pregnancy.

Miscarriage: 

Hyperinsulinemia and insulin resistance may contribute to oxidative stress and inflammation, which can impair embryo implantation and lead to early pregnancy loss.

Metabolic syndrome, characterized by chronic inflammation and hormonal imbalances, may increase the risk of miscarriage due to abnormalities in uterine receptivity and embryo development.

Placenta Previa: 

Hyperinsulinemia and insulin resistance may affect placental development and implantation, increasing the risk of placenta previa.

Metabolic syndrome, particularly obesity and dyslipidemia, is associated with placental abnormalities and impaired vascularization, contributing to placenta previa.

Preterm Birth: 

Hyperinsulinemia and insulin resistance may promote inflammation and oxidative stress, leading to premature cervical ripening and preterm labor.

Metabolic syndrome, characterized by chronic inflammation and hormonal imbalances, increases the risk of preterm birth due to placental dysfunction and uterine abnormalities.

Preeclampsia: 

Hyperinsulinemia and insulin resistance may contribute to endothelial dysfunction and systemic inflammation, increasing the risk of preeclampsia.

Metabolic syndrome, particularly obesity and dyslipidemia, is associated with increased oxidative stress and impaired vascular function, further predisposing women to preeclampsia.

Rh Incompatibility: 

Hyperinsulinemia and insulin resistance may affect placental function and fetal blood flow, increasing the risk of Rh incompatibility and hemolytic disease of the newborn.

Metabolic syndrome, characterized by dyslipidemia and inflammation, may exacerbate placental abnormalities and increase the likelihood of Rh incompatibility.

Stillbirth: 

Hyperinsulinemia and insulin resistance may impair placental function and fetal oxygenation, increasing the risk of stillbirth.

Metabolic syndrome, particularly obesity and dyslipidemia, is associated with placental insufficiency and fetal growth restriction, further predisposing women to stillbirth.

Uterine Rupture: 

Hyperinsulinemia and insulin resistance may weaken uterine muscle tone and increase the risk of uterine rupture during labor.

Metabolic syndrome, characterized by obesity and hormonal imbalances, may further compromise uterine integrity and increase susceptibility to uterine rupture.

Obesity among pregnant women is a growing concern globally, mirroring the increasing prevalence of obesity in the general population.

According to the World Health Organization (WHO), approximately 15% of pregnant women worldwide are estimated to be obese.

The prevalence varies by region, with higher rates observed in developed countries compared to developing nations.

Prevalence in Europe: 

In Europe, obesity among pregnant women is also on the rise, reflecting the general trend of increasing obesity rates in the region.

According to data from the European Perinatal Health Report, obesity rates among pregnant women vary across European countries, ranging from around 10% to over 20%.

Countries with higher obesity rates in the general population tend to have higher rates of obesity among pregnant women as well.

Prevalence in Malta: 

Specific data on the prevalence of obesity among pregnant women in Malta may not be readily available.

However, given the overall rising trend of obesity in Malta, it's likely that obesity rates among pregnant women in Malta are also increasing.

Addressing obesity among pregnant women in Malta is important to ensure optimal maternal and fetal health outcomes and reduce the risk of complications during pregnancy and childbirth.

Overall, obesity among pregnant women is a significant public health issue worldwide, including in Europe and Malta. It poses risks to both maternal and fetal health and requires attention through preventive measures, early intervention, and comprehensive prenatal care.

  Maternal Health Risks: Obesity increases the risk of various health complications for the mother during pregnancy, including: 

Gestational Diabetes: Obese women are at higher risk of developing gestational diabetes, a type of diabetes that occurs during pregnancy, which can lead to complications for both the mother and the baby.

Hypertension and Preeclampsia: Obesity increases the risk of developing high blood pressure and preeclampsia, a potentially serious condition characterized by high blood pressure and protein in the urine, which can lead to complications such as premature birth and low birth weight.

Cesarean Section (C-Section): Obese women are more likely to require a cesarean delivery due to factors such as macrosomia (large fetal size), labor complications, and increased risk of birth injuries.

Gestational Hypertension: Obesity is associated with an increased risk of developing gestational hypertension, a condition characterized by high blood pressure during pregnancy, which can increase the risk of complications such as preterm birth and low birth weight.

Sleep Apnea: Obesity increases the risk of sleep apnea during pregnancy, a condition characterized by pauses in breathing during sleep, which can lead to poor sleep quality and daytime fatigue.

Fetal Health Risks: Obesity during pregnancy also poses risks to the developing fetus, including: 

Macrosomia: Obese women are at higher risk of delivering larger-than-average babies (macrosomia), which can increase the risk of birth injuries, shoulder dystocia, and the need for cesarean delivery.

Birth Defects: Obesity may increase the risk of certain birth defects in the baby, including neural tube defects and congenital heart defects.

Stillbirth: Obesity is associated with an increased risk of stillbirth, particularly in pregnancies complicated by other factors such as gestational diabetes and hypertension.

Childhood Obesity: Babies born to obese mothers may have an increased risk of developing obesity and related health problems later in life.

Management and Prevention: Managing obesity during pregnancy involves a multidisciplinary approach, including: 

Prenatal Care: Close monitoring of maternal and fetal health throughout pregnancy, including regular prenatal visits, screening for gestational diabetes and other complications, and management of maternal health conditions such as hypertension and diabetes.

Nutrition and Exercise: Encouraging healthy eating habits and regular physical activity to help manage weight gain and reduce the risk of complications.

Weight Management: Providing support and resources for weight management before, during, and after pregnancy, including counseling, dietary interventions, and lifestyle modifications.

Supportive Care: Providing emotional support, counseling, and education to pregnant women with obesity to address concerns, reduce stress, and promote overall well-being.

Complications Management: Prompt identification and management of complications such as gestational diabetes, hypertension, and preeclampsia to reduce the risk of adverse outcomes for both the mother and the baby.

Overall, obesity during pregnancy presents significant health risks for both the mother and the baby, highlighting the importance of preventive measures, early intervention, and comprehensive prenatal care to optimize maternal and fetal outcomes.

Worldwide: Obesity in pregnancy has become a global health concern, with increasing prevalence observed in many regions. According to the World Health Organization (WHO), approximately 10% to 25% of pregnant women worldwide are estimated to be obese. However, these rates vary widely across countries and regions due to differences in population demographics, lifestyle factors, and healthcare access.

Europe: In Europe, obesity rates among pregnant women have been steadily increasing over the years, mirroring the general trend of rising obesity rates in the population. According to data from the European Perinatal Health Report, the prevalence of obesity among pregnant women varies across European countries, ranging from around 10% to over 20%. Countries with higher obesity rates in the general population tend to have higher rates of obesity among pregnant women as well.

Malta: Specific data on the prevalence of obesity among pregnant women in Malta may vary and may not be readily available. However, given the overall rising trend of obesity in Malta and Europe, it's likely that obesity rates among pregnant women in Malta are also increasing. Addressing obesity in pregnancy in Malta is important to ensure optimal maternal and fetal health outcomes and reduce the risk of complications during pregnancy and childbirth. Regular monitoring, appropriate prenatal care, and lifestyle interventions are crucial for managing obesity in pregnancy and promoting healthy outcomes for both the mother and the baby.

 Impact of Obesity in Pregnancy: Obesity during pregnancy increases the risk of various complications for both the mother and the baby. Maternal health risks include gestational diabetes, hypertension, preeclampsia, cesarean delivery, and increased likelihood of postpartum hemorrhage. Obese pregnant women are also at higher risk of developing gestational diabetes, which can lead to macrosomia (large birth weight) in infants, birth injuries, and increased risk of neonatal hypoglycemia. Additionally, obesity in pregnancy is associated with an increased risk of preterm birth, stillbirth, miscarriage, and congenital anomalies. Maternal obesity may also complicate labor and delivery, leading to prolonged labor, difficulties with anesthesia, and increased risk of operative interventions. Postpartum complications such as wound infections and delayed wound healing are also more common in obese women. Long-term implications for the baby include an increased risk of childhood obesity and metabolic syndrome.

Impact of Type 2 Diabetes in Pregnancy: Type 2 diabetes during pregnancy, also known as gestational diabetes, poses risks to both the mother and the baby. Maternal complications include an increased risk of developing preeclampsia, hypertension, cesarean delivery, and type 2 diabetes later in life. Uncontrolled gestational diabetes can lead to macrosomia in infants, increasing the risk of birth injuries, shoulder dystocia, and neonatal hypoglycemia. Infants born to mothers with gestational diabetes may also experience respiratory distress syndrome and have an increased risk of childhood obesity and type 2 diabetes. Maternal glucose levels are closely monitored during pregnancy to reduce the risk of complications for both the mother and the baby. Management strategies may include dietary modifications, glucose monitoring, insulin therapy, and regular prenatal care to optimize outcomes for women with gestational diabetes.

 Worldwide: Type 2 diabetes in pregnancy, also known as gestational diabetes, is a significant global health issue. The prevalence of gestational diabetes varies widely across different regions, with estimates ranging from 1% to 14% of pregnancies worldwide. Factors contributing to the prevalence of gestational diabetes include changes in lifestyle, dietary habits, and increasing rates of obesity worldwide.

Europe: In Europe, the prevalence of gestational diabetes has been increasing in recent years, paralleling the rise in obesity rates and changes in lifestyle factors. The prevalence varies across European countries, with estimates ranging from around 1% to 10% of pregnancies. Countries with higher rates of obesity and diabetes in the general population tend to have higher rates of gestational diabetes as well.

Malta: Specific data on the prevalence of gestational diabetes in Malta may vary and may not be readily available. However, given the overall rising trend of obesity and diabetes in Malta and Europe, it's likely that the prevalence of gestational diabetes is also increasing. Addressing gestational diabetes in Malta is important to prevent complications for both the mother and the baby, including macrosomia, birth injuries, and long-term health risks. Regular screening, early detection, and appropriate management strategies are essential for optimizing outcomes for pregnant women with gestational diabetes in Malta.

 Gestational diabetes occurs during pregnancy, typically in the second or  third trimester, and is marked by high blood sugar levels. Insulin  resistance, driven by hormonal changes during pregnancy and exacerbated  by factors like obesity, plays a key role. Obesity and metabolic  syndrome increase the risk, and gestational diabetes itself raises the  chances of developing type 2 diabetes later. Inflammation and oxidative  stress worsen metabolic dysfunction and may lead to complications.  Management involves lifestyle changes, sometimes insulin therapy, and  addressing underlying metabolic issues to reduce future risks for both  mother and child. Understanding these metabolic factors is crucial for  detection, management, and prevention of complications in gestational  diabetes. 

59 Year old doctor from Germany takes health into her own hands and reverses her type 2 diabetes. She helps people understand the power of diet and lifestyle and the limits of mainstream medical care with specific emphasis on  pregestational diabetes 

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2. S, Hernandez TL. Low-Carbohydrate Diets for Gestational Diabetes. Nutrients. 2019;11(8):1737. doi:10.3390/nu11081737
3. Trout,  K.K., Compher, C.W., Dolin, C., Burns, C., Quinn, R., Durnwald, C.,  2022. Increased Protein with Decreased Carbohydrate Intake Reduces  Postprandial Blood Glucose Levels in Women with Gestational Diabetes: The iPRO Study. Women’s Health Reports 3, 728–739. doi.org/10.1089/whr.2022.0012
4. Mulla  WR. Carbohydrate Content in the GDM Diet: Two Views: View 2:  Low-Carbohydrate Diets Should Remain the Initial Therapy for Gestational  Diabetes. Diabetes Spectr. 2016;29(2):89-91. doi:10.2337/diaspect.29.2.89 
5. Moreno-Castilla  C, Hernandez M, Bergua M, et al. Low-Carbohydrate Diet for the  Treatment of Gestational Diabetes Mellitus. Diabetes Care.  2013;36(8):2233-2238. doi:10.2337/dc12-2714
6. Cypryk  K, Kamińska P, Kosiński M, Lewiński MP-MA. A comparison of the  effectiveness, tolerability and safety of high and low carbohydrate  diets in women with gestational diabetes. Endokrynologia Polska. 2007;58(4):313-320. ISSN 2299-8306
7. Cui, M. et al. (2022) ‘Effect of Carbohydrate-Restricted Dietary Pattern on Insulin  Treatment Rate, Lipid Metabolism and Nutritional Status in Pregnant  Women with Gestational Diabetes in Beijing, China’, Nutrients, 14(2), p. 359. doi:10.3390/nu14020359.
8. Mierzyński  R, Poniedziałek-Czajkowska E, Sotowski M, Szydełko-Gorzkowicz M.  Nutrition as Prevention Factor of Gestational Diabetes Mellitus: A  Narrative Review. Nutrients. 2021;13(11):3787. doi:10.3390/nu13113787
9. Moses  RG, Barker M, Winter M, Petocz P, Brand-Miller JC. Can a Low–Glycemic  Index Diet Reduce the Need for Insulin in Gestational Diabetes Mellitus?  Diabetes Care. 2009;32(6):996. doi:10.2337/dc09-0007 
10. Filardi  T, Panimolle F, Crescioli C, Lenzi A, Morano S. Gestational Diabetes  Mellitus: The Impact of Carbohydrate Quality in Diet. Nutrients.  2019;11(7):1549. doi:10.3390/nu11071549
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12. Ali  AM, Kunugi H. Intermittent Fasting, Dietary Modifications, and Exercise  for the Control of Gestational Diabetes and Maternal Mood  Dysregulation: A Review and a Case Report. International Journal of Environmental Research and Public Health. 2020;17(24):9379. doi:10.3390/ijerph17249379
13. Callahan  ML, Schneider-Worthington CR, Martin SL, Gower BA, Catalano PM,  Chandler-Laney P. Association of weight status and carbohydrate intake  with gestational weight gain. Clin Obes. Published online April 9, 2021:e12455. doi:10.1111/cob.12455

 Hot flushes, also known as hot flashes, are sudden feelings of warmth,  typically felt in the face, neck, and chest regions. They are commonly  associated with menopause but can also occur due to other hormonal  changes or medical conditions. During a hot flush, the skin may become  red and sweaty, and some individuals may experience a rapid heartbeat or  chills afterward. The exact cause of hot flushes is not fully  understood, but hormonal fluctuations, particularly a decrease in  estrogen levels, are believed to play a significant role in triggering  them. Hot flushes can vary in frequency and intensity among individuals  and may disrupt sleep and daily activities for some people. Treatment  options include hormone therapy, lifestyle changes, and medications to  alleviate symptoms. 

 Insulin resistance, hyperinsulinemia, and metabolic syndrome can all  influence hot flushes. These conditions disrupt hormonal balance and  blood vessel function, increasing the likelihood and severity of hot  flushes. Managing these metabolic factors through lifestyle changes and  medications may help alleviate symptoms. 

 Glycaemic variability, insulin resistance and hot flashes 

In addition to reducing hyperinsulinaemia, a TCR approach reduces glycaemic variability – keeping blood sugars more stable and can successfully reduce abdominal adiposity. 

1. Dormire  SL. The Potential Role of Glucose Transport Changes in Hot Flash  Physiology: A Hypothesis. Biol Res Nurs. 2009;10(3):241-247. doi:10.1177/1099800408324558
2. Dormire  S, Howharn C. The Effect of Dietary Intake on Hot Flashes in Menopausal  Women. J Obstet Gynecol Neonatal Nurs. 2007;36(3):255-262. doi:10.1111/j.1552-6909.2007.00142.x
3. Namgoung, S. et al. (2022) ‘Metabolically healthy and unhealthy obesity and risk of  vasomotor symptoms in premenopausal women: cross-sectional and cohort  studies’, BJOG: an international journal of obstetrics and gynaecology [Preprint]. doi:10.1111/1471-0528.17224.
4. Huang  W-Y, Chang C-C, Chen D-R, Kor C-T, Chen T-Y, Wu H-M. Circulating leptin  and adiponectin are associated with insulin resistance in healthy  postmenopausal women with hot flashes. PLoS One. 2017;12(4). doi:10.1371/journal.pone.0176430
5. Thurston  RC, Sowers MR, Sutton-Tyrrell K, et al. Abdominal adiposity and hot  flashes among midlife women. Menopause. 2008;15(3):429-434. doi:10.1097/gme.0b013e31815879cf

Menopause is a natural biological process that marks the end of a woman's menstrual cycles and fertility. It typically occurs between the ages of 45 and 55, with the average age of onset around 51 in most women. Menopause is characterized by a decline in the production of reproductive hormones, particularly estrogen and progesterone, by the ovaries.

During menopause, a woman's menstrual periods become irregular and eventually cease altogether. The transition leading up to menopause is called perimenopause, during which women may experience symptoms such as hot flashes, night sweats, mood changes, vaginal dryness, and changes in sleep patterns.

After menopause, women may experience long-term changes in their bodies, including a higher risk of osteoporosis (bone thinning) and heart disease due to the decline in estrogen levels. However, menopause is not a disease but a natural phase of life, and many women navigate this transition with few or manageable symptoms.

Treatment options for menopausal symptoms may include hormone therapy (estrogen therapy or combined estrogen-progestin therapy), lifestyle modifications, and alternative therapies such as herbal supplements or acupuncture. It's essential for women to discuss their menopausal symptoms and concerns with their healthcare provider to determine the most appropriate treatment plan for their individual needs.

  Hyperinsulinemia, insulin resistance, and metabolic syndrome can worsen  menopausal symptoms such as hot flashes and mood swings. They may also  contribute to weight gain, increase the risk of cardiovascular disease  and osteoporosis, and impact mental health including depression and anxiety during menopause. Managing  these metabolic disturbances through lifestyle changes and medical  interventions is essential for alleviating symptoms and reducing health  risks during this phase of life. 

As oestrogen/progesterone are insulin  sensitizing hormones, a reduction in these hormones can increase  insulin resistance which may contribute to the metabolic dysregulation  and symptoms of menopause. This section includes studies that support  potential benefits of a TCR approach to help manage areas of common  concern during menopause, primarily as a means of reducing glycaemic  variability and insulin resistance.

Insulin resistance, weight gain and cardiovascular disease 

Therapeutic carbohydrate reduction is one way to combat insulin resistance, weight gain, and inflammation – risk factors for CVD. Insulin resistance also contributes to platelet dysfunction and clotting risk. 

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2. Blomquist  C, Chorell E, Ryberg M, et al. Decreased lipogenesis-promoting factors  in adipose tissue in postmenopausal women with overweight on a  Paleolithic-type diet. Eur J Nutr. 2018;57(8):2877-2886. doi:10.1007/s00394-017-1558-0 
3. McPhee  JC, Zinn C, Smith M. Exploring the acceptability of, and adherence to a  carbohydrate-restricted diet as self-reported by women aged 40-55  years. J Holistic Performance NutritionTM. doi: 10.26712/230120181 PDF 
4. Segal-Isaacson  C, Johnson S, Tomuta V, Cowell B, Stein DT. A Randomized Trial  Comparing Low-Fat and Low-Carbohydrate Diets Matched for Energy and  Protein. Obesity Research. 2004;12(S11):130S-140S. doi:10.1038/oby.2004.278 
5. Nickols-Richardson, S.M. et al. (2005) ‘Perceived hunger is lower and weight loss is greater in  overweight premenopausal women consuming a low-carbohydrate/high-protein  vs high-carbohydrate/low-fat diet’, Journal of the American Dietetic Association, 105(9), pp. 1433–1437. doi:10.1016/j.jada.2005.06.025. 
6. Simpson,  S.J., Raubenheimer, D., Black, K.I., Conigrave, A.D., n.d. Weight gain  during the menopause transition: Evidence for a mechanism dependent on  protein leverage. BJOG: An International Journal of Obstetrics &  Gynaecology n/a. doi.org/10.1111/1471-0528.17290

For more on this see CVD, obesity, and insulin resistance sections.

 Preeclampsia is a pregnancy-related condition characterized by high  blood pressure and organ damage. Metabolic factors, including insulin  resistance and metabolic syndrome, are implicated in its development.  These factors contribute to endothelial dysfunction, inflammation, and  oxidative stress, which increase the risk of hypertension and organ  damage. Hormonal imbalances further exacerbate the condition. Management  involves monitoring blood pressure, lifestyle changes, and sometimes  medication. Understanding the role of metabolic abnormalities is crucial  for identifying high-risk individuals and improving management  strategies for better maternal and fetal outcomes.