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November 10, 2022
243: Why Lifestyle Medicine is The Key for Optimal Pregnancy Health with Dr. Kristi VanWinden

Do you want to have the best pregnancy possible? Dr. Kristi VanWinden is sharing the solution of Preconception Health to help you have the healthiest pregnancy possible. In this episode, you will learn: Why preconception care...


Do you want to have the best pregnancy possible? Dr. Kristi VanWinden is sharing the solution of Preconception Health to help you have the healthiest pregnancy possible.

In this episode, you will learn:

  • Why preconception care is important for pregnancy health
  • How to optimize your physical and mental health before pregnancy
  • The importance of lifestyle interventions in reducing the risk of pregnancy complications


Resources:
Improving Women’s Health Across the Lifespan by Nancy Eriksen, Michelle Tollefson, Neha Pathak  | Paperback and Hardcover


Other episodes you'll enjoy
194: Preconception Care Improves Women's Health and Families with Dr. John McHugh


About Dr. Kristi VanWinden

Dr. Kristi VanWinden, MD, FACOG, DipABLM, is a Maternal Fetal Medicine specialist in the San Francisco Bay Area, California. As an MFM specialist (also known as Perinatologist), Dr. VanWinden is an Obstetrician / Gynecologist with special training and interest in pre-conception and pregnancy care, high-risk pregnancies, and in prenatal diagnosis and ultrasound. She first embraced lifestyle medicine in 2011 when looking to improve her own health and has been involved with the American College of Lifestyle Medicine since 2017. She is a member of the ACLM Women’s Health Interest Group and is co-chair of the Pregnancy Subcommittee. She has authored numerous educational materials on lifestyle medicine and reproductive health.

Connect with Dr. Kristi
Email: kvanwinden@outlook.com


Website Link for this episode:
https://www.healthylifestylesolutions.org/243


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Transcript

[00:00:00] Dr. Kristi VanWinden: You have a higher risk of all of these pregnancy complications. And so somebody who's had a pregnancy complication before would really encourage them, especially to try to wait at least 18 months before their next pregnancy, cuz that really shortly spaced pregnancy is just gonna raise the risk of it happening again.

[00:00:17] Maya Acosta: You have more power over your health than what you've been told. This is the Healthy Lifestyle Solutions Podcast. I'm Maya Acosta, and I'm passionate about finding healthy lifestyle solutions to support optimal human health. If you're willing to go with me together, we can discover how simple lifestyle choices can help improve our quality of life and increase longevity in a big way.

[00:00:41] Maya Acosta: Let's get started. Dr. Kristi VanWinden will show us how to optimize our health before pregnancy for better outcomes. She's a maternal-fetal medicine specialist and contributor to the book Women's Health Throughout the Life Span. We prepare for pregnancy by managing our weight, chronic medical conditions, and medications.

[00:01:03] Maya Acosta: In her practice, she sees many women with pre-existing chronic conditions, pregnancy complications, and fetal abnormalities. While lifestyle medicine cannot prevent all conditions and complications, it can positively influence outcomes. Stick around to learn more about what you can do to improve your transits of having a healthy pregnancy.

[00:01:23] Maya Acosta: Also, share this episode with one remarkable woman in your life. As always, the full bio and the links for each of my guests are found on the website healthylifestylesolutions.org. All right. Welcome back to another episode of the Healthy Lifestyle Solutions Podcast. I'm your host, Maya Acosta. So as you know, on this podcast, we cover the six pillars of lifestyle medicine, and from time to time then I'll have other content that I think pertains to you that you might be interested in.

[00:01:53] Maya Acosta: So today we're gonna revisit, you know, female health and pregnancy and the things that women can do to have a healthy pregnancy. I'm sure have a lot of questions as we go through the conversation. But, I have Dr. Kristi VanWinden, and she is a diplomat of the American Board of Lifestyle Medicine. She's a maternal-fetal medicine specialist in the San Francisco Bay Area in California as an MFN specialist, also known as a perinatologist.

[00:02:23] Maya Acosta: Dr. VanWinden is an obstetrician-gynecologist with special training and interest in preconception and pregnancy care, high-risk pregnancies, and in prenatal diagnosis and ultrasound. She first embraced lifestyle medicine in 2011 when looking to improve her own health and has been involved with the American College of Lifestyle Medicine since 2017.

[00:02:45] Maya Acosta: She's a member of ACLM’s Women's Health Interest Group and is co-chair of the pregnancy subcommittee. She has authored numerous educational materials on my sub-medicine and reproductive health. Welcome, Dr. VanWinden. 

[00:03:00] Dr. Kristi VanWinden: Thank you so much for having me. I appreciate it.

[00:03:02] Maya Acosta: I always appreciate when doctors like yourself take the time from your busy schedule to come and have a conversation with me.

[00:03:09] Maya Acosta: You're of tremendous value, you know. So I wanna start off with that many individuals, especially women, uh, don't think of preconceptual Health. And so when I had Dr. McHugh on the show before, you know, I learned a lot of things. And, of course, I'm reading the materials that are provided by, especially the one on Women's Health Throughout Lifespan.

[00:03:31] Maya Acosta: I read a lot of that content, and I'm thinking, wow, you know, I am not a mom, and so I would've not known that everything that we do up to the point of conception plays a key role in the health of not only the child but also the woman's health and how she'll go through her pregnancy. So let's get started on all of that.

[00:03:52] Maya Acosta: First of all, you're a contributor to that book that I just referenced.

[00:03:56] Dr. Kristi VanWinden: Yes, correct. I contributed to the preconception pregnancy and postpartum chapters in that book. Yeah, and just to put in a little plug where that team that put that together is working on a preconception and pregnancy starter kit that will be available through ACLM pretty soon.

[00:04:12] Dr. Kristi VanWinden: So bunch of handouts that are supposed to be more patient-facing that kind of summarize that same information.

[00:04:18] Maya Acosta: Oh, well, this is very exciting, and I wish I had the book here. I have my library there, but, uh, you know, all my books, but I usually try to promote books like that, Help women. I believe this copy of this book, The Women's Health Throughout a Lifespan, is designed for really medical professionals who work with women.

[00:04:37] Maya Acosta: Yes, that's right. Yeah. This is a great way to inform them of the things they might have not learned in medical school, how they can support patients, female patients, specifically in the areas of nutrition, exercise. But also, you know, there's the focus on prevention. And so I'm excited that we're gonna talk about that, the idea of focusing on prevention so that we can prevent unhealthy or risky pregnancies.

[00:05:02] Maya Acosta: And then also all the other things that happen after conception, after delivery, really. So the first question that you posted here I really like is how you came into the interest of lifestyle medicine in women's health. And so I'm gonna ask you that one. Uh, Dr. VanWinden. First of all, let's get started in learning a little bit about yourself.

[00:05:21] Maya Acosta: Now you live in the San Francisco area. I'm curious two things. How did you decide that you wanted to work with women in the field as an OB-gyne? So that's one thing. And then, how soon after that did you learn about lifestyle medicine?

[00:05:35] Dr. Kristi VanWinden: I've always had an interest in kind of general wellness and that intersection that we have between conventional medicine and where other evidence-based medical, you know, um, interventions may kind of cross over, but not necessarily the ones that we see in medical school.

[00:05:54] Dr. Kristi VanWinden: And I always thought it was really interesting to see how other cultures and other societies function and how so many diseases that we see in the United States may be very rare or even non-existent in those cultures. So then you find that they move to the US, and they become just the same as anyone else.

[00:06:11] Dr. Kristi VanWinden: So I've always had an interest in kind of women's health and. Wellness. And I think OB-gyn is a very interesting field because it's so broad and it, it really touches on women with all kinds of different things. You know, just unifying them by this experience of pregnancy. But they're all so different and, and often it's a very exciting and rewarding time, but it's also a time where a lot of complications can arise.

[00:06:33] Dr. Kristi VanWinden: It's definitely a stressor for the body. And I think what initially got me interested in lifestyle medicine was just near the end of my residency, you know, 2010, 2011. I was really dealing with some of my own health concerns, you know, from just years of neglecting my own health, not eating well, not sleeping well.

[00:06:51] Dr. Kristi VanWinden: And I started investigating this, you know, diet that I'd heard about, the whole food plant-based diet. It was really the first time I'd ever heard about it, and I ended up deciding to take a little challenge for myself and try it for a month. And this was, you know, 11, almost 12 years ago. And I never went back because I just felt so much better.

[00:07:08] Dr. Kristi VanWinden: At that time, I didn't know anything about the other pillars of lifestyle medicine. I just knew about this kind of way of eating. So over the next few years, I really sort of learned more about other interventions that are important for health too, and the other pillars that encompass lifestyle medicine and eventually found ACLM  and was so excited to see this group of like-minded people that were also interested in this.

[00:07:29] Dr. Kristi VanWinden: And I think specifically for me cuz, because my field, as you mentioned, is maternal-fetal medicine, so it's dealing with a lot of high-risk pregnancies. I just started seeing more and more over the years how many pregnancy complications could potentially be avoided if we addressed underlying medical issues first.

[00:07:46] Dr. Kristi VanWinden: And this really drove my interest in kind of exploring how this intervention that had been so helpful for me could potentially be helpful so for my patients and improve their health and their pregnancies and then their infant’s health. 

[00:07:59] Maya Acosta: So, it was early in your career, I mean, during residency, when you learned about really the power of nutrition.

[00:08:05] Maya Acosta: I'm always in the awe when I learn about that because I think of, for example, my husband being of a different generation of physicians who have been in practice for so many years and still kind of shy away from social media and all of that to the younger physicians and even people in medical school, you know, that are beginning to be more open to lifestyle, the importance of how lifestyle plays a role in our health.

[00:08:30] Maya Acosta: I guess when you look back, it's like obvious, but um, for all of us, it's like, well, of course, if we're not exercising, if we're not eating the right foods, of course, we're bound to get sick. But you learned in your area of wanting to support women. You learned early on that food was key. And I had someone on the show who said it, put it this way, and I really like it.

[00:08:51] Maya Acosta: He said, “If the field of Lysol medicine were a puzzle was six pieces, nutrition would be the biggest piece of the puzzle.” And I said, Yeah, that's a wonderful way to put it. Because we do want to support women in all the other areas with stress management, having healthy relationships, and all of that. But if the food is not there, if the right foods are not there, then they'll suffer with some of those conditions that you see.

[00:09:17] Maya Acosta: I was wondering if you could tell us more about that. What are the biggest issues that are, that you see that are affecting pregnancy in your practice?

[00:09:25] Dr. Kristi VanWinden: So for my practice, I, I would, there are a couple of categories of problems that come up. The first is women who have long-term medical conditions that exist before pregnancy.

[00:09:36] Dr. Kristi VanWinden: So people who have diabetes or hypertension or obesity or any other medical condition because oftentimes those can impact pregnancy and sometimes worsen in pregnancy depending on the situation. A big category is these women who have chronic conditions that we really want to optimize or improve before they get pregnant or manage during pregnancy.

[00:09:57] Dr. Kristi VanWinden: And then the second group is complications from pregnancy. So people who came into pregnancy appearing fairly healthy, and then they develop gestational diabetes or preeclampsia or pre-term labor or something that is impacting the pregnancy that was unexpected. And then probably the third big category is fetal conditions.

[00:10:17] Dr. Kristi VanWinden: So the mother may appear healthy, but there could be abnormalities to the baby's development, whether it's a genetic problem or a birth defect or growth that's too fast or too slow or something that doesn't appear correct. So that would be another category, and it's really not uncommon at all for these areas to overlap.

[00:10:33] Dr. Kristi VanWinden: So a lot of times, we'll see multiple of those conditions that kind of overlap with each other. You know, lifestyle medicine can't remove all of these complications necessarily, but there are conditions in all three of those categories that can be positively influenced by improving our lifestyle before pregnancy or early in pregnancy.

[00:10:53] Maya Acosta: Okay. So, being that you've touched these points and like in three different points, I think I'm gonna start with the first one of sort of a preexisting chronic condition. I'm wondering what your perspective is on PCOS because we hear that often and that's, you know, polycystic ovarian syndrome, which I wanna say there's a new name for it.

[00:11:14] Maya Acosta: Am I correct? Are people starting to address it differently?

[00:11:17] Dr. Kristi VanWinden: You hear different terms used, but yet a lot of people still say PCOS. We all know what that…

[00:11:23] Maya Acosta: We all know it as PCOS. Um, you hear that's a condition that many women who are afflicted with PCOS then tend to have fertility issues. And I have a niece who's who I'm very close to, who many, many years ago started battling with this.

[00:11:38] Maya Acosta: And even then, I think I understood, at least from my perspective, I don't have a medical background, but I said that's an insulin issue. You know, that's what, because I used to listen a lot to Dr. Mark Hyman before I learned about lifestyle medicine. My perspective was, you gotta address this. And then her doctor said, No, you're perfectly healthy.

[00:11:56] Maya Acosta: We're gonna put you a metformin. And sure enough, she became pregnant, and she cycled like that. Infertility, metformin, pregnancy. And the whole time, I'm concerned about her health because I'm thinking there's gotta be something to this. This is not just a; it's not a fertility issue that is a symptom or a side effect of having PCOS or something like that.

[00:12:17] Maya Acosta: So I would love for you to clarify that. And then, about a month ago, she called me, and she said, I've been diagnosed with type two diabetes. It was no surprise to me at all because I sort of saw this coming. My niece is morbidly obese, you know, she's uh, very heavy. You know, patients tell what they wanna tell.

[00:12:36] Maya Acosta: They'll say this is in defensive decisions. That's this why I say it. Sometimes they'll say, Well, my doctor said I'm perfectly healthy. I'm fine. There's nothing wrong with me. So then I'll ask a couple more questions to see if the doctor really said that. But he never, you know, checked anything else.

[00:12:51] Maya Acosta: And then suddenly she has type two diabetes, and with every pregnancy, there was more weight gain, and I'm sure more insulin problems and all of that. So I was wondering, before we actually speak about the pregnancy, can you address PCOS and tell us what you know about it? 

[00:13:07] Dr. Kristi VanWinden: Yeah, so PCOS  is something that is a very challenging condition to treat.

[00:13:12] Dr. Kristi VanWinden: You know, there are some great lifestyle interventions that are starting to show a lot of promise in improving the underlying issues under, you know, with PCOS, right? Because it's a chicken and the egg situation as you're kind of describing, you know, is it the insulin resistance that's causing the, the obesity that's causing the insulin resistance?

[00:13:29] Dr. Kristi VanWinden: And it's a constellation of multiple things that are happening at the same time. You know, from the perspective of pregnancy, the big issues we think about are just fertility. So just getting pregnant and then, of course, the insulin resistance that classically goes along with it. So people are very commonly diagnosed with gestational diabetes, even if they're not diabetic outside of pregnancy because they have, and we'll talk more about gestational diabetes later, I'm sure.

[00:13:56] Dr. Kristi VanWinden:  But they have this baseline level of insulin resistance that just makes them more prone to any little thing sort of tipping them over into the diabetes range. So, you know, PCOS is something that's often managed by people who deal with infertility or general gynecologists because often these patients are coming and looking to become pregnant or looking for cycle regulation, you know, cause they often have irregular cycles.

[00:14:18] Dr. Kristi VanWinden: And so, you know, from my standpoint, by the time they get to me, oftentimes they've passed that point, and now we're dealing with how to manage the pregnancy with this condition that might make them more prone to, you know, gestational diabetes and other factors that could impact that pregnancy.

[00:14:32] Maya Acosta: Yes, absolutely.

[00:14:34] Maya Acosta: So while you know, PCOS can cause fertility problems, again, that's like you said, it's an issue that needs to be addressed so that it doesn't complicate a pregnancy later on. Okay. So now, a woman say she's fairly healthy for the most part. If she's planning on, you know, becoming pregnant, what's the most important thing that she can do before she actually becomes pregnant?

[00:14:58] Maya Acosta: What can she do to optimize her health and the health of her baby?

[00:15:01] Dr. Kristi VanWinden: Well, I think the first thing that's super important is just planning ahead because not everybody thinks this way. Not everybody thinks, Oh gosh, I'm thinking about pregnancy, so I should do all of these things to optimize my health beforehand.

[00:15:14] Dr. Kristi VanWinden: A lot of people just get pregnant, and then they start asking those questions after. Even just asking the question and intending to plan ahead is already a step ahead of many people. Preconception care is probably our biggest opportunity for improving pregnancy health, and it's often the missed opportunity because not everybody obtains preconception care.

[00:15:35] Dr. Kristi VanWinden: So we know anybody in this field will tell you 50% of pregnancies are unplanned. So we need to sort of, a, a healthcare profession, look at every visit that we have or every interaction we have with reproductive age women as a potential preconception visit. So if somebody has a medical condition or they're on medications that might need to be adjusted for pregnancy, it's really important that we discuss with them contraception and pregnancy planning and what to do if a pregnancy does occur because we don't know that they're gonna come back before they get pregnant.

[00:16:08] Dr. Kristi VanWinden: So that's really important. But for those women that do plan, and now they're coming in and. Yep. I'm planning a pregnancy in the next year or so. I think it's really important for them to realize that what they need to do is just kind of get into the best physical and mental health they're able to do. Pregnancy's a huge stressor on the body.

[00:16:26] Dr. Kristi VanWinden: It's a normal process, but it's a stressor. And so I tell people it's like training for a big event. You're probably gonna be able to finish it even without training, but it might hurt a lot more to do so. It might be harder to recover from. Being prepared for that pregnancy in advance is really gonna help you get through it in the smoothest way possible.

[00:16:43] Dr. Kristi VanWinden: So when we think about kind of like preconception interventions, we wanna really look at chronic medical conditions, optimize them as much as we can, streamline medications so that people aren't taking unnecessary medications, and hopefully using medications that are safe in pregnancy, updating all the routine healthcare that might be due.

[00:17:03] Dr. Kristi VanWinden: Managing weight is really important, so if people are able to get to a normal BMI before pregnancy, that's incredibly helpful. But even a modest weight loss of somebody who's overweight or obese, even just a really small 5%, 10% weight loss, can be really beneficial and really reduce the risk of pregnancy complications.

[00:17:23] Dr. Kristi VanWinden: So it doesn't necessarily mean they have to make it to a normal weight to have some benefit. And then prenatal vitamins. You know, I tell people to start a prenatal vitamin at least two months before they attempt conception. And really that's because you wanna get those micronutrient stores built up before pregnancy.

[00:17:39] Dr. Kristi VanWinden: It's really important for preventing birth defects. Some of the things that we are trying to do with prenatal vitamins is increase the folic acid level to reduce the risk of birth defects, and that has to be done really before pregnancy. And then also because at the beginning of pregnancy, a lot of women are nauseous and they have a hard time taking their vitamins.

[00:17:56] Dr. Kristi VanWinden: It's helpful to kind of really get those stores up beforehand. And then I'll go through with them kind of like each of the six pillars of lifestyle medicine. We can talk about specific recommendations if you'd like for those, but you know, really kind of addressing their lifestyle from the holistic perspective and looking at all of the pillars and how we can maybe make some improvements before they get pregnant.

[00:18:15] Maya Acosta: Sure, and I'm glad that you addressed that 50% of those pregnancies are unplanned. Because that puts a woman at a different place as opposed to one who is going to plan out her life for the next 20, 30, 40 years, or whatever it may be. She can be in the middle of a career, in the middle of a project, anything like that, and suddenly the pregnancy is gonna change everything, and her stress will be different than someone who has prepared for it. 

[00:18:41] Maya Acosta: So, I had a couple of questions before we talk about lifestyle medicine. Are women, in general, choosing to have children at an older age? Is there an average age of patients that you see now, or do you have, it's just very broad nowadays? 

[00:18:57] Dr. Kristi VanWinden: Yeah, I think that's a question that varies, um, geographically and regionally, um, pretty significantly.

[00:19:05] Dr. Kristi VanWinden: You know, I, I work in California now, and we certainly have a much higher average age of pregnancy than I saw when I worked in Arizona for a time. So I think part of it is just social and sort of areas with, you know, more women going into careers or with longer education, they tend to delay pregnancy more.

[00:19:27] Dr. Kristi VanWinden: But as a whole, yes. You know, we see the age of pregnancy just creeping up little by little since probably the eighties. And that carries with it additional risks because many of the things that we think of as pregnancy risks just gradually increase with every additional year of age that we get. 

[00:19:47] Maya Acosta: So, of the conditions that you see, which one do you feel is more common for women who are older and pregnant?

[00:19:54] Dr. Kristi VanWinden: So actually there are quite a few conditions that might be more common with older age. So when we think about fetal conditions, there's an increased risk for genetic issues with babies that are conceived later in life. You know, things like Down Syndrome or Trisomy 21 is technical name for it, but other genetic conditions as well.

[00:20:13] Dr. Kristi VanWinden: Birth defects, those kinds of things. So it can be from a baby's perspective, but it can also be maternal conditions. So there's a higher risk of gestational diabetes of blood pressure issues in pregnancy. Of conditions like placenta previa, which is, can cause bleeding. It's a, an issue where the placenta implant is low in the uterus and can cause bleeding and sometimes require C-section delivery.

[00:20:36] Dr. Kristi VanWinden: There's a higher risk of C-section because they actually, interestingly, have a higher chance of labor not progressing normally. For whatever reason. We don't completely understand why, but a number of these conditions are just more common with older age. So everything and, and the risk, you know, at the very end of pregnancy, the risk of stillbirth increases.

[00:20:54] Dr. Kristi VanWinden: So somebody who is much older, their risk of stillbirth, you know, At the due date or even a little before the due date is like somebody's risk normally would be well past the due date if they were younger. So we have to be a little more cautious with all of those pregnancies. But really it's broad spectrum of things that can change.

[00:21:12] Maya Acosta: Sure. Yes. And I asked just because it seems like there are women who are choosing to have children at a later age, and it kind of, in many ways, you know, if nature had designed it that way, it would be more ideal because then we're more set to be like more available for the children. Our finances and our careers are where we want them to be by the time like maybe you're 40 or something like that, but biologically the body just doesn't allow for that.

[00:21:39] Maya Acosta: So, Okay. So let's talk about when a woman is pregnant, and I guess this is where we can bring in lifestyle medicine, but what can she do to have the healthiest pregnancy possible?

[00:21:52] Dr. Kristi VanWinden: Yeah. So again, we wanna kind of go back to all six of the lifestyle medicine pillars as things that can be beneficial to look at.

[00:21:59] Dr. Kristi VanWinden: So we wanna look at her diet. The classic kind of lifestyle medicine recommendation is a whole, unprocessed, plant-predominant diet, and that is a perfectly appropriate thing to eat during pregnancy. Sometimes people will feel like they're getting pushback from family members, that they're not gonna have enough protein or something, and that that's absolutely not true.

[00:22:19] Dr. Kristi VanWinden: And I know you're gonna have Kayli Anderson on in the near future too, to discuss nutrition and pregnancy, and she'll get into this in a lot more detail. It's absolutely appropriate to have, you know, really have a focus on whole and unprocessed foods as much as possible and eat as many plants as possible in pregnancy.

[00:22:36] Dr. Kristi VanWinden: I think sometimes exclusion diets are hard. So if I tell people avoid these things, it's harder for them to do. So if I had one recommendation for people to include rather than exclude for their diet, it would be fiber. That people need to really be intentionally adding fiber to their diet. And the reason is because there's a lot of benefits to higher fiber diets in pregnancy.

[00:22:58] Dr. Kristi VanWinden: You know, reduced risk of preeclampsia and and other conditions. It's really very effective. But also fiber is only found in plant foods and it's kind of a good marker of something that's unprocessed, right? So even a plant food that's been heavily processed will be stripped of its fiber. So if you're really intentionally eating higher fiber foods, it's going to help you sort of push some of the other not-so-good things off your plate.

[00:23:23] Dr. Kristi VanWinden: It may not exclude them completely, but at least you'll start having the benefit of more plants and more fiber on your plate and in pregnancy. That's a great way to start. If somebody's not quite eating a ideal diet to, just start with trying to get at least 25 grams of fiber on their plates in the first trimester, and then increasing that in the second and third trimester and working up slowly because you don't wanna cause a lot of bloating and things that can happen at the beginning, but over the course of a few weeks, really trying to bring that level up.

[00:23:50] Dr. Kristi VanWinden: There are some foods in pregnancy that we really try to avoid for safety reasons, not so much for nutrition, but there's a list that most people will receive when they start prenatal care and most of it, raw or undercooked or processed animal foods. And this is really because they can carry some foodborne infections.

[00:24:08] Dr. Kristi VanWinden: Also, fish with high mercury content are kind of a no-no in pregnancy. You wanna really limit those. The only plant foods on that list are raw juices like unpasteurized juices and raw sprouts. So bean sprouts, alfalfa sprouts, things like that. We try to avoid those in pregnancy, but really trying to, you know, eat as healthy as possible.

[00:24:26] Dr. Kristi VanWinden: Lots of small nutrient-dense meals scattered throughout the day cause it's kind of hard to eat larger meals by the end of pregnancy. And then, you know, there's this myth, right, that I'm eating for two. You'll hear that a lot, And that's not actually true. So, you know, we wanna, in the first trimester, people really don't need any additional nutrition and then, later in pregnancy, they might need another three to 500 calories per day, but really not a full adult diet times two, cuz that's really gonna lead to excessive weight gain and larger babies and gestational diabetes.

[00:24:55] Dr. Kristi VanWinden: So, from a dietary standpoint, that's kind of where I would start.

[00:24:59] Maya Acosta: Wow. If I can, if I can just ask a couple of questions about nutrition. First of all, you're saying later in their pregnancy, just adding three to 500 calories in addition to what they eat is about all they need? That's not much,

[00:25:12] Dr. Kristi VanWinden: Mm-hmm. , It's not as much as people think. It really is pretty modest increase, right?

[00:25:17] Maya Acosta: Yeah. So I'm wondering also, because I can see, I imagine how difficult it would be to incorporate more plant-based foods once you're. If you haven't already kind of started making a transition, you're dealing with all sorts of things during your pregnancy. Mm-hmm. , it probably is recommended to the, if you can incorporate these healthy foods before your pregnancy, that's why it's just easy.

[00:25:39] Maya Acosta: It's just becomes a lifestyle when you're pregnant. At least, that's what I'm thinking. So the other thing that I wonder, and if you know patients who are more plant-forward, do they tend to have less nausea? And what about like the swelling of the legs? Is that less because of what they eat?

[00:25:56] Dr. Kristi VanWinden: Yeah. So, you know, nausea can happen in any pregnancy.

[00:26:00] Dr. Kristi VanWinden: We think it's probably 85 to 90% of pregnant women are gonna have some degree of nausea. So, it’s unlikely that even with an ideal diet, that they'd be completely immune to that, you know? But there is probably some improvement in that, and like conditions like hyperemesis, which are really severe, nausea that you know often lands people in the hospital, maybe less with plant-predominant diets.

[00:26:24] Dr. Kristi VanWinden: This is something that isn't, we don't have a lot of great data on, but just incidentally, it seems like people who are taking in lower protein, higher carbohydrate, just very bland kind of diets at the beginning, can control the nausea a little bit better without medications.

[00:26:40] Maya Acosta: Have you been able to successfully either transition a pregnant patient to a whole food, plant-based diet or at least incorporating more plants into their diet without the patient resisting it?

[00:26:53] Dr. Kristi VanWinden: I think it's easier to do before pregnancy, just like many of these changes, and like you said, once you've done the change, it's not that hard to continue it once you're pregnant, but it's difficult to make major lifestyle changes once you're pregnant. And it's also difficult because your time is limited.

[00:27:10] Dr. Kristi VanWinden: You know you're only pregnant for 40 weeks by the time you come in and have your first appointment. You're probably 10, 12 weeks long, and you don't have that much time to make dramatic changes. So I have certainly gotten people to eat more plants, more fiber. Again, that's often where I'll start with people if they seem a little resistant.

[00:27:26] Dr. Kristi VanWinden: People who have had prior complications are often a lot more receptive and kind of understand, okay, I think I need to change something. But to certainly, before pregnancy, we have more time. We have more time to think about it and read about it and make changes and experiment with what works for them.

[00:27:42] Dr. Kristi VanWinden: And I think that's, you know, ideally the time to make an intervention like this if we're able to. Right. But it's absolutely fine if somebody feels motivated to make that change in pregnancy, they can.

[00:27:52] Maya Acosta: Right. I always find it amazing how, when it in terms of even exercise, when an individual, just a regular person who was never athletic, adopts this way of living, and suddenly they find themselves with more energy, and suddenly they're running marathons.

[00:28:06] Maya Acosta: Right. ? Mm-hmm. . I love that whole idea. I feel the same way about pregnancy that you would probably be surprised if you adopted a lifestyle before your pregnancy. Like how much better you would feel. I don't know. I'm excited about, you know, in the future, having more data on this and being able to make those comparisons.

[00:28:27] Maya Acosta: Speaking of marathons, what are your recommendations as far as exercise, because I, that might be another concern that we may have, like mm-hmm. Is it safe for me to run, for example?

[00:28:38] Dr. Kristi VanWinden: Yeah, so my general discussion with people about exercise and pregnancy is if they have been doing an activity regularly outside of pregnancy, it's almost always safe to go ahead and continue that.

[00:28:50] Dr. Kristi VanWinden: So I wouldn't necessarily recommend somebody take up running if they weren't a runner before pregnancy, but if they were running regularly, it's absolutely fine to continue that as long as they don't have any complications of the pregnancy that arise. You know, it's really important that they stay hydrated because it's very easy to get dehydrated in pregnancy, and really just listen to their body.

[00:29:08] Dr. Kristi VanWinden: You know, if they need to reduce their intensity a little, do that. You know, don't push themselves to the utter limit, but it's fine to continue, in many cases, even pretty vigorous activities. The only things that are kind of, you know, not appropriate for pregnancy would be activities where you have to life flat on your back for long periods of time.

[00:29:28] Dr. Kristi VanWinden: Or you have really extreme temperatures like hot yoga would not be recommended. You know, things that could make you fall or contact sports, scuba diving, we don't want you to do in pregnancy, but almost all other activities are, are gonna be safe to continue to do with some modifications as your body changes.

[00:29:45] Maya Acosta:  That's great to know. I assume that they would be that fear. Not only that, but you know, I've seen women in my family when they're walking towards, especially that last trimester, the last couple of months, walking really helps to alleviate some of the achiness things are happening in the body. Mm-hmm. So what other recommendations do you make in terms of lifestyle?

[00:30:06] Dr. Kristi VanWinden:  Well, sleep is really important, and this is a challenging one in pregnancy because, you know, sleep is impacted in so many different ways. By pregnancy, it's uncomfortable. Sometimes people have to sleep in a position they're not used to. They're often getting up to go urinate multiple times during the night.

[00:30:22] Dr. Kristi VanWinden: So it makes it really tough. But really just trying to make sleep a priority. You know, going to bed early enough that they can have time to get good restful sleep. ACLM, I think, has some good handouts on sleep hygiene, so kind of learning how to make your environment the most conducive to sleep. You know that it's a little cool, it's dark, it's not, you know, too stimulating.

[00:30:42] Dr. Kristi VanWinden: In pregnancy, pillows are your friend, you know, lots and lots of pillows to prop up, you know, your knees and your hips and kind of put them anywhere that's uncomfortable so you can get yourself into a comfortable position. Some people have sleep apnea, and if you have sleep apnea before pregnancy, you should certainly keep using a CPAP machine if you have one, which is the airway machine that people sleep with.

[00:31:04] Dr. Kristi VanWinden: And some people develop sleep apnea in pregnancy. So if people are finding they're waking up, you know, gasping for air, where they have a partner in the bed that's saying, You sound like you're snoring really loudly. And then you have these pauses. They should get a sleep study because that's actually something that can develop in pregnancy from the swelling that happens in the airways.

[00:31:22] Dr. Kristi VanWinden: That's even if it's not happening before pregnancy, they may need a little extra support, and that's really important to prevent high blood pressure in pregnancy.

[00:31:31] Maya Acosta: Very good. That's the first time I hear this, the not getting enough sleep is what can contribute to a high blood pressure in a pregnant woman.

[00:31:40] Dr. Kristi VanWinden: So disrupted sleep is associated for sure with high blood pressure. So not sleeping enough is probably not great either, but people who have really, who have sleep apnea or who have very, very disrupted sleep have a higher risk of developing something like preeclampsia. 

[00:31:58] Maya Acosta: Oh wow. I'm so glad you're talking about this.

[00:32:00] Maya Acosta: Especially when we move further into preeclampsia. I'm very interested in that topic. Okay. And other things like stress management. Mm-hmm. , uh, building healthy relationships. What do you say to your patients? And as a matter of fact, I was just thinking, too, while you were talking about, you know, just not getting adequate sleep is, do you even have time to speak with your patients about mental health?

[00:32:22] Maya Acosta: Just checking in during their pregnancy to see how they are, like, I'm sure there are so many emotions that are happening during a pregnancy, especially if it wasn't planned. Do you have time to screen for things like depression or mental health issues?

[00:32:37] Dr. Kristi VanWinden: Yeah. Well, the good news is that as a sort of medical society, we've decided that this is really important.

[00:32:44] Dr. Kristi VanWinden: So we've started to find ways to build in screening for depression and anxiety and something called ACEs, which stands for Adverse Childhood Experiences, which are traumatic events that can then carry on into adulthood and cause health issues as well. We've found ways, at least a lot of practices to incorporate questionnaires and screening tools as part of routine prenatal care, or they're sent to the patient in advance, and they fill them out.

[00:33:13] Dr. Kristi VanWinden: Same thing with postpartum screening, because we really realize that these things need to be addressed, and it shouldn't be just, Oh, I had five minutes, so I brought it up with this patient. It really needs to be universal screening because emotional wellness is super important in pregnancy. It's tough. 

[00:33:29] Dr. Kristi VanWinden: Pregnancy is a strain on the body and the mind. And you know, people might feel unwell, they might feel pain, they might not be sleeping. They might have stress and anxiety that's from the pregnancy itself, or feel like they're out of control cuz it's so many changes that are happening to their body. And then relationship strain is a lot more common in pregnancy.

[00:33:46] Dr. Kristi VanWinden: It's hard sometimes for couples to maintain a, a relationship even that was positive beforehand. So it's really important to address those. You know, I, because I deal with higher-risk pregnancies, I often get consultations for people who are on psychiatric medications and other medications to discuss kind of the pros and cons of continuing those in pregnancy.

[00:34:05] Dr. Kristi VanWinden: But in almost all cases, it's better to continue treatment because we really want the emotional stability that comes with being treated, and it's actually riskier to the pregnancy, in many cases, to go off of medication and then have uncontrolled kind of mental health conditions and toxic emotions and all these things that kind of come up.

[00:34:26] Dr. Kristi VanWinden: The medication itself is far less risky than some of the complications that can happen if we withdraw that acutely, and then the patient sort of decompensates if that makes sense.

[00:34:33] Maya Acosta: Oh, yes. And that the ACEs screening, I think it was maybe last year or the year before that California was the first state to recommend medical professionals to screen for this. Is that right? 

[00:34:46] Dr. Kristi VanWinden: That's right. Yeah. 

[00:34:47] Maya Acosta: Yeah. That's wonderful news. And I often talk about ACEs, at least when I get the opportunity. I also wonder if you're screening for that pregnant patient and she has grew up with these things in place, I wonder what the prevalence is or the risk are for her own child to then grow up being exposed to these things that could contribute to health issues as well.

[00:35:11] Maya Acosta: So you guys do so much to try to support patients. It's like, how do you do? Like what kind of support is available for a female who is undergoing some stress mental health issues? 

[00:35:21] Dr. Kristi VanWinden: It can be challenging, and it really depends on the resources within that patient's specific healthcare system. So, It's tough because, you know, they roll out a screening tool that's adopted on a state level, but then the interventions for that are not necessarily so global, right?

[00:35:38] Dr. Kristi VanWinden: So there are resources out there. There are therapists that are specifically trained in trauma-informed therapy and techniques to address either childhood traumas or adulthood traumas. There are social workers that are amazing. So often, with the ACEs screening, we also provide a resilience screening. So you can kind of see how is this patient adapting or coping with this.

[00:36:01] Dr. Kristi VanWinden: So somebody who has, you know, some screening positive on the ACEs screening, but then they have a really high resilient score, they may not need help. You know, because they're just able to cope better. So often it's trying to figure out who really needs the help—and then finding whatever community resources and local resources are available for that particular person.

[00:36:20] Maya Acosta: Yes. Oh, I'm so glad you touched on it because, yeah, especially not everybody has access to therapy, to a coach, to someone who can support them. And the more we talk about at least making resources available that are downloadable content or just even audiobooks like I often recommend content related to childhood trauma and so that people can do their own inner work if they're interested.

[00:36:45] Maya Acosta: Okay. So now you then, so the next area that we'll talk about, I guess, is when an individual, when she has really put all the efforts to prevent any kind of complications during a pregnancy, and yet something does show up. I was wondering if you can talk about gestational diabetes and how does that happen?

[00:37:05] Maya Acosta: At what point in the pregnancy does that show up? What are the implications? And then how do you help the patient manage this condition?

[00:37:12] Dr. Kristi VanWinden: Sure. So gestational diabetes is diabetes, that happens only during pregnancy. So somebody, by definition, that means that they didn't have diabetes before pregnancy cause that would be a different type of diabetes.

[00:37:25] Dr. Kristi VanWinden: But somebody comes into pregnancy, and they have either, you know, normal blood sugars or maybe some mild prediabetes. And then, as the pregnancy progresses, the placenta, which is this organ that essentially connects the mom and the baby, is just pumping out hormones throughout the pregnancy. And these hormones do all kinds of different things in the body, but some of them make you more resistant to insulin.

[00:37:48] Dr. Kristi VanWinden: And so essentially what happens is as the placenta grows, the hormone levels go up, insulin resistance starts increasing, blood sugar starts increasing. And for some people, if they have some reserve there that won't do anything, it won't tip them into the diabetes range. They might run at a little bit higher blood sugar, but that's it.

[00:38:05] Dr. Kristi VanWinden: For a lot of women who have gestational diabetes, that insulin resistance sort of increases to a point where when we screen them for gestational diabetes, they look like they're diabetic. And so this is usually diagnosed. We typically screen people between 24 and 28 weeks for this. And it's done with a, what's called a Glucola test, where they drink a sugary drink, and then we test their blood sugar later to see how their body manages that sugar, how well it's able to break it down and get rid of it.

[00:38:33] Dr. Kristi VanWinden: And so if somebody has higher blood sugar after drinking the drink, that means that they weren't able to kind of reduce that level very quickly. And that essentially means that they have gestational diabetes. So it can happen to anybody, but there's certain risk factors that we think of. So if somebody's had gestational diabetes before,

[00:38:50] Dr. Kristi VanWinden:  If they pre-diabetes or insulin resistance, like if they have obesity, if they're at an older age, family history is also huge. So if somebody has family members that have diabetes or gestational diabetes, then they're more likely to have it as well.

[00:39:02] Maya Acosta: Now, when they develop this gestational diabetes, do they have the typical, or you call it the common symptoms that a, say, a type two diabetic would have, like maybe a little bit of neuropathy or frequent urination, or what do the patients experience during this pregnant time, during the pregnancy? 

[00:39:21] Dr. Kristi VanWinden: So for the vast majority of patients, this is completely without symptoms, and the only reason that they know that they have gestational diabetes is because we have tested them for it, and we do a universal test because it is such a common condition. Okay? So, know that the longer term complications of diabetes, like neuropathy or problems with the eyes or the kidneys or other things, does not tend to happen with gestational diabetes because it's such a short window of time.

[00:39:47] Maya Acosta: So, they don't have symptoms, but they will have higher risk of having complications because it's gestational; it's developed during their pregnancy. 

[00:39:55] Dr. Kristi VanWinden: Right. So the biggest concerns are baby concerns. Not so much mom concerns, but high blood sugar and pregnancy can cause babies to grow too quickly. So sometimes they can be extra large for their age.

[00:40:09] Dr. Kristi VanWinden: That, in turn, can cause for more difficult deliveries. So there's something called shoulder dystocia, where the shoulders can get stuck after delivery of the baby's head, and that can be very dangerous. That's more common with diabetes and with a large baby. So there's a higher risk of C-section. Also, there's a higher risk of stillbirth.

[00:40:25] Dr. Kristi VanWinden: And really terribly, you know, uncontrolled cases. And then, after birth, the baby has a higher risk of having some complications. So even after birth, the baby can develop low blood sugar, which is kind of a response to being suddenly cut off from that high blood sugar source that they were having for all these months.

[00:40:42] Dr. Kristi VanWinden: Like the baby often will have low blood sugar, and sometimes that requires pretty aggressive treatment. They're more likely to have to go to the NICU, and they're more likely to have jaundice and other kind of complications after birth. So really, the better we can control the blood sugar in pregnancy, the lower the risk is to the baby.

[00:40:57] Maya Acosta: Does it also mean that the child can then have a higher risk for just developing diabetes through his or her life?

[00:41:06] Dr. Kristi VanWinden: Yeah. So any exposure to diabetes in pregnancy, whether it's gestational diabetes or type two diabetes or other conditions, has downstream effects for that baby's own life. There are lots of reasons for that.

[00:41:20] Dr. Kristi VanWinden: You know, some of it might be environmental that they're just raised in a household where people eat a certain way or maybe are more prone to diabetes. But you know, we see that risk even with babies that are adopted. So it's not necessarily always environment. We know family history plays a role in diabetes, just genetics, you know. And that's something that even if it's not the direct descendant, you know, it's the aunt and the grandparents all had diabetes, that baby's gonna be at higher risk of diabetes.

[00:41:45] Dr. Kristi VanWinden: But there's also, you know, several mechanisms by which just being exposed to higher blood sugar for that period of time in the, in the womb can place them at higher risk of developing diabetes and other chronic conditions later.

[00:41:57] Maya Acosta: Wow, this is incredible. How common is this knowledge? Do most female patients know this, that gestational diabetes can put their child at risk?

[00:42:08] Dr. Kristi VanWinden: You know, I think as a community, we are probably not as good about talking to patients about long-term risks. We focus a lot more, you know, I feel like, in pregnancy, many women are, they all know I have a risk of having a big baby, right? This is something they've all heard, but I think the potential risks for 10, 20 years down the road aren't always so clear.

[00:42:28] Dr. Kristi VanWinden:. So it's definitely something that I will talk to patients about, and I find it's a good way to motivate somebody who may be a little reluctant to do the management for diabetes in, in pregnancy and kind of saying, Oh, I feel fine. I don't really wanna do this. Sometimes explaining to them, you know, this is really to benefit your baby long term.

[00:42:45] Dr. Kristi VanWinden: You know, that can sometimes be that little factor that motivates them more to say, Hey, maybe I should control this more tightly. It's definitely something talked about more now than it was historically, but I don't know that every woman is getting this information when they are diagnosed.

[00:42:58] Maya Acosta: Yeah, it just, it sounds scary.

[00:43:00] Maya Acosta: I feel that in many ways, you know, because women, more and more, you know, throughout the years, are developing sort of like fertility issues. The focus is on just becoming pregnant without thinking about all the things that you teach, which is what to do, how to optimize the body before pregnancy, and then how to stay healthy so that the child can also be healthy.

[00:43:22] Maya Acosta: So, I don't know if I asked, how do you manage gestational diabetes? Can you try to reverse it or control it during the pregnancy? Or is it just you have to just manage the pregnancy? Just make sure that, just kind of watch the patient through the delivery. How does that work?

[00:43:39] Dr. Kristi VanWinden:  Yeah, so really, the mainstay of treatment for gestational diabetes is lifestyle change.

[00:43:43] Dr. Kristi VanWinden: The recommendations are typically, most patients are gonna see a dietician. They're gonna be told to follow the ADA diet or the American Diabetes Association diet or something very similar to that. So that's a usually a low-carb, higher-fat diet. And the reason for that is that, in the short term, that makes the blood sugar numbers look better, right?

[00:44:03] Dr. Kristi VanWinden: If you eat zero carbs and you only eat fat and protein, your blood sugar won't change. It's basically gonna stay flat. So if you're just treating the number, that's a great way to make those blood sugar numbers look better, you know? And what the patient's doing in the meantime is they're using something called a glucometer to prick their finger, usually four times a day at least, um, to check their blood sugars.

[00:44:22] Dr. Kristi VanWinden: And so we're monitoring their blood sugar response first thing in the morning, and also after meals, and then giving them tips, you know, diet tips, telling them to walk after meals, things like that. If they aren't getting sufficient control of their blood sugar, with those changes, then we move on to things like medication, so insulin, or sometimes pills for diabetes and pregnancy.

[00:44:43] Dr. Kristi VanWinden: So really that's the management, you know, our, we don't, it's something that happens later in pregnancy. It's often diagnosed in the very end of the second or third trimester. So it's harder to really conceptualize actual reversal of it. So we manage it the best we can, and some people do great. They have never had another blood sugar that's elevated after they kind of make some changes.

[00:45:01] Dr. Kristi VanWinden: So that's really kind of how it's managed. And then after deliveries, you know, six weeks or so after delivery, they should always be screened for diabetes again to make sure that it's resolved.

[00:45:11] Maya Acosta: Great. That's great news. All right. Gestational hypertension or preeclampsia. Now, what contributes to that, and also how do you manage this?

[00:45:19] Maya Acosta: I've seen, I don't know anyone who's gone through preeclampsia, but what I've seen is that they have to be even more managed and controlled or what contributes to that?

[00:45:28] Dr. Kristi VanWinden: Gestational hypertension and preeclampsia are two disorders on a spectrum of high blood pressure and pregnancy, and these are conditions that 

[00:45:37] Dr. Kristi VanWinden: are high blood pressure caused by the pregnancy. The risk is somewhere in the neighborhood of five to 10% of pregnancies, although in a higher-risk area, we may see more. And really, the main risk factors we think of are anything that affects your blood vessel health, any condition that affects the health of your vascular system.

[00:45:56] Dr. Kristi VanWinden: You know, that could be autoimmune disease. Hypertension that exists before pregnancy is, is a main risk factor. Obesity we don't completely understand the trigger for what causes preeclampsia, but we know it's rooted in your placenta. So people who have. Abnormal placentas or abnormal blood flow to the placenta so that, that interface between the uterus and the placenta is abnormal.

[00:46:21] Dr. Kristi VanWinden: They are at dramatically higher risk of these conditions. So when this starts happening, you know, there's really such a wide spectrum of how this can present. So sometimes people can have really mild versions of this where it happens near term or at term, and it's not affecting any other organs in their body.

[00:46:39] Dr. Kristi VanWinden: It's just high blood pressure, and it's managed with delivery. Simple as that. So let's have a baby and let you start healing from. Sometimes it can be a lot more severe; sometimes it can happen very early in the pregnancy. In those cases, it might require hospitalization, medications, and frequently a preterm delivery for safety of the mom, essentially.

[00:46:59] Maya Acosta: Wow. That's another scary condition again. Well, if this is associated with hypertension, then again, what you're saying is that perhaps by optimizing the health before the pregnancy, you can reduce the risk for developing preeclampsia.

[00:47:12] Dr. Kristi VanWinden: Absolutely. So when I talk to people about minimizing their risk of preeclampsia, this is a common question

[00:47:19] Dr. Kristi VanWinden: when somebody's been through it, they don't wanna go through it again. If they have hypertension, getting that under control or trying to improve, that is a huge step. The other thing I tell people is the placenta is kind of analogous to the heart. It's a good way to think about it. So the placenta is full of little blood vessels, and those blood vessels have to work with nice

[00:47:39] Dr. Kristi VanWinden: smooth blood flow through them in order to prevent preeclampsia from happening. Our hearts have small blood vessels in them, the coronary arteries, and those have to work well in order to prevent heart disease. So anything that's heart-healthy is really placenta healthy. So I tell people heart-healthy diets, things like that are, are super important for protecting your placenta and helping it function the best it can.

[00:48:01] Dr. Kristi VanWinden: We use frequently in medicine now we use low-dose aspirin in pregnancy for anybody that's at higher risk of preeclampsia. And a lot of people have heard about aspirin for older family members that have heart disease, and so I'll kind of give them that analogy. This is why we're using aspirin for preeclampsia, is we want those little blood vessels to function the best they can.

[00:48:21] Dr. Kristi VanWinden: It's something that, you know, I think anything that's heart healthy is gonna be really beneficial, especially if you're doing this discussion between pregnancies and you're thinking about how to make the next one best. What's really interesting, though, about aspirin is that it definitely reduces the risk of preeclampsia, and I use it all the time, but the risk reduction is only between 10 and 30%.

[00:48:40] Dr. Kristi VanWinden: So it's not a miracle cure, and a lot of people will still end up with preeclampsia, but there's at least one study out there showing that high fiber diets may have up to 67% reduction in preeclampsia. It's amazing. So, When I talk to people about aspirin, I also talk to them about high-fiber diets because even though we don't have a ton of data on it, it is a really low-risk intervention.

[00:49:02] Dr. Kristi VanWinden: It's healthy for other reasons, and why not do it if it potentially could have such a big reduction in risk for preeclampsia?

[00:49:08] Maya Acosta: Yeah, no kidding. I'm so glad you added this. First time I'm hearing this as well. But then again, you know, why would I know this. But it's sort of like that's how I feel in general, that if your pregnancy is not planned and you haven't been studying or preparing on pregnancies, it's like you get hit with everything at one time, like how to go through pregnancy and you know what to expect.

[00:49:30] Maya Acosta: All these different things. And so there's also this other thing that we listed here, which is preterm labor and birth. What can you tell us about that?

[00:49:37] Dr. Kristi VanWinden: Preterm birth really falls into two big categories. There is spontaneous preterm birth, which is when preterm labor happens, or some other condition leads to spontaneous earlier delivery.

[00:49:50] Dr. Kristi VanWinden: And then there's indicated preterm birth, which is the term we use to describe preterm births for things like preeclampsia or something else where it's us inducing the the birth early because we are concerned about health of either the mom or the baby. So preterm birth is any birth below 37 weeks of pregnancy.

[00:50:07] Dr. Kristi VanWinden: It happens in somewhere between 10 and 12% of all pregnancies. Two-thirds of them are spontaneous, and one-third are indicated roughly. It depends on the population, but we know that an indicated preterm birth is gonna be very conducive to lifestyle changes in terms of reducing their risk in a future pregnancy, because those are, again, things like preeclampsia or other conditions that we might have some way of intervening for spontaneous preterm births we don't understand as well.

[00:50:35] Dr. Kristi VanWinden: You know, if somebody could figure out all the triggers for what causes early labor. This would be a Nobel Prize-winning paper because nobody really knows all the triggers. We have some risk factors that we know of, and we know that there are certain things that we've figured out that might reduce the risk a little, but nobody can really tackle this problem completely.

[00:50:52] Dr. Kristi VanWinden: So there's some information out there that certain dietary patterns, like the dash diet's been studied and Mediterranean diet has been studied and may improve the risk of spontaneous preterm birth. And it may do so on a level similar to what we use, you know, medically, which is something like progesterone supplements, but we just don't have great data on it.

[00:51:08] Dr. Kristi VanWinden: So really when we talk about how lifestyle might impact your risk of preterm birth, the biggest bang for our buck is gonna be to reduce medical complications that might lead to an indicated preterm birth. And there's really not much we can do once the process starts. So, if somebody comes in, in preterm labor, like there's really nothing we can do at that point, lifestyle wise, we just have to kind of manage it from a medical perspective.

[00:51:30] Maya Acosta: And to think that all she was thinking about was just having a child, that's all. She just wants to have a child, doesn't want all the other complications. So now let's say that she's gone through one or two pregnancies and has had some of these complications. So gestational diabetes or preeclampsia, and she might be done having children if she decides to do so to stop.

[00:51:52] Maya Acosta: Can she still suffer health issues as a result of these pregnancies?

[00:51:57] Dr. Kristi VanWinden: Yeah, so pregnancy complications and future health is a really important area that's still being researched. But we know that adverse pregnancy outcomes or some kind of complication of pregnancy is strongly related to future health risks.

[00:52:14] Dr. Kristi VanWinden: And so, for example, gestational diabetes, at least 50% of people with gestational diabetes will develop type two diabetes within the next ten years. Okay. And probably longer if you look at a lifetime. Preeclampsia is really strongly associated with developing high blood pressure later in life, heart disease or cardiovascular disease, and other complications, other health complications as well.

[00:52:37] Dr. Kristi VanWinden: And somebody who's had that really severe type of preeclampsia I mentioned where it happens really early or it impacts baby's growth in, in a negative way. They have a 10 times increased risk of cardiovascular disease later in life. So it's really dramatic. So these people really need to have more screenings.

[00:52:53] Dr. Kristi VanWinden: They need to have, you know, more follow-up with their regular doctor after pregnancy. And we are now starting to recognize that adverse pregnancy outcomes are a cardiovascular risk factor, just like high cholesterol, just like hypertension, just like diabetes. And cardiologists are starting to recognize this as a pregnancy-related cardiovascular risk factor.

[00:53:15] Dr. Kristi VanWinden: So they're eligible for more screenings. But I think it's also important to empower these women, right? That this doesn't necessarily mean doom and gloom. You have to develop these things. I think it's amazing that pregnancy brings to the surface diseases that are already happening that we don't know about.

[00:53:31] Dr. Kristi VanWinden: So it's like a little glimpse of your future. It's like a little window into your future life, and it gives you the chance to say, Oh, I am at higher risk of this. It hasn't happened yet. I have a chance to make some changes now before it ever happens, which is just an amazing and empowering thing for them to think about rather than looking at this as kind of a futility.

[00:53:52] Maya Acosta: Yes. And as you're talking about that, I'm just thinking of the overall idea of our immune system in general and how when we're faced with certain viruses and bacteria; it's like we're testing the immune system to see how, how strong, how healthy we are. And correct me if I'm wrong, I'm just thinking this way.

[00:54:10] Maya Acosta: So what you just said is actually very important. Like the woman, we just never know what is brewing. I say that a lot, even though I don't pronounce it right. But we don't know what is cooking, you know, brewing in our body when we don't eat the right foods when we don't exercise, all of that. So things can be happening, but the pregnancy can actually like you said, can be an indicator of how we are doing.

[00:54:33] Dr. Kristi VanWinden: I also like, Yeah, so the, Oh yeah, I was just gonna say, yeah, so the pregnancy, exactly what you said, it acts as a stress test. So it's basically like going through any other stress test in our body. Yeah, and I mentioned earlier this analogy of the placenta to the heart, and I think. It's also helpful to kind of think about it that way because the placenta has similar physiology, similar biology to the heart, but it's only designed to work for 40 weeks.

[00:54:59] Dr. Kristi VanWinden: The heart is designed to work for 70-plus years, so all the risk factors that impact the heart also impact the placenta, but you see those effects much more quickly, right? So you can now see in the course of a short period of pregnancy, it's almost like you take a lifespan and you squish it down into those 40 weeks, and you can see what's happening to your heart and other organs by looking at what's happening to that placenta.

[00:55:23] Maya Acosta: So, no, this is a great conversation that we've had because I really feel that this is new information for many, many people. And I'm thinking like how this could even help women who have younger children, right? So they're done, like I said, having children, but maybe if they have had these complications, they wanna get those regular checkups just to make sure because they don't necessarily come back to that same physician, that same OB-gyn who treated them initially.

[00:55:50] Maya Acosta: So do you have any tips, any additional tips for women who are considering either having children or who have had difficult pregnancies?

[00:55:59] Dr. Kristi VanWinden: One other thing I would mention just in terms of planning for multiple pregnancies is to think about the inter-pregnancy interval, which is what the term that we use for.

[00:56:12] Dr. Kristi VanWinden: The duration between the delivery of one baby and the conception of the next one. There's pretty good information out there that the ideal inter-pregnancy interval is between 18 months and five years. And if you have really closely spaced pregnancies, less than 18 months, but certainly less than 12 or less, you know, the, the closer space they are, the more it is or very, very long durations between pregnancies, you have a higher risk of all of these pregnancy complications.

[00:56:40] Dr. Kristi VanWinden: And so somebody who's had a pregnancy complication before would really encourage them, especially to try to wait at least 18 months before their next pregnancy, cuz that really shortly spaced pregnancy is just gonna raise the risk of it happening again.

[00:56:53] Maya Acosta: Wow. That's also another great tip, and it makes sense as well that you probably wanna allow the body to heal and recuperate from such a stressful event in a way.

[00:57:03] Maya Acosta: Gosh. And you know, the pressures that women have when they first start having children is to have them back to back so that they can be close in age. So many… 

[00:57:11] Dr. Kristi VanWinden: Especially when they start older, especially when they started an older age, that's a challenge because sometimes if you're having your first baby late in life, you wanna really kind of

[00:57:19] Dr. Kristi VanWinden: have them close together. But it is really ideal to try to wait a little bit, at least, at least give it a year. But if somebody's had preeclampsia, I'd definitely try to give it a little bit more time.

[00:57:29] Maya Acosta: Right. So I was wondering as we're wrapping up, if you could tell us a little bit more about the ACLM Women's Interest Group?

[00:57:36] Maya Acosta: Well, I often mention it on the podcast, but the women's, the pregnancy group. Mm-hmm, the subcommittee on pregnancy. And also, so every time I get an opportunity, I mentioned that the Lifestyle Medicine conference is, is, will take place in November in Orlando. And so during those meetings, that's when people in some of these, uh, subcommittees or groups have the opportunity to come together to network or to join one of ACLM's interest group.

[00:58:05] Maya Acosta: So tell us a little bit about your experience working in the Women's Health Interest Group and also being part of the Pregnancy subcommittee.

[00:58:12] Dr. Kristi VanWinden: Yeah, I was so excited to hear about the Women's Health Interest Group when it was starting because it's an area that's not discussed a whole lot in women's health.

[00:58:20] Dr. Kristi VanWinden: And so finding others across the country and even across the world that are interested in optimizing women's health and reproductive health using lifestyle is really powerful. So the Women's Health Group is awesome. If anybody is interested in joining, you know, we meet quarterly, usually, and there's lots of great ideas, and it's such a broad scope of people who attend those meetings with so many different backgrounds, some medical, some not, some, just all kinds of different backgrounds and just, you know, keeping ideas together.

[00:58:46] Dr. Kristi VanWinden: A lot of the real work of that group comes from these subcommittees. So Nancy Erickson and I co-chair the pregnancy subcommittee, which I know you're, you know, Nancy, and you've, um, been familiar with this group also. But our real goal as, as a subcommittee is to develop a lot of educational material and a lot of resources for both patients and providers who are looking for something streamlined that can kind of answer questions like we've discussed today about planning for pregnancy, preconception health, postpartum health, and everything related to that.

[00:59:16] Dr. Kristi VanWinden: So we are, again, working on, I mentioned earlier at the beginning that we're working on a starter kit. So the ACLM has a couple of starter kits that are more designed for general populations, and we're working on a women's health-specific starter kit that's targeted specifically for reproductive age

[00:59:32] Dr. Kristi VanWinden: women who are considering pregnancy or who might just be thinking it's a possibility and looking at each pillar for both the preconception period and the pregnancy period and kind of how we can optimize each of those. So we're working on that. We have done handouts on gestational diabetes and some other things that are patient-facing handouts that are also available.

[00:59:51] Dr. Kristi VanWinden: So really just trying to work on finding ways to educate and helping those providers out there who do most of the prenatal care in this country who aren't that familiar with this, to have a really easy resource that they can hand out to direct patients, like additional information.

[01:00:06] Maya Acosta: Sure. This is exciting.

[01:00:07] Maya Acosta: When would materials like this be available?

[01:00:10] Dr. Kristi VanWinden: So the starter kit we're hoping to have available by the meeting in November. We are in, we've gone through many, many courses of revisions, and we're just kind of making it look pretty right now. So we're hoping that that will be available very soon. A lot of the other resources are already on the website, so they, um, are currently available.

[01:00:28] Maya Acosta: Oh, wonderful. And is this something, so if we wanted to send some of the listeners who might be interested somewhere to obtain some of these resources, are they available to everyday people if they go to the ACLM website?

[01:00:40] Dr. Kristi VanWinden: Yeah, so the ACLM website, a lot of the patient-facing information is available, so I would have to double check on the gestational diabetes one, but I believe it is, it's definitely something that's the goal is to have the starter kit available just like the other ones that they have on the website that you can freely download.

[01:00:57] Maya Acosta: Yeah, no, I'm so excited. You know, I remember years ago when my sisters started having children in the one book that everybody had to have is What to Expect When You're Expecting. Mm-hmm. , remember? Mm-hmm. Absolutely. And, and now. So many resources available, but back then, we didn't know about lifestyle medicine.

[01:01:15] Maya Acosta: So the fact that this material is now becoming available to support women so that they know that it's not just about being concerned, whether there's, you know, family history or a genetic component that you have to be concerned about, but really there are things that you can do right now to optimize the health of your baby and for yourself as well during your pregnancy.

[01:01:36] Maya Acosta: So you don't have to be at the mercy of this. And so you can reduce your risk for having complications during your pregnancy. You wanna have a healthier birth and all of that. And so these resources are being made available. That's why I love being part of the American College of Lifestyle Medicine because I learn about health professionals like yourself who are equipped with this knowledge.

[01:01:56] Maya Acosta: And then you're educating patients. How frustrating is it for you or not to speak with colleagues about this content? Are they open to what you have to say?

[01:02:05] Dr. Kristi VanWinden: I think that a lot of them are open, you know? But it is kind of a paradigm shift for a lot of people. And most people did not train hearing this kind of stuff.

[01:02:13] Dr. Kristi VanWinden: So I think lifestyle interventions were always taught, at least when I was in medical school, as kind of this first line. You try it for a little while, and then when it doesn't work, you move on to other things. And so I think the key is looking at it differently that this actually can be a really powerful treatment.

[01:02:32] Dr. Kristi VanWinden: It can be an intervention, it can actually be an alternative to our other medical treatments, but it relies on the patient, and it relies on them being really motivated and being willing to make bigger changes. And the bigger changes, the bigger the benefit. It's something that I think I'm really trying to, you know, the word out, and I love talking to patients about it

[01:02:50] Dr. Kristi VanWinden: cause I feel like a lot of times they'll go, Oh my gosh, I've never heard this before. How's nobody told me this before? You know? And I'm starting to find that more people are open to thinking about sort of looking at this paradigm. Maybe not diving in headfirst into every single recommendation, but at least understanding how powerful it can be.

[01:03:08] Maya Acosta: Yeah, absolutely. And, like I said, I haven't heard of a lot of these things because why would I? But also, now that I know, now I can share it with other people as well. And again, I like the point that you made that the pregnancy for a woman can be like a stress test, right? To see where we are in our health and perhaps even prevent advanced chronic conditions in our own health because the baby kind of woke us up to that

[01:03:34] Maya Acosta: Mm-hmm. . So this has been wonderful. Is there anything else that you'd like to share with my listeners before we wrap up?

[01:03:40] Dr. Kristi VanWinden: I think those are the main points. I would just put a one-line plug at the end of this for being aware of health equity issues that come up with lifestyle medicine too. Because one of the challenges is that we know people of color in this country are at higher risk of a lot of complications.

[01:03:58] Dr. Kristi VanWinden: And this is related to a number of things, but primarily related to exposure to racism and chronic inflammation. And what we don't want to do is give lifestyle medicine to those patients who come forward to us and say, I'm really self-motivated, and I've heard about this, and I wanna do this, but we need to get it out into all the communities that need it and these higher risk groups that might not hear about it otherwise, because if we don't do that, we're gonna widen healthcare disparities.

[01:04:22] Dr. Kristi VanWinden: So I think that's one other thing I'm really passionate about is just making sure that we're getting this out to everybody and not kind of just the people who ask for it.

[01:04:29] Maya Acosta: Right. Thank you for bringing it up, because I know that ACLM has an entire group dedicated to trying to bridge that gap. I don't know if that explained it correctly, but in other words, trying to make these resources available to everyone, not just for the people that

[01:04:47] Maya Acosta: you know, self-educate and know how to find the resources. But I think people that live, you know, in those limited areas that have suffer health disparities, I think in many ways they're people that are used to not having the resources. It's just a way of life. But when we bring this information and, and explain it in a way that empowers them, they are more likely to take control of their health.

[01:05:09] Maya Acosta: And so I'm so happy that you bring it up because it's a topic that is very important to me as well, to make sure that we outreach to people who need it the most. And what I love about lifestyle medicine in general, is that it doesn't really cost that much money to find ways to manage your stress, to eat healthier foods.

[01:05:28] Maya Acosta: Of course, some people, they're at the mercy of their environment or their surroundings, so they may not have access to healthier foods. But the more we talk about this and talk about resources that are available, the more we help empower everyone. So, yeah, thank you for bringing that up too.

[01:05:44] Dr. Kristi VanWinden: Thank you so much.

[01:05:45] Dr. Kristi VanWinden: I really appreciate the chance to talk about this. It's really exciting. So thank you for having me. 

[01:05:49] Maya Acosta: It really is. Yeah. Thank you for, you know, just taking the time to put all of this together, all this information, and it's gonna be very useful for my listeners. And, of course, we'll share it to everyone.

[01:06:00] Maya Acosta: And also, so if people are interested and it's just contacting you directly, are you available, do you have a website, Any other resources you'd like to share? 

[01:06:08] Dr. Kristi VanWinden: I, um, provided you with an email address. They're welcome to contact me. If they're members of ACLM, they can get, get to me through ACLM Connect, which allows for messaging, and I'm happy to reach out to anybody if anybody is interested in joining the pregnancy subcommittee or being involved in some of the projects we're working on

[01:06:25] Dr. Kristi VanWinden: we're always open to ideas and new members. If anybody is interested, they're welcome to reach out to me. 

[01:06:30] Maya Acosta: Oh, okay. And, I have another question about that. Is there anything happening at ACLM? I know that the Women's group did something virtually last year. Is there anything that the Pregnancy Subcommittee is doing this year at ACLM?

[01:06:42] Maya Acosta: I'm assuming that they'll be getting together to network and to connect. 

[01:06:48] Dr. Kristi VanWinden: So the Women's Health Group has a specific scheduled in-person kind of meeting, so that's gonna be great to see everybody after a couple of years of not being able to. The pregnancy subcommittee doesn't have one on the official agenda, but we probably will create a little, little coffee time or something where we can meet up, and anybody who wants to come and join is welcome to do that.

[01:07:06] Dr. Kristi VanWinden: So we'll put that information out there on the website when we decide what we're gonna do.

[01:07:10] Maya Acosta: Well, awesome. It sounds like you'll be at the conference and so will I. So I hope to meet you in person. Yes. So excited. Well, thank you so much, Dr. VanWinden, for being with us. Dr. Kristi VanWinden co-wrote the chapters on preconception health, pregnancy, and postpartum for the Women's Health Throughout the Lifespan book.

[01:07:30] Maya Acosta: This book is designed for clinicians who work closely with women. I've had other health experts and contributors to this textbook on the show. A preconception and pregnancy starter kit will be available, uh, through ACLM pretty soon. Dr. VanWinden’s journey began near her residency years around 2010, 2011 when she was dealing with her personal health issues.

[01:07:54] Maya Acosta: She wasn't eating or sleeping well. Around that time, she participated in a one-month challenge embracing a whole food plant-based lifestyle. This challenge would improve her health and result in a better patient care approach where she now educates her patients about plant-based nutrition and lifestyle medicine.

[01:08:11] Maya Acosta: I asked Dr. VanWinden why she chose to work as an OB-gyn. She has always had a general interest in health. However, OB-gyn address various areas of female health. Pregnancy is an exciting and rewarding time for the mother, but complications can also arise. Dr. Van Winden specializes in high-risk pregnancies managing gestational diabetes, preeclampsia, and preterm birth.

[01:08:37] Maya Acosta: Let's recap some of these categories as she spoke about gestational diabetes is diabetes that happens only during pregnancy. It's usually diagnosed between 24 and 28 weeks of pregnancy. Risk factors for gestational diabetes are pre-diabetes, insulin resistance, PCOS, obesity, and older age. Family history is also a risk factor.

[01:09:00] Maya Acosta: The primary treatment for gestational diabetes in pregnancy is to change the lifestyle and ensure that the patient is healthy throughout the pregnancy and after the delivery. People with gestational diabetes have 10 times increased risk of developing type two diabetes in the future. Hypertension and preeclampsia are two disorders on a spectrum of high blood pressure

[01:09:22] Maya Acosta: in pregnancy. Preeclampsia is strongly associated with developing high blood pressure later in life, heart disease, and cardiovascular disease, and other complications. Women with abnormal placentas or abnormal blood flow to the placenta are at a higher risk of developing these conditions. High-fiber diets may have up to 67% reduction in preeclampsia.

[01:09:45] Maya Acosta: There are two types of preterm births, spontaneous and indicated preterm birth, and this is birth below 37 weeks of pregnancy. Dr. VanWinden’s goal is to inform future moms of what they can do to prepare their bodies and minds for conception. She works on prevention and lifestyle interventions to support pregnant moms.

[01:10:06] Maya Acosta: When speaking about high-risk pregnancies, Dr. VanWinden said that pregnancy brings issues that are already developing to the surface. In other words, pregnancy is like a stress test for the body. She's passionate about educating women to consume a healthier diet, maintain a healthy weight, and exercise before and during pregnancy.

[01:10:26] Maya Acosta: Before becoming pregnant, you will want to address preexisting conditions, including diabetes, hypertension, and obesity. These conditions can impact the pregnancy or worsen during the pregnancy. Thus putting the mother and child at risk of complications. Lifestyle medicine cannot prevent all of the difficulties that arise during pregnancy.

[01:10:46] Maya Acosta: However, enhancing nutrition and exercise before and during pregnancy can help improve outcomes. While she acknowledges that many pregnancies are unplanned, preconception care is the most significant opportunity to improve pregnancy. We need to share this information with women of childbearing age.

[01:11:05] Maya Acosta: Address other topics related to pregnancy, such as the age of the mother, adding fiber to our diets, exercising while pregnant, PCOS, and the myth of eating for two, avoiding certain activities that require laying on the back and the importance of sleep, resilience screening, and how adverse pregnancy outcomes are related to future health risks.

[01:11:27] Maya Acosta: So much content that we cover in this episode. I would love it if you can share this with a remarkable woman in your life who can hear the benefit of lifestyle medicine. And also, stay tuned for episode 244 because registered dietician Kayli Anderson is joining us once again. And this time, we are going to address pregnancy on a plant-based diet.

[01:11:49] Maya Acosta: As always, my friends, thank you for being listen. You've been listening to the Healthy Lifestyle Solutions Podcast with your host, Maya Acosta. If you've enjoyed this podcast, do us a favor and share with one friend who can benefit from this episode. Feel free to leave us an honest review on Apple Podcast that helps us to spread our message.

[01:12:10] Maya Acosta: Thanks for listening.