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Guest: Dr. Grishma Desai – Obstetrician and Gynecologist. Specialised in infertility, presently working as a consultant at private hospital in Mumbai.
- Purpose of this podcast.
-To help females or couples who are planning a pregnancy, who want to lose weight before pregnancy.
-Some females who want to lose fat because their doctors suggested them.
-Post pregnancy females who want to lose extra fat
-Health complications during, before and after pregnancy.
Dr. Grishma Desai has successfully completed around 500 deliveries, and treated around 200-300 gynaecology patients (PCOS, menstrual problems, infertility etc) personally.
-Dr. Desai mentioned that there is no single approach to anything in health, everything is a team approach, especially when we talk about women because in India they have more of a sedentary life compared to men, times are changing now but their bodies are still not used to increased physical activities that we do.
-Women from teenage years have not paid attention to their fitness levels and from the starting it starts affecting the gynaecological system, of course other systems we know, cardiovascular, obesity related problems. But from a gynac point of view the thing starts from teenage itself.
-If the girl is overweight, even her menses start late, a lot of times even before her menses start obesity has already played havoc on her entire menstrual system because certain things have to be in place for normal menses to start at the right time.
-A lot of times we have overweight girls, mostly PCOS, the bane of young girls with their menstrual issues at the time being, it causes menstrual irregularities, heavy bleeding, painful bleeding, causes infertility, later in life it increases the risk of diabetes.
-And it’s not a patient wise approach or a woman’s age wise approach, Dr. Desai thinks that fitness needs to be a part of womens or girls from day 1.
-Couples who are obese and overweight and have trouble conceiving, its a common finding that we notice, we advice them to do some exercises on a daily basis and lose weight, it has magical effects. As long as there is no underlying medical problem with the male or female, even a few kilos of weight loss has shown remarkable effects in a couple conceiving. And it’s not just about women, in men too it increases energy levels, sperm quality and motility.
-There’s no doubt that fitness is very very important in a woman’s life.
- What is PCOS?
-It’s a mystery condition, we don’t know whether to call it a disease, it’s not a disease, it’s just how reproductive system in a woman function, the basis of it is from the ovary, the ovary become polisistik which means every cycle the ovary is supposed to release one egg and release of that egg causes certain hormonal changes, which prepares the entire reproductive tract for the next period.
-What happens in some women for one reason or the other, either a genetic predisposition or a family history.
-What happens is for a few cycles initially the egg is not released, because the egg is not released the ovary is producing estrogens and androgens, and these androgens are the cause of the synthesis of other hormones in the body which regulate blood pressure, sugar levels, weight gain, appetite and a lot of things.
-Once you realise that, that cycle is not working regularly, everything else in the entire body is disturbed, one of the ways to break this chain of the entire metabolic syndrome developing from the irregular periods is weight loss, very often the girls who suffer from PCOS either because of the PCOS have developed weight issues or sometimes the overweight itself causes the hormonal imbalance which then causes PCOS like effects in the body.
-Exercise tends to break that cycle by causing regular periods, and the regular periods cause the good hormones that are required by the functions throughout the rest of the body.
-There’s another kind of PCOS called lean PCOS, which means PCOS in thin girls, it’s less common but it’s just as difficult to treat, exercise may not be the only thing that’ll help but fitness and physical activity could help to make the important hormonal changes are required to break that cycle.
- How being thin causes problems in pregnancy?
-In India, due to lack of communication about nutrition, we’ve issues like malnutrition among people from a young age and most pregnancies are unplanned and there’s nutrition deficiencies, anemia, low calcium/Vitamin D levels, to gain weight most people rely on carbs and sugar, because of that there’s protein deficiency, once you’re pregnant protein deficiency results in weak fetus and lot of other complications.
-Sedentary lifestyle is not good for anyone, it can lead to hormonal balances.
- Common diagnoses
- Unmarried girls – Menstrual problems, irregular periods, heavy bleeding, painful bleeding.
- Married couple – Problems in conceiving which is mostly due to being overweight.
- Old women – Menopause, fibroid related symptoms.
- Difficulties while handling patients.
-We’ve to be with the patient for the entire nine months so the difficulties that we’ve to face from day one, the biggest fear is that she is prone to developing gestational diabetes and hypertension, these are the two things we constantly lookout for.
-Another thing we see in overweight women, especially someone who has a family history of obesity, in that case the baby becomes overweight too soon, the baby puts on more weight that it is supposed to and along with that the other problems related to the baby, the baby doesn’t get the proper nutrition because of being overweight or whatever nutrition is falling short, because delivery is difficult with obese women and big baby.
-When the women is obese, the doses of anestheisa has to be high too and we’ve to be ready for the complications of it, obese women are more likely to go postpartum bleeding also.
-Females who get pregnant are forced by their families to eat in access. In pregnancy appropriate weight gain for an average weight lady should be:
-Not more than 2-3Kgs in first trimester
5kgs in second trimester
5Kgs in the third trimester; Overall around 11-12kg is appropriate.
-Sometimes I advise my patients to have their in-laws call me in case they make her eat a lot and unhealthy foods in order to make her gain weight.
- Postpartum depression
-Postpartum depression is a very complex entity, there’s no particularly one reason, but there’s some association with unhealthy habits and unhealthy eating that has persisted through pregnancy and even after that when you’re emotionally.
-If you’re blue and down, you find solace in high calorie foods, it perpetuates the entire unhealthy cycle.
-Resumption of exercises after pregnancy is one of the good ways to avoid postpartum depression.
-Staying sedentary and in bed the whole day is very unhealthy postpartum, the lady who just delivered a baby has to be up and about if she’s not in pain.
-Exercise and normal routine helps in avoiding postpartum depression for sure.
- Exercise during the pregnancy
-Exercise is allowed during pregnancy and even encouraged, but the right kind of exercises, but if there are certain conditions like the placenta is low, the cervix is short or there is a chance of preterm delivery then only the to be mother is advised complete bed rest, otherwise not. (Not too strenuous)
-You can even exercise in the first three months of the pregnancy, people telling you to rest because it’s the initial phase of your pregnancy are wrong. But if your gynaec told you not to, then don’t.
-About sex, it is allowed during pregnancy, there’s no restriction, it won’t harm the baby.
- Age factor
-Nowadays many women have to delay the decision of pregnancy due to their work and goals. Unlike our mothers and grandmothers who were pregnant around the age of 21-25.
-Late marriages lead to late pregnancies, there are complications for women who get pregnant post 30, post 40 it’s not encouraged. The fertility rate also decreases.
-Infertility cases are increasing because women are focusing on making a family less and getting an identity of their own more, to get work etc.
-There’s not a correct age for any particular woman, life of every woman is different, of course an early pregnancy is encouraged, if you’ve found your life partner and you’re sorted, before 30 is the right right to plan a pregnancy.
- Protein intake for pregnant woman
-Protein intake is very important during pregnancy for the baby’s growth, protein deficiency sometimes leads to the baby having less weight, low birth rate etc.
-We’re not advised to suggest whey protein to women because sometimes some whey protein brands have additives that are harmful for the mother and the baby, it damages your kidneys, but if the brand is tested then there’s no problem.
-A good and well managed diet is recommended for the mother so that there’s no vitamin deficiencies in the baby and the mother herself.
- Top 5 myths
- Nani-maa ke nuskhe are so well established in minds of people that are hard to break.
- Eating rosogollas and khoya would lead you to have a fair complexion baby.
- Blaming the mother for the sex of the child – it’s not the mother, it’s the husbands genes that are deciding the sex of the baby.
- Not advised to consume lemon, curd, rice etc post pregnancy – Don’t stay away from these food articles, consume them.
- There are innumerable myths on techniques that help you have a boy child – None of them work!
- You’re “impure” during your periods. – You’re not.
- Period during pregnancy – Starting and ending
-The diagnosis of pregnancy is due to cessation of periods.
-For the duration of 9 months after getting diagnosed with pregnancy, the to be mother is not going to have periods.
-Roughly 6 months after the delivery, she has lactational amanoeia while she’s breastfeeding, she will not get her period during that time.
-Delivery related bleeding might happen on and off which is normal.
-Periods start after the breastfeeding is reduced a little bit and the cycle starts again.
Chirag Barjatya 