Fetal Health and Development

Mamas on Bedrest: How Progesterone Helps Prevent Preterm Labor

June 9th, 2014

Greetings Mamas!!

Mama on Bedrest Addison asked this question of the community:

“Previous Bedrest Mama Here… I am currently 26 weeks, 3 days, due Sept. 6. I delivered my first little one at 35 weeks, after 5 weeks of bedrest. This pregnancy, I am getting Makena injections weekly and was wondering if they’ve worked for any mamas with previous preterm labor. Thank you in advance.”

First, I’m really grateful to Addison for asking her question and feeling comfortable enough with our community to share her story. The quick answer to Addison’s question is, “Yes, Makena injections do work.” Now let’s look at why Makena or 17 Alpha hydroxyprogesterone caproate (17OHP) shots work.

It really comes down to simple physiology. We all know that estrogen and progesterone cause the cyclic changes that are our menstrual cycles. In the first 2 weeks of our menstrual cycles, estrogen levels rise as a follicle in the ovary matures an egg in preparation for ovulation and subsequent fertilization. Estrogen also prepares or “plumps up” the uterus to receive the fertilized egg for implantation and subsequent development into the baby. At Ovulation, estrogen levels dramatically drop (and the egg is released from the ovary) and progesterone levels begin to rise during the last 2 weeks of the menstrual cycle. Progesterone maintains the plumped up uterine tissue so that the fertilized egg can implant in the uterine wall. If there is no implantation, progesterone levels drop and the outer uterine layer “sloughs off” and this sloughing is the resulting menstrul period.

If there is fertilization, the progesterone levels continue to rise so that the uterine wall continues to be a plump and fertile “ground” into which the growing and developing fertilized egg can embed. Progesterone levels will remain high thoughout much of the pregnancy, but especially during the first trimester so that the uterine wall stays rich and nutrient dense to “feed” the fertilized egg. By the end of the first trimester, the placenta has developed and it assumes the primary role of feeding the growing infant and progesterone levels will decrease, but still remain high in comparison to non-pregnancy levels.

So one can see that progesterone plays a vital role in the development of an infant. When progesterone levels are not high enough, the uterus doesn’t “plump” enough to be able to host a fertilized egg.  When this occurs, a woman may miscarry early on in the pregnancy. This is what I had, and why I lost 2 of my pregnancies in the first trimester. Upon further evaluation, my OB discovered that I had a luteal phase defect; I didn’t make enough progesterone during the second part of my menstrual cycle, so my uterine lining would plump up, but not be sustained in an early pregnancy. Luteal Phase defect has also been named as the reason that I developed Uterine Fibroids. Without adequate progesterone in the second half of my menstrual cycles, my uterine linings didn’t fully “slough off” and my estrogen levels weren’t offset. So I had too much estrogen, not enough progesterone and fibroids-which love and live off of estrogen-and were able to grow.

But why do some women need to take progesterone in their pregnancies? If the placenta takes over the role of feeding and nourishing the infant, why do women need progesterone? The simple answer is because the uterine walls still need to be plump to maintain the pregnancy. This is the major role of progesterone during pregnancy. Yes, in early pregnancy it helps provide nourishment to the developing fetus, but progesterone’s major role is to sustain a rich, plump uterine wall in which the fertilized egg embeds, from which the placental tissue can draw nutrients and develop and so that the uterus remains a safe, protective environment for the growing baby.

Prescription progesterone helps prevent preterm labor in 2 particular situations: Incompetent Cervix and Preterm Labor.

Incompetent Cervix. A woman who has an incompetent cervix has a cervix that is shortening and thinning too early in the pregnancy. If this shortening and thinning occurs before 37 weeks of gestation, a woman is at risk of going into preterm labor. If a woman has a cervix that is shortening and thinning and is only carrying one baby, inserting progesterone gel into her vagina daily (Beginning between 20-23 weeks and continuing until 37 weeks or just before) will help keep her progesterone levels up, keep her uterus and cervix nourished and in functional form and prevent preterm labor. To date, there are no side effects to mama or baby from progesterone gel.

Preterm labor. Preterm labor is labor that occurs spontaneously before 37 weeks of pregnancy. The exact causes of preterm labor are unknown, but the bottom line is that the uterus begins to contract and be “inhospitable” to the growing baby, forcing it out. Progesterone shots have proven to be very effective at preventing preterm labor and preterm birth in women with a history of previous spontaneous preterm birth and who are carrying only one baby. Progesterone shots are either compounded (individually made solutions of) progesterone or Makena, pharmaceutically manufactured progesterone. Progesterone shots are typically started between 16-20 weeks and given weekly until 37 weeks of gestation. There have been no reported side effects of progesterone shots to mamas or babies.

So this is the long and short on progesterone. If you have been prescribed progesterone to prevent preterm labor, know that it has a long track record of efficacy and an equally long track record of no negative effects (except for some mild vaginal irritation with the gel and some mild irritation at injection sites) on mamas and babies. While it’s no fun to have to use progesterone gel or to take progesterone shots, know that this course of treatment is highly effective and will give you and your baby a great chance of going to full term pregnancy.

 

Resources:

March of DimesA

Agency for Healthcare Research and Quality: Progesterone to Prevent Preterm Birth.  A Review of the Research About Progestogens for Women at Risk.

Stepping into the Global Prenatal Initiative on Behalf of Mamas on Bedrest!

May 16th, 2014

Global Prenatal InitiativeGreetings Mamas!!

A few weeks ago (March 21st to be exact) I introduced you to the Global Prenatal Initiative. Well, things have been heating up since that post and I want to give you an update-mainly because I have jumped in with both feet and am involved with organizing the US Prenatal Education Association!

No one is more acutely aware of the shortcomings in US prenatal care than Mamas on Bedrest. While it is safe to say the we receive prenatal care, in many instances one would be loathe to say that it is patient centered, baby friendly or offering a compassionate start to our little ones. And while many of the interventions that Mamas on Bedrest endure are necessary, how they are administered and how Mamas on Bedrest are cared for are often lacking in the compassion and nurturing department.

The foundation principle of the Global Prenatal Initiative is,

“The time spent in the womb is the foundation for long-term health, emotional security, intelligence, creativity and much more for every human being. It is vital that the link between these early stages of human development, their long-term impact and the current global challenges be known.”

~ Julie Gerland, GPI Co-Founder and Director

Dr. Gerland and other members of the United Nations have been collaborating to improve maternity outcomes and have come to the very reasonable conclusion that to make any sort of appreciable impact on our cultural deficiencies and disparities, it is imperative that we focus on human development-namely improving birth outcomes and in turn, life expectancy and quality of life. Their major focuses are:

  1. Confronting family poverty
  2. Ensuring work-family balance
  3. Advancing social integration
  4. Inter-generational solidarity

This is all well and good, but what does this mean for Mamas on Bedrest exactly???

  1. It means empowering mamas about what they can do to feel safe, secure and healthy during pregnancy.
  2. It means empowering mamas to provide safe, secure environments for their babies to develop and grow-both in utero and externally. We have to remember, whatever mama is experiencing during her pregnancy, her baby is also experiencing. As much as possible, we want those experiences to be peaceful and to have positive impacts on baby’s growth and development.
  3. It means working with both parents in the pre-conception and prenatal periods to foster healthy relationships, ones in which as much as possible both parents stay connected (not necessarily married) and involved in the lifelong growth and development of the baby.

Mamas, We already know so much of this! We know what it’s like for our families to face financial challenges because we go on bed rest and are not paid while we are not working. We know what it’s like to lose a job because we go on bed rest! We know what it is like to have to choose to nurture our children on bed rest in lieu of pursuing a career. We know what it is like to try to navigate bed rest without the support of family. We could (wo)man these panels ourselves and give birds eye views of what life is like when we don’t have the resources necessary for a peaceful pregnancies. And while all of you are welcome to step up in support of the Global Prenatal Initiative, I am stepping in and stepping up on behalf of high risk pregnant women, the Mamas on Bedrest. Stepping into this community of global prenatal health workers, it is my intention to not only represent Mamas on Bedrest but to also be your eyes, your ears and most importantly-YOUR VOICE! This is the chance for our voices to be heard, for our stories to be told and for the management of high risk pregnancies to be evaluated and changed as necessary to suit the needs of Mamas on Bedrest. I am counting on you all to speak up! I am counting on you all to tell me exactly what you needed when you were on bed rest; what would have made bed rest bearable and more successful. In return, I will relay your thoughts and request to my colleagues in the association, as well as to the pertinent United Nations sub-committees on human growth, development and overall well being.

The time has come, Mamas! We have the chance to change the course of prenatal care and birth outcomes for generations to come! Most importantly, we have the chance to make much needed changes in the care of high risk pregnancy!

 

 

Mamas on Bedrest: Are We on the Brink of a Cure for Pre-Eclampsia?

May 2nd, 2014

Greetings Mamas!

May is Pre-Eclampsia Awareness Month. As our way of honoring this occasion, I present to you an interview that I did with Dr. Karine Kleinhaus. Dr. Kleinhaus is the Divisional Vice President North America for and Israeli based biotechnology company called Pluristem Therapeutics, Inc. Pluristem is a leading developer of placental based cell therapies. They are currently developing a treatment that, if effective, will treat pre-eclampsia in pregnant women and very likely remove the need for women to be placed on bed rest for pre-eclampsia.

As you can image, when I first learned of this technology, I was floored. Then I got excited. Pre-eclampsia is one of the leading reasons that Mamas are prescribed bed rest during their pregnancies. It can have serious health consequences for mamas and their babies, including kidney and liver damage in mamas, prematurity and the associated developmental issues in infants and even death. Pre-Eclampsia is thought to be the result of inflammation in the uterus and with the placenta that leads to the elevated blood pressure, the protein in the urine, liver assault and, if not adequately treated progresses to HELLP Syndrome (High blood pressure, Elevated Liver Enzymes and Low Platelets).

In February of this year, The American Heart Association and the American Stroke Association announced that new research data shows that women who have pre-eclampsia during their pregnancies are at increased risk of heart disease and stroke in later life. So as you can imagine, if the therapy being developed by Pluristem is successful, many women stand to be saved a lot of discomfort from a potentially life threatening illness during their pregnancies, will avoid bed rest and its complications and avoid the risk to their cardiovascular health later in life. This is win-win-win!!

Dr. Kleinhaus was kind enough to spend quite a lot of time with me explaining the treatment and its potential in the treatment of Pre-Eclampsia. Listen to this interview carefully. It’s really interesting and chocked full of very useful information. Once you finish, share your comments in the comments section below.