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Friday, January 4, 2019

Preterm birth and heart disease risk for mom

When I’m dragging and feeling tired during the occasional low-energy day, my go-to elixir is an extra cup (or two or three) of black French press coffee. It gives my body and brain a needed jolt, but it may not help where I need it the most: my cells.
The cellular basis of being tired

What we call “energy” is actually a molecule called adenosine triphosphate (ATP), produced by tiny cellular structures called mitochondria. ATP’s job is to store energy and then deliver that energy to cells in other parts of the body. However, as you grow older, your body has fewer mitochondria. “If you feel you don’t have enough energy, it can be because your body has problems producing enough ATP and thus providing cells with enough energy,” says Dr. Anthony Komaroff, professor of medicine at Harvard Medical School. You may not be able to overcome all aspects of age-related energy loss, but there are ways to help your body produce more ATP and replenish dwindling energy levels. The most common strategies revolve around three basic concepts: diet, exercise, and sleep.

Diet. Boost your ATP with fatty acids and protein from lean meats like chicken and turkey, fatty fish like salmon and tuna, and nuts. While eating large amounts can feed your body more material for ATP, it also increases your risk for weight gain, which can lower energy levels. “The excess pounds mean your body has to work harder to move, so you use up more ATP,” says Dr. Komaroff. When lack of energy is an issue, it’s better to eat small meals and snacks every few hours than three large meals a day, according to Dr. Komaroff. “Your brain has very few energy reserves of its own and needs a steady supply of nutrients,” he says. “Also, large meals cause insulin levels to spike, which then drops your blood sugar rapidly, causing the sensation of fatigue.”

Drink enough water. If your body is short on fluids, one of the first signs is a feeling of fatigue. Although individual needs vary, the Institute of Medicine recommends men should aim for about 15 cups (3.7 liters) of fluids per day, and women about 12 cups (2.7 liters). Besides water and beverages like coffee, tea, and juices, you can also get your fluids from liquid-heavy fruits and vegetables that are up to 90% water, such as cucumbers, zucchini, squash, strawberries, citrus fruit, and melons.

Get plenty of sleep. Research suggests that healthy sleep can increase ATP levels. ATP levels surge in the initial hours of sleep, especially in key brain regions that are active during waking hours. Talk with your doctor if you have problems sleeping through the night.

Stick to an exercise routine. Exercise can boost energy levels by raising energy-promoting neurotransmitters in the brain, such as dopamine, norepinephrine, and serotonin, which is why you feel so good after a workout. Exercise also makes muscles stronger and more efficient, so they need less energy, and therefore conserve ATP. It doesn’t really matter what kind of exercise you do, but consistency is key. Some research has suggested that as little as 20 minutes of low-to-moderate aerobic activity, three days a week, can help sedentary people feel more energized.
When being tired warrants a visit to your doctor

You should see your doctor if you experience a prolonged bout of low energy, as it can be an early warning of a serious illness. “Unusual fatigue is often the first major red flag that something is wrong,” says Dr. Komaroff. Lack of energy is a typical symptom for most major diseases, like heart disease, many types of cancer, autoimmune diseases such as lupus and multiple sclerosis, and anemia (too few red blood cells). Fatigue also is a common sign of depression and anxiety. And fatigue is a side effect of some medications.
If you delivered a baby early, you may want to pay closer attention to your heart health. A study published in the journal Hypertension shows that a history of preterm birth (defined as a birth before the 37th week of pregnancy) may bring health risks for not only for baby, but for mom, too.

The study found that women who delivered a baby preterm were more likely to experience rising blood pressures later, compared to women who delivered closer to term. If they had this pattern, they were also more likely to show signs of coronary artery disease, which is associated with an increased risk of heart attack and stroke.

Because of the unique demands that pregnancy places on a woman’s body, it may serve as a stress test for a woman’s heart, says Dr. JoAnn E. Manson, the Michael and Lee Bell Professor of Women’s Health at Harvard Medical School. Pregnancy-related conditions (for example, gestational diabetes and pre-eclampsia) are known to raise a woman’s risk of developing cardiovascular disease. Preterm birth should now join that list, says Dr. Manson.

“I think this study adds to the mounting evidence that preterm birth is yet another complication of pregnancy that indicates a higher risk of cardiovascular disease in the mother,” she says.
The association between early birth and heart disease risk

The study looked at data from more than 1,000 mothers in several major US cities. Researchers divided the women into three categories — “low stable,” “moderate,” and “moderate increasing” — based on how their systolic blood pressure (the first number in a reading) changed over time. Women who had what was defined as “moderate increasing” blood pressure were 19% more likely to have delivered a baby early than women with “low stable” blood pressure. In addition, more than 38% of the “moderate increasing” group developed coronary artery calcifications (a marker for higher risk of future heart attack), seen on CT heart scans, compared with 12.2% of the “low stable” group. Women who had both a preterm delivery and “moderate increasing” blood pressure had more than double the risk of developing arterial calcifications, compared with women who delivered at term and had a lower blood pressure pattern.

The associations researchers found were stronger in women who experienced high blood pressure conditions during pregnancy, but were also found in women who did not. Interestingly, women who had a “moderate increasing” blood pressure pattern but delivered a full-term baby didn’t seem to have excess risk for artery calcifications.

But not all preterm births bring the same potential heart risks. The study authors found that a preterm birth alone wasn’t enough to raise risk. That happened only when women had both a preterm birth and a pattern of increasing blood pressure in the years that followed. This may be the case because there are other factors that can result in a preterm birth, such as carrying twins or other multiples, or having a physical problem with the cervix, says Dr. Manson. For women with such conditions, a preterm delivery would not be expected to reflect higher cardiovascular risks, says Dr. Manson.
If you gave birth early, pay attention to all heart disease risk factors

Having a preterm birth or other pregnancy-related complications doesn’t mean you are doomed to develop cardiovascular disease. Steps you can take to reduce your risk include the following:

    Discuss your pregnancy history with your doctor. Your doctor should be aware that you delivered preterm and should also know about any other pregnancy-related complications you had, such as gestational diabetes or pre-eclampsia — and should understand that it may raise your risk for future heart disease.
    Track your blood pressure. “Your blood pressure should be monitored closely, at least once a year, and preferably more often,” says Dr. Manson. Self-monitoring using a blood pressure machine monthly at home might also help you spot troubling trends early. Blood pressure should ideally remain below 120/80 mm Hg. If it rises above that level, discuss it with your doctor.
    Maintain a healthy diet and lifestyle. It’s been said a million times before, but eating a well-balanced diet rich in fruits, vegetables, and whole grains can help head off cardiovascular disease. Avoid excess sodium, red meat, and heavily processed foods whenever possible. And of course, don’t smoke, and make time to squeeze in regular exercise.

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