Pregnant woman at work with laptop looking stressed

Dealing with stress during pregnancy

It is completely normal to feel some amount of stress during pregnancy, primarily because of the uncertainty that might come into play the first time you become pregnant. But if the stress and anxiety become constant, the effects on you and your baby could be lasting.

When you’re stressed, your body goes into “fight or flight” mode, sending out a burst of cortisol and other stress hormones. These are the same hormones that surge when you are in danger and they prepare you to run by sending a blast of fuel to your muscles and making your heart pump faster. In fact, constant stress could alter your body’s stress management system, causing it to overreact and trigger an inflammatory response. And inflammation, in turn, has been linked to poorer pregnancy health and developmental problems in babies down the road. Chronic stress may also contribute to subtle differences in brain development that might lead to behavioural issues as the baby grows.

Here are a few ways to manage your stress and reduce anxiety at work and at home:

  • Practice saying “no”: Being pregnant is as good a time as any to get rid of the notion that you can do it all. Make slowing down a priority, and get used to the idea of asking your friends and loved ones for help.

 

  • Cut back on chores: And use that spare time to rest and relax, both physically and mentally

 

  • Take advantage of sick days or vacation whenever possible: Spending a day — or even an afternoon — resting at home will help you get through a tough week.

 

  • Try deep-breathing exercises, yoga, or stretching: These exercises help in calming the body and in alleviating any negative thoughts that may arise due to stress.

 

  • Get regular exercises such as swimming or walking: Being pregnant does not imply that you have to completely put a halt to any physical activities. Low to moderate intensity of exercise can have a positive effect on you and your fetus.

 

  • Do your best to eat a healthy, well-balanced diet so you have the physical and emotional energy you need: A balanced diet would generally contain 5-6 servings of fruits and vegetables every day, as well as plenty of whole grains and foods that are high in calcium – like milk, calcium-fortified foods, and yogurt – along with a variety of protein sources, such as pulses and legumes, soy products, poultry, and meats and an amount of healthy fats such as nuts and seeds.

 

  • Go to bed early: Your body is working overtime to nourish your growing baby and needs all the sleep it can get.

 

  • Limit “information overload”: Reading about pregnancy and listening to your friends’ pregnancy stories are fine — but don’t delve into all the scary things that might (but probably won’t) happen during your pregnancy. Focus instead on how you’re feeling and what’s happening to you now.

 

  • Join a support group: If you’re coping with a difficult situation, spending time with others in the same boat can ease your burden. Many women create support networks using social media or by joining groups online.

 

  • If you’re under unusual stress or feel like you’re at your breaking point, ask your healthcare provider to refer you to a therapist, who can better assess how strong your anxiety has become and what you may need to do to feel better. Listen openly to what she has to say. Getting help during pregnancy will protect you and your baby from unnecessary risks and reduce your chances of postpartum anxiety and depression.

The Aster Nurture program aims at nurturing, caring and protecting you, the mother, and your newborn baby from the time when you conceives till when your child is 5 years old. After enrolling in this program, you will be entitled to a range of benefits that will ensure that you have a healthy and happy pregnancy. The antenatal care package that you can avail of, contains antenatal group classes that aim to educate the expectant mothers about the various physical and emotional changes that occur during the term of pregnancy. Attending these classes along with other new mothers would give you a sense of support and help eliminate any negative thoughts that you might be harbouring. Furthermore, sharing your pregnancy stories with others will help you understand the nature of your stresses and the steps that you can take to reduce them.

 

Dr. Sejal Devendra Surti

Specialist Obstretician/Gynaecologist

Aster Hospital, Mankhool

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Foods to avoid during pregnancy

Prior to getting pregnant, women must ensure that they are taking the utmost care of their physical and mental health. The very first step in pre-pregnancy healthcare management becomes the consumption of a balanced and nutritious diet. A balanced diet would generally contain 5-6 servings of fruits vegetables every day, as well as plenty of whole grains and foods that are high in calcium – like milk, calcium-fortified foods, and yogurt – along with a  variety of protein sources, such as pulses and legume, soy products, poultry, meats, and an amount of healthy fats such as nuts and seeds.

Women seeking to get pregnant must also ensure that their diet contains sufficient quantities of folic acid. By taking 400 micrograms (mcg) of folic acid a day for at least three months before conceiving and during the first trimester, women can cut their chances of having a baby with neural-tube defects, such as spina bifida, by 50 to 70 percent. The primary sources of folic acid include leafy vegetables, potatoes, grains and liver. In addition to folic acid, a special vitamin compound containing vital micronutrients is also recommended as a supplement to a balanced diet.

However, in order to ensure that there are no complications during pregnancy, women should also avoid certain food substances. Listed below are foods that might be detrimental to women during the course of their pregnancy:

  • Raw Meat: Uncooked seafood and rare or undercooked beef or poultry should be avoided because of the risk of contamination with coliform bacteria, toxoplasmosis, and salmonella.

 

  • Deli Meat :Deli meats have been known to be contaminated with listeria, which can cause a miscarriage. Listeria has the ability to cross the placenta and may infect the baby, which could lead to infection or blood poisoning and may be life-threatening.

 

  • Fish with Mercury: Fish that contain high levels of mercury should be limited to 2-3 servings per week and cannot be avoided, as it is the best source of DHA. However, since high levels of mercury consumption during pregnancy has been linked to developmental delays and brain damage, eat up to 12 oz. (340 g) or 2 average meals a week. Seafood is also the predominant source of omega-3 fatty acids that are vital for neural development.

 

  • Smoked Seafood –Refrigerated, smoked seafood often labelled as lox, nova style, kippered, or jerky should be avoided because it could be contaminated with listeria.

 

  • Raw Shellfish: The majority of seafood-borne illness is caused by undercooked shellfish, which include oysters, clams, and mussels. Cooking helps prevent some types of infection, but it does not prevent the algae-related infections that are associated with red tides.

 

  • Raw Eggs: Raw eggs or any foods that contain raw eggs should be avoided because of the potential exposure to salmonella.

 

  • Soft Cheeses: Imported soft cheeses may contain listeria.  You would need to avoid soft cheeses such as brie, Camembert, Roquefort, feta, Gorgonzola, and Mexican style cheeses that include queso Blanco and queso fresco, unless they clearly state that they are made from pasteurised milk.

 

  • Pate: Refrigerated pate or meat spreads should be avoided because they may contain the bacteria listeria.

 

  • Caffeine: Although most studies show that caffeine intake in moderation is permissible, there are others that show that caffeine intake may be related to miscarriages, insomnia and increased levels of heartburn. Avoid caffeine during the first trimester to reduce the likelihood of a miscarriage. As a general rule, caffeine should be limited to fewer than 200 mg per day during pregnancy. Sources of caffeine include tea, coffee, soft drinks, energy drinks etc.

 

  • Alcohol: There is NO amount of alcohol that is known to be safe during pregnancy, and therefore alcohol should be avoided during pregnancy. Prenatal exposure to alcohol can interfere with the healthy development of the baby. Depending on the amount, timing, and pattern of use, alcohol consumption during pregnancy can lead to Fetal Alcohol Syndrome or other developmental disorders.

 

Dr. Sejal Devendra Surti

Specialist Obstetrician/Gynaecologist

Aster Hospital, Mankhool

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GERD

GERD – Symptoms and Prevention

GERD is a condition in which the stomach acid or contents from the stomach flow back into the food pipe (esophagus). The backwash (reflux) irritates the lining of the esophagus and causes GERD. Gastroesophageal refers to the stomach and the esophagus. While reflux refers to the back-flow of acidic or non-acidic stomach contents into the esophagus. A band of muscles at the junction of the stomach and esophagus called the lower esophageal sphincter (LES) normally act, in conjunction with the diaphragm, as a barrier to prevent the reflux of stomach contents into the esophagus. It is when that barrier is relaxed at inappropriate times or is otherwise compromised that reflux occurs.

GERD is characterized by symptoms and/or tissue damage that results from repeated or prolonged exposure of the lining of the esophagus to contents from the stomach. If tissue damage is present, the individual is said to have esophagitis or erosive GERD. The presence of symptoms with no evident tissue damage is referred to as non-erosive GERD.

GERD symptoms are often persistent, such as chronic heartburn and the regurgitation of acid. But sometimes there are no apparent symptoms, and the presence of GERD is revealed only when complications become evident. While the symptoms of GERD vary from person to person, the majority of people with GERD have mild symptoms, with no visible evidence of tissue damage and little risk of developing complications.

Periodic heartburn is a symptom that many people experience. If it occurs occasionally just after a meal and less than once per week, it is likely a “benign” condition. However heartburn that occurs more frequently than once a week, becomes more severe, or occurs at night and wakes a person from sleep, may be a sign of a more serious condition and consultation with a physician is advised. Even occasional heartburn – if it has occurred for a period of 5 years or more, or is associated with difficulty in swallowing– may signal a more serious condition. People with long standing chronic heartburn are at greater risk for complications including stricture or a potentially pre-cancerous disease that involves a cellular change in the esophagus called Barrett’s esophagus.

Persistent chronic heartburn and acid regurgitation are the most common symptom of GERD. But there are numerous less common symptoms that also may be associated with GERD. These may include:

  • Belching
  • Difficulty or pain when swallowing
  • Water brash (sudden excess of saliva)
  • Dysphagia (the sensation of food sticking in the esophagus)
  • Chronic sore throat
  • Laryngitis
  • Inflammation of the gums
  • Erosion of the enamel of the teeth
  • Chronic irritation in the throat
  • Hoarseness in the morning
  • A sour taste
  • Bad breath

Chest pain may also indicate acid reflux. Nevertheless, this kind of pain or discomfort should prompt urgent medical evaluation in order to exclude possible heart conditions. Relief of symptoms after a two-week trial therapy with a proton pump inhibitor (a prescription medication that inhibits gastric acid secretion) is an indication that GERD is the cause. This can also be confirmed with pH monitoring, which measures the level of acid refluxing into the esophagus and as high as the larynx.

On the positive side, since GERD is a lifestyle disorder, making significant changes in your lifestyle and eating habits can greatly reduce the impact of GERD or even prevent its onset to begin with. Here are 10 tips you can try to prevent GERD.

  1. Lose weight. Obesity is the leading cause of GERD because the extra stomach fat places pressure on your abdomen, pushing gastric juices up into your esophagus.
  2. Avoid foods known to cause reflux.If you’re at risk for GERD, avoid:
    • Fatty foods
    • Spicy foods
    • Acidic foods, like tomatoes and citrus
    • Mint
    • Chocolate
    • Onions
    • Coffee or any caffeinated beverage
    • Carbonated beverages
  3. Eat smaller meals.Large meals fill the stomach and put pressure on the LES, making reflux and GERD more likely.
  4. Don’t lie down after eating.Wait at least three hours before you lie down after a meal. Gravity normally helps keep acid reflux from developing. When you eat a meal and then stretch out for a nap, you’re taking gravity out of the equation. As a result, acid more easily presses against the LES and flows into the esophagus.
  5. Elevate your bed.Raising the head of your bed six to eight inches can help gravity keep gastric acid down in your stomach. You could also use a wedge-shaped support. Don’t use extra pillows, as they only raise your head and will not help with GERD. You need your entire upper body elevated to get relief.
  6. Review your medications.There are a number of medications that can increase your risk of GERD, either by relaxing the LES, interfering with the digestive process, or further irritating an already inflamed esophagus. These medications include:
    • Non-steroidal anti-inflammatory drugs, or NSAIDs
    • Calcium channel blockers (often used to treat high blood pressure)
    • Certain asthma medications, including beta-agonists like albuterol
    • Anticholinergics, medications used to treat conditions such as seasonal allergies and glaucoma
    • Bisphosphonates, used to boost bone density
    • Sedatives and painkillers
    • Some antibiotics
    • Potassium
    • Iron tablets

If you are taking any of these medications, talk to your doctor about switching to another drug that does not have the same effect on the upper digestive tract. However, never stop taking a prescribed medication without first consulting your doctor.

  1. Quit smoking.Some studies have found that nicotine can relax the muscles of the LES and can also interfere with your saliva’s ability to clear acid out of the esophagus.
  2. Cut back on alcohol.As with smoking, alcohol can cause the LES to relax. Alcohol can also cause the esophageal muscles to spasm.
  3. Wear loose-fitting clothes.Do not wear tight clothing or belts that can constrict your stomach.

In the UAE itself, there has been a rise in the incidents of patients suffering from some degree of GERD. Specialists at Aster Hospital and Clinic often receive 2 to 3 patients a day with GERD. In the last 1.8 years, they have treated around 320 patients with the condition. Aster Hospital and Clinic has initiated a “GERD Awareness Campaign” to educate the residents of UAE on alarming symptoms or critical symptoms associated with the disease which, if noted, should prompt medical attention. Through dedicated programmes for the general population, Aster aims to encourage early diagnosis and proper treatment in order to improve the quality of life of people suffering from the condition.

 

Dr. Sabu Antony

Specialist Gastroenterologist

Aster Clinic, Bur Dubai (AJMC)

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5 Natural ways to keep your skin moisturised

The dual nature of being the largest organ in the body and also forming the outermost protective layer of the body makes the human skin extremely vulnerable to environmental factors. Changes in temperature, humidity and precipitation have a direct impact on the skin. Dry skin is one such disorder that is fairly common during the winter months. The drop in temperature lowers the humidity levels which in turn draw out the moisture from the skin leaving it dry, flaky and causing it to itch. Despite being an extremely common condition, having dry skin does not have any long-term detrimental impact on an individual’s health. Although, it can be a side effect of dermatological conditions such as eczema or ichthyosis. However, since dry skin is caused primarily by environmental factors, the solutions to combat it are extremely straightforward. Listed below are some natural topical remedies that can be used to combat dry skin.

  • Natural oils. Refer primarily to grapeseed, almond and jojoba oils that are readily available in many health stores worldwide. Usually found in bottles that are plain and basic-looking, they don’t contain extra chemicals and they offer the same moisturising benefits as those expensive, fabricated moisturisers. And there’s no denying these oils soften your skin, provide a protective barrier against the wind and cold weather, and smell nice without any of that mysterious artificial “fragrance” that pops up in so many beauty products.

 

  • Olive oil. If you really want to save money or just don’t have time to get to the store, you can find a soothing oil right on your kitchen shelf. Olive oil is a great natural moisturiser that can be used to soften your skin or condition your fly-away, winter-ravaged hair. It also has anti-inflammatory properties which can soothe reddened skin and some types of outbreaks and rashes; there have been claims it can protect against skin cancer too, although these claims are still under investigation.

 

  • Shea butter. Shea butter is a fat extracted from the nut of the shea tree found primarily in Africa where it’s long been used to treat dry, sore skin, for other purposes. Shea butter melts at skin temperature so it’s easily absorbed, and it contains vitamin A, which is beneficial in repairing parched cracked skin. However, since gaining in popularity and being used as the basis for many beauty products, shea butter based lotions and moisturisers may contain a host of added chemical compounds. In order to get the best results, therefore, it is advised to seek a pure version of shea butter in order to get its maximum effects.

 

  • Edible Remedies: There are also numerous products in the kitchen that can be used to treat dry and itchy skin. Some of the things that boost your skin’s health and appearance from the inside also do so when applied on the outside. A couple of the best are honey and milk-based products including yoghurt and cream. When added to tea, honey acts as an antibacterial and antioxidant to boost your immune system and fight off seasonal bugs. When slathered onto your body and face, left on for about ten minutes and showered off, it offers unparalleled softness and smoothness. Yoghurt is also an antioxidant and anti-inflammatory that can take the edge off itchiness and loosen the tightness you feel when your skin dries out. As with honey, rub it in, let it soak in and rinse it off. You can mix and match these edible ingredients along with others such as cream, avocado and oatmeal to create a personal solution to your skin’s particular needs.

 

  • Water: The most basic, and yet the most important way to combat seasonal dry skin is to ensure that you are always well hydrated. Drinking water helps replenish the moisture that is lost by your skin and prevents it from becoming flaky and cracking. Furthermore, placing buckets or pans of water in certain locations in your house can help counteract the dryness that results from the excessive use of heaters in the winter.

 

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acid_reflux

High Incidence of GERD in UAE

According to Healthline, up to 60 percent of the adult population worldwide experiences some form of acid reflux and about 20 to 30 percent of people complain about having weekly symptoms in a 12 month period.

An increasingly common digestive disorder, gastroesophageal reflux disease (GERD) occurs when the stomach acid or contents of the stomach make their way back into the esophagus (food pipe). This backwash creates a feeling of uneasiness and irritates the esophageal lining resulting in severe heartburn, which is the primary indicator of having GERD.

According to the Scientific and Research Committee of the Emirates Gastroenterology Society, as of 2014, more than 30 percent of the population of UAE suffered from acid reflux.

The most common signs and symptoms of GERD include a burning sensation in the chest (heartburn) which sometimes spreads to the throat along with a sour taste in the mouth, chest pain, difficulty in swallowing, dry cough, hoarseness of voice or a sore throat, the sensation of a lump in the throat etc.

The primary causes of GERD rest on an individual’s eating habits. However, there are also other factors that can exacerbate the symptoms of GERD, such as obesity, smoking and heavy consumption of alcohol and caffeine.

UAE has seen a rise in the cases for chronic GERD over the last decade. The concurrent rise in obesity rates is a cause that has contributed the most to the alarming rise in GERD. According to a disease study report, obesity in UAE is double the world’s average. A report entitled “Global Burden of Disease Study 2013” shows that over 66% of men and 60% of women living in the UAE are obese or overweight. Almost 47.5 percent of UAE residents are overweight, with a BMI between 25 and 30 and about 13 % are obese with a BMI of over 30.

Obesity is the accumulation of body fat to a degree that it makes a person more susceptible to diseases and health problems, one of which is the prevalence of GERD. Studies indicate that obese individuals are three times more likely to have heartburn than people with normal weight, because the extra fat around the belly increases the pressure on the stomach, forcing the stomach acid to back up into the esophagus. Obesity also increases the risk of having fatty liver, a condition describing the buildup of fat (adipose tissue) in the liver. Individuals who have fatty liver are also at a greater risk of being diagnosed with GERD.

Obesity is the result of risk factors such as genetics, lifestyle, inactivity, unhealthy diet, medical problems, certain medications etc. The rise in the consumption of fast food explains the rise in the levels of obesity across the UAE. Long working hours coupled with the lack of time to cook and eat healthy, has caused people to gravitate towards fast food.

Furthermore, due to the extremely hot summers that last for nearly half the year, residents of UAE do not engage in too many physical activities or sports. The scorching temperatures prevent people from walking or cycling to their destinations, resulting in them using air conditioned cars everywhere they go. Lack of physical activity coupled with the rampant fast food consumption has resulted in UAE having one of the highest rates of obesity in the world, which has, in turn, caused the prevalence of GERD in nearly 3 million people across the seven Emirates.

Another key factor in rising levels of GERD cases amongst UAE residents, is the high rates of smoking present in the UAE. According to the WHO report on the “Global Tobacco Epidemic”, 12.8 percent of adults in the UAE smoked some form of tobacco daily. Doctors say that smoking contributes to GERD by relaxing the lower esophageal sphincter (a ring of muscle connecting the esophagus and stomach) which is one of the body’s main defences against GERD. Smoking also reduces  saliva, that contains an acid-neutralizing substance called bicarbonate, which is a natural antacid. Smoking is harmful to mucus membranes that help protect the esophagus from acid damage. It also prompts the stomach to produce more acid, increasing the risk of gastric juices being refluxed into the esophagus.

The symptoms of GERD can be prevented by simple changes that individuals can make in their everyday lifestyle. A change in one’s diet can be a great help. Furthermore, by quitting smoking an individual can not only greatly reduce their chances of getting heartburn and GERD but also eliminate the possibility of being diagnosed with pulmonary disorders.

 

Dr . Amal Premchandra Upadhyay

Consultant in Gastroenterology

Aster Hospital Mankhool

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