Welcome to the weekly ZIP - your Zenith Informed Pregnancy!
Read on for a quick zip through 3 of the week’s most popular pregnancy questions, and the evidence behind them. Plus - bonus content on the latest & greatest in the world of pregnancy research.
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This week's top pregnancy questions:
1️⃣ Is it possible to eat too much Halloween candy?
2️⃣ What’s a cervical check, and can I decline it?
3️⃣ Why do I have itchy hands and feet - is this normal?
Is it possible to eat too much Halloween candy?
Happy Halloween! With candy bowls everywhere and cravings in full swing, it’s normal to wonder how much sugar is actually okay during pregnancy, especially when everyone has an opinion on what you’re eating and drinking. So what does the evidence say — and do a few extra Skittles packets really matter?
📚The tl;dr from the evidence: Fear not – there is no compelling evidence that one single instance of eating lots of candy has negative effects on mom or baby’s health during pregnancy. Aside from the potential short-term discomfort of a stomachache or sugar crash, one day of high sugar intake is not considered risky (without existing complications, such as gestational diabetes), so trick-or-treat to your heart (or stomach’s!) desire.
Consistently high sugar intake (over weeks or months) is what the evidence has shown can be associated with potential risks, like developing gestational diabetes, high blood pressure, or having a big baby. If you’re amongst the group of many moms with a sweet tooth and lots of sugary cravings constantly throughout pregnancy, it’s more important to consider monitoring the amount of sugar you’re consuming and balancing candy with other sweet items that include more nutritional benefits (like fruits).
👀 Read Penny’s full summary of the evidence for more on Halloween candy and sugar intake
What’s a cervical check, and can I decline it?
If your social feeds are filled with moms wondering whether to get a cervical check, you’re not alone. Late pregnancy often comes with your doctor offering one… and a lot of questions. Can it predict when labor will start? Do you have to get one? Here’s what the evidence says, and how to decide what feels right for your body and your situation.
📚The tl;dr from the evidence: Cervical checks are a procedure where your provider manually assesses the cervix to understand any changes - specifically, dilation, effacement (or thinning), and position. They can be useful, but are not always necessary.
What are they most useful for? Providing information about your cervix to help plan appropriately for labor (including assessing potential induction), confirm labor based on symptoms, or monitor progress in labor. However, it does not reliably predict when labor will start, or how quickly labor will progress - moms can be dilated for weeks with no labor, or conversely, move quickly from closed to fully dilated.
What are some common hesitations? The procedure may be uncomfortable, and lead to minor cramping or bleeding. It can sometimes also lead to stress/anxiety for moms if cervical changes are progressing more slowly than expected or desired, or the results don’t match expectations. Each procedure comes with a small risk of introducing vaginal bacteria to the uterus, which may lead to infection. The risk of infection from a single cervical check is small, but can be higher if your water has broken, or with repeated cervical checks (each additional check increases risk, and a 2021 study found that women with more than 7 cervical checks had an increased risk of infection).
In short, there are pros and cons. Cervical checks are common in late pregnancy, but not required. You can always ask why it’s being recommended, what information it will give you right now, and decline if it doesn’t feel useful or aligned with your preferences. Like any procedure in pregnancy - it depends on your informed choice and consent.
👀 Read Penny’s full summary of the evidence for more on cervical checks
Why do I have itchy hands and feet - is this normal?
Suddenly itching like crazy? All sorts of aches, pains, and body changes can show up over the course of 9 months, including normal skin changes and heightened skin sensitivity. How can you tell if your itchy hands and feet is just another harmless pregnancy annoyance, or warrants a call to the doctor to rule out something more serious?
📚The tl;dr from the evidence: In general, itching and skin sensitivity can be completely normal and harmless – lots of it happening around your belly, breasts, and thighs as your skin stretches. However, if the palms of your hands and/or soles of your feet specifically are giving you trouble, it could be a sign of an uncommon but more serious condition called cholestasis, or intrahepatic cholestasis of pregnancy (ICP).
A few signals that this isn’t “normal” itching and you should consult with your doctor: itching on your palms and soles without an accompanying rash, itching that is worse at night and may even disrupt your ability to sleep, and onset of itching after 20-28 weeks. Any of these accompanied by other abnormal pregnancy symptoms like dark urine, yellowing of the skin or eyes (jaundice), or abdominal pain should warrant working with your doctor to rule out ICP and ensure you receive the right course of care for your symptoms.
What actually is ICP, and how does it happen? ICP is a liver disorder that can happen during pregnancy (affecting ~0.2-0.3% of pregnancies in the U.S.), and is caused by a number of potential factors, including – you guessed it – hormonal changes (interfering with how the liver moves bile), along with genetic predisposition, environmental factors, and any history of liver disease. If you are diagnosed with it, your doctor will work with you to manage the condition, often with medication and increased monitoring for both you and your baby to check liver function and bile acid levels.
👀 Read Penny’s full summary of the evidence for more on itching and ICP
🤓 Zenith's top read of the week
Bonus: what the Zenith team found interesting this week. Think cool pregnancy research or recently published studies, news in pregnancy health and policy, and more!
Pregnancy and postpartum dynamics revealed by millions of lab tests (Alon Bar et al, Science Advances) - For those who have gone through a pregnancy and postpartum period, the findings of this paper will come as no surprise. Published earlier this year, it’s an amazing look at how pregnancy and childbirth might affect the maternal body, and how long (if ever) it takes for the body to return to “normal” – examining over 70 lab tests pre- and post-pregnancy for over 300,000 women. They found that nearly half of the tests take 3-12 months to return to the pre-pregnancy baseline (much longer than the 6 week “postpartum bounceback” that is so pervasive on our social feeds, in workplaces, and beyond).
The postpartum period is physiologically intense, and this paper is an excellent reminder that the 6 week postpartum period often cited in the U.S. is way too short. It’s great to see data backing up the extent of the physical recovery needed, and hope that more work like this can support policy objectives around better supporting mothers in the postpartum period and providing more adequate maternity leave and coverage. Plus, anytime we’re talking about an observational study in pregnancy on the scale of 44 million measurements collected, we’re thrilled to be taking meaningful steps towards closing the huge data gaps that exist today! 🤓
Key excerpt:
“ Here, we present the dynamics of 76 lab tests based on a cross-sectional analysis of 44 million measurements from over 300,000 pregnancies. We analyzed each test at weekly intervals from 20 weeks preconception to 80 weeks postpartum, providing detailed temporal profiles. About half of the tests take 3 months to a year to return to baseline postpartum, highlighting the physiological load of childbirth."