Diets & Exercise Tips to Regain Your Pre-Pregnancy Body Shape

WORDS DR VICKY KOH

DR VICKY KOH
Medical Director
Clinic RX
WELL, READ THIS FIRST

Every woman’s body is unique. Therefore, the question of the ‘right option’ or ‘best option’ is something that each and every woman has to figure out on her own.

For example, mothers that breastfeed often experience rapid weight loss and may benefit from an increased intake of certain nutrients or supplements. Women that gave birth via caesarean section may need a longer time to recover. Existing health issues and lifestyle variables also need to be considered.

If you are interested to find out more about the topics discussed below, you should discuss the matter further with your doctor.

BREASTFEEDING CONSIDERATIONS

Postpartum weight loss averages about 4.5 to 5.5 kg in the first 6 weeks. Women often return to their pre-pregnancy weight within a year, though this time frame varies depending on how much weight was gained during their pregnancy.

Breastfeeding aids in weight loss since it consumes extra calories, resulting in a natural weight loss for many women.

Breastfeeding women should pay special attention to their diets at this time.

While experiencing weight loss after giving birth may seem like a good idea, doing so too quickly will actually hinder healing!

POST-PREGNANCY DIETARY RECOMMENDATIONS

Dietary recommendations should include a variety of fresh produce, whole grains, lean proteins, and healthy fats.

Breastfeeding mothers, in particular, should drink a lot of water (6-10 glasses daily). Try to stay away from sodas and other sugary drinks.

Meanwhile, for moms that had a C-section, they should focus on eating foods that are high in protein. Avoid junk foods and take vitamin supplements, especially if they are nursing.

Vitamin and mineral supplements are crucial for moms during and after pregnancy.

This is because nutrients such as calcium, iron, vitamin D, folic acid, zinc, and more are normally redirected from the mother’s bloodstream to the developing infant.

Furthermore, the delivery process as well as breastfeeding depletes the body of essential vitamins.

Hence, postnatal supplements such as calcium, vitamin D, B vitamins, docosahexaenoic acid (DHA), magnesium, selenium, iodine, and choline may be helpful in replenishing nutrients that were used up during pregnancy and after childbirth.

EXERCISE RECOMMENDATIONS

Regular exercise after childbirth will help strengthen and tone your muscles while increasing your energy levels and making you feel less weary.

It also aids in the loss of excess weight.

During the first 6 weeks, the uterus returns to its pre-pregnancy size, and some women may feel uterine cramping and discharge.

However, mothers are recommended to gradually resume their exercise habits, starting with less strenuous activities during the first few weeks after giving birth.

A few days after delivery, you can start doing gentle abdominal and pelvic floor exercises if they don’t cause you any pain.

Try to proceed at your own pace—you can gradually increase the duration and tempo of your workout of over time.

Swimming, cycling, yoga, pilates, mild weight training, and low-impact aerobics are all good alternatives after the first few weeks.

Important Advice to Stay Prepared During the Monsoon Season

WORDS LIM EN NI

The Malaysian Meteorological Department (MetMalaysia) recently announced that Malaysia will experience continuous heavy rainfall from mid-November, leading to probable major flash floods in several states, and the monsoon season will last until early next year.

We would like to outline several precautionary measures for residents in flood-prone areas, from a community pharmacist’s point of view, to proactively mitigate flood damages ahead of the period and in the aftermath.

BEFORE A FLOOD
  • Closely monitor your surroundings and stay up to date on weather forecasts and warnings
  • Assemble disaster supplies, including long-term medications and first aid kits in water-proof bags in case of evacuation.
  • People, especially the elderly, with chronic diseases, are advised to visit their nearest pharmacy and bring along with their chronic medications, in order to keep a record in the pharmacy and have an up-to-date medication list; this will be useful should one lose the hard-copy of their prescription and face difficulties in retrieving their medication
AFTER A FLOOD
  • Due to poor sanitation and hygiene in flood areas, there is a high risk of flood-borne diseases such as leptospirosis, cholera, and dengue fever. Keep an eye out for general symptoms such as fever, headache, diarrhoea, muscle aches, and vomiting. In the case of any such symptoms, please visit the nearest healthcare centres immediately.
  • Alpro Pharmacy and DOC2US have launched the Life-saving Medication Care Programme, which provides a one-time supply of medications for up to 7 days for free. Those with contaminated or lost chronic disease medications can visit an Alpro Pharmacy outlet and speak to the pharmacist for more details. Note that a police report copy of the flooding is required for verification purposes.

Stay dry, stay safe!

How Breast Ultrasound & Mammogram May Save Your Life

WORDS LIM TECK CHOON

DR WINNIE NG NYEK PING
Consultant Clinical Oncologist
Subang Jaya Medical Centre
NO FAMILY HISTORY OF BREAST CANCER = NO PROBLEM? WELL, THINK AGAIN!

“Even if one has no known family history of cancer, external factors such as environmental exposures, prolonged exposure to female hormones and lifestyle features may contribute to an increased relative risk of breast cancer,” says Dr Winnie Ng, a consultant clinical oncologist.

“Aside from genetics, there are numerous underlying possible causes of breast cancer,” says Dr Ng
  • Alcohol intake
  • Smoking
  • Prolonged exposure to female reproductive hormones such as oestrogen, such as in women that reach menstruation at early age, women that have never been pregnant, women on oral contraceptive pills, women that experience menopause late, and woman that have their first full-term pregnancy at a later age
  • Postmenopausal women on hormone replacement therapy
  • Obesity

Theerfore, even if you have no family history of breast cancer, Dr Ng recommends that still going for breast cancer screening.

“The easiest method of screening is by self-examination of the breast,” she adds.

How to perform a breast self-examination. Click on this image to view a larger version.
AS WE STILL DON’T HAVE A CURE FOR BREAST CANCER, SCREENING REMAINS THE MOST PRACTICAL SOLUTION TO DETECT BREAST CANCER EARLY

Dr Ng recommends that

  • Women below 40 should undergo a breast ultrasound
  • Women above 40 are advised to go for a mammogram

You should consult your doctor about your risk factors and how often you should go for breast cancer screening.

 “A breast cancer diagnosis is not a death sentence. Self-tests and regular screenings can save lives,” says Dr Winnie Ng.

Keep the Hope of Pregnancy Alive in Spite of Breast Cancer

WORDS LIM TECK CHOON

DR CHRISTINA LAI NYE BING
Consultant Clinical Oncologist
Sunway Medical Centre
DR HOO MEI LIN
Consultant Gynaecologist and Fertility Specialist
Sunway Medical Centre
WHY IS BREAST CANCER SO PREVALENT AMONG YOUNGER WOMEN THESE DAYS?

Aside from unhealthy diet and exposure to cancer-causing chemicals or carcinogens in the environment, Dr Christina Lai Nye Bing shares that one possible factor is that women are choosing to marry and have children at a later age.

This somewhat paradoxical concept can be explained by the link between breast cancer and the female sex hormone oestrogen.

“Breast cancer is a hormone-related cancer, and high levels of oestrogen in the body increases the risk of breast cancer as it encourages cancer cells to grow by promoting cell division and reproduction,” Dr Christina explains. “Women in the previous generation who get married and have children earlier have a lower risk of breast cancer, as the oestrogen in their body decreases when they are pregnant and choose to breastfeed.”

IS PREGNANCY IMPOSSIBLE AFTER CHEMOTHERAPY?

Given that chemotherapy plays a big part in the treatment regime of many women with breast cancer, this raises the concern of whether the dream of having a family in the future an impossible one for them.

The unfortunate truth is that chemotherapy affects a woman’s fertility, with a 40% to 80% chance of early menopause.

The ovaries stop producing eggs upon menopause, so with that, the dream dies… or does it?

While Dr Hoo Mei Lin admits that the damage to the ovaries due to chemotherapy is irreversible, there is still a glimmer of hope.

“Patients can plan ahead, as conservation methods such as embryo freezing, egg freezing, and ovarian tissue freezing are available to enable patients to fulfil their wish of having children,” she shares.

Egg and ovarian freezing are suitable options for women that do not have a partner prior to having to undergo chemotherapy.

KEEP THE DREAM ALIVE

Dr Hoo advises breast cancer patients to have an open mind about their future and even consider having children.

After all, breast cancer patients under the age of 45 have an 80% survival rate after treatment!

“With the rapid advances in medical technology today, there is hope for breast cancer patients and survivors to plan their future. Technologies like egg and embryo freezing gives them the opportunity to have children in the future,” she says.

When it comes to cancer diagnosis, the focus is often about treating it, making fertility an afterthought. However, with the advancement in medical technology, surviving a cancer diagnosis is becoming increasingly successful hence, it is important to speak to your doctor as there are ways to help preserve fertility.

Invasive Mold Infections: A Rare but Deadly Fungal Disease

WORDS DR LOW LEE LEE

DR LOW LEE LEE
Infectious Disease Physician
Sultanah Bahiyah Hospital
FUNGI: OUR FRIENDS & FOES (IT’S COMPLICATED)

Fungi are found naturally in our environment. There are many different types of fungi, over 2 million species however about 600 fungi have caused diseases.

Invasive fungal infections typically manifest as a severe and aggressive form of the disease, leading to corresponding to high prevalence and death rates if left untreated.

These infections include invasive mold infections.

INVASIVE MOLD INFECTIONS AT A GLANCE
  • Usually caused by Aspergillus (giving rise to invasive aspergillosis) but can also be caused by other rarer molds such as Mucormycetes (giving rise to mucormycosis).
  • These molds produce spores; most of us encounter these spores every day without getting ill, but people with compromised immune systems may develop complications as a result of these spores.
  • Despite invasive aspergillosis and mucormycosis being relatively uncommon, invasive mold infections are often life threatening. If left untreated, the mortality rates can reach 100%!
  • Various parts of the world reported superinfections of invasive aspergillosis and mucormycosis in patients with COVID-19, which are associated with increased risk of death. COVID-19 likely increases the risk for fungal infections because it weakens the immune system or due to certain therapies used for treatment such as steroids.
  • There are no specific symptoms, as symptoms can vary depending on the type of infection. This makes diagnosis an infection a challenging and sometimes complicated task!
Invasive Aspergillosis
Aspergillosis and how it affects our lungs. Click on the image for a larger, more detailed version.
  • Invasive aspergillosis is uncommon and occurs primarily in immunocompromised people.
  • Commonly seen in people that have undergone stem cell and other organ transplants (especially lung transplant), as well as in patients with blood-related cancers such as acute leukemia.
  • Typically affects the lungs, but it can also spread to other parts of the body.
Mucormycosis
  • Mucormycosis is rare and estimated to affect approximately 10,000 cases worldwide, barring India. If India is included the numbers rise to 910,000 cases annually!
  • Typically occurs in the sinuses of the nose or lungs; however it can spread to the brain and other organs as well.
COMMON SYMPTOMS OF A POSSIBLE INVASIVE MOLD INFECTION
  • Typical pneumonia symptoms including fever, chest pain, cough, coughing up blood, and shortness of breath
  • Sinus infection, which may be painful
  • Pain, tenderness, swelling and pressure around the eyes, cheeks, nose or forehead
  • One-sided facial swelling
  • Headaches
  • Nasal or sinus congestion
  • Black lesions on nasal bridge
HOW TO REDUCE YOUR RISK OF AN INVASIVE MOLD INFECTION
  • When performing activities that involve close contact with soil and dust, such as yard work or gardening, take care to wear shoes, long pants, and long-sleeved shirts
  • Whenever possible, avoid dusty areas like construction or excavation sites; wear a N95 mask when you have to visit these areas
  • Keep your house dry and mold-free
  • Avoid staying in a moldy home (even while it is being cleaned)

#YouMatter Promotes Mental Health Awareness and Creates Safe Space

WORDS LIM TECK CHOON

In conjunction with World Mental Health Month in October, Suria KLCC together with The Body Shop invites the public to be part of the change in temoving the stigma of mental health problems. Also coming onboard this year is the is Mental Illness Awareness & Support Association (MIASA).

The campaign with the tagline #YouMatter will run until 10 November 2022.

A SAFE SPACE FOR PEOPLE TO GATHER AND CONVERSE ABOUT MENTAL HEALTH

A safe space is available Suria KLCC for people to come together and converse about mental health without the fear of receiving judgment and being stigmatized by the rest of society.

This safe space, called Safe Space @ Suria KLCC, will be open for the duration of this campaign.

SAFE SPACE @ SURIA KLCC

  • Located at Level 1, Ampang Mall (you can’t miss it)
  • Will be opened throughout the campaign (until 10 November 2022)
  • 10 am to 10 pm daily
  • Participate in workshops, talks, and panel discussions with mental health professionals
  • Talk to the stationed mental health volunteer for more information

The calm room in Safe Space @ KLCC allows one to de-stim and find peace of mind.
WELCOMING THE CALM AFTER A TURBULENT MCO

“The last two years marked a turbulent and uncertain time for all,” says Andrew Brien, the Executive Director of Suria KLCC Sdn Bhd. “With the pandemic in the rear-view mirror, there’s no better time to reconnect and focus on recovery.”

He adds: “The Safe Space @ Suria KLCC is a welcoming space where the community can come together to share and learn. After all, a problem shared is a problem halved—we want people to leave the space feeling better and with more insight about themselves or others.”

A TIMELY EFFORT TO REACH OUT TO AND EMPOWER YOUTHS

YAM Tengku Puteri Raja Tengku Puteri Iman Afzan Al-Sultan Abdullah, the Founder and President of the Green Ribbon Group, emphasizes that Safe Space and similar efforts are needed to show our support for those with mental health problems as well as to highlight an ongoing commitment towards doing more for the cause.

She adds that for this year, the focus is on the mental health of youth. “The focus on youth mental health this year is especially timely for the Green Ribbon Group. We are very fortunate to be able to pilot programmes in secondary schools and universities that focus on mental health literacy, self-management and peer support. This has always been a dream of mine—to reach out to our youth and empower them to prioritise their mental health.”

Founder and President of MIASA, Anita Abu Bakar shares a similar sentiment. “Looking after each other should be everyone’s responsibility and not just the health sector alone,” she says. “This is why we should strive to prioritise community-based mental health support—so that the burden of care can be shifted from being shouldered solely by our incredible frontliners to being shouldered by all of us. Through efforts like this, it is our sincere hope that the scale of our response to the issues surrounding community mental health can begin to match the scale of the challenge itself.”


For more information on MIASA, you can visit www.miasa.org.my (link opens in a new tab), while more information on the Green Ribbon Group can be found by visiting greenribbongroup.com (link also opens in a new tab).

See the map below if you’re unsure as to where KLCC Suria is.

How Intraocular Lens Can Help People with Cataract and Presbyopia

WORDS LIM TECK CHOON

DR CHEONG FOOK MENG
Consultant Ophthalmologist
Gleneagles Hospital Kuala Lumpur
CONCERNING CATARACT

Dr Cheong Fook Meng shares that it is normal to develop cataracts as you age.

However, this condition can also be caused by eye injuries as well as certain diseases or medications.

As one’s cataract progresses, the lens in their eyes gradually become hard and cloudy, allowing less light to pass through. This leads to diminished vision and even complete blindness in severe cases.

ABOUT PRESBYOPIA 

“Presbyopia is another condition that occurs naturally as a person ages; your eyes gradually lose the ability to focus on nearby objects,” says Dr Cheong.

With presbyopia, the lens inside the eye progressively loses its flexibility, making it harder for the affected eye to focus the light reflected from objects.

A common sign that someone may have developed this condition is having to hold reading materials at arm’s length to make out what they are reading.

BOTH CAN BE TREATED WITH SURGERY & IMPLANTATION OF INTRAOCULAR LENS

“This surgical treatment allows the removal of the eye’s cloudy natural lens and replacing it with an intraocular lens,” explains Dr Cheong.

The intraocular lens is clear, made to fit one’s eye shape and personalised according to the patient’s condition and needs.

Intraocular lens (labelled as lens in the image). Click to view a larger version of this image.
TYPES OF INTRAOCULAR LENS AVAILABLE IN MALAYSIA
  • Monofocal lenses correct a single range of vision, usually to see distant objects. Additional issues will need to be fixed through other means.
  • Toric lenses are suitable for patients who also have astigmatism but, similar to monofocal lenses, they restore vision for only one area of focus.
  • Multifocal lenses are designed to provide clear vision for distant and near vision.
GOING FURTHER WITH EXTENDED DEPTH-OF-FOCUS INTRAOCULAR LENS  

Extended depth-of-focus intraocular lens delivers an enhanced range of vision with a reduced frequency of glares and halos, regardless of the lighting conditions.

During the day or when driving at night, these lenses deliver great vision and clarity.

For presbyopia

Extended depth-of-focus intraocular lens can be used to correct presbyopia, by creating a single elongated focal point to enhance one’s range of distance for which their eye can see an object clearly.

For cataract

While all lenses can fix cataracts, extended depth-of-focus intraocular lens may improve one’s quality of life.

They provide distant, intermediate (at arm’s length, such as for reading a newspaper or working on a laptop) and functional near vision (up close, such as for reading books and mobile phone screen), with minimum visual disturbances.

They may even decrease a patient’s need to wear glasses after their cataracts have been removed.

Important Things That You Should Know About Silent Heart Attacks

WORDS LIM TECK CHOON

DR PATRICK TIAU WEI JYUNG
Consultant Cardiologist
Sunway Medical Centre

Dr Patrick Tiau reveals that silent heart attacks, also known as silent myocardial infarction, account for 45% of heart attacks.

These heart attacks are “silent” because they occur without the usual, recognizable symptoms of a heart attack.

COMMON SYMPTOMS OF HEART ATTACK
  • Chest pain (often described as heavy or pressure sensation)
  • Radiating pain in the arm, neck, or jaw
  • Sudden shortness of breath
  • Sweating
  • Dizziness
HOWEVER, THESE SYMPTOMS ARE USUALLY NOT PRESENT WHEN ONE HAS A SILENT HEART ATTACK!
Because of this, many people may not know that they have experienced one until days or even weeks after.

However, Dr Patrick shares that there are some early warning signs to look out for.

SIGNS THAT YOU MAY HAVE HAD A SILENT HEART ATTACK

It’s good to consult a doctor when you have concerns, especially if you experience these signs and fall under the high-risk below (see below).

  • Feeling tired
  • Indigestion
  • Nausea
  • Sweating.

Dr Patrick says, “We have come across many patients who have dismissed the early warning symptoms as simply feeling tired, indigestion, nausea or sweating. By the time they seek out medical treatment for these symptoms, they are shocked to learn that what they are experiencing is actually due to a reduced blood flow to their heart, and that has caused them to have a silent heart attack.”

Silent heart attacks can lead to more serious health complications if left untreated over an extended period of time, such as an increased risk of another, potentially more deadly heart attack.

COMMON RISKS OF SILENT HEART ATTACKS
RISKS THAT CANNOT BE AVOIDED 
  • Age. The risk increases as we grow older.
  • Gender. Men are more at risk than women. However, women are more prone to a higher risk of complications after experiencing one, especially if they are diabetic.
  • Family history. The risk is higher for people with a family history of heart diseases.
RISKS THAT CAN BE MODIFIED 
  • Smoking. Chemicals in cigarettes stimulate one’s heartbeat and can dramatically increase one’s risk of heart attack.
  • High cholesterol. Individuals with elevated cholesterol levels can lead to formation of atherosclerotic plaque in the blood vessel and reduce blood flow to the heart.
  • High blood pressure: Having high blood pressure puts extra strain on the heart muscle. Over time, this causes the heart muscle to stiffen, thicken, and perform less optimally.
  • Individuals that are overweight or obese, especially when their weight tends to sit at the waist, are more at risk even if they do not have any other risk factors.
  • Physical inactivity. Doing regular exercise helps protect the heart by keeping under control other risk factors such as cholesterol, blood pressure, diabetes, and obesity.

“Undeniably our heart health is essential to allowing us to have a well-balanced and fulfilling life,” he says. “The heart itself is the first and last sign of life that is responsible for, quite literally, keeping us going. In combatting heart attacks, the most important thing to remember is that prevention is definitely better than cure.”

DR PATRICK’S TIPS TO REDUCE YOUR RISK OF SILENT HEART ATTACKS

Make the necessary small changes to daily lifestyle to reduce one’s risk factors. These changes include:

  • Regularly monitor blood pressure and cholesterol
  • Get sufficient exercise
  • Quit smoking
  • Eat a balanced diet of fruit, vegetables, lean meats and whole grains
  • Ensure that one’s blood pressure, cholesterol and blood sugar are well-controlled
  • Inform a doctor as soon as possible about any unusual symptoms that may indicate a silent heart attack

Once you go home from the hospital, it is essential that you keep taking your medications as prescribed. “This will ensure your heart health is kept in check, possibly for the rest of your life,” says Dr Patrick.

Consider joining a support group. Dr Patrick acknowledges that heart attack survivors may start to develop feelings of shock, sadness, and anxiety. This is normal, and these feelings can be managed with the right support.

“Some people find it helpful to join a support group where they can talk with others that have gone through a similar experience, or seek out companionship and encouragement through avenues such as the gym, or yoga classes,” he advises.

The Iron In Every Woman

The Iron In Every Woman

May 8, 2022   Return

WORDS LIM TECK CHOON

It can be great to be a woman living in 2019. We have our first female Deputy Prime Minister and more women in our government than before. Women have more access to education, career and social rights than before. Things can be better, of course, hence this year, for International Women’s Day, we are calling for #BalanceforBetter.

However, making great strides require iron in both fortitude and health. No matter how strong one’s fortitude can be, one also requires iron – the mineral– as it is an essential component of health. Unfortunately, iron deficiency in women is far more common than it should be.

Hence, HealthToday is pleased to invite you to join us this month as two experienced experts have kindly shared with us their insight on this subject.

 

Dr Jameela Sathar

Consultant Haematologist

Hospital Ampang

Iron Deficiency: It’s More Than Just Anaemia

Oxygen is essential to convert the calories in the food we eat into energy, which then powers many essential functions of the body. It is transported in red blood cells, and iron is needed to make these cells. Hence, if our body is a factory, then that of someone with iron deficiency (ID) is comparable to a factory that is running on low efficiency due to shortage of power.

Most people usually equate  ID to anaemia, a condition in which the red blood cells do not carry enough oxygen from the  lungs to the rest of the body. However, Dr Jameela Sathar explains that ID doesn’t spring up abruptly overnight – anaemia is actually the manifestation of advanced ID.

“You can go on for many years before developing anaemia,” she says about people who have ID.

We Need A Change In How We Usually Detect Id

In the blood, iron is stored in a protein called ferritin. Healthcare professionals measure the levels of ferritin in the blood as an indication of the levels of iron in the body, and someone with ID typically has less than 30 nanograms (ng) of ferritin for each millilitre (mL) of blood.

However, most hospital laboratories tend to diagnose someone with ID only when there is less than 13 ng of ferritin in 1 mL of blood. Dr Jameela feels that this value is too low as by that stage, the person already has developed anaemia.

Additionally, taking absolute numbers at their face value  may not give an accurate picture. For uncomplicated cases, the serum ferritin value of less than 30 ng/mL indicates ID, but Dr Jameela points out that for patients with inflammatory diseases (chronic heart failure, chronic kidney disease, rheumatoid arthritis, etc), serum ferritin below 100 ng/mL may also indicate ID.

Therefore, Dr Jameela advocates for a nationwide policy to adjust  the cut-off point in diagnosing someone with ID.

For members of the public, however, the take-home message is that we don’t necessarily have to develop anaemia if we have ID. Measures can be taken to improve ID before it reaches the anaemia stage.

The Hidden Consequences Of Anaemia

Aside from having to deal with the symptoms of ID listed previously, there are other downsides to having anaemia:

  • Patients with anaemia undergoing surgery have a higher incidence of needing blood transfusions. This increases the overall treatment cost and the risk of possible side effects of blood transfusions (infections, lung injuries, etc).
  • Higher risk of developing infections of the urinary and respiratory tracts.

Therefore, We Should See A Doctor If We Suspect That We Have Id

How do we know if we may have ID?

  • Hair loss
  • Brittle nails
  • Headaches
  • Pica (an appetite for substances with little nutritive value like ice)
  • Fatigue
  • Frequent infections
  • Depression
  • Concentration impairment
  • Taste disturbance
  • Anaemia/pallor.

The doctor will typically order a blood test that specifically measures our ferritin levels. If the test shows low ferritin levels, we will receive appropriate treatment.

 

Associate Professor Dr Ina Ismiarti Shariffuddin

Consultant Paediatric Anaesthesiologist

University Malaya Medical Centre

Iron & The Pregnant Woman

During pregnancy, a woman needs even more iron than normal, as her body needs to increase red blood cell production in order to nourish the child she is carrying. Hence, iron intake is an important consideration, as it now potentially affects the well-being of both the mother and child.

How much iron does a pregnant woman need?

According to Assoc Prof Dr Ina Ismiarti Shariffuddin:

  • A 55 kg woman requires about 1,000 mg of iron throughout her pregnancy.
  • During the second and third trimester, she needs about 500 mg of iron for red cell expansion. 300-350 mg of iron needs to be transferred to the foetus through the placenta for foetal development, while the remaining 100-200 mg is stored as standby in case of blood loss during delivery.

Mothers-to-be should consult their gynaecologist on how much iron they should take in their diet.

ID symptoms that pregnant women should watch out for

These include:

  • Breathing difficulties.
  • Fainting.
  • Tiredness.
  • Heart palpitations (rapid heartbeat).
  • Sleep difficulties.

Assoc Prof Dr Ina cautions that severe ID can lead to heart failure and further complications to the delivery at a later date. It can also increase the risk of developing perinatal infections, pre-eclampsia and bleeding. The baby can also be affected by severe ID, as he or she faces an increased risk of being prematurely born, halted growth while still in the womb, and low birth weight.

shutterstock_5798784...

How ID in pregnant women is treated

Assoc Prof Dr Ina shares that iron pills and supplements containing iron, vitamin B12 and folic acid specially formulated for pregnant women can be offered to overcome ID.

Intravenous iron – which is given through a drip – is considered for those whose pregnancy has entered the second trimester onwards, as well as for those who do not respond well to iron pills.

Therefore, expecting mothers should see a gynaecologist if they suspect that they may be suffering from ID. Prompt measures to manage ID would go a long way to ensure the safe delivery of a healthy baby. HT

Five Reasons Why Malaysian Women Can’t Conceive, and What Can be Done about Them

Five Reasons Why Malaysian Women Can’t Conceive, and What Can be Done about Them

May 8, 2022   Return

WORDS LIM TECK CHOON

Dr Agilan Arjunan

Consultant Gynaecologist & Fertility Specialist KL Fertility Centre

 

Infertility cuts deep into the heart. It hurts for a couple who long for a child, but can’t conceive despite trying so hard, and the hurt is made more intense by the fact that the joy of pregnancy and childbirth is all around them. Other couples share stories, photos, and Facebook posts of their parenthood experiences, making a couple’s inability to conceive seem even more unfair.

Yet, the door to parenthood may not be closed permanently. As fertility treatments become more advanced, we are starting to have more control over our chances of conceiving a child. There are still many things that are up to chance, but we also have more options than before to address difficulties in conceiving. This month, fertility specialist Dr Agilan Arjunan takes a look at some of the main causes of infertility among Malaysian women.

AGE: IT’S MORE THAN JUST A NUMBER

Dr Agilan had touched on this in recent articles but it’s worth bringing up again because a woman’s advancing age remains the most common cause of her difficulties in conceiving a child.

  • A woman’s most fertile period is usually during her mid-20s.
  • Her fertility begins to decline after the age of 30.

However, starting a family in the early twenties is not an option for every woman. A woman these days is more likely to be able to commit to starting a family in her thirties or even forties, a time when her fertility is on a decline.

What can we do about this? A fertility specialist can run a test called the anti- Müllerian test to estimate how many primordial follicles remain in a woman’s ovaries. For this test, the woman only needs to provide a sample of her blood. Once the test result is in, the fertility specialist can advise on the next best step.

In-vitro fertilization (IVF) may be helpful when it comes to selecting the highest quality egg cell for fertilization, therefore overcoming the issue of lower quality eggs produced at a later age.

Another option is for the woman to have her eggs frozen when she is at a more fertile age. These eggs can be thawed and used when she is ready to start a family at a later age.

To understand why fertility drops with age, we first need to understand how the ovaries work.

Dr Agilan shares that a woman only has approximately 10% of her egg reserve remaining by the time she turns 30, and the reserve continues to deplete until she reaches menopause and, hence, the end of her childbearing days.

  1. The ovaries release a mature egg cell during a woman’s menstrual cycle (typically around day 14), and new life is formed when a sperm cell fertilizes this egg during sexual intercourse.
  2. The egg cell develops from a pre- existing cell in the ovary called the primordial follicle. This process occurs under the infuence of hormones such as the follicle stimulating hormone (FSH).
  3. Now, the woman is born with a set number of primordial follicles. No new primordial follicles will be made after she is born. Therefore, once all her primordial follicles are used up, she will no longer be able to produce any more egg cells.
  4. Another issue that arises is that the quality of the egg cell produced tends to decrease with the woman’s age. This may occur even when a woman still has a good number of primordial follicles. This is because the good quality eggs tend to be released during the woman’s most fertile period. Egg cells produced at a later age tend to have a higher risk of being abnormal.

ISSUES WITH THE FALLOPIAN TUBES

Figure A. Blockage in the fallopian tube can prevent a mature egg cell from being fertilized by a sperm cell.

As indicated in Figure A, the fallopian tube is a tube-like structure that provides passage for the mature egg cell to travel from the ovary to the uterus. During sexual intercourse, it will encounter a sperm cell during its journey, and the subsequent fertilization will give rise to new life.

These days, fallopian tube issues are increasingly common. These issues include blockage and damage which prevent the egg cell from ever meeting the sperm cell.

Dr Agilan explains that these issues arise because more women are becoming sexually active at a younger age. This increases their risk of developing pelvic inflammatory disease (PID), especially if they do not practice safe sex. Some women may not realize that they have PID because its symptoms can be either absent or very mild.

Other possible causes of fallopian tube issues include ruptured appendix and a previous ectopic pregnancy (which happens when an embryo attaches itself into the fallopian tube instead of the endometrium in the uterus).

What can we do about this?

If fallopian tube issues are suspected to be the cause of a woman’s difficulty in conceiving, a type of X-ray test called hysterosalpingography can be performed to confirm that this is indeed the case. Once this is confirmed, there are a few options depending on the nature and location of the damage or blockage.

  • laparoscopic surgery can be done to repair fallopian tube damage.
  • If the fallopian tube damage isn’t too close to the uterus, surgery may be able to repair the damage. However, there is risk of scar tissues forming at the site of surgery during the healing process, causing the fallopian tube to be blocked.
  • In-vitro fertilization is most likely the best option for couples wishing to have a child despite the presence of damaged or blocked fallopian tubes. The fertility specialist can extract eggs directly from the ovaries, bypassing the fallopian tube altogether.

ENDOMETRIOSIS

The innermost layer of a woman’s uterus is called the endometrium. It is here that  the embryo, which develops from a mature egg cell that has been fertilized by a sperm cell, implants itself to develop into a baby. If no fertilization occurs, the lining tissue thickens and breaks down before exiting the body as menstrual flow.

“Endometriosis arises when tissues from the endometrium grow outside of their usual place in the endometrium,” says Dr Agilan. “They may grow in the fallopian tubes, ovaries and even in the pelvis.”

These cells thicken, break down and bleed during the menstrual cycle, and this becomes a problem as the blood and broken-down tissue cannot exit the body. This leads to irritation in the surrounding tissue as well as formation of scars and cysts.

“ENDOMETRIOSIS, UNFAIRLY CALLED THE CAREER WOMAN’S DISEASE, WAS ONCE THOUGHT TO BE CAUSED BY DELAYED CHILDBEARING. WE NOW KNOW THAT’S NOT TRUE AT ALL.”

Consequently, someone with endometriosis can experience great pain. Her fertility is very likely to be affected as well, as endometriosis can reduce both the number of eggs as well as quality of these eggs.

What can we do about this? Treatment of endometriosis, which typically involves hormone therapy, makes it harder for a woman with endometriosis to conceive, as it prevents ovulation. Therefore, if the woman wants to have a child, the fertility specialist will recommend temporarily stopping treatment.

If necessary, laparoscopy can be performed to reduce the severity of endometriosis and improve the chances of pregnancy. Intrauterine insemination (IUI) may also be useful as this procedure allows the injection of sperm cells directly into the uterus, therefore improving the chances of a successful fertilization.

POLYCYSTIC OVARY SYNDROME (PCOS)

Polycystic ovary syndrome (PCOS) is a lifelong condition that give rise to several bothersome, uncomfortable and even painful symptoms, as seen in Figure B. According to Dr Agilan, it affects about 20% of women worldwide, and in Malaysia, it is especially common among Indian women.

Depending on the severity of her PCOS, the affected woman’s ovaries may fail to regularly release eggs. Dr Agilan shares that it is not unheard of for women with PCOS to not have their period for up to six months, perhaps even a year. This naturally affects their ability to have children.

What can we do about PCOS? Dr Agilan notes that more than 50% of women with PCOS have higher than normal levels of the hormone insulin, even though they are not diabetic.

“The higher the insulin levels, the harder it is for the woman to form a mature egg cell and ovulate,” he says.

Therefore, a way to increase the woman’s chances of conceiving a child is by reducing the insulin level. This is done by prescribing metformin, the staple medication for people with diabetes.

PROBLEMS AFFECTING THE UTERUS

“These problems include the presence of fibroids, which can affect the ability of a fertilized egg to implant into the endometrium or displace the fallopian tube and make it difficult for the sperm cell to meet the egg cell,” Dr Agilan says.

Another, rarer condition is adenomyosis, which is a type of endometriosis. In this case, endometrial tissues are found in the wall of the uterus, giving rise to an enlarged uterus, heavy and/or prolonged bleeding during menses and pain.

What can we do about it? Because problems with the uterus usually affect the ability of the woman to stay

pregnant – which is to say, it may prevent an embryo from being implanted or staying implanted in the endometrium – there is no simple “one size fits all” solution. The fertility specialist evaluates the patient and considers the best options on a case by case basis. HT

Guys aren’t left out! Dr Agilan will turn the spotlight on the main reasons why men have a hard time making babies in the next Woman’s Health and Fertility column. Watch out for it!

If you like this article, do subscribe here.