Covid-19, HEALTH AND WELLBEING, PREGNANCY, SELF-CARE

HOW’S YOUR HEART THIS VALENTINES DAY?

@cardiomyopathyuk hashtag #beatingfortwo

What is Peripartum Cardiomyopathy?

Peripartum cardiomyopathy (or PPCM) happens during pregnancy, usually starting between the final month of pregnancy and the first five months after giving birth. In PPCM the woman’s heart becomes enlarged and its pumping action weakened. 

PPCM is similar to dilated cardiomyopathy, in that it affects the left ventricle of the heart. This is the main pumping chamber of the heart: pumping blood out of the heart and to the rest of the body. Normally the left ventricle pumps blood out of the heart efficiently, with enough pressure to reach all areas of the body. In PPCM, the left ventricle chamber becomes enlarged. As the ventricle becomes bigger than normal, the muscular wall becomes stretched and thinner. This makes the muscle weaker which, in turn, means that it works less well. 

Why is it important now, in the midst of a pandemic?

Even without the pandemic it’s an issue that was overlooked, despite the damage it can cause to women and their families. Symptoms are often missed or misdiagnosed. But when you add the pandemic lens, people are less vigilant as their focus is on Covid symptoms, and are less likely to seek medical help. Because awareness of the condition is currently so low, opportunities to detect and treat PPCM early are being missed, and as a result, women’s lives are being put at risk. 

75% of people mistake symptoms of heart conditions as ‘normal’ during and after pregnancy 

Cardiomyopathy UK urges the public and healthcare professionals to recognise cardiac symptoms in women and take action to cut maternal deaths

  • 70% of people are unaware of serious heart conditions that can develop during and after pregnancy 
  • 75% of people think common cardiac symptoms are ‘normal’ to experience during and after pregnancy 
  • 55% would be more cautious about seeking medical help as a result of concerns over Covid-19
  • Cardiomyopathy UK launches Beating for Two to raise awareness of serious heart conditions, like peripartum cardiomyopathy, that develop during and after pregnancy

Cardiomyopathy UK has launched its new campaign, Beating for Two, to raise awareness of the potentially life-threatening heart muscle disease, peripartum cardiomyopathy (PPCM), which can develop during the last part of, or in the first few months after, pregnancy. 

New research commissioned by the charity shows the majority of people (70%) are unaware that serious heart conditions such as PPCM can develop during and after pregnancy. And in a small survey of patients and the family of those who have been diagnosed with PPCM, prior to diagnosis, 98% were unaware that serious heart conditions can occur during and after pregnancy. 

While people are better at spotting more obvious cardiac symptoms such as chest pain and heart palpitations, three quarters (75%) of those surveyed think common cardiac symptoms are ‘normal’ during and after pregnancy, and 66% wouldn’t seek medical help if they were to experience them.

Some of the less obvious cardiac symptoms, which often get overlooked but could signal a serious heart problem, such as PPCM, include:

  • tiredness completing everyday tasks
  • shortness of breath when at rest or lying down
  • sudden swelling of the ankles
  • excessive and rapid weight gain 

Top reasons people gave for not seeking medical help if they or a loved one were experiencing PPCM symptoms include ‘assuming the symptoms are ‘normal’ during pregnancy’ (58%), ‘assuming symptoms will go away on their own’ (32%), ‘fear of being viewed as overreacting or fussy’ (29%) – something which is higher in women than men (32% to 26%) – and ‘feeling guilty for using the NHS’s time’ (24%). 

The campaign is timely and of paramount importance as the data shows the pandemic has had an impact on people’s behaviour, with 55% saying that because pregnant women are in a higher risk category, they would be more cautious about seeking medical help as a result of concerns over Covid-19.

Cardiovascular disease is the most common cause of maternal death in the UK, with PPCM accounting for one-third of cardiovascular maternal deaths. However, because awareness of the condition is low, opportunities to detect and treat the condition early are being missed, and as a result, women’s lives are being put at risk.

When showing concern over symptoms, 45% of those in the Patient Survey who have been diagnosed with PPCM, were told symptoms were ‘normal’ during and after pregnancy.

Through its Beating for Two campaign, Cardiomyopathy UK wants to make it easier for women and their families to spot the signs of PPCM, and to feel confident seeking medical help sooner.

Survey respondents indicated that, if they knew more about which symptoms were ‘normal’ and ‘not normal’ during and after pregnancy, 66% would feel more confident raising concerns with a healthcare professional. 

The charity also wants healthcare professionals to ‘think heart’ when considering symptoms, and to ask about history of medical problems that run in the family to ensure PPCM symptoms are not being mistaken as ‘normal’.

Joel Rose, Chief Executive of Cardiomyopathy UK, says:

“During pregnancy, an expectant mother’s heart is put under additional pressure as it adapts to keeping two humans alive. This incredible organ is beating for two, but we don’t always give it the recognition and attention it deserves. While PPCM is thankfully rare, its effects can be devastating if left undetected. 

“However, the condition is completely manageable if caught early and most women who are diagnosed live healthy and fulfilling lives. 

“We know women often put their needs to the bottom of the priorities list, but we urge people to trust their instincts and to watch for signs that their heart might be struggling to cope, during pregnancy and after birth. 

“If you feel that something isn’t right speak to your GP, midwife or health visitor.” 

Cardiomyopathy UK is working hard to ensure better recognition of the symptoms so that every woman with PPCM is diagnosed in time to manage the condition safely.

Sascha Wells-Munroe OBE, Deputy Chief Midwifery Officer for England, says: 

“It is vital that any woman with any cause for concern about her or her baby’s health speak to their midwife or maternity team without delay. It can be easy to think that symptoms like tiredness or shortness of breath are ‘normal’ but, no matter how big or small a symptom might be, please seek advice – the NHS is here for you. 

“Alongside our NHS ‘Help Us Help You’ maternity resources, campaigns like Cardiomyopathy UK’s ‘Beating for Two’ provide critical reminders that it’s just as important as ever to seek help from maternity services and it’s so crucial that women and healthcare professionals alike ‘think heart’ to make sure no opportunities to keep women and babies safe and healthy are missed.”

For more advice and information about the signs and symptoms to look for, and what is ‘normal’ and what is not during and after pregnancy, visit: http://bit.ly/2YmaUF4

About Cardiomyopathy UK

Cardiomyopathy UK is the national charity for people affected by the heart muscle diseases cardiomyopathy and myocarditis. We provide support and information services, work to raise awareness of the condition, campaign for better access to quality treatment and promote research.

Stay Present,

Em x

Photo by Suhyeon Choi on Photo by Marcin Jozwiak on Photo by Sharon McCutcheon on Photo by Giulia Bertelli on Photo by SJ Objio on Photo by Kelly Sikkema on Photo by JESHOOTS.COM on Unsplash

FOOD, HEALTHY EATING, MUM GUILT, PREGNANCY, Proactive Parenting

Is a vegan diet healthy when you’re pregnant?

Becoming vegetarian is something I’ve thought deeply about recently. When coaching clients, removing meat from ones diet and eating more fruit and veg is something I always promote for health, weight loss and longevity. But one question I was recently asked by a soon to be mum was –

‘Is a vegan diet healthy when you’re pregnant?’

So to answer this question is Louise Palmer-Masterton, founder of multiple award-winning restaurants Stem & Glory. Warning – there’s mouth watering food pics from Stem + Glory throughout this post!

Veganism on its own tends to attract advice and comment from family, friends and so called ‘experts’, albeit largely well-meaning. It’s interesting that when you throw vegan pregnancy into the mix, and suddenly it becomes about moral choices. Veganism is ok it seems when it’s our own choice, but can be questioned when we are dealing with an unborn child.  The idea that we are omnivorous and therefore a vegan diet cannot be safe in pregnancy is a fairly widely held view.

This is a view that I, and many others, wholeheartedly disagree with. My own experience with being vegan during pregnancy is that it was completely normal. I was almost 40 when I became pregnant with my first daughter. I was very fit and healthy. My diet at that time consisted of mainly vegetables, small amounts of (mainly) wholegrains, lots of tofu, lentils, nuts, seeds and beans, and I continued eating in exactly the same way throughout my pregnancy. I had no morning sickness, no cravings, no complications, no deficiencies and delivered both my children safely at home. I said to myself when I first became pregnant that if I craved something in pregnancy, then I would eat it. Fortunately, I didn’t have any cravings. 

Sea Spiced Tofu

When writing this article I started wondering if my experience was an isolated one, or if in fact many vegan women experience completely problem-free pregnancies. I spoke to seven women who had been vegan through pregnancy (sometimes multiple pregnancies), and here is what they told me:

Can you get the right nutrition?

All of the vegan women I spoke to were very well researched on the subject of vegan nutrition. They were all aware of the need to increase protein intake in pregnancy by 10-20%, and did so with greater attention to eating balanced meals. Not all of them ate protein rich foods such as tofu, with many preferring natural, pulses, grains and vegetables. One of the women had a pre-existing iron deficiency which was managed through pregnancy, but none of the others developed an iron deficiency. One of the women not taking supplements increased her iron levels during pregnancy.

It is recommended in pregnancy for all mothers to take folic acid. With regard to vegan pregnancy it’s also recommended to take B12 and vitamin D. For both pregnancies, I did take a pregnancy multivitamin, and the recommended folic acid. Half of the women I spoke to did take supplements, but half did not, only taking the recommended folic acid. 

S&G Tacos

Angie, who was pregnant twice 33 and 40 years ago, and has raised four vegan children, says she “just ate sensibly, mainly fruit and veg. I’d been vegan for 13 years before I became pregnant and had never been unwell so assumed all was ok.”

This was echoed by Lee who has been through two pregnancies; “Didn’t even think about nutrition, I just followed what my body craved and had zero nutritional issues.”

Helen, who has been vegan for many years, said: “I always try to follow a balanced diet.  Supplements are recommended to pregnant people of all persuasions.  I took vegan vitamins and iron before, during and after my pregnancy.” 

Emma, who had been vegan for five years and continued to be vegan throughout her entire pregnancy said: “My iron levels were tested as standard and I was told the results were fantastic (without supplementation). I only supplemented folic acid, an algal oil omega 3, spirulina (for B12) and a probiotic, all of which would be useful to supplement in any pregnancy, whatever the diet. The omega 3 was a ‘top up’ since I was already consuming foods such as walnuts, chia seeds, hemp seeds etc.  Throughout my pregnancy I ensured I was receiving the correct nutrition in the same way anybody would, I consumed a healthy diet. I don’t like the way people like to make out that vegans are thinking at every meal about where they are going to get certain nutrients from, it’s nonsense, no one does that.”

Neither myself nor any of the women I spoke to reported any nutritional issues during their pregnancies.

Perfection on a plate – Katsu curry.

What are good vegan foods in pregnancy?

The women I spoke to also all followed a wholefood natural diet during pregnancy. None experienced cravings! Two of the seven experienced severe morning sickness and lived on toast for the first trimester. Two were diagnosed with gestational diabetes in the second trimester which they managed successfully on a wholefood vegan diet.

Soups and stews were frequently mentioned as ‘go to’ meals. Often mentioned were Marmite, tofu, tempeh, brown rice, aduki beans, lots of fresh organic veg, nuts, miso soup, peppermint tea and ginger.

Buffalo Cauliflower wings

Helen opted for bland but healthy: “When I had morning (all day) sickness I ate a lot of baked potatoes, as I didn’t fancy much else.  Luckily potatoes have vitamins in the skin, and so I felt they were better than other bland things.  I supplemented potatoes with vitamins and iron.  I also remember eating dried mangoes, cucumber, and miso at some points, and drinking orange juice.  When I recovered from the morning sickness, I ate a lot of everything.” 

For Holly who was also diagnosed with gestational diabetes in her second trimester, nut butters were a life saver due to their high fat/protein and low carb content. 

Danielle developed cholestasis in her second trimester which meant she could only eat low fat foods “so the vegan diet was great for this”.

Tracey who had severe morning sickness treated it with “lots of miso soup, peppermint tea, fennel seeds & crystallised ginger”.

Raw mango ‘cheese’cake

Atma was vegetarian when she became pregnant, but took the decision to go vegan. “Now I was carrying my own child it brought the ethics of the dairy trade to the forefront of my mind, I was unable to ignore it any more” Atma had previously studied macrobiotics, and when diagnosed with gestational diabetes in her second trimester was able to control the diabetes by applying macrobiotic principles. Not only did her bloods stabilise, but she felt happier, healthier and more clear headed than ever before.

Do pregnant vegans feel healthy?

They do! None of the women I spoke to had any issues with energy levels, and outside of the complications already mentioned, without exception all the women felt healthy during pregnancy. They felt the gestational diabetes was easier to manage on a vegan diet.

Emma said she continued to be vegan whilst breastfeeding and had a wonderful pregnancy with no issues whatsoever: “I wasn’t sick once, I had no cravings, I felt great the whole time, had energy, my skin was the best it’s ever been and I continued to work-out throughout the entire pregnancy. Postpartum I was told I had great colostrum, since my baby only lost 70g initially and I had a plentiful supply of milk, the health visitor actually said I had too much!”

Danielle: “I am very strong and the muscle of the household, even when pregnant if something needs lifting, I’m your girl”. I echo this and was practising and teaching ashtanga yoga until days before I had my first child, and full of energy throughout both pregnancies.

What do the health professionals think?

Now this really did give me a pleasant surprise. Every single one of the women I spoke to remarked on how helpful and understanding their health care team were of their vegan diet. Not one of them, including those with gestational diabetes, was advised to eat animal products.

Helen’s experience was consistently positive: “Two health professionals guessed I was vegan and were highly supportive. My first midwife appointment went something like this: ‘Have you read the list of things you need to stop?’ ‘Yes.  I don’t smoke or drink or eat those things anyway.’ ‘Are you a vegan then?’ ‘Yes.’ ‘Excellent, I won’t need to persuade you to eat more fruit and vegetables.’ The second was a health visitor at my child’s one-year review.  The conversation went something like this: ‘What is your child’s favourite food?’ ‘Tofu.’ ‘Are you a vegan then?’ ‘Yes.’ ‘Please tell me which cheese to buy.  What is the best milk?  Where do you eat out?’

Pulled Mushropom ‘Duck’ Pancakes

Emma: “I didn’t tell the midwives that I was vegan because I expected a negative response that I didn’t want to have to deal with at that time. However, in hospital after the birth the team were very supportive in providing me with decent vegan food.”

Says Che; “in my first pregnancy one of my Midwives was vegan herself and brought vegan biscuits to the antenatal classes. Second time the midwife was very supportive and unphased by the veganism. If anything, my GP and Midwives said ‘well, you don’t eat any of the stuff you have to avoid anyway so that’s good’.”

City Bowl

Two out of the seven women I spoke to however remarked on how terrible the vegan options were whilst they were in hospital!

So, if you are vegan or vegetarian, don’t let the myth that we need animal products put you off sticking to your plant-based diet. Eating a healthy vegan diet during your pregnancy can be good for you and your baby – and as there aren’t any vegan foods that are on the ‘no go’ list during pregnancy, you won’t have to give anything up either.

Louise Palmer-Masterton

Thank you for contributing this very interesting piece Louise.

Louise Palmer-Masterton is founder of multiple award-winning restaurants Stem & Glory; hip and trendy but accessible plant-based restaurants, serving delicious gourmet vegan food from locally sourced ingredients, 100% made on site. Stem & Glory also offers click-and-collect and local delivery in London and Cambridge.  www.stemandglory.uk  Lets hope these restaurants find their way to Wales, the food looks amazing.

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love and best wishes Em x