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Tag: gestational diabetes

  • Pregnancy Can Change Your Shoe Size Forever

    Pregnancy Can Change Your Shoe Size Forever

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    One night in July, a few weeks after my son was born, I lay awake, desperately scrolling through photos of injured feet. The mounting pain from an ingrown toenail in my right foot had become excruciating, and the internet promised to help. I could no longer deny the fact that the exorbitantly expensive Hoka sneakers I’d bought just months before—to prevent pregnancy-related foot pain—had become too small. To my horror, my feet had grown half a size. Permanently.

    Pregnancy books had informed me about the less rosy aspects of new motherhood, such as shedding hair (the baby’s and mine) and uncontrollable crying (the baby’s and mine). I was even prepared for my feet to temporarily swell through the trimesters. But no one told me they might stay that way. Unlike the rest of my body, my feet did not revert to their original size 9.5 after birth. Five months later, I am now the disgruntled guardian of a large infant—and even larger feet.

    Mom Feet is not a niche condition. Studies have found that anywhere from 44 to 61 percent of new moms experience lasting foot growth, and many seem to be surprised when it happens, just as I was. “Why does no one talk about the PERMANENT foot size changes after pregnancy?” one Reddit user lamented. My thoughts exactly.

    Temporary swelling in the feet (and hands) is a normal part of pregnancy, particularly in the third trimester. Extra fluid in the body tends to pool in “gravity-dependent areas,” causing ankles and toes to become noticeably puffy, Silvana Ribaudo, an ob-gyn at Columbia University Irving Medical Center, told me. This is not the same thing as Mom Feet, which I learned the hard way by wearing my Hokas long after they’d started to pinch.

    Foot swelling subsides after a person gives birth, but structural changes in the foot do not. Permanent foot growth, like most other disconcerting bodily changes that happen during pregnancy, can be attributed to hormones—in this case, one aptly named relaxin. It relaxes body tissue so that a growing baby can unfurl, then squiggle out. These changes are especially welcome in the pelvic region. In the feet, not so much.

    If a pre-pregnancy foot is like an ice-cream sandwich straight out of the freezer—sturdy, structured—one relaxed by relaxin is a sandwich left out in the sun. The hormone causes the ligaments and tendons in the foot and ankle to lose their rigidity and strength, so the foot tends to spread out, Alexandra Black, a podiatrist at Foot and Ankle Specialists of Central Ohio who co-authored a recent review of pregnancy-related foot changes, told me. Throwing pregnancy weight on them only compounds the problems. “It leads to more of a flatter foot, a wider foot, and a longer foot,” Black said. According to the few small studies on the topic, pregnant feet, on average, go up by roughly half a shoe size and lengthen by 0.4 inches. It is a small consolation that this effect is most pronounced during first pregnancies, meaning that feet won’t grow indefinitely along with one’s brood.

    It would have been nice to learn this before I bought my Hokas, of course. Had I known better, I probably wouldn’t have purchased so many Nike Air Maxes in recent years, or suggested to my husband that we buy matching white Jordans at an outlet mall during our honeymoon. Now those beloved shoes, along with the Hokas, have been banished to storage, while I’ve had to pay up for new winter boots, high heels, and sandals.

    Having to buy new shoes is expensive but admittedly kind of fun. Other consequences of Mom Feet are not. Footwear is annoying, because even a small shift in foot size can lead to shoes that don’t fit. And the collapse of the arch in your feet can be especially painful. Mine used to be graceful, like the arc of a leaping gazelle. Now the gazelle has face-planted. That’s because a tendon on the inside of the ankle, which normally acts like a bungee cable stabilizing the arch, goes slack during pregnancy. Lengthening and flattening this tendon can cause “a flat-foot deformity,” Black said, “and it’s kind of hard to reverse that.” Flat feet can cause the knee and tibia to over-rotate, throwing the bones and muscles involved in walking and standing into disarray—a “major contributor to pain” in pregnancy, one review noted. Conditions such as painful heels caused by plantar fasciitis, leg cramps, bunions, and nail issues are all linked to Mom Feet.

    Had I known about Mom Feet, I might have been better prepared for it. Some pregnant people and new moms find it helpful to use compression stockings to reduce swelling and get orthotics for extra arch support, Black said. Unfortunately, none of my doctors (who I should note were very good) warned me about it. Ditto for any pregnancy book I read, such as What to Expect When You’re Expecting, which said only that swelling of the feet was “normal” and “temporary.” I am far from the only person who has been caught off guard by newly big feet. Mystified mothers abound on pregnancy forums; colleagues told me they were “not warned” and “had no idea this was A Thing.”

    Perhaps the reason it is commonly overlooked is that, in the grand scheme of things that mothers-to-be have to deal with, such as gestational diabetes and life-threatening spikes in blood pressure, foot pain is relatively inconsequential. Because foot-size changes “are not concerning for the well-being of mom or baby,” they might not be deemed worthy of discussion, Leena Nathan, an ob-gyn at UCLA Health–Westlake Village, told me.

    But perhaps Mom Feet isn’t talked about because many things about it are still unknown. Not everyone experiences pain, and although permanent changes are well documented, feet might still possibly revert to their original size eventually. “It can take several years,” Ribaudo said, but “sometimes it never goes back.”According to Nathan, it isn’t well understood why some people experience changes in foot size and others don’t. Even the true prevalence of this condition isn’t known for certain, because the few studies that have examined it were small. One thing is clear, however: There is a dearth of research on foot changes during pregnancy, because pregnant women, in general, are understudied. People are “hesitant to do research on pregnant women, because it’s a sensitive population,” Black said.

    During my pregnancy, I was often shocked at how little was known about concerns both minor and monumental: whether eating pineapple would induce contractions, for example, or when the baby would actually be born. Walking, climbing stairs, and having sex are commonly recommended to help induce labor, but “it’s difficult to establish whether they actually worked—or whether labor, coincidentally, started on its own at the same time,” notes What to Expect When You’re Expecting. Pregnancy literature is rife with these sorts of equivocations. Many times over the trimesters, I wondered why so much of pregnancy still felt so medieval, full of guessing, folklore, and hearsay. It’s 2023: Why are new moms still surprised when their feet grow? To this, I have found few satisfactory answers. But at the very least, I have found an ingrown-toenail treatment that works.

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    Yasmin Tayag

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  • Why So Many Accidental Pregnancies Happen in Your 40s

    Why So Many Accidental Pregnancies Happen in Your 40s

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    After she turned 42, Teesha Karr thought she was done having kids. Six, in her mind, was perfect. And besides, she was pretty sure she had started menopause. For the past six months she’d had all the same signs as her friends: hot flashes, mood swings, tender breasts. She and her husband decided they could probably safely do away with contraception. But less than a month later, Karr felt a familiar twinge of pain in her ovary—the same twinge she’d felt every time she’d been pregnant before.

    Karr felt embarrassed. “Teenagers accidentally get pregnant. Forty-two-year-old women don’t usually accidentally get pregnant,” she told me. But, really, 42-year-old women accidentally getting pregnant is surprisingly common. Nearly 4 percent of all new babies are born to women 40 and older, according to the latest data from the National Center for Health Statistics. As many as 75 percent of pregnancies in this age range are unplanned. It’s a frequent enough occurrence that the plots of Downton Abbey, Sex Education, And Just Like That, Grey’s Anatomy, and Black-ish have depended on it.

    Many women still believe that by their 40s, unintended pregnancy just isn’t something they have to worry about. After all, many of us are told our whole lives that our biological clock is ticking, that our fertility plummets after 35, and that if we wait too long we’ll likely need some form of reproductive technology to get pregnant—if we can get pregnant at all. If conceiving at this age is so hard, surely you wouldn’t get pregnant by accident, right?

    To understand why pregnancy can, and does, happen at this age, it helps to consider the wacky in-between land that is perimenopause. This stage, which can last anywhere from a few months to about eight years, is typically assumed to be a smooth transition into menopause. In reality, it’s more like the hormonal chaos of puberty, when the ovaries first sputter to life, wreaking all sorts of bodily havoc as they try to figure out their new groove.

    In perimenopause, the ovaries are once again trying to adapt to a new normal. Only now they’re in overdrive, sending out scattered spurts of estrogen to recruit a much scarcer pool of eggs to release during ovulation. During this time, you might ovulate twice in one cycle, miss a cycle altogether, or experience unpredictable flash periods. “Those ovaries are kind of going nuts,” Robin Noble, a gynecologist and menopause specialist in Maine, told me. That can have all sorts of weird consequences. For one, extreme hormone spikes can stimulate the ovary to release extra eggs, which is one reason why fraternal twins are more common in older pregnancies.

    If your ovaries are still ovulating, however sporadically, then you can still get pregnant. The likelihood of getting pregnant does decline with age, particularly toward the tail end of your 30s. By 40, according to the American Society for Reproductive Medicine, the chance of getting pregnant during a single menstrual cycle is less than 5 percent. The problem starts when these low odds lead women to use less reliable contraception, such as the rhythm method or withdrawal. Thanks to hormone spikes and the menstrual cycle becoming less predictable, those methods become even riskier during perimenopause, and the odds can stack up.

    “I hear it every day,” Rachel Pope, an OB/GYN and the head of female sexual health at University Hospitals, in Ohio, told me. “Many women really think that their reproductive potential doesn’t exist anymore, which is not true.” In reality, you can’t be sure you’re in menopause—and therefore really done worrying about pregnancy—until you haven’t had a period for at least a year. For this reason, the Menopause Society recommends keeping a hormonal IUD in or continuing hormonal birth-control pills for a year after your last period, just in case.

    To add to the confusion, some symptoms of perimenopause—missed periods, fatigue, mood shifts—resemble early signs of pregnancy. Lisa Perriera, an OB/GYN and the chief medical director of the Women’s Centers, a group of abortion clinics across several states, sees women almost every month who are shocked to find that their body is still capable of getting pregnant. “I’ve definitely cared for my share of 47-year-olds that are like, ‘I just thought it was menopause,’” she told me.

    Because women in their 40s may be expecting aging-related changes in their body but not looking out for signs of pregnancy, many don’t realize they’re pregnant until 16 or even 20 weeks along, Perriera said. That’s what happened to Anne Ruiz. In 2017, the 43-year-old mom wasn’t experiencing any signs of perimenopause but figured her window for pregnancy was closing fast. Her period had always been irregular, so she wasn’t overly concerned when it didn’t come for a month or two. By the time she started getting morning sickness and took a pregnancy test, she was almost four months pregnant.

    Ruiz and her husband welcomed the news, but also felt overwhelmed. “It was probably maybe like 60 percent excited and 40 percent Oh my God, how are we going to start over?” she told me. She gave birth the next year and immediately got an IUD.

    Facing a pregnancy at a time when you think it is no longer a possibility can be profoundly distressing. “I do see a lot of people shaken by it,” Pope said. “Having a pregnancy that’s not planned can be just so life-altering,” especially at a time when abortions are difficult or impossible to access in many states. A common first reaction is denial. After Christina Ficicchia started experiencing irregular periods, at 42, her gynecologist told her she was in perimenopause. So when she missed a period entirely, she assumed her menstrual cycle was on its way out. Then she started “feeling” pregnant—“after you’ve been pregnant a few times, you kind of know,” she told me. Yet even after a positive pregnancy test, she asked her doctor to take an in-office test to confirm the results. After planning her first two children, Ficicchia struggled to wrap her mind around the choice that she now faced: “It was one that I realistically never thought that I had to make.”

    Many women face extra distress because they know that being pregnant over the age of 40 comes with greater risks. The chance of miscarriage above that age rises to one in three, if not much higher, according to the Mayo Clinic. Pregnant people over 40 are also at a greater risk for preeclampsia, gestational diabetes, placenta previa, preterm delivery, hypertension, pelvic-floor injuries—“basically everything that could go wrong,” Pope said. Risks for Down syndrome and other chromosomal abnormalities also rise.

    After talking with her obstetrician, Ficicchia ultimately chose to continue her pregnancy. Despite her heightened anxiety, she delivered her fourth child, Emmerson, at age 43 with no complications. Karr wasn’t so lucky. After she and her husband adjusted to the news, Karr told her other children to expect a new sibling, and even told her colleagues. Then, at her eight-week ultrasound, the technician told her the fetus had no heartbeat.

    After finally having allowed herself to imagine another baby in her future, Karr was crushed. “I was pretty set with where I was in life and then this all happened and turned everything upside down,” she said. She is still trying to make sense of the loss, and dreads the weekly emails she still receives from pregnancy websites, telling her what to expect at each stage of pregnancy and advertising breastfeeding products. “If I’d known what was happening in my body, then this would have never happened,” she told me. “I was not informed.”

    Of course, bodies can be confusing even for the extremely well informed—for instance, doctors who spend their days explaining perimenopause to their patients. When Pope missed her period in July and started feeling tenderness in her breasts, she had a hunch that she knew what was going on: perimenopause. At 38, she was on the early side. Still, she thought, “this is probably it,” she said. A spontaneous pregnancy seemed unlikely, given that she and her husband had used IVF for their two children and were planning on using it again.

    “Then my husband, who’s a family doctor, was like, ‘Maybe you should check a pregnancy test,’” she said. In fact, Pope wasn’t perimenopausal. She was five weeks pregnant.

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    Rachel E. Gross

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