Title: Healthy YOU Podcast, Episode 7: Planning for Pregnancy: Pre-pregnancy health
Host: Frankye Myers, Chief Nursing Officer for Riverside Health System
Expert Guest: Dr. Jeffrey Henke, OBGYN with Riverside Partners in Women’s Health
Frankye: From Riverside Health System, this is the Healthy You Podcast where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients, and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health.
So let's dive in to learn more about becoming a healthier you.
I am really excited to have Dr. Henke, O B G Y N, who is with Riverside Partners and Women's Health. Join us today on the Healthy You Podcast. Welcome Dr. Henke.
Dr. Jeffrey Henke: Good afternoon.
Frankye: Good afternoon. Your reputation precedes you.
Dr. Jeffrey Henke: Nice. Um,
hope that's good.
Frankye: In a positive way, I hope you delivered a lot of babies out there and, and have a, um, great reputation in the community, so,
Dr. Jeffrey Henke: well, thank you.
Frankye: Thank you for what you do. Um, Dr. Hinkley, briefly describe why you decided to pursue a career in ob gyn.
Dr. Jeffrey Henke: Uh, well, there's, there's, you know, lots of factors that go into that. Not all those are identifiable, but, um, absolutely part is the, the mentors that you have as you're right, coming up and, and then, um, it's one of the few specialties in which you do, um, a little bit of everything.
So every, every, uh, You, you have obstetrics, but you also have gynecology. You have, uh, teenage patients, you have postmenopausal patients, you have elderly patients. You're, um, you know, you're in the operating room one day, but you're providing primary care the next day. Uh, and, and so it spans this wide range of, of different things.
So if you're somebody who, um, gets bored easily, right? It, it's a nice way to. Everything be, be kind of different, just patient to patient day to day. Right.
Frankye: So I know, um, you know, I have two children. Mm-hmm. Uh, two grown children, and then I had complications, um, getting pregnant and then more importantly having a history of fibroids, you know, keeping them to viability.
So I'm very fortunate that I was able, and I had a great relationship with my ob, G Y N.
Dr. Jeffrey Henke: And, and that's the other thing. There's not too many other areas of medicine where you might see somebody, uh, 12, 15 times in a year. Right. That you're not really sick. Right. Right. You're in general healthy and having a normal process.
But, but you know, so you create these long-term relationships. Right. Uh, when, when you're healthy. Uh, so. It's different than other kinds of medicine in, in that way. Okay,
Frankye: great. Great. Um, talk a little bit about things you could, should consider before you get pregnant.
Dr. Jeffrey Henke: Um, well, uh, you know, in, in general for most people getting pregnant, it's a, uh, you know, kind of a normal, natural life, life process, right?
It doesn't require a lot of planning. Right. Um, Uh, you know, uh, you don't need to stop your contraception early. You can, you know, if you're using birth control pills or i u d, you can have those things removed. Uh, you know, i u d removed or stop your birth control pills, say, you know, the month before you want to try to conceive.
Uh, there's no long washout period to that. Uh, if you have, uh, chronic health problems, right? That's probably the biggest group of people that you know need. Plan ahead a little bit, so, right. Like fibroids. Fibroids is, is one thing, unfortunately. Yeah. And, and yes. You know, we've kind of waxed and waned on that.
Right, right. You know, for a long time we really didn't treat those, uh, right. Prior to pregnancy. Um, we went through a phase where we did Right. And we were kind of back to not treating them. Okay. Uh, pre conceptually, um, chronic high blood pressure Okay. Is, is, uh, certainly one of the bigger things that we see.
And so, you know, seeing your family doctor or your cardiologist and switching over to a blood pressure medicine that's, uh, safe during pregnancy. Okay. Uh, the, the things we use during pregnancy are not typically, uh, things people use when they're not pregnant. So instead of being on a, uh, something like Lisinopril, you might switch over to Nife Aine.
And so, so those are things that are easy to do ahead of, of time. Right, right. Uh, diabetes, oh. There's a big impact of your hemoglobin a1c on the risk of fetal anomalies, so, okay. Uh, Uh, for instance, if your hemoglobin A1C is 10, your risk of that baby having a fetal anomaly is almost 10%. Wow. So, you know, way higher than right, than the average.
If, if your hemoglobin A1C is 13, uh, that doubles to 20%. Wow. So, um, you know, having that as well controlled. Possibly can prior to conception is, is really important. Right. Uh, so
Frankye: Okay. Great information. Um, I know one of the things that within my friend group as women are waiting longer Yeah. Due to careers to have babies.
Is there a really a right time? So some say you should have 'em in your twenties Yeah. And before you're 35. What are your thoughts around
that?
Dr. Jeffrey Henke: Well, I mean, that's complicated. You know, when should you have baby isn't really how that works. Right, right, right. You, you have your children when, right, right.
You know, and when, but from a risk factor perspective, when you can perspective. Right, right. And so, um, cuz I get asked this question, you know, not, not infrequently, right? It gets phrased a little differently. Okay. Am I too old to have another child or am I too old to have a child? And Right. And no, you know, Of course, biologically becomes a time when you're unlikely to get pregnant or unlikely to have a child.
But we currently have three patients in our practice that are 44. Wow, that's great. Um, so, so later ages than we would normally kind of think of as. Optimal, let's say. Right. And, and they're all got there for different reasons. Right. You know, it's just when, when it happened, maybe. Yes. Um, genetics is the, you know, is the, obviously the thing people worry about.
So, so two things happens as you get older. Uh, one is you have an increased risk of what are called trisomies. And the number that's been used for a long time is, is age 35. There's nothing particularly magical about 35. Okay. You know, it's not dramatically different than 34. Right. Or 36 or 37. Right. That makes sense.
Uh, it, it was just when they did the first studies, they broke the studies into groups of five. Okay. And the first group that they saw an increased risk was a 35 to 40 year old age. Okay. 40 year old age group. And so they just use 35. Okay. So the, the risk of having a child. with any kind of chromosome. Abnormality is about one in 200.
Okay. At age 35. Okay. Down Syndrome specifically is the one everybody right knows about. Right. Uh, is about one in 400. Okay. So, So, yes. It's, you know, higher than when you were 25, but it's still one half of 1%. Right. So, right. You know, 99% of the time you're fine. Right, right. Um, and there's some new testing that has come out in the last, uh, 10 years.
Okay. Called, um, non-invasive prenatal testing. It's blood work that can, can be done at 10 weeks. Okay. Anywhere after 10 weeks. That's, you know, really accurate. If you had a child with a trisomy, it would detect it 99.8. percent of the time. That's great. And if, and it's real accurate, right? So if it, if it says, you know, your child has trisomy 18, it's gonna be correct.
99.8% of the time too, right? So, um, you know, simple blood work done at 10 weeks, right? Get, gets you the information that you, that you want. The other problem is you accumulate things as you get older. Right. So,
Frankye: yeah. So that would be accurate.
Dr. Jeffrey Henke: Back back to that diabetes and
Frankye: things you don't want. Yeah. Right. It's not, none of it's great.
Dr. Jeffrey Henke: Maybe a little wisdom in there, but Right. But most of it's not good. And so, so, uh, you know, diabetes and high blood pressure are gonna be more common if you're 40. Right. Having a pregnancy than, than if you were 20 and being, and having a pregnancy. So, so those kind of, uh, you know, Whatever you wanna say.
It co we call 'em comorbidities, right? Are more prevalent as as you age. Okay, great. So they require management
Frankye: . Great, great, great information. Can you talk a little bit about healthy weight? And I know that's something that I struggled with because when you get pregnant, you, you feel like you can eat anything you want.
That's a, that's a, all your cravings, you,
Dr. Jeffrey Henke: it's a delicate topic.
Frankye: You need to make sure you have them and then you, you. Astronomical amount of weight. And then you have this very small baby. So, well that's a, that's, and you call it baby weight. And that's,
Dr. Jeffrey Henke: so we, we don't talk about that. Right? There's a, you know, there's a secret to longevity in my, my professional, right?
Frankye: And one, but we wanna educate and support them so they can make an informed decision route, which route they want.
Dr. Jeffrey Henke: Is, is being thoughtful about how we address all this. Um, I mean, from a realistic standpoint. You know, our population is reflective of the American population. Right? Right. Know obesity is a significant problem.
Yes. Um, from a practical aspect, the idea that you're going to, you know, just from a doctor's standpoint, that I'm gonna tell a patient, uh, you need to lose 50 pounds before you get pregnant. Right. It, it, one is it's unlikely to happen, and two, it's not very fair. Right. And, and so we don't really head into it that way.
Right? Um, there are guidelines for weight gain during pregnancy, and those guidelines are modified based on where you start the pregnancy.
That makes sense.
And so, um, trying to minimize the risk of gestational diabetes, uh, gestational hypertension, right. Uh, which, which you know, are important. Uh, complicating factors of pregnancy, right?
And so the, the, well, to give you an idea, if you took the average baby placenta, amniotic fluid, breast tissue, blood uterus, et cetera, and you add it all together, it's about 18 pounds. Okay? So anything beyond that isn't, isn't the pregnancy.
Frankye: So me gaining
50, when I was told to gain 25,
Dr. Jeffrey Henke: there may have been a, you had some extra cushion in there.
Yes. Right? And, and. Um, so the guidelines,
Frankye: I didn't want it
on the day of delivery. I can just tell you that. Well,
Dr. Jeffrey Henke: so that's right. And, and, and that's the other piece of this too, is there's, there's, um, yeah, there's increasing your risk of, of complication to the pregnancy. Right. And there's also just the idea that this is gonna be with you afterwards.
Right. And it's gonna be something that you kind of have, you know, should deal with. Right. And unfortunately, you know, right after you've had a baby, A great time to lose weight. Uh, you know, uh, losing weight and being careful with your diet and ex takes energy, right. While you're, you're raising a child, you, you're, you have less time and less energy than you ever had before.
Frankye: Absolutely.
Dr. Jeffrey Henke: Is not a good time to, to engage in a big weight loss program. Absolutely. But anyway, so the guidelines in general, um, Uh, you know, if you're, nor if your average weight, which is a BMI of 18 to 25, let's say, uh, you know, it's gonna be right around 30, 35 pounds, right? And the idea is you would gain two to four pounds in the first trimester, then roughly a half to one pound a week after that, right?
That timeframe. Uh, it goes down, uh, by roughly 10 pounds if you're, uh, BMI's, uh, 25 to 35. And if it's over that, um, They'll say 11 to 20 pounds. So if you just said 15 pounds, right? Uh, so somewhere around 30, you know, 20 ish. Okay. To 15. Okay. And, and yeah, we don't a pound here or there isn't a big deal. Right.
You know, those are, those are ballpark numbers for people. Right. Um, and, and the other question we get asked is, is there a special diet I should be on you high protein or. And there really isn't, right? It's the same type of, of, uh, good nutritional, right? Basic, the basic nutritional princess to know. Um, one of my favorite old time things is eating around the outside of the, yeah.
Around the outside of the grocery store, right? So the, you know, uh, lean cuts of meat, fresh vegetables, right? You know, less processed stuff is whether you're pregnant or not, is a good way to do things. Prenatal vitamins. Uh, yes. Yes. Tell about things you can do ahead of time. Um, so the thing that differentiates a prenatal vitamin from just your basic one a day is the amount of folic acid it has in it.
Okay. Um, and this all comes outta studies that were done in the eighties, uh, to help prevent what are called neural tube defects. Yes. So spin bifida, SoCon, and Anencephaly and, uh, if you're a low risk patient, uh, 800 micrograms is enough, and if you're high risk a thousand, okay. That's a very small difference and it's hard to differentiate low risk and high risk.
So we kind of just, all prenatal vitamins have a thousand micrograms in them. So, um, There's the gummies sometimes. Yes. The, the prenatal vitamins are pretty big. Okay. And so sometimes people have a hard time swallowing them, you know, so, uh, the gummies are okay. Uh, but they don't have any iron in 'em. Oh, okay.
And that's another important, I'm sure, part of this. And so we're not as, if that's all you can tolerate, then fantastic. But otherwise
Frankye: it could impact your energy level.
Dr. Jeffrey Henke: Right. Well, yeah. So it's just a normal part of pregnancy. Uh, most pregnant women are on the, somewhat, a little bit on the anemic side, right?
Because you make more plasma than you make red blood cells. Okay. So you, you look like your anemic, right? It dilutes it, right? Yeah. So you, uh, rebuilding your iron stores with a prenatal vitamin is okay. Helpful. That's
Frankye: really great information. Dr. Henke. Um, I wanted to ask a little bit about, You know, you talked a little bit about family history mm-hmm.
Or, or looking at those comorbidities Sure. Prior to getting pregnancy so they can be managed, um, ethnic, ethnicity and risk factors and genetic testing. Can you talk a little bit about that?
Dr. Jeffrey Henke: Yeah, so, so we break genetic testing into kind of two broad categories. There's testing that's specific to your current pregnancy.
Okay. So those are gonna be test for Down syndrome, right? So that's, that's done while you're pregnant and it only applies to that pregnancy, right? Um, one of the. Kind of more, uh, popular and, and, and expansive things. It's done now is uh, what's called carrier te, excuse me, carrier testing. Okay. So that is really optimally done when you're not pregnant.
Okay. Um, because once you're pregnant, it's a little too late to Right, right. Act on. So, um, there's two that are suggested for everybody, uh, cystic fibrosis and something called spinal motor neuron Atrophy. Um, and, you know, those can be done anytime. Okay. There's, there's also a broad panel of carrier testing for things that are less, you know, much, much less common.
Right. Um, and you know, once again, that's something that you might come in for a, a preconceptual counseling Okay. And be offered you. Talk about that, and then that can also be based on your family history. You know, uncle Joe had this or, or my mom has. Von Willy bronze or something, right? Something that, you know, travels in my family and testing could be arranged prior to getting pregnant.
Okay. Uh, and just to explain, carrier testing. So Carrier, you don't have the disease yourself, your carrier for in an order, in order for your pregnancy to be affected. The father of the child also has to be a carrier. Okay? And so we test the mom first, uh, and if she's a carrier, then you would test the. To see if they're a carrier.
Right. And, um, you would only be concerned if both parties are a car carrier for that, that one thing. Right,
Frankye: right. All right. Talk a little bit about the three trimesters and, um, for our listeners, are there things that they should watch or really understand as it relates to that progression?
Dr. Jeffrey Henke: Well, they're, they're gonna be very, different things
so, you know, we roughly break that into, you know, so pregnancies are 40 weeks long, so, okay, so by definition they're, they're 280 days from the first day of your last menstrual period. Okay. So we, you know, commonly in the US we talk about nine months. Uh, and, and that's really confusing to people, right?
Right. Because everybody thinks there's four weeks in a month. You don't really, there's four and a half. So I tell pay, you can either. Nine, four and a half week months, or you can have ten four week months, but you do it however you want, but we're going, we're gonna talk it in weeks. Right? And so if we kind of think of 13 weeks, um, the, the first trimesters often, you know, uh, morning sickness, breast tenderness fatigue, right?
Are, are, you know, kind of the hallmarks of that. Uh, and usually, you know, a risk of miscarriage is, you know, uh, early pregnancy loss. Kind of big anxiety there right then. Then typically once people will get into the beginning of the second trimester, they're starting to feel much better, uh, starting to get their energy levels.
That's kinda the happy part of pregnancy. Right? Right. Um, and the. It's kind of the big thing that happens there. Screening for diabetes, uh, happens during the second trimester and, uh, birth defects. So you have your morphology, ultrasound, you have your glucose screening test, um, and then kind of towards the end of that is when, so 30 weeks give or take a little bit.
That's when a lot of the, uh, they may have been diagnosed. Gestational diabetes and people who are gonna develop gestational hypertensive problems. Right. Often start that somewhere at the, you know, beginning of the third trimester. Okay. Okay. And then, uh, Size catches up so the, the happy part starts to kind of fade the glamor.
Right.
Frankye: You know, you start running outta room. Right.
Dr. Jeffrey Henke: I feel special, you know, all that kinda fades and, uh, lumbar pillow. I can't sleep and uh, you know, my feet hurt, my back hurts. I can't. Right. I grunt and groan when I Right. Stand up. Absolutely. And sit down. And all that kind of starts to happen around 32, 34 weeks and, So, yeah, so they each have their own identities.
All right.
Frankye: Thank you so much for what you do. Um, it takes a special person, um, to be an ob gyn and it's such a major pivotal milestone giving birth and having a baby. How many births are you responsible for bringing into this world? Dr. Hinky? I
Dr. Jeffrey Henke: could ask that and I'm not. Anecdotally, if, if I just kind of did the averages right.
So I've been,
I've been here 32. Okay. Coming up on 33 years. Okay. And, you know, we deliver somewhere 150 babies a year, roughly. Okay. So, I don't know what the real number is, but somewhere 4,500. 500. Wow. Wow. And then I trained in a residency that was really, really busy. So, uh, there were at least two or two to 3000.
My residency. Right. So, so it's a bunch. Yeah.
Frankye: Congratulations.
Dr. Jeffrey Henke: It's enough.
Frankye: That's a, that's a powerful legacy. Yeah. Yeah. So thank you. It's been a pleasure talking with you. Sure. Is there anything you would like to tell our listeners before we wrap up today?
Dr. Jeffrey Henke: No, I mean, I, I think, you know, I, I would say, I think there's been a fair amount of, of change over the last few years in ob gyn and, and certainly in openness to, Uh, kind of partnering with our patients to, uh, you know, create, create the experience that they're looking for.
Right? Uh, we started a midwife, uh, practice about, uh, five years ago. And so that's been a really, uh, important part of, of, uh, our group practice. Right? Uh, one of the newer things that, that we've expanded over the. Year or two are, uh, group prenatal classes.
Frankye: Oh, that's good.
Dr. Jeffrey Henke: Yeah. That's really been really good.
A neat thing. Um, we have a cohort of 10 to 12 patients. Uh, they have a two hour session with a mid let the midwives leave. Right. Uh, an hour or so of that is just educational. Right. Uh, talking about pregnancy, childcare. I talked to them about contraception. Right. And really, and then there's a breakout session with the midwife to have a more traditional prenatal appointment as part of that.
Right. And, uh, so that's, that's, you know, those are all aimed at trying to be more, um, I don't wanna say inclusive, but, but supportive through education of the community and collaborative as well. Absolutely. With our patients. And, uh, so that's been a kind of the latest
change.
Frankye: If there's someone out there listening.
May have just found out they're pregnant. Yeah. Or beginning that planning phase of pregnancy. Mm-hmm. Um, what suggestions would you give them as they look at exploring finding an obgyn if they don't currently have one? Um,
Dr. Jeffrey Henke: well, I think this is gonna be pretty biased. I, I think having, there's a whole bunch of things.
Uh, one is having access to, um, a nicu, right? Having, going to a facility that. Neonatal intensive care unit, uh, available is, is really important cuz everybody starts out, of course, thinking and hoping that everything's gonna be fine and, and they baby born full term without any difficulties. Right? But the fact is that that isn't the case for a lot of people.
And so being able to have your, um, newborn that needs some special attention right, uh, in your town. Absolutely. In Richmond or Norfolk. Well,
Frankye: high gas is too. Yeah. Yeah. Right. Well, why commute outside the community? Just
Dr. Jeffrey Henke: getting through the tunnel? I mean, yeah. So, so that, and then, and then the midwives, right?
I, I think they're fantastic. Absolutely. And, uh, they bring a very, uh, different, uh, field to everything Absolutely. That I, I think is very positive. Um, and so I think those are, Starting places.
Frankye: Absolutely. All right. Well, thank you. Sure. It's been my pleasure, Dr. Henke.
Dr. Jeffrey Henke: Okay. Thank you.
Frankye: All right. Thank you for listening to this episode of Healthy You.
We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline.com.
