Bridget Jones’s Baby – is having a baby over 40 good or bad?

I’m quite excited Bridget Jones is about again and she’s having a Baby; more importantly it’s a hatrick for me adding to the 2 other films, plus it’s the best one yet and ‘bang on’ so to speak in terms of what is happening right now with women in the UK who want to have babies.

Hopefully having a baby over 40 is going to be the hottest thing in town soon  (maybe I’m exaggerating this a little). I’m not sure if Bridget’s surprise conception was down to the fact that she thought she wasn’t capable of having a child over 40, so stopped trying with contraception,  or something else.

For me having a baby over 40 is always something I celebrate in my line of work! As a fertility Nutritionist I’m inside an ‘ older mum bubble’ , where anything is possible, however when I venture out and meet people ( which I occasionally do!)  its almost whispered that its ‘not right’ or that ‘it’s a bit of a worry isn’t it?’ In fact having a baby at 40  seems almost as taboo as a teen pregnancy according to ‘ word on the street’!  Thankfully this is beginning to change, and lets hope in some small way Bridget will have helped in this quest!

The message that you are almost irresponsible even trying over 35 is plastered everywhere. It is even worse if you are over 40 as when you start trying it all seems to become more scary as are the messages about potential birth defects, miscarriages, and if by some miracle you have the child,  then there is the issue that they might have development issues and there is more chance of autism. The list goes on, and the stories I have heard about how it’s not a good idea to try after 37, are enough to age your eggs overnight and sew your own bits up! If it’s not enough hearing this from GPs or IVF clinics, the media coverage on this is certainly relentless, something that is repeated almost weekly in the many columns of broadsheets and tabloids. 

As a Nutritionist this whole issue of  ‘ old eggs’ and the ‘geriatric mother’ (as was mentioned in Bridget Jones’s baby)  gets me very riled up as its one of the fastest growing age group of women I have coming through my door in the last 2 years and its one I’m getting results with, despite the fact they are ‘ past it’ according to those in the know! This is anecdotal to my practice, but lets take a look at this more closely…

For the first time in decades women over 40 have now taken over the teen pregnancy rate. How’s that for a statistic? A more sombre statistic that ‘its not safe to have a baby over 35’ seems to be hitting home as this age group accounts for the largest amounts of abortions of any other more recently.

Also if we look back a few decades to the 1920s, being an older mum was more accepted. Many were even giving birth when grandmothers and 42 years old was a time when many stopped adding to their families.
 
Today,  an interesting statistic is  that many women in their 40s are also first time mums.  The UK Office for National Statistics figures show that pregnancy rates for over-40s are doubling and in the last years,  this has gone from  only a mere six per 1,000 to now
14 conceptions per 1,000.

Only recently an article in the London Standard mentioned that London is leading the charge for women giving birth to babies over 45. So there is definitely something going on out there with women not giving up or even coming into motherhood later on in life.

In fact, the true statistics about female fertility are far less scary than we are led to believe. Women do lose a lot of their eggs by 30, but that still leaves them with many tens of thousands, when only one is needed to make a baby. Something many ladies are not told in IVF clinics where  egg donation is offered if over 37, or if they have been trying for over 6 months.
 
Other scaremoungering comes from of all places the  journal Human Reproduction. But if you take a closer look at this article in 2004 the  statistic were drawn not from modern day but from birth records from 1790-1830.  When correct me if I’m wrong, there was no access to modern health care or nutrition and many were possibly only living to 45 anyway, so actively avoiding Sex. So no…. ‘Bridget Jones, wanton sex goddess, with a very bad man between her thighs!’ there!
 
The truth is everyone is different and if you  put in the work and follow a healthy lifestyle, diet and stress levels are managed appropriately, you just may well have the fertility of a 20 something!

In my view Fertility isn’t always age specific and there might actually be some truth in what I talk about daily that diet and tailored intervention  improves fertility at any age. A study in 1995 conducted by Surrey University and Foresight with over 300  couples ranging from 25-45 years old gave couples with previous infertility and miscarriages a tailored dietary and supplement programme over 2 years. During this time 81% of them went on to have healthy babies http://www.zestnaturalhealth.co.nz/preconception-care-and-fertility/how-effective-is-preconceptive-care/  similar studies are also being conducted by Foresight and also the University of New England.

Lord Robert Winston seen as a one of the grandads of modern fertility talked recently in a daily mail article about women’s fertility being sound until around 45, which might have raised a few eyebrows. I can’t corroborate this empirically but share his view, as do see a heck of a lot of women who are getting pregnant these days over 40.

I believe in fertility in older women wholeheartedly, as my own grandmother was part of this ‘gang’ and had my mum when she was 37. This isn't an isolated incident and its shown to happen time and time again, defying the naysayers. Thankfully many I work with don’t give up, but to be honest with all the media attention about ‘Britain facing an infertility time bomb’ it can be very hard to cut through the negativity.

As always Bridget Jones is ‘On trend’ as it has been right from the first film! Let's hope it starts a ripple effect, where ladies feel they don’t have to feel old and ‘past their sell by date’ when trying over 35,  or worry about the issues with their ‘ageing eggs’ Hoorah for Bridget is what I say and as Daniel Cleaver would say ‘ Hello Mummy’!

Back to school – another reminder of your empty house, or the start of deficiencies that lead to fertility issues?

Yes its that time of year again when all the offers and retail are uber hell bent on selling stuff to parents to equip them for school/nursery/ college etc. However like the new year and Christmas it’s a time of year that makes many who are on a difficult fertility journey sad. Another reminder that you are years behind on this happy moment of taking a photo of your little one against the door in their new school uniform and another time where you can’t get involved with all your friends who are now pushed into a whole new routine and change of life.

When it comes to food it’s a time I normally become a ranting nutritionist (don’t get me started on Halloween and Christmas) as it is a time where ‘ packed lunches’ become king, and a hoard of vile candies, chocolates, flapjack like concoctions, waxed small processed cheeses and flabby white bread ham sandwiches are thrown at you, which will leave anyone nutrient deficient let alone a child!( I know some of you make healthier choices, but sadly its hard with retailers making it oh so easy to eat crap!)

My point is, that the deficiencies start as early as preteens. I’m seeing so many ladies now who were overweight and showing signs of hormonal dysregulation at as young as 10 when we went through a detailed consultation.

I see fertility issues as a deficiency in most cases, where there isn’t enough ‘raw ingredients’ to make good hormones, or at worse too many high processed carbohydrates that have caused the hormonal issues, and I can almost pinpoint when it started to happen. With teens this can present when the body starts to show dysregulation with acne, painful periods, putting on weight and having mood swings. Which contrary to popular belief aren’t a normal part of life when your hormones start to show their face!  Like menopause hormones need at least 10 years to regulate when they start, so that means if a girl starts her period at 12 it won’t be until 22 that she is really normalising and coming out the other side! This is exactly the same for menopause. Sadly in the medicalised and ‘ fix it’ society we live in we see things like heavy periods, acne and pain as something to ‘ turn off’ rather than look at the root  cause and this( ie poor diet and environmental stressors)  So many of the ladies I support are put on the hormonal contraceptive pill to ‘ regulate the period’ Newsflash – the pill doesn’t ‘Regulate’ your period, it mimics pregnancy hormones, and invariably  puts your body to sleep in terms of hormones. Many are even unaware that the ‘ bleed’ they have isn’t actually a period, its is a withrwawal from the hormone bleed! When many of these ladies  start to think about babies that is when  they come off the pill and find they have oestrogen dominance and the same issue comes back again they had at 16!

PCOS is the number 1 cause of infertility now. This is something new I’m seeing in the last 4 years. Prior to that it wasn’t top of the list. There is a genetic predisposition to PCOS, but as the saying goes ‘ genetics loads the gun and the environment pulls the trigger’ ie it may be in the family but you can exacerbate this by the choices you make food wise and stress also makes this worse.

Its not all doom and gloom though, as this can be fixed. I see this time of year always as a new beginning. You may not have a child right now, but why not start to look at September as the start of your new term or semester? Add in some changes to your diet and seek out someone who can guide you. I really don’t know what I would do if I wasn’t a nutritionist, as the food isles and marketing behind food is so relentless.  This makes it nigh on impossible to make these ‘ healthy choices’ yourself. Worse still its made even more impossible to attain by the rise of the ‘ Green smoothie goddesses’ on places like Instagram!  With correct guidance and support your body might just be back on the right tracks for Christmas!  

 

Natural Killer Cells - are we being pulled into the hype?

I see a lot of clients and have over the past few years been increasingly aware of the area of reproductive immunology. Like most the starting point for this was the book ‘ Is your body baby friendly’ by Dr Alan. Dr Alan Beer is the man behind the whole area of reproductive immunology and the originator of the ‘Chicago protocol’. He set up his clinic as a pioneer and he was instrumental in the fertility world with regards to looking into the immune system as a causative factor to multiple miscarriage and failed implantation. As a result, many IVF clinics started looking at Cytokines, the bodies ‘war’ machine and as I like to call them the ‘ Special forces’ or more commonly know - Natural Killer Cells.

What are NK cells and how are they relevant to pregnancy?

Natural killer cells are under normal circumstances a natural and healthy part of the immune system. They are there to eliminate anything harmful that could cause a threat to your body. They are a type of white blood cell that provides a rapid response to infected cells and go to task particularly if they are needed in the case of tumours that start to form but equally get in there with viruses, parasites and bacteria.

When we get pregnant, NK cells need to get the signal to ‘ power down’ - after all although it is the most natural thing in the world  to be pregnant, it is essentially 50% foreign DNA. At the time of pregnancy (and normally the first 12 weeks) the brain needs to give the signal to lower the natural defences of the body, a situation that can understandidly confuse things. It must be really hard for the body's immune system to ignore what looks like a pathogen starting to develop, via the uterus, as during this early time - implantation starts a whole chain reaction where it then starts to establish its own blood supply!

http://www.notesformedicalstudents.com/2013/09/antigen-representing-cells.html 

What should happen before an expensive blood test for NK cells

If you have had multiple miscarriages or grade A eggs at IVF and your partners sperm has also been verified as good with no DNA fragmentation, then the next step for me is always a hysteroscopy. This procedure involves taking a biopsy of your uterine lining and the results will show if there is unusually high NK cells. For me this is the most effective way to establish if NK cells are invasive and could be causing miscarriage.

What normally happens…

If you are working with a progressive IVF centre, they may after 3 or more failed IVFs or miscarriages, send off for a raft of blood tests, which cost a pretty penny!

What you need to know before ordering or letting your reproductive specialist lead on some very expensive tests is the difference between blood NK cells and uterine  NK cells. Another thing to keep in mind which takes it a little deeper is you should know is that NK Cells are deemed Bright NK, Super Bright and Dim NK cells http://www.jimmunol.org/content/181/3/1869.full.pdf

..’During implantation, CD56^bright NK cells are reputed to play an important role whereas CD56^dim NK cells are mostly negatively associated with reproduction'.

In a few studies they found that the proportion of the uterine CD56^dimCD16⁺ NK cells was significantly lower in IVF patients as compared to the controls (6.9 and 13.7% ) The proportion of CD56^bright NK cells  was no different between IVF patients and controls in the uterus (28.8 and 33.5%) This data indicated a shift in the ratio towards the beneficial CD56^bright NK cells and away from the harmful CD56^dim NK cells…’http://molehr.oxfordjournals.org/content/10/7/513.full

In peripheral blood there is no shift in the CD56^dim/CD56^bright ratio

Blood NK cells are very different to uterine NK cells leading some experts to conclude that “measuring any parameter of NK cells in blood is not useful in trying to understand the cause of reproductive failure” http://humrep.oxfordjournals.org/content/early/2015/12/05/humrep.dev290

The important thing to keep in mind when you have had multiple miscarriages is that the you need to know a little more about these new tests before proceeding to the next stage and what inevitably can then involve more costs. It is my view that a biopsy is the only way to confirm high NK cells which may be causing some issues with implantation and growth of the baby.

1.Gilman-Sachs A, DuChateau BK, Aslakson CJ, Wohlgemuth GP, Kwak JY, Beer AE, Beaman KD. Natural killer (NK) cell subsets and NK cell cytotoxicity in women with histories of recurrent spontaneous abortions. Am J Reprod Immunol. 1999 Jan;41(1):99-105. 

2.https://www.researchgate.net/publication/51477139_The_effect_of_pregnancy_on_uterine_NK_cell_KIR_repertoire

3. http://www.ncbi.nlm.nih.gov/pubmed/10783371 

4. http://www.jimmunol.org/content/181/3/1869.full.pdf 

5. http://humrep.oxfordjournals.org/content/early/2015/12/05/humrep.dev290 

Vitamin A ~ is is safe in pregnancy?

The new year has started off with a bang! Lots of clients who have been working with me for 3 months or more are now pregnant – Yay! As most are new mums a few have got in touch about Midwives and Drs misconceptions and concerns about vitamins and minerals, as this is where the medical community start to get involved. One of the concerns is about Vitamin A and its ability to cause birth defects; so let me respond and shed some light on this.

I have looked into this issues myself quite thoroughly and the research links I have cited below mention that the research is over 30 years old in regards to the potential causes of birth defects. I will say that again.... In time frame only 18 cases have been cited where this has caused deformities. 

I’m sure you are aware that any adverse reaction to drugs need to be reported.  All medicines are reported under the medical misuse category.

Drugs cause death and other health conditions by the hundreds of thousands annually. vitamins don't cause death http://bit.ly/1Ogey41  We don’t have anything for supplements to report on this, but as always if anything does show ‘Teratogenicity ie potential for birth defects it has to be reported as such.

A basic look into drugs commonly used to help women conceive and to help those with sticky platelet, such as Aspirin have far more potential to cause birth defects, http://www.mayoclinic.org/drugs-supplements/analgesic-combination-acetaminophen-salicylate-oral-route/before-using/drg-20069948 and not to mention fertility drugs that many use unwittingly without looking into the small print, that can also cause deformities and also death. http://www.drugs.com/pro/clomid.html  My point here, is many of my clients are getting all wound up about something, without looking into the issues more closely, and colleagues in the medical profession are making a point of issuing notice on Vitamin A without also mentioning that drugs, many of them used in fertility circles, have far more of a chance of giving ladies birth defects,  And those were taken at the correct dosage!

Of the 18 reported cases over the last 30 years who had babies with deformities all of the women in regards to Vitamin A took over 25,000IUs of Vitamin A, which exceeds the RDA on this by an exponential amount. As always the devil is in the detail. Most  supplements will show 2 forms of Vitamin A – the one that can cause more damaging effects at high levels  is retinol only and not a mixed between Retinol and beta carotene,  which is what most supplements have in them.

It is worth noting also in this instance that Natural Vitamin A ( retinol) is found in high doses in organ meat, such as liver. Which up until the 1970s was consumed and readily available. Many children, like our parents who, were born after the war were given cod liver oil daily, to ensure they didn't have deficiencies. This form of fish oil has a much higher form of Vitamin A.

One of the sources of this information is NHS choices website. In this website, which I find extremely unhelpful and very uniformed it says things like ‘ you should be able to get all you need nutrients from your diet and don’t need any extra vitamin A’. Also rather unhelpfully in the article they put the measurement in Mgs not IUs, which is the standard international unit used to measure Vitamin A, so right from the start shows a fundamental misunderstanding about vitamin A.  http://www.nhs.uk/Conditions/vitamins-minerals/Pages/Vitamin-A.aspx

In terms of its use in pregnancy it is vital and essential nutrient and the most important and well known role of vitamin A is in relation to eye function. Vitamin A is necessary to prevent drying of the eye ( Xerophthalmia) and corneal changes. It is also used for retina function. 500,000 people lose their site each year due to vitamin A deficiency. Vitamin A levels are also inportant in thyroid health as it is needed for the uptake of idone and is required for thyroid hormone triiodothyroxine (T3) to bind to intracellular receptors. 

Vitamin A is needed in pregnancy for:  - Growth, Immunity, epithelial tissue maintenance and during cell proliferation, ie foetal growth!

http://ajcn.nutrition.org/content/71/5/1325s.full

I work with many clients and look into deeper analysis of fertility issues and pregnancy complications and one area I am fascinated in is Epigenetics. Many people who have polymorphisms in their BCMO1 gene have an issue converting beta carotene into retinol. So I welcome the use of mixed vitamin A for them in a retinol base, as they will have a problem converting Beta Carotene in the body http://www.ion.ac.uk/blog/anonymous/tue-2014-06-17-0954/are-you-converting-enough-beta-carotene-vitamin-55-people-may-not  Many of the studies on the populations in the human genome project also had the potential for poor eye sight also so were really in need of vitamin A, should the gene express.

I ask questions about eyesight as part of my consultations and also look at this from a family health position, as there is the potential here also to pass this on to off spring! One anecdotal thing I’m noticing much more than when I was a child is that there seems to be a huge amount of kids with glasses at a young age. I only remember a few in my whole school growing up, so I’m wondering if reduced amounts of vitamin A in pregnancy are a result of this?

WHO recommendations. More recent than 1995 http://www.who.int/elena/titles/vitamina_pregnancy/en/

American Teratology Society information on Vitamin A http://www.teratology.org/pubs/vitamina.htm

Further information on Vitamin A http://lpi.oregonstate.edu/mic/vitamins/vitamin-A#safety

On a personal note. I have used many American supplements for the last 8  years of working with women all of which have mixed vitamin A around 5000IUs and I have confidence on these levels of Vitamin A.  I have worked with hundreds of ladies and so far no issues with this, with my recommendations!

I hope this helps you to make a more informed decision about vitamin A and its use in pregnancy and preconception.

References

1.http://www.teratology.org/pubs/vitamina.htm 

2.Teratogenicity of high vitamin A intake. N Engl J Med. 1995 Nov 23 ;333(21):1369-73 

Wiegand, et al. 

3.Safety of vitamin A: recent results. Int J Vitam Nutr Res. 1998;68(6):411-6. Rothman, et al. 

4.Teratogenicity of high vitamin A intake. NEJM. 1995 Nov 23;333(21)1369-73. 3. Miller, et al.

5.Preconceptional vitamin A use. Reprod Toxicol. 1998 Jan-Feb; 12(1)75-88 

6.Tolerable levels of 10,000IUs https://umm.edu/health/medical/altmed/supplement/vitamin-a-retinol