Maggie McKay (Host): The first time a woman gets pregnant, there's so much to learn. It can be daunting. So, what if you could get ahead of the curve and prepare beforehand? Today, we'll find out how with Dr. Kristen Myhand, OB-GYN physician, and Dr. Whitney Lyn, a Family Medicine physician. And we'll find out how to get ready for the ride of your life.

 Welcome to Total Health Talks, your Cook County Health Podcast, where we empower your journey to better health. I'm your host, Maggie McKay. And today, we're going to talk with Dr. Kristen Myhand and Dr. Whitney Lyn about how to best prepare for pregnancy. Would you please introduce yourselves? Let's start with you, Dr. Lyn. It's so good to have you here.

Whitney Lyn, MD: Thank you for having me. My name is Dr. Whitney Lyn. I'm a family medicine physician here at the Cook County Health, and I mainly focus on Maternal Child Health. So, as a family physician, I am giving the prenatal care as well as deliver the baby and then take care of mom and baby as baby grows.

Host: And Dr. Myhand?

Kristen Myhand, MD: Hi. I'm Dr. Kristen Myhand. I am an OB-GYN at Cook County. So, I see women from beginning to end of their life cycle and their reproductive cycle. And pregnancy and prenatal care, especially for our population, is such an important topic to discuss.

Host: Dr. Lyn, what do women need to know before they get pregnant? What would you tell a woman that she should be doing now before she gets pregnant to ensure a healthy pregnancy?

Whitney Lyn, MD: You know, that's a great question. And so, a lot of women don't get ready for pregnancy until they are pregnant. What we want to really help ensure that we're having healthy pregnancies, we would like for women to get ready for being pregnant. So, what does that mean? So, that means going to the doctor, reviewing your doctor, you know, what are your risks, looking over your family history, not just the family history of yourself, but also as your partner of who you were thinking about having a child with. Kind of getting any surgical histories. You want to make sure that, you know, they're getting a complete physical, if they need a Pap smear, things like that to really get started.

And one of the other things that is really important is starting those prenatal vitamins. We would like to make sure that every woman has all the essential nutrients prior to pregnancy and not after pregnancy or finding out after pregnancy. And last but not least is also making sure that they are up -to-dte with all their vaccinations, because that's also part of having a healthy pregnancy?

Host: And Dr. Myhand, speaking of nutrition, do eating habits affect fertility? And what kind of things should somebody avoid? And also, what about being overweight? Can that affect a pregnancy?

Kristen Myhand, MD: So, eating habits are the paramount part of our life cycle in general. What we eat determines our health status. Food is medicine, essentially, and it's natural medicines made for us to really grow and have all the nutrients that we're supposed to have without needing supplements.

With that being said, in our society, we've kind of pulled away from the more natural foods that we used to know as an older society. My recommendation for anyone attempting pregnancy or who's already pregnant is to try to eat whole foods. When I say that, I mean lean proteins, green leafy vegetables, things that come from the earth, fruits and vegetables. Try to decrease the amount of processed foods that we take, so chips, luncheon meat, deli meat, things like that, that have so much sodium and so little benefit for our nutrition.

Also, as a pregnant woman, you want to avoid any raw fish. So, no sushi while you're pregnant, no raw meat, like anything that's tartar. We want to decrease, again, those lunch meats, hot dogs, just because of the nitrates and the smoked meats that can also have things and that can be dangerous to a pregnancy.

As far as being overweight, well, think about fertility. Being overweight definitely causes a decrease in our fertility rates. So, trying to have an optimal weight, working out, making sure that you have good heart health, decreasing the amount of body fat that we have, definitely increases our fertility rates. The same for being underweight. Women who are underweight also struggle with fertility rates. So, being in that healthy spot of eating a healthy, balanced diet, as well as working out, definitely increases our rate of fertility.

Host: And let's talk about the evolution of prenatal care. There are people who are still a little skeptical of vitamins in general, but we've learned a lot about what folic acid really can do. So, Dr. Myhand, could you tell us a little bit about prenatal care, prenatal vitamins, and what we're supposed to have, how much is good enough?

Kristen Myhand, MD: Yeah. So, prenatal care is important, especially in the beginning of the pregnancy to catch any of those things that we can fix or improve in the beginning of pregnancy to give us better pregnancy outcomes. When we think about vitamins, the reason that Dr. Lyn spoke about taking vitamins before pregnancy is because folic acid helps decrease issues with the baby's spine and skin development over the spine. So, it's very important to have those nutrients in place before we even think about a pregnancy to ensure that our little one has the best chance of the healthiest start in life, which is what we hope for all of our little ones that we're having and working so hard to get.

Host: Okay. Not to be shallow, but can you take prenatal vitamins even when you're not going to get pregnant because they are so good for your hair?

Kristen Myhand, MD: Of course, you can. In fact, and this is maybe me being a little more thorough than I should be, but when women come to me and they're not on any contraception or birth control, I always offer them prenatal vitamins to have on board just because it helps their overall health and they are not dangerous to us, but only help make us better and prepare for pregnancy.

Host: Dr. Lyn, what about vaccinations? This is a big one. What vaccinations should we be planning to get before we get pregnant? And is it okay to get a flu shot while you're pregnant?

Whitney Lyn, MD: Yes, it is. So, we actually want all of our patients to have it. Whether you're pregnant, not pregnant, around children, don't have children, we want everyone to be vaccinated against the flu, because it can be deadly. And especially being pregnant, it can cause some issues. So, you know, we've seen women who have gotten the flu during pregnancy. And potentially, it increases your risk for preterm loss of the child, as well as low birth weights. So, there are effects to it. And I think society today with the mistrust with vaccines, but when it comes to the flu, that's very important because it does play a risk and the outcome of your future child.

Some of the other vaccines that are a little bit more important as well, you know, we've seen this with the rise of measles, but measles, mumps, rubella, those kinds of things, we actually check to make sure if mother is immune or not immune. Yes, you got those vaccines when you were younger, but sometimes you can lose that immunity over time. And so if a mother has, we need to get them vaccinated either prior to pregnancy or after pregnancy. But that's why it's one of those important things that before you have a child, you have that discussion with your physician so that if you need those vaccines, let's get you vaccinated before you get pregnant, because you can't get those vaccines while you're pregnant. So, it's really one of those things that you really want to take care of at the beginning.

And this also includes even the COVID vaccine. It's safe to take during pregnancy. But once again, if you get it during pregnancy, it can also cause the potential risk to child. So it's very, very important to really look at the vaccines that you can take and which ones you can't take and which ones you should try to take before pregnancy.

Host: That is very eye-opening. I had no idea about the flu and what an impact it could have on your pregnancy. That's a little scary, so that's a good one to know. Dr. Myhand, once pregnant, one of the things women will talk about a lot are weight changes, and they'll say things like, "Oh, I'm eating for two." So, is that a myth? Are there some parameters a pregnant woman can consider for this?

Kristen Myhand, MD: That is 100% a myth. We are not eating for two, especially in the beginning of pregnancy when there can be so many changes with our diet, nausea, no appetite, more of an appetite. It's important to remember that we should eat our normal diet with maybe a bagel added to our day. That's about all you need extra for a healthy pregnancy.

A lot of times I encourage patients to try to limit their extra intake as much as they can to decrease the weight gain in pregnancy. Because at the end of pregnancy or in the postpartum period, it'll be easier to go back to your pre-pregnancy weight. I will say though, as a person who's been pregnant before, it's so hard to control what you eat and your appetite and when you're hungry or not hungry. So, in those situations, I definitely recommend that we try to choose healthy options. So, if we have to eat, if we're really, really hungry, yes, eat. Don't deny yourself. But choose an apple or choose a salad if you can. Choose something that's healthier as opposed to like me, peanut butter and jelly sandwiches throughout my entire pregnancy.

Host: I have to say, when I was pregnant, that's the only time in my life I could give up soda, because everyone said you can't have caffeine. Soda is so bad for you anyway. And that's what it took for me to give it up to be pregnant. And then, I went back on it and then I gave it up forever. But, if you're ever going to want to, you know, set the course for a healthy life, it's when you're pregnant, I would think. And hopefully, it sticks with you, because then you have to raise your child to eat healthy.

Kristen Myhand, MD: Yeah.

Host: Dr. Lyn, what's your best advice about things women can do to feel better while pregnant, whether that's around weight changes, morning sickness, mental wellness?

Whitney Lyn, MD: Being pregnant, as I tell a lot of women, is probably the hardest part of your life. You've got a second person in you and you are the host for, as I tell my women, they're parasites. You know, they live off of you. So with that, if you're feeling better, baby's feeling better, right?

So, one of the things I tell all mothers is that you have to find time for you. Even though you're carrying this thing with you, you need to find time with you, because that's really going to help most with, you know, mental support. I want my women to stay active. A lot of women feel like, "Oh my God, I'm pregnant, so I have to be on bed rest," all those kinds of things. We want our women out there being active. I'm not saying get ready to run a marathon, but you can be active. You can go out and walk. You can go out and run. For myself, I've had two kids. I played tennis until I was 36 weeks pregnant for the first one, and 39 weeks I was pregnant for the second one. So, you can stay active and do the things that you need to do safely. But we got to keep that blood flowing.

And then, one of the other big things is, you know, mental health. A lot of things are changing. Hormones are changing. A lot of our women are working. A lot of our women have other children. So, they have a lot of things on their plate. One of the things that we want to make sure is that, listen, if you need therapy, or if you need medication for therapy, all those kind of things that can happen, we want you to say something, right? Because you're not alone in what's going on. Every woman has felt this. They might not come out and say it, but it is normal to say, "Yeah, I'm feeling a little bit down today. So, I might need to start talking to someone," and there's nothing wrong with that.

Weight changes, we've all had it, ups and downs. I wish I could still get the weight off my two kids, and I'm still working on it, but I'm going to get there. Once again, one of those things you don't beat yourself up about. Know you have it, and what are we going to do to change it? Because keeping it healthy keeps you happy, and keeps family and baby healthy. So, all of those things, we just want women to be cognizant of and make sure they're taking care of themselves.

And last but not least, morning sickness. Yes, it is not a good feeling. I had it up to 20 weeks. You can have it, you know, from the beginning to the end. You actually can really have morning sickness for that long. And I had mine up to five months. It was the worst thing ever. I'm not going to lie. But there are a lot of things that we can do for it. So, there's medications that can help. There's home remedies that can help. But we don't want women to not think that it's not normal, because it is. So, it's just doing the various things. Some women, it's just changing their food. Some women we have to give medications for. Some women have it as extreme where we have to admit you, because you can't keep anything down. So, those things do happen. It's just how do we handle it when they arise. But saying something is the most important.

Host: Is it a myth-- two things, because these helped me. I don't know if it was just in my head because people told me it would, prenatal yoga and hard lemon candy, you know, like lemon drops.

Whitney Lyn, MD: Yes. So, for the prenatal yoga, I tell every single woman to do. I don't say, you know, you have to go out and spend $45 per class to do it. I tell people to get on YouTube, because those things are expensive. And especially with the population that we serve, those options aren't always there for them. So, I say get on YouTube, find some classes and I'll give them some classes that they can do. And I said, "Not only does it help with the pain and the changes that your body is going through, but it even helps with labor, especially with the breathing, you know, the stretches and things like that. I see a world of difference for my women who've done it" to my women who have not done it.

With the various hard candies, I say, you know, any hard candy will help, but more of that will help is like the ginger. So, the ginger hard candies, the ginger drinks, the ginger ale that is true ginger, those kind of things will definitely help with, you know, that nausea and vomiting feeling. But always, you have to do everything in small meals. So, I actually tell women to get a straw. Don't gulp, because I know you're so thirsty you're going to gulp, but your stomach is so sensitive it's going to come right back up. So, basically, we have to trick our body. And so, we have to take small sips just to get what we need to get in to make ourselves feel better. But those small meals, things like that, will definitely help.

Host: I really wish I met you two before I got pregnant. All this information is so helpful. Dr. Lyn, what kind of support does Cook County Health provide?

Whitney Lyn, MD: You know, so we have a lot of opportunities and options here at Cook County Health. So, one of our big programs is our Healthy Starts program. It was a grant that we got from HRSA. And so, they have a wide variety of things that we can do to help our patients before pregnancy, being pregnant, and after pregnant, so things like getting jobs, education, diapers, formula, getting to your transportation of your prenatal appointments.

Some of the things that we also have that, you know, a lot of people don't talk about is like domestic partner violence. We actually have a program for new-time fathers where they have like a support group on things that they should get ready for and prepare for. What do you do when that happens? So, a lot of our workers, they work in the community. So they're introduced to our patients here in the clinic. And then, they go out into the community to each of our patients' homes, get to know them, find out what they need, how can we support you, and they do it all the way up until the child is 18 months old. So, there's a lot of opportunities for us to help our mothers and our new fathers of how can we be a successful family. How can we grow as a family? And how can we better ourselves? And even when it comes to housing, those are a lot of the things that we help them with. And so, that's a really big program with getting, you know, car seats, things like that, that a lot of people think it's easy and that's part of pregnancy and it is, but it's very hard for the patient population that we serve. And so, we try to figure out how can we help you in that to take something off of the load that you have.

Host: That's so thoughtful. Like we said in the beginning, it's so daunting. All the things you don't know until you get pregnant, and then you're like, "What?" Then, you think you've got it wrapped up and there's another thing and another thing. So, I think that's amazing that you cover all those bases that aren't even, you know, medically involved.

Dr. Myhand, if you were to offer your best advice for women who are thinking about getting pregnant or women who are newly pregnant or even thinking about having a second baby, what would you tell them about a healthy pregnancy?

Kristen Myhand, MD: I would tell them always be on the lookout for ways to make their lives a little bit healthier, meaning a little tweak in the diet to help make the diet a little healthier, more beneficial for you and baby. I'll also tell them be flexible. It is so many changes, so many unexpected changes, even with attempting pregnancy, being pregnant and then being postpartum and wanting a second baby. So many changes happen throughout each of those situations that we have to be flexible and give ourselves grace, giving ourselves grace and setting the expectation that things will change, that things are going to be different than they were before definitely helps our mental health as we transition through all these phases. That would be my number one tip for surviving these different times in our life cycle.

Host: Would you like to add anything in closing, Dr. Lyn?

Whitney Lyn, MD: Yeah. You know, just to piggyback on what Dr. Myhand said, you know, giving yourself grace, but giving your body a chance to recuperate. We want women to at least give themselves like a year before they do that so they can settle into that motherhood. And when you get ready for a second one, you know, if the first one was difficult, you know, each pregnancy is different, but that second one might be as well. And so, once again, it's having those conversations right after pregnancy of how do we want to prevent pregnancy until you are ready? You know, when do you want to do that? And, you know, as we were talking about earlier with the prenatal pills. Even if you're on contraception, I'm well above my age of probably having children and I still take a prenatal pill. So, once again, it's always keeping yourself prepared, because you never know what's going to happen. But also, you know, having those conversations with your family and your doctor to make sure it's the right time to really do that.

Host: Thank you both so much for being here today and sharing your expertise. This has been so helpful and educational. Like I said, I have learned so much and I wish I had talked to you before I got pregnant. So, thank you again.

Kristen Myhand, MD: Of course.

Host: Again, that's Dr. Kristen Myhand and Dr. Whitney Lyn. As we wrap up another insightful episode of Total Health Talks, make sure to visit cookcountyhealth.org/podcast and subscribe to our podcast, share and connect with us on social media. Stay tuned for more engaging discussions. This is Maggie McKay signing off from Total Health Talks. Stay well.