Navigating the labyrinth of prenatal care can be daunting, especially when it comes to understanding the myriad of blood tests and their implications for both mama and baby. The complexity of managing and interpreting tests like hemoglobin, hematocrit, and ferritin for expectant mothers adds another challenge. Each test serves a critical function: hemoglobin measures the part of the blood that transports oxygen, hematocrit assesses blood volume, and ferritin gauges stored iron levels, essential for preventing iron deficiency anemia. Amidst these vital evaluations, pregnant women are often left pondering which tests are necessary, when they should be taken, and how to interpret their results. This confusion is compounded by the fact that iron needs surge by 1.5 times during pregnancy, making the stakes even higher. As such, ensuring optimal health during pregnancy involves frequent consultations with healthcare providers and a proactive approach to understanding and managing one’s blood health—a vital yet intricate part of prenatal care.

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To help clarify this complex area, we sat down with Stephanie Middleberg, a registered dietitian and author with extensive experience in maternal nutrition. Drawing from her decade-long practice guiding expectant mothers, Stephanie emphasized the importance of tailored nutritional strategies that align with the necessary blood tests during pregnancy. Her holistic approach focuses on the tests and how diet can optimize maternal health and fetal development. Through her forthcoming book, “The Big Book of Pregnancy Nutrition,” Stephanie aims to empower women with knowledge and practical advice on navigating prenatal nutrition, highlighting the synergy between what you eat and the outcomes of these critical blood tests.

TEST: Iron: Ferritin, hematocrit, hemoglobin

Hemoglobin is a crucial component of the blood that transports oxygen from the lungs to various tissues throughout the body, while ferritin indicates stored iron levels. Low iron levels can lead to conditions such as iron deficiency and iron deficiency anemia, which occurs when there are not enough healthy red blood cells to carry adequate oxygen to the body’s tissues. During pregnancy, a woman’s iron needs increase by 1.5 times, and approximately 40% of pregnant women worldwide experience iron deficiency, particularly in the third trimester. Obstetricians typically screen for iron deficiency during the first prenatal labs and possibly midway through the pregnancy. However, if symptoms like weakness, an inability to maintain body warmth, shortness of breath, paleness, or a rapid heartbeat occur at any point, it’s crucial to consult a doctor to check iron levels. Iron deficiency anemia is associated with serious complications such as low birth weight and delayed neurocognitive development in newborns. To prevent this, taking an iron supplement and consuming a diet rich in absorbable iron is advisable. The most effective forms of iron during pregnancy come from animal proteins, known as heme iron, which include red meat, poultry, fish, liver, and other organ meats. Although plant-based forms of iron, or non-heme iron, such as cooked spinach, kale, beans, lentils, tofu, and pumpkin seeds, are less efficiently absorbed, they are still important dietary sources of iron.

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TEST: B12

Vitamin B12 deficiency is a common issue during pregnancy, particularly affecting women who follow a vegan or vegetarian diet, those who have used birth control for extended periods, individuals who frequently use antacids due to gastrointestinal issues like heartburn, and those diagnosed with celiac disease. Research indicates that 38% of all pregnant women are deficient in vitamin B12 at the time of delivery, with the rate rising to 62% among vegetarian pregnant women. This deficiency is concerning as low levels of vitamin B12 have been linked to several adverse pregnancy outcomes, including preterm birth, early miscarriage, preeclampsia, neural tube defects, and small size for gestational age.

Fortunately, B12 deficiency is relatively easy to prevent and address. Healthcare providers typically recommend taking a B12 supplement and incorporating B12-rich foods into one’s diet. Effective dietary sources of vitamin B12 include red meat, poultry, organ meats, salmon, sardines, shellfish, and full-fat dairy products such as Greek yogurt, cottage cheese, and hard cheeses. By ensuring adequate intake of vitamin B12, pregnant women can significantly mitigate the risks associated with its deficiency.

TEST: Hemoglobin AIC

The Hemoglobin A1C test provides valuable insights into your blood sugar levels over the past three months, offering a broader perspective than the instantaneous snapshot of fasting blood glucose tests. Despite the significance of blood sugar management, the majority of pregnant women are not tested for gestational diabetes until weeks 24-28 of their pregnancy. Given the potential complications associated with high blood sugar levels, it’s worth considering early testing. An A1C level of 5.7 or higher is indicative of prediabetes, and research strongly suggests that such levels at the onset of pregnancy can be predictive of gestational diabetes. If your levels are elevated early on, there’s no need for undue concern. Instead, this early discovery provides a crucial opportunity to take proactive steps towards managing your blood sugar right from the start of your pregnancy, helping to ensure your health and that of your baby.

TEST: Vitamin D

Vitamin D deficiency is a common concern and the risk increases during pregnancy. While most prenatal vitamins include Vitamin D, they often do not contain sufficient amounts to elevate levels to a normal range, generally considered at least thirty nanograms per milliliter. However, reaching this baseline may not be enough for optimal health; a more desirable target is around forty nanograms per milliliter. Depending on your lab results and the contents of your prenatal vitamin, you might need to supplement with additional Vitamin D, potentially ranging from 2,000 IU to 5,000 IU daily. It is important to monitor your levels closely because it is possible to have too much Vitamin D. Consulting with your healthcare provider and conducting follow-up tests will ensure your levels stay within a healthy range. Since Vitamin D is difficult to obtain in adequate amounts from food alone, supplementation is often necessary. Additionally, Vitamin D is fat-soluble, meaning it’s best absorbed when taken with food. Aim for at least 30 minutes of sun exposure daily to naturally boost your Vitamin D levels.

In the field of pediatric dentistry, a significant number of myths and misconceptions about tongue ties persist, affecting the understanding and decisions of parents and caregivers. Dr. Fatina Shtivelman, a board-certified pediatric dentist with extensive experience and a personal connection to the subject, offers insights into these common fallacies. Here, Dr. Shtivelman debunks the widespread myths surrounding tongue ties, utilizing her comprehensive knowledge and expertise. It explores the critical importance of accurate diagnosis and timely treatment of tongue ties, emphasizing their role in successful breastfeeding, speech development, and overall orofacial health.

Dishing out this gem of information, the mission is to arm parents with the superpowers of knowledge, enabling them to leap to informed decisions in a single bound and to champion the cause of early intervention and robust support for the little ones grappling with tongue ties.

What are some of the most common misconceptions or myths surrounding tongue ties in your practice?

As a board-certified pediatric dentist, the education I received in school and residency about lip and tongue ties was all of five minutes from one lecture. I initially became passionate about learning and helping mothers struggling with breastfeeding because of my experience. My son Julian was born with a lip and tongue tie. I was having a hard time emotionally and physically trying to feed him. I was determined to breastfeed him because of what I felt would benefit him. Julian was born with a significant anterior tongue tie with limited tongue movement. He latched at the hospital, and the lactation consultant explained that I needed to continue working on it at home. Once I came home, I was still very uncomfortable with bleeding nipples and a baby who was constantly crying. It was extremely draining on me. Nursing him would take over an hour each time. I said to myself, “This cannot be normal.”  I spoke with friends and worked with a second lactation consultant.  She recommended a nipple shield which helped to reduce my pain, but feeding time still took forever, and I was still experiencing discomfort. I knew I had to seek more help because I couldn’t continue doing this daily. 

I didn’t understand the difference between a shallow and deep latch at that time.  The importance of lip and tongue mobility helps many things, including the ability to latch easier, milk expression, painless and efficient nursing, decreased stress for mom, and decreased frustration for the baby.  When I decided to have the lip and tongue tie procedure done, it was like night to day.  Many of my questions were answered, and my insecurities went away as we were both thriving and much improved.  The third lactation consultant we worked with, Andrea Syms-Brown, helped us immensely. 

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The biggest misconception is that “the baby will grow out of it.” This is counterintuitive since proper lip and tongue movement is important for nursing, feeding, speech, and orofacial development.  With the proper consultation, education, and early diagnosis, the answers to many of these issues can be solved, and many new mothers will have an easier time. Many times, even though a baby can nurse, lip and tongue movement restrictions can interfere with feeding. Babies become agitated quickly because they cannot use their tongue to lift and swallow.  If the tongue does not go into the proper position during feeding, they are more likely to develop jaw and airway issues, including snoring and grinding. Speech-related issues may occur, too, if the tongue is restricted from being in the correct position causing improper articulation, lisps, or speech delays. Knowing what I know now, I believe all babies should be evaluated for lip/tongue ties to allow proper development and be able to thrive during these years of life.

How does a tongue tie affect breastfeeding, and what are some misunderstandings parents may have about this issue?

A tongue tie affects breastfeeding because the tongue has restricted movement. This restricted movement does not allow the baby to latch properly. A shallow latch is more painful for the mother and leads to an inefficient milk transfer. As a woman, I have a very high physical pain tolerance, but this was something I never experienced. Between the bleeding nipples and my son “gumming” because of his frustration, it hurt so much that I felt like I was seeing stars.  As a mother, you want to do what’s best for the baby, so you close your eyes, take deep breaths and keep going. 

Many people think the tongue tie will go away. Dr. Baxter, who has written a book and course on tongue ties, said it best:” A restricted tongue is like trying to run with your feet tied together.”How can you be fast, efficient, and keep up with someone when your feet are tied together? You can’t!! 

There’s often debate about whether tongue ties require treatment. Could you clarify when intervention is necessary and when it might be optional?

There is a lot of debate about this topic, but I have seen firsthand the benefits of early diagnosis, education and making the necessary referral to address the issue.  If a baby is born with webbed fingers, the doctor immediately makes a referral because you can see it, and an evaluation is performed to fix the issue. Since lip and tongue ties are in the mouth and are not always as obvious initially, the intervention tends to happen only when an issue arises.  If there is difficulty breastfeeding due to latch issues, speech concerns, difficulty brushing, or tooth decay, a consultation is necessary to review the options and tongue and lip release done to alleviate these problems. Function is the key, and if the restrictions do not allow proper function, a release is recommended. If there are no significant functional issues, the baby can latch, is gaining weight, the mom is not experiencing discomfort, and the function is normal, I often monitor and reevaluate if needed.

Some people believe that tongue ties only affect infants and breastfeeding. Could you discuss other potential impacts of untreated tongue ties across different age groups?

Mothers also seek us out when starting their babies on solids. With little ones, picky eating, gagging, and a preference for only softer foods are the main reasons mothers bring their children in for a consultation. Tongue/lip restrictions also do not allow for proper oral-facial development and strengthening of the oral muscles, which is needed for speech and language development.

Toddlers and young children come in mostly because of speech delays and articulation concerns. As I mentioned earlier, Julian had a significant tongue tie, and his first lip/tongue procedure significantly helped with his nursing. However, he also had speech delay and articulation concerns, and the fluidity of his speech was an issue. This led to a lot of behavioral issues since people couldn’t understand what he was saying. If people can’t understand a child, many times, a child will start hitting, biting, or pushing to communicate and meet their needs. This is extremely concerning as a parent, and I now understand how important it is for a child to communicate and allow them to continue to flourish and grow.

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Speech difficulties can affect school-aged children and teenagers socially and academically. Many children are perceived as quiet or sometimes more withdrawn, creating self-esteem issues due to their lack of ability to communicate effectively. 

Are there any alternative treatments or therapies you commonly recommend or encounter for tongue ties, and what misconceptions might surround these alternatives?

Absolutely!! I think it’s important to note that a team approach is the best approach!! Creating a team with lactation consultants and speech therapists is best. Working with a lactation consultant will help to develop the proper latch after the release to minimize the discomfort for the mother and make breastfeeding a rewarding experience. Working with feeding and speech therapists is also key for proper follow-up care for feeding, speech, and language development. Having a myofunctional therapist on your team can be beneficial as well.  They help ensure the correct stretches and exercises are being done to improve muscle function and coordination of oral muscles while also minimizing scar tissue that can occur. Craniosacral therapists can perform massages to help to alleviate tension in the baby. When the nervous system is relaxed, you can perform tasks more naturally and easily.