Jun 16, 2016

Interviewer: You're clumsy but you're also pregnant. Do these things go together? We'll find out next on The Scope.

Announcer: Questions every woman wonders about her health, body, and mind. This is "Am I Normal?" on The Scope.

Interviewer: We're talking with Dr. Kirtly Parker Jones. She is the expert on all things women. Dr. Jones, there's been a lot of emails from audience who are pregnant and they're complaining that they feel imbalanced, kind of clumsy. I've never been pregnant before so I don't know if this is normal or not, I wanted to ask you.

Dr. Jones: If you were pregnant before I think you might understand that. So let's divide it up and talk about what is clumsy. Does clumsy mean you are tripping or falling over a little bit?

Interviewer: I think it's maybe like . . .

Dr. Jones: Is it not knowing where your body is or does clumsy mean dropping things? So first of all, when you're pregnant and you put about 25 lbs in your front, it's like wearing a backpack on your waist and in fact it really does redistribute the center of gravity and your body is no longer anything like what you're used to. So a lot of balance is having to know where your body is, but all of a sudden your body is hanging out front and it's not hanging out the back. So women who are strong in their glutes and in their hamstrings, all of a sudden you not only have a belly out front, but you have breasts out front.

Now this can be particularly important when where you are in your center of balance matters. So it's recommended that women not ski in the third trimester.

Interviewer: Okay, that sounds kind of dangerous.

Dr. Jones: Yes, and people want to ski and they say "Oh, I've never fallen before." Well you've never been pregnant this much before. So skiing at an altitude, of course we're always worried because people always come from sea level and they're in their second trimester and they're skiing at 8,000, 9,000 feet can get a little hypoxic and dizzy. But falling on your belly is a problem. It's a real problem because if you fall on your belly you can shear the placenta away from the wall of the uterus so you can have something called an abruption.

So first of all you're putting about 15, 20 lbs where it's not supposed to be in your belly, you're putting another couple pounds in front on your breasts and then you're redistributing another 10 or 15 lbs of water and other things, so there you are at 30 lbs in places you just don't anticipate it.

Interviewer: Is that normal? To gain about . . . What's the average?

Dr. Jones: Thirty lbs.

Interviewer: Thirty lbs, okay.

Dr. Jones: Yes, that's recommended, somewhere between 25 and 30 lbs. So imagine in a short period time meaning 9 months and in most of it in the last 6 months, that all of a sudden you're 30 lbs heavier in a distribution that you're not used to.

There are some other things about your balance. Balance also has to do with what's happening with your proprioception in your feet and ankles. What's proprioception? That's your ability to tell whether you're balanced or off balanced. Well in the last trimester your feet get puffy, and you are wearing shoes you may not normally wear. In fact you'll see a lot of women in the winter who are pregnant wearing flip flops because they can't get their puffy little feet in anything else.

Interviewer: Right, yeah I have seen that.

Dr. Jones: So they might trip over their flip flops because flip flops don't always fit right over your foot, they kind of hang out in front, you're not used to wearing them. So not only can you not always feel your feet so well because your feet are puffy and sometimes really puffy, but you're wearing shoes that may not be exactly fit for you and you're used to them.

The third thing is a little less common but notable, and that is when you're pregnant, particularly in the second and third trimester, the cornea, or the shape of the eyeball in front tends to get a little more water. So both for people who have glasses and especially people who wear contacts, they may not see as well. So not seeing as well when you're walking, you may not see the curb as well.

So if you're already struggling with your eyes, and you've taken off your contacts and you're not wearing them because they're uncomfortable or you can't see as well when you're pregnant, that gives you another risk for fall.

Interviewer: So we talked about imbalancing or lack of balance, but in the beginning we also mentioned clumsiness. They're holding something and they drop it, is that part of pregnancy?

Dr. Jones: Well it can be. So remember we talked about feet getting puffy? Well hands get puffy too.

Interview: Oh and that causes them to drop things

Dr. Jones: So you don't feel things the way you used to and a significant number of women get carpal tunnel syndrome, meaning the nerves that go through your wrist provide the sense of touch to your fingers and those nerves can get compressed as you get more swollen. So carpal tunnel not only can be uncomfortable but it can cause numbness. But when you can't feel that well because your fingers are puffy or you have carpal tunnel, you can't always pick things up correctly. Or you don't know how well you're grabbing them.

So what do you do with all this? The good news is pregnancy doesn't last forever. That's the good news.

The second bit of good news is the symptoms we're talking about usually happen in the last six months and most acutely in the last three months when you're the biggest and most swollen. If you find your feet and hands are getting really, really puffy and your face is really puffy you should probably talk with your doctor because some people develop high blood pressure in pregnancy and they get pretty puffy. And this is may be something we call preeclampsia. Not all people who are puffy have preeclampsia but you should check that out.

The other thing to pay attention to is maybe this isn't the day to be riding your motorbike or skiing downhill or on your skateboard because falls in pregnancy can be risky to the mom and the fetus. So take it easy. Things that require more balance, I'd take some more caution about those.

Announcer: We are your daily dose of health science conversation. This is The Scope, University of Utah Health Sciences Radio.

For Patients