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If you’re over age 21 and have had a well-woman exam, you’ve probably had a pap smear. It’s a quick test, and can be briefly uncomfortable, but what does it check for and how often should you get one?

Jade Elliott spoke with Martie Nightingale, a certified nurse-midwife with Intermountain Healthcare, to answer your questions about pap smears, why they’re important and what it means if your test comes back abnormal.

What is a pap smear and what does it check for?

A pap smear is a test that detects precancerous changes on the cervix. The cervix is the lowest part of the uterus, located inside the vagina. A virus called the human papillomavirus or HPV, often causes cervical cancer. HPV can be passed during sexual contact.

A pap smear requires your provider to place a speculum into the vagina to view the cervix, then scrape away cells from the cervix using a brush. Once removed, the cells are tested for abnormal changes.

Why is it important to get a pap smear?

Getting regular pap smears allows these precancerous changes to be detected and treated before it turns into cervical cancer.

Women with early cervical cancers usually have no symptoms.

Symptoms of cervical cancer often do not begin until the cancer is growing quickly and begins to spread to other body parts. When this happens, the most common symptoms are:

Abnormal vaginal bleeding
Unusual vaginal discharge
Pain during intercourse

What to know before your appointment?

Schedule your pap smear for a day when you are not having heavy period bleeding. If you must go during your period, avoid putting anything in your vagina for at least 24 hours before your appointment.
Avoid douching.
Abstain from sexual intercourse for one to two days before your Pap smear.

At what age should you get your first pap smear? How often should you get a pap smear?

Current recommendations for cervical cancer screening include pap testing every three years beginning at age 21, and beginning at age 30 a pap test with HPV testing (co-testing), every five years, or pap testing alone every three years. Women with HIV or a weakened immune system may require more frequent or additional testing.

What does it mean if your pap smear comes back abnormal?

Most abnormal test results don’t mean you have cancer. An abnormal pap can result from temporary changes like a vaginal infection, or reactive or repairing cells that may need to be monitored a bit more frequently.

What would be the next steps if it’s abnormal?

Recommended next steps depend on your age, type and severity of abnormality, and previous history, and may include additional testing for high-risk HPV, repeat testing in one year, or a colposcopy exam with cervical biopsy.

Where can women go for more information?

American College of Obstetricians & Gynecologists (ACOG) is a great resource for patient information.

Cervical Cancer Screening

Abnormal Pap Test results

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.

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Weight gain during pregnancy occurs because you’re growing another human and a placenta. Your blood volume also increases. Many women are concerned about losing that extra weight after childbirth.

Jade Elliott spoke with Martie Nightingale, certified nurse midwife with Intermountain Healthcare, who is also a plant-based endurance athlete and certified yoga instructor, to help answer your questions about how to lose weight safely after pregnancy.

Why does it seem like it takes a long time to return to your pre-pregnancy weight?

If you consider it takes nine months to gain the pregnancy weight, it makes sense it will take some time to lose it. If you’re a first-time mom, it’s helpful to know it takes a minimum of six weeks for your body to fully recover from childbirth, so have realistic expectations about weight loss. During the first six weeks, primary goals may include physical recovery, baby care and adjusting to being a new mom. Self-care is vital in the first few weeks and should include getting adequate sleep, minimizing stress, eating healthfully and hydrating. A focus on self-care and healthy lifestyle will often lead to a natural weight loss during the first few weeks.

Can breastfeeding help you lose weight?

According to research, breastfeeding helps with weight loss. Plus, breastfeeding is so healthy for babies. Babies who are breastfed have less risk for obesity, diabetes, and asthma. There are also antibodies in breastmilk that help prevent infections.

If you are breastfeeding, you need more calories and to stay hydrated

Here’s what’s recommended:

275 calories above normal if pregnant

500 calories above normal, if breastfeeding

75-80 grams additional protein if breastfeeding

Have a healthy snack with protein almost every time you breastfeed. You need approximately four liters of water per day to provide for your hydration as well as milk production needs.

You won’t get down to your pre-pregnancy weight when breastfeeding. Set realistic expectations. That last bit of weight may not come off until weaning. This is due to weight in the breasts and extra body weight and fluid to support breastfeeding.

Returning to exercise

By naturally returning to exercise, you’ll start to lose weight. During the initial two weeks after childbirth, limit exercise to gentle walking as you feel up to it. Pay attention to your postpartum bleeding and don’t over-exert. From two to six weeks postpartum, slowly integrate exercise like longer walks and gentle yoga. An incremental increase in exercise over six weeks is preferred to being sedentary for six weeks and then abruptly beginning exercise.

What kind of diets are best to help you lose weight?

Focus on eating a whole-foods plant-based (WFPB) diet that doesn’t include meat, dairy, or processed foods. The WFPB has been shown in research to result in the most weight loss when compared to other diets like Mediterranean or keto and has the best health outcomes, including lowest risk for cardiovascular disease, diabetes, and cancer. Patients following a WFPB diet also report improved mood, increased energy and reduced constipation.

Try to limit processed foods and focus on increasing whole grains, and fresh vegetables and fruits. Enjoy a colorful diet of vegetables, fruits, grains, beans and legumes. Nutrition experts are talking about plant-based diets, where most of the protein you eat is plant-derived, and now there’s much more availability of plant-based proteins and recipes. Focus on including beans, legumes, tofu and tempeh, using meat substitutes and analogs only sparingly as they are processed foods.

Avoid diets that are a fad, or extreme diets that are not proven by research.

Where can women go for more information?

Physician’s Committee for Responsible Medicine 21 Day Kick-Start
Nutrition Facts
There are a variety of smart phone tracking Apps that can help you monitor healthy intake and/or activity.

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.

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All types of women become pregnant, those who have a regular exercise routine, or those who exercise sporadically or not at all. There are also women who have jobs that require a lot of physical activity. That means pregnant women have all types of questions about what kinds of physical activities they engage in.

Jade Elliott spoke with Martie Nightingale, a certified nurse midwife with Intermountain Healthcare, who is also a plant-based endurance athlete and certified yoga instructor, to help answer your questions about exercise during pregnancy.

Why is it helpful to exercise during pregnancy?

Pregnant bodies, just like regular bodies, benefit from movement. And unless your provider has told you not to exercise, it’s healthy to engage in physical activity or movement. If you’re pregnant and new to exercise, find something you enjoy and start slowly. Just walking or simple stretching, like yoga, has tremendous benefits. Exercise shouldn’t create stress, but rather reduce it. The types of exercises most recommended by experts during pregnancy includes walking, swimming, riding a stationary bike and prenatal yoga.

Ideally, pregnant women should get at least 150 minutes of moderate-intensity aerobic activity every week like brisk walking, with an hour daily being ideal.

Benefits of exercise during pregnancy include reduced back pain, decreased constipation, reduction in excessive maternal weight gain, postpartum weight loss, improved overall fitness, decreased risk of gestational diabetes, preeclampsia, deep vein thrombosis, varicose veins, postpartum depression and anxiety and possible reduction in risk of cesarean delivery. The pregnant body changes quickly over nine months and can place strain on a woman’s self-image. Exercise has been shown to improve mood and self-image, while also assisting to reduce stress.

Research shows women who do exercise during pregnancy typically continue to exercise afterward, so it’s a good habit to form.

How might women need to modify their exercise when they’re pregnant??

Few activities are restricted during pregnancy, but you’ll want to be cautious about participating in contact sports or extreme activities like skydiving, scuba diving or any which increases risk of falls like mountain biking, downhill skiing or horseback riding, especially as pregnancy progresses and balance may become compromised. In general, overly vigorous activity in the third trimester, activities that have a high potential for contact, and activities with a high risk of falling should be avoided.

Some yoga positions are not advisable during pregnancy, so do check with the instructor so they can assist with modifications. After 20 weeks, avoid lying on your back to exercise or standing in one position for long periods.

You can do some crunches, but use caution with abdominal exercises, particularly later in pregnancy and immediately after childbirth as this can cause separation of the abdominal muscles or diastasis recti. Immediately after childbirth, there are some abdominal exercises which are helpful to begin right away. These focus on your breath to help bring in the muscles and strengthen them. Talk to your provider for specific cautions and exercises to avoid.

Any recommendations for target heart rates during pregnancy?

Target heart rate is not used to assess exertion due to wide variation in individual heart rate responses during pregnancy, instead ratings of perceived exertion (RPE) should be used to assess intensity instead of traditional heart rate–based methods.

Where can women go for more information?

• American College of Obstetricians & Gynecologists (ACOG)
• American College of Obstetricians & Gynecologists (ACOG): Exercise During Pregnancy
• National Academy of Sports Medicine: Exercises to prevent diastasis recti

  The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.

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You might not be aware, but if you’re pregnant, it’s important to be tested for a common bacteria called Group B Strep before delivering your baby. You could have Strep B and not even know it and pass it along to your baby.

jade Elliott spoke with Taylor Hanton, a neonatal nurse practitioner with Intermountain Healthcare, to help us understand why going to your prenatal visits and getting tested for Group B Strep, will help you and your baby stay healthy.

What is Group B Strep?

Group B streptococcus [strep-tuh-KOK-uh s] (also called “group B strep” or simply “GBS”) is a common bacteria. Since these bacteria live in the human genital and gastrointestinal tract, it’s not the same bacteria that causes strep throat, and in adults it usually doesn’t cause illness. When a pregnant mom has Group B Strep it can be dangerous for her newborn because the unborn baby can be exposed to this bacterial environment once mom’s water breaks. For this reason, most healthcare providers and hospitals have adopted a national standard to screen all pregnant women for this bacteria. This ensures the best outcome for your baby.

Why is Group B Strep during pregnancy a concern?

If you have Group B Strep during your pregnancy, there’s a chance you could pass the bacteria on to your baby. The bacteria can live in the rectum and vagina, so a baby can become infected during childbirth. Infection can cause serious, even life-threatening, problems in a newborn, such as lung infections, blood infections, and meningitis (inflammation of the tissues around the brain and spinal cord). That’s another important reason to keep all your prenatal visits and deliver in a hospital.

Group B Strep is common – ask your provider about testing

Studies show about 20 percent (1 out of 5) pregnant women carry the Group B Strep bacteria but have no symptoms. For this reason, it’s recommended that all pregnant women be tested for it late in pregnancy (usually starting at about 36 weeks gestation) to detect this common bacteria, so that your doctor can plan steps to help protect your baby. Testing is sometimes done earlier if preterm delivery is anticipated.

Testing is quick and simple. Your provider will swab your vagina and rectum and send the sample to a lab to be cultured. A positive test result means Group B Strep is present. A mom can test positive for GBS with one pregnancy and negative with a subsequent pregnancy. The culture result can take 1-2 days, so it is important to have this information before mom goes into labor.

If you have Group B Strep, special precautions need to be taken before your baby is born

The most common cause of newborn infection is from GBS bacteria. Based on data from the Utah Department of Health from Jan 2015 – July 2019, the incidence of newborn infection caused by GBS is higher in Utah compared to the national incidence (UT 0.4 cases/1000 live births vs. national incidence of 0.22 cases/1000 live births). Symptoms can be very mild, but if left untreated, it can even cause death in the newborn. Screening all pregnant moms for GBS as well as treating those positive with GBS has significantly reduced the incidence of GBS infection in newborn infants.

Your baby will need special treatment and care in any of these circumstances:

• You’ve tested positive for Group B Strep
• You’ve previously had a baby who developed a Group B Strep infection after birth
• You’ve had a urinary tract infection during pregnancy that was caused by Group B Strep
• The labor is preterm (less than 37 weeks gestation) and you haven’t had a Group B Strep test
•  The labor is term and GBS is unknown and risk factors develop during labor

Antibiotics administered during labor

To minimize the risk of passing Group B Strep to your baby, moms who test positive for Group B Strep will be given antibiotics during labor through an IV to help get rid of some of the bacteria. Sometimes extra monitoring and/or treatment may still be indicated for your baby if antibiotics are administered shortly before birth. If you’re planning a C-section delivery, your labor hasn’t begun, and your water hasn’t broken yet, you may not need antibiotics.

Monitoring your baby after birth

After birth, your baby will need to be watched carefully for any signs of Group B Strep disease. Your baby’s physical exam, vital signs and blood pressure will be monitored more frequently and screening labs and/or blood cultures may be needed. Your baby may need antibiotics if there are any concerns for infection.

Some signs of infection include: increased or rapid breathing, needing oxygen, abnormal vital signs such as high or low temperature or increased heart rate), fatigue, disinterest in oral feeding, and decreased urine output. Depending on your baby’s clinical exam and lab results, care can be continued in a well-baby nursery or a Newborn Intensive Care Unit.

Finding out moms are GBS positive in advance makes it more likely mom and baby can remain together after delivery. The overall goal is to treat babies who are at the highest risk of being infected with GBS bacteria, while limiting the exposure of all newborns to unnecessary antibiotics.

For more information go to Intermountain Healthcare.org

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.

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High blood pressure is very common. According to the Centers for Disease Control about half of Americans have high blood pressure. And many of them may not know it. That’s why it’s known as the silent killer. If you’re pregnant and have high blood pressure, you need to know you have it, so you can take steps to manage it.

Jade Elliot spoke with Dr. Tania Bodnar an OB/Gyn with Intermountain Healthcare, to help us understand why going to your prenatal visits and checking your blood pressure will help you and your baby stay healthy.

What is high blood pressure?

High blood pressure or hypertension is when your blood pressure, the force of your blood pushing against the walls of your blood vessels, is consistently too high. People with high blood pressure have systolic blood pressure greater than 140 mm Hg or a diastolic blood pressure greater than 90 mm Hg or are taking medication for hypertension.

Can you get high blood pressure for the first time, during pregnancy or is it something you have prior to pregnancy?

It can happen both ways. Some women have chronic high blood pressure which is high blood pressure prior to pregnancy. Some women develop high blood pressure during pregnancy.

Some people have chronic high blood pressure and are already being treated for it by a primary care provider and others don’t know they have it. That’s why it’s important to go to your prenatal visits and have your blood pressure checked. Some women can acquire high blood pressure during pregnancy, especially towards the end of pregnancy. It is important to know if your blood pressure is high and if it’s getting worse, because this could become dangerous for the pregnancy and ultimately the baby.

Technically, a woman is considered to have chronic hypertension if the high blood pressure is diagnosed before 20 weeks of pregnancy. Alternatively, if it is diagnosed after 20 weeks of pregnancy we call this gestational hypertension.

Hypertension in pregnancy in the U.S. is common and increasing

According to the CDC, in the United States, high blood pressure happens in 1 in every 12 to 17 pregnancies among women ages 20 to 44.3

What are the risk factors for high blood pressure?

• First pregnancy
• Young age at first pregnancy
•  Advanced maternal age
• Obesity
• Decreased physical activity
• Smoking or drinking alcohol
• Diabetes
•  Autoimmune disease
• Engaging in assistive reproductive technology such as IVF
• Carrying multiples (like twins or triplets)

But, super-fit, healthy young women can have hypertension.

What are the symptoms of hypertension?

Many people have no symptoms at all. Worsening hypertension can cause headaches, blurry vision, floaters in the eyes. In severe cases people may experience shortness of breath or chest pain, or abdominal right upper quadrant or epigastric pain.

Identifying whether your symptoms are due to pregnancy, hypertension or COVID-19 can be confusing. Talk to your provider about any concerns.

Why is it important to manage high blood pressure during pregnancy?

• Complications can be very serious and include:
• Preeclampsia, when high blood pressure can lead to organ damage in the mother and ultimately cause problems with the baby
•  Eclampsia, when the mother can have seizures
• A stroke due to very high blood pressure.
• Decreased blood flow to the placenta can lead to baby receiving less oxygen and fewer nutrients, causing low birth weight
•  Sometimes a recommendation is made for a preterm delivery

It’s often during the third trimester when symptoms can get worse and high blood pressure can become preeclampsia, but it can happen before this as well.

Get your high blood pressure checked regularly

If you’re doing some of your prenatal appointments virtually, there are ways to have your blood pressure checked remotely. Talk to your OB or midwife. You may need to do in-person visits more frequently than other patients without high blood pressure.

Is it safe to take high blood pressure medications when you’re pregnant?

Some high blood pressure medications are safe during pregnancy and some are not, so check with your primary care provider and your OB or midwife if you already have high blood pressure. It’s good to talk about it with them before you’re thinking getting pregnant.

If you already had hypertension, before you got pregnant, you provider may need to adjust your medication to something different. If you are taking a medication for your high blood pressure that is not considered safe in pregnancy and this wasn’t changed for you prior to getting pregnant, you may need some closer follow ups and ultrasounds to make sure there was no danger caused to the baby.

Can changing your diet and exercise help hypertension?

Diet and exercise are important for overall health and are somewhat helpful in controlling regular hypertension, but not as helpful at controlling it during pregnancy. It’s recommended however to stay active and eat a well-balanced diet during pregnancy. Medication can be an important way to control high blood pressure.

Further testing for gestational hypertension

If you have high blood pressure when you’re pregnant, blood tests may be done to make sure it’s not progressing. Depending on your diagnosis, additional monitoring may be recommended, including checking on the baby as through non-stress tests, fluid checks or growth scans.

Ultimately, the treatment for hypertension is delivery. In some cases, you may need to deliver your baby early to keep you and your baby safe. Sometimes gestational hypertension doesn’t resolve after delivery and can lead to chronic hypertension, but this does not happen often.

What can happen to the baby if you are diagnosed with high blood pressure during pregnancy?

Since early delivery can occur, babies can be found to be a small birth weight due to the decreased blood flowing through the placenta. Sometimes babies have low platelet counts and low while blood cell counts, and it is usually not treated if babies are not symptomatic. There can be a risk that the lungs are not fully developed if you delivered prematurely. If your obstetrician can anticipate this, we give you a medicine called betamethasone which is a steroid to help accelerate the lung maturity in your baby.

For more information visit:

intermountainhealthcare.org

acog.org

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.