Grávida com diagnóstico de diabetes: e agora? com Alexander Buarque e Isabela Windlin

I remember the obstetrician saying, you can't eat this, you can't eat that, you can't eat that. Then I looked at him and said, so what am I going to eat? Well, of all the fears we have during pregnancy, I hadn't thought about gestational diabetes. Imagine. Because there was no case in the family, I didn't know anyone who lived with diabetes. I didn't have it. It wasn't an issue.

There are several complications that we can have, both for the fetus and for the mother. And the number of complications in situations is enormous. You know, this period of internalization started out of necessity. As soon as I found out I was pregnant for the second time, I also discovered that my glucose levels were a little higher than normal for a woman who wasn't pregnant. Oh, okay. But for a pregnant woman, it wasn't good. And then I came across the word gestational diabetes. At that moment, where did I go? To Google, of course. I started looking for information, but I couldn't find any reliable sources. And from that moment on, I thought, hmm, so let's do a special internalized season about everything that involves motherhood and those unforeseen events that can happen with the arrival, right? With the news of a pregnancy. That's why today I have the privilege of bringing here to our studio a specialist in neuropsychology, a master's degree in neurology, a psychologist, Isabella Vindlin. My lady, welcome. Thank you very much for being here. I invite, right, my lady. She is the mother of Nicolas, two years and seven months old, and she lived with seasonal diabetes. Soon you will explain to us, right, how this news came about and how you dealt with diabetes during pregnancy. And with us, Dr. Alexander Bork is here. Thank you, doctor.

Thank you for the invitation.

I, doctor, have already been at other carnivals talking about mental health at work. Dr. Alex, you have always taught me a lot. Thank you. Especially about ergonomics at work, how important this is, right? For maintaining our health. But more than that, today Dr. Alex is the supervisor of practical internships in the specialization course in occupational medicine at the USP Medical School. He is the director and will soon be the president of the Sao Paulo association of Occupational Medicine and a member of the International Commission on Occupational Health. Did I say that right? Absolutely right.

Done. Perfect.

Very good. He is married to I. Alves Nicolas. Father too. It's a lie that you have the same name as your children. How incredible is that? He is the father of Nicholas and also of Isabella, who is seven Years old and Luca.

Exactly. There's a lot of pressure for college entrance exams. Let's see if you will pursue a career in medicine.

Hey, and why is Dr. Alex here? Dr. Alex also works in a laboratory that today supplies glucose meters. Right. And then at that moment, when I was thinking about some news. You are 43 years old, pregnant with seasonal diabetes. What can I do? Right. And then the first thing I did was talk to the doctor. I said, doctor, can I really use this meter? I can't. And then I remember that you gave me a class on seasonal diabetes, especially for very active women. Right. Who are working. I would really like for us to start with you explaining how we can define the condition of a pregnant woman who has gestational diabetes. Very cool. Thank you for the invitation again, Isabella. Well, let's understand what differentiates this gestational diabetes from type 1 or type 2 diabetes that was diagnosed before pregnancy. Yes. So gestational diabetes will not meet the criteria for diabetes. And it will be diagnosed during the gestation period, usually in the 24th or 28th week after having done the June blood glucose test. And then it is done in the first trimester. Then in the second trimester, the glucose tolerance test is done. A test where you administer a sugar syrup. A sugar. And the. And the pregnant woman then has a measurement, both fasting, one hour and two hours, depending on this curve. This pregnant woman, you can discovering that she has real diabetes and because she had diabetes, she. She didn't know, or she will have a diabetes that doesn't meet these parameters, which we will call gestational diabetes, which is a more intermediate parameter. And that's what's important. And then when we talked at that time, it has a lot to do with the fact that the pregnant woman who discovers that she has gestational diabetes doesn't have a habit developed throughout her life, like for example in type 1 diabetes, of eating, of taking care, of measuring blood glucose. And she needs to learn this very quickly from one day to the next. And then we talked a lot about this issue of monitoring blood glucose, how important it was to help develop this self care. Right. No, not excluding the other important points in relation to gestational diabetes, but this was a point that we talked a lot about as we were going to help you. Right. To learn what is good for me to eat, what this diet was like, which is the main point. Right. Of treatment of gestational diabetes. The issue of nutrition. Exactly. I remember the obstetrician saying, you can't eat this, you can't eat that. You can't eat that. Then I looked at him and said, so what am I going to eat? What am I going to eat? Exactly. So it's a moment of anxiety, doubt and fear when you're deprived of doing what you've always done. What was my glucose level at that moment? 92. If I hadn't been pregnant, I would have gotten through it just fine. But the obstetrician said, look, if you don't take care of yourself, depending on what you eat, you could develop seasonal diabetes. So I used a meter that monitored everything I ate every hour, and I didn't develop gestational diabetes. In your case it was different, right? Issa, you really had diabetes during pregnancy. How did you find out and what did you do?

Well, of all the fears we have during pregnancy, I hadn't thought about gestational diabetes. Imagine. Because there was no case in the family. I didn't know anyone who lived with diabetes. I didn't have it. It wasn't an issue. Right. And then I went for the 24 week exam and there was a bump there, right? So there was a spike at some point there. I remember that I was looking at it alone and thought, ah, just one. One doesn't give anything. Right? It was above. But then it was explained to me that in any of the measurements that had been taken, something like that, right. Would already be diagnosed. And I already had some signs because of Nicolas size at the time. So he was a little bigger and the amniotic fluid was also increased, which were already signs as well. Repeat. What were the signs that were already there in your body and that later led to the diagnosis. It's the size of the baby and the amount of amniotic fluid too. The size of the baby, which in that period of weeks, of the 24 weeks, he was bigger than the stage. So much so that he was born before the time and above. Also at 3700 he was born.

Okay, and for how many weeks?

37. It was just right by a hair's breadth. It wasn't before. Okay. And? Well, your example there in that question was perfect. Right. And now what? What should I do? I have a little curiosity, which is that on the day I spoke to my doctor, who had in fact been diagnosed with gestational diabetes, I had a trip to the United States in two days. I had bought a ticket that had been left over from the pandemic and was about to expire. So we said, no, then it will have to be now, because after the birth we won't be able to. So it will have to be now. And then I said, and now how am I going to do it? If I know how to control it here at home, I will be able to. But what about there? What am I going to do at the airport? What am I going to do when I want to eat? So. So, guys, I had a nutritionist, Kisses Bruna. She saw me during her lunch break when I was desperate for myself. She gave me a lesson. She taught me about the issue of food fiber, the order of food, reading the labels of. Absolutely. Well, and at the time I didn't know about meters.

So I went, guys, with a little pen on the plane there, measuring each meal, everything, and leaving blood everywhere. Right, guys, look, you can't be a criminal because you'll leave depending on the meter you use. You'll leave, right? The blood spread around.

Yes. And it's uncomfortable too, right? For the love of God.

Okay. Didn't you know about this other one?

No, I only started using it a little bit a while later. Then it's another relief in life, like, right?

Yes.

And then I remember, guys, I how much more prepared we are here in Brazil, it seems. I don't know if it was the region one was in, but I remember going into a supermarket, a little supermarket there in San Francisco. Yeah. And I read, I wanted to have some yogurt. I read all the labels. There wasn't any without sugar. They all had it. There wasn't any natural yogurt with nothing. There wasn't any. I couldn't find it. And it went down like that. So it was really difficult. At that time there, that little week, I had a huge spike in my blood sugar after some salty meal. To this day I don't know what it was. I was taking care of everything. And yeah, I think it was more or less like that. Right.

The main change you had to make in your routine was to read the labels of things before eating so as not to eat anything with sugar, right? You cut out bread. Yum. You cut out pasta.

Yum.

Well, then someone who's here watching said, ah, but that's all right. The fact is that many things that are written on the labels, as without added sugar, don't mean they don't have sugar. They do have sugar. You know what I discovered? Even salt has sugar, people. I'm kidding. Hello, editor. This is a joke. But I read the labels and everything has sugar. So we get really worried. Because Dr. Alex, just look at the responsibility. The mother is there gestating, right? Like I am here, right? Antonio is here. Then you receive this information about seasonal diabetes or pre diabetes, which was my case. And you put a rope around your neck, you have no way out, and then you're in a bubble environment where someone will be able to cook for you, where you will eat things. In this, you can't.

No, you can't be so strict like that. And that's a lot of responsibility. Why? What is the danger of gestational diabetes, Alex? Well, there are several complications that we can have, both for the fetus and for the mother. And of course, within type 1 diabetes, gestational diabetes is the one with the lowest risk per fetus. Pregnancy is one of them. Right. Because we can have a combination of malformation, weight gain, etc. As mentioned here. So these are some examples. And of course there are worse outcomes. But we are mainly talking about these cases. Right. And the issue of diet that you mentioned is fundamental, because now we have to restrict. So in other words, the pregnant woman is not going to eat any sugar. Because we are talking about sugar being a type of carbohydrate. So we are talking about carbohydrates that we will have to make choices, right? Low glycemic carbohydrates, those carbohydrates that will not cause spikes in blood glucose levels, that the body has time to recover. So it will not happen all at once. So these are the carbohydrates that are preferred for pregnant women. Of course it changes. We have to have a balanced diet with fiber. With all this, and as you said, and the great difficulty, especially at work, if it is already difficult at home, imagine sometimes even at work, to be able to regulate this diet. And of course, sometimes you are not used to doing physical activity, among other things, that you will have to change your routine a lot.

Exactly. I discovered then to control pre diabetes, which I did not develop. I did not develop.

Uh huh.

In fact, in the last exam, the size. Right. Of Antonio, the measurements are within the average. So what does that mean? When the woman gains a lot of weight or has uncontrolled diabetes, the baby gains a lot of weight and is born premature. Right?

That's it. In short, that's it. Uh huh.

But then I discovered what to eat, when to eat, and physical activity. But there was one thing I ate that seemed supernatural. Melon. I started one night as if there was no tomorrow. Oh, since it's melon, can I eat it? So put your phone on the meter. 180. It went from 90 to 180. So not all fruits are harmless, right, doctor?

Yes, because it also depends on fiber content and other factors. And blood sugar levels won't change just because of the food you eat. That's why physical activity also helps control it. But for example, factors like stress.

I was going to get into that now. So stress is a factor that can also significantly increase blood sugar levels. So it's a biological parameter. Even if we were to look at it, I'd like you to talk about it now. What? When Issa said, oh, I had a salty meal and my blood sugar spiked.

Uh huh.

Can you remember the context of that meal? If you're living in an environment with a situation that seemed threatening to you, that is very stressful.

Oh, I don't think that specific context, like maybe it was something there, a sauce, something that had a little sugar, something like that. Right. But I keep thinking back there in the beginning, I had several peaks and how much it had actually affected my emotions. That's it. There you go. You. No, it hits me in a place. Right. Of guilt for what I did wrong and that I might be a threat to my baby. Right. It's something very intense and it really affects me a lot. So I remember having been there, having a bad time. Your mental health was affected by the news of diabetes? Totally. Totally. I was tense, um, tense. Very scared. But I was very scared of what? If that specific peak would do something wrong, would cause something bad. Right. Okay. I think it was a little too neurotic. But yeah, I think it's just this combination of you not having any preparation, not having imagined. No one in your family, diabetes, no one. No one in your life. It was really. We know that diabetes is a disease that needs to be controlled and chronic. Right. You can live your whole life with it under control and everything. But even so, in the context of pregnancy, it's not what we're expecting, right. We're not expecting another disease during pregnancy. We're just expecting joy and frustration. Right.

Just an illusion. Just an illusion.

You know that even I have a friend who got pregnant very close to me and she took advantage of the pregnancy to go to several restaurants with long lines because she was going to cut the line. So she managed to go to all the restaurants that no one could get into. And I didn't see it. I hadn't thought about it.

I'm only going to wear the pregnancy necklace today.

So on the other hand, I stopped having fun, stopping going to restaurants, because I don't do that people. And I think a lot about people with Diabetes. How are they doing? Right, because it's very strict. Very strict.

Then, after you had Nicolas, your levels returned to normal quickly.

Yes, the same as right after birth. That's how it is.

Okay, it may be, it may be. It may last longer, but it's normal.

Yes. I took good care of myself too. I did a lot of physical activity. When I put on the monitor, the meter, I even noticed how much my blood sugar dropped after the physical activity. So I was able to control it. I didn't need to take insulin. Right, because we know that there are still more serious cases.

Exactly. More serious.

But I had to be strict. Exactly. Yes. And a really good control.

Yes. What happens during pregnancy is that you never expect to hear about complications. You expect it to be a state of absolute grace and for everything to flow without any unexpected events. And it will. Especially if you are working in an environment where there is no policy that benefits. Right. The health of pregnant women. Dr. Lexo, you are an occupational physician, an ergonomics specialist, and we are talking about well being, which is now even a topic of the NRI itself. Psychosocial risks. Is there anything that companies can do knowing that pregnant women, right, with this diagnosis, need a different diet? Anyway, is this utopia or not? Is it possible to do something for these women?

No, it is quite possible. Mainly because there is a huge change in women's routine and the company has to be a facilitator, right? It has to be able to provide these facilities. Of course, depending on the size of the company. Sometimes there are things that we can mention here that will be more difficult to implement. But let's start first with regard to the period of, for example, maternity leave, which can be extended, right? So in addition to the constitutional right we, which we already have regarding the license, but the extension that the corporate citizen program has, which allows the company to extend the license for another two months. So this is an important point and a benefit for the company, because all of this amount is deducted from the company's income tax. So it's a win win situation and ends up being a great benefit for the company. In relation to this extension period, we're talking about legal issues. Women, pregnant women will have specific parking spaces, but flexibility, for example, at work, which is a fundamental point that we're talking about, so that they can leave work earlier. But let's talk about pregnant women, right? When we talk about pregnant women, in addition to flexibility, they can take a period of pregnancy, sometimes even longer, the third trimester or more, with the possibility of working from home Right. Working from home requires easier access. Right. We have to look at the conditions as a whole. If before it was important for everyone to have breaks, for example, for pregnant women and diabetic patients, she will need these breaks even more intensely because she has to take so many frequent blood glucose measurements. Well, I'm going to have to have a place, for example, where all these needles will be inserted. Right. Or if she has to use insulin. So there has to be a place prepared for both storage and for the proper disposal of these biological wastes.

Right?

Right. Well, and along with this, there is a dense policy of local flexibility for storage allowing, sorry.

The places, the places to put and allow this break more frequently, you know? Well. And this autonomy of you to make the decision of whether you leave. And another important point has to do with diet. We've already talked here about how important it is to have a balanced diet. And in relation to low glycemic carbohydrate. Carbohydrates. How are we going to do this? Some companies prepare a specific meal for people with diabetes or high blood pressure. So sometimes if you have a company that has a cafeteria, you can communicate and have this specific meal prepared for pregnant women with diabetes. It's an interesting action to make eating easier. And if that's not the case, I have to have a pantry for this person to bring their own lunchbox to have their food already prepared, or for a nutritionist who has a refrigerator, a microwave, so that you can have adequate food in all these conditions. And in addition, if we go further, we have a multidisciplinary team to provide support. And I'm not just talking about the doctor, I'm not talking about the psychologist, but sometimes a nurse's monitoring is nearby. These sensors allow, for example, you to monitor remotely, sharing the information with your doctor. So and even the results that you may be using from capillary blood glucose, which is sometimes more accurate for some situations, but in this case, especially for developing this self knowledge, it is important, right? As we said at the beginning, you didn't have diabetes. Now you are pregnant, which is a lot of change in your routine. And now you have another disease that you need to treat. So you have to have this education, then promote lectures, workshops, education on diabetes for these pregnant women, allowing this to become a little more fluid, a little more practical. So this flexibility, this sensitivity on the company's side is fundamental. And this is not a cost. Attention, this is not a cost, this is not a privilege. This is even part of mental health rights, right? Because this Employee who is doing her best. Still talking about someone who is working in a company is doing her best, but she is going through a phase, a phase in which she needs more flexibility. There's another point you mentioned that I wanted to make so I wouldn't lose track of the subject.

And besides her. Right. It's essential to remember that this pregnant woman cannot be exposed to risks. There you go. Because in other words, you have the right. Right, right. That she is not exposed to risks. So she has the right to have another job. Or if there is no other alternative, she will have to take time off work.

Normally, we adapt and we remember nr. 1, the psychosocial issue. It is also a risk. So extremely stressful situations, they are a difficulty for this control. Right. So it is also an important element. And we are just starting out on this. Just starting out, Right. Oh, I'm dying to know about the effects of stress on the body. Dr. Alex will talk about this soon. Let me just confirm with Issa, because you didn't have a formal job, you were a self employed entrepreneur, right?

Self employed. Very good. Self employed. Well, how was it to deal with the schedules, the pressures and the need to earn money to meet financial responsibilities? Right. How did you deal with all that? Well, it's like this. I had to plan and organize myself for this whole process, right. I had to organize myself to be able to set aside a few months of leave. Right. Based on my money that I had worked with before. Right. So I started organizing myself that way, of course. And I had my husband's support too. Well, and during work, I started. There was a time when I started to have very limited movement because in addition to gestational diabetes, I had shortness of breath, back pain, pelvic pain. I had a lot of it because of his weight. Right. So at some point I needed someone to help me because I do child assessments and I needed to play with children on the floor a lot. Right. And I started to not be able to sit on the floor or if I sat down to get up, it was the end of the world. So I needed to seek support. For example, with mine, I had to do pelvic physiotherapy because of the pain I had in my hip there, very strong. And then she taught me how to position myself, how to, well, set myself up there to be able to sit. How is the right way to get up from the floor, which sometimes we don't learn, right. Having a big belly. And so I was adjusting myself in that sense. Right.

Everything that issa brought doctor, is ergonomics. Yes. All of this, all of this. We, the first thing we say that we cannot forget is that mental health is ergonomics because it has to do with how we organize our work, how we organize our lives, how this issue of purpose is. And a new purpose arises, right. That is born for our lives. So everything is very interrelated, right. This issue of ergonomics. Ergonomics is not just the same chair that we are talking about comfort. We started talking about comfort, right?

Uh huh.

And ergonomics has to do with this cognitive issue. Sometimes we have a hormonal change in women and it causes burning words. So and then you have cognitive issues due to all of this, even diabetes itself, which is due to these hormonal changes that appeared during pregnancy. And then there are these issues of attention, decision making, memory. So all of these cognitive aspects and then there are the emotional aspects. And when you see these difficulties that come your way, it makes you more stressed and sometimes you think you're a different person, you're not managing and you have to overcome all of this. So it's a process that I think even a psychologist can help us with, but it requires this self knowledge. Add I have a new disease, but I need to know myself. I need to know my situation. I need to know how I'm going to take care of myself, how I'm going to take care of myself in these situations, what strategies I'm going to use. So sometimes we're going to have to look for some professionals for this help. But from an ergonomics point of view, it's essential that we think not only about comfort, but also about the issues that are aspects that will interfere and this interferes. Do I have to have the same goals as other people? Right. When I'm in this period, what's the sensitivity? Do I sometimes even have to reduce my time to take care of my health condition?

Stop. In my case I had to, right? I had to guess. Funny thing is I planned to stop a month before, 40 weeks. And he was born a month before. Almost, right? More or less. Right. So I ended up not having any rest, Right. I worked until, I don't know, a Friday. He was born the following Tuesday. And then you managed to take some time off? I managed to take five months of leave. Stopped. Right.

People stopped. It's like you're just sitting on the couch, right? You just stayed with the baby, you didn't have to work outside the house.

Exactly.

You did it, you did it, you did it.

But I'm exposing myself a little. Right. As soon as he was born. Right. That period of pregnancy, I started there with a feeling of great sadness. Baby. I thought it was the baby blues, but it kept going on to the point where I was really feeling really bad. Right. And then I needed a therapy. I've always been in therapy all this time. But I ended up needing medical help. Right. I went to a psychiatrist who diagnosed me with postpartum depression and she's a specialist in maternal and child health. Right. She even explained to me the association. Of some occurrences there. Right. In the complications during pregnancy with diabetes and postpartum depression, including gestational diabetes as a risk factor for developing depression. Because you come from a stressful situation, your stress starts before the period. Right. So thinking about this issue of risk to mental health. Right. We're going to say it here, right? Let's suppose that the company thinks that you went on leave. That's guaranteed, Right. But sometimes leave can also be very difficult in these cases, right?

Tell me, doctor, don't tell me. Yes, yes, it's essential. And, and, and putting this context at work, what happens? A program to monitor these pregnant women in the company, which is another action that the company can take. Uh, it helps. Sometimes they give a kit to the mother for the baby's first days, a little outfit, an ointment, etc. A bag to accompany the baby. Diapers, Right? Yeah. But also other actions like flexibility, of course.

And also multidisciplinary monitoring. So when you completely disconnect from the company, we're not saying that you're going to work, that you can't. Right. Later when you're on leave. But if you completely disconnect, even more anxieties and fears arise regarding will I return and will I be there with my job guaranteed. I was told that such and such a person was fired as soon as she returned to work. All the anguish. So knowing that there is a breastfeeding room there means that the company is looking after the pregnant woman when she returns.

Uh huh.

Right. A lactation room, a milking room. The team's closeness shows care, reduces anxiety and fear about returning to work, which is the hardest part. Exactly. And the regulatory standard itself that talks about returning to work, we're talking about returning to work. We usually talk about illness. But before even returning to work was done when pregnant. Now it's no longer necessary because the standard has changed. But when returning the. This return should be gradual. No one goes back. Sometimes everyone says that, right? Sometimes we hear a lot at the company. You have to come back 100%. Otherwise you don't need to, you know. No, it doesn't exist. No one goes back 100%. We always go back gradually. The surgeon who is away for months. Imagine if that surgeon were pregnant, right? And he only came back after six months. He loses his skill. He has to recover this skill. Well, in all professions we won't be the same. Not even remembering the computer password when you take a 30 day vacation. So imagine getting back into this routine. And this routine has to be gradual. So having this gradual acceptance sometimes even means reducing the goals. Yes. There are companies that can adopt, for example, the first month that a person returns, they don't have this goal set. They will work at the average of the entire team to receive the bonus. Then it will increase. It will increase gradually. This is important. This is taking care of this pregnant woman. So this is the ideal world, of course. But unfortunately we still live in a world where no one wants us to get pregnant, right? How is it that our dream is that there is a policy for returning, right? So that this pregnant woman has support during pregnancy. But we know that many women even postpone pregnancy because they fear how much it could harm their career. Because they know the news. Well, if I'm not mistaken, 50% of women after having their first child either get fired or have to leave because they can't do it. Because they go back to that same lifestyle. And it won't work, it won't hold up. And before we move on to our conclusion, I just want to make one point. Issa, Because I didn't have diabetes. Well, I didn't have diabetes. I didn't identify with that job. When she comes back, she says, I'm going back to that job. No, it's not me anymore, right? Totally. That identity update. And obviously you're not the same person anymore, right? Well, I didn't have postpartum depression. I had depression during pregnancy. Wow. Uh huh. Precisely because I already knew that at 39, when I had my first pregnancy, I would have to stop being who I had always been, to be a person that I didn't know how I would be. But that there was already a demand, right, of getting this right, that right. And then I remember my psychiatrist saying, issa, we're going to have to start medication to help you through this. And that was the best thing that happened. Because after that my condition didn't get worse. Imagine if I had refused the feeling, the sadness. I wasn't sad because I was pregnant. I was very happy, but I was Sad, because I knew I had to stop being who I had always been. In other words, the only version I knew until then. Another important thing is that pregnancy, a pregnant woman, she is not sick, but she is not in a normal state either. Yeah. And since we are not bleeding, I always have to mention this. Okay, Doctor, I told my obstetrician the other day, I said, look, I'm a little tired of justifying my irritation, which comes from shortness of breath. My diaphragm tightens and my right rib hurts because it presses on the liver. So there is such a misconception about how pregnant women are that they no longer have the right to feel pain. Right? We know that pain, that doesn't hurt twice as much. Because besides holding on, doing your best, you still have to show that, okay, you're pregnant, but you're not sick. How many times do we hear that, uh, I'm pregnant, but I'm not sick. There are things like that. Yeah, it's limited. Something like that anyway. There's a lack of common sense, actually. I mean, right. In this talk about it being necessary in the workplace, starting with the fact that companies don't even want women to get pregnant. The other day, I heard a friend saying, for his sake, don't get me pregnant this year, okay? So I grabbed him and called him. I said, let me tell you something. This is harassment, and you can't say that, but we know it exists. Quote, to wrap things up, we have to talk about stress. But before we talk about how stress affects all of this, let me just say one thing. Doctor, you have three children. Did you find out about these pregnancies? How did the blood test, the pharmacy test? Did you wake up? Did you dream, honey? Did you get pregnant? How did it go?

The pharmacy test is almost always the curiosity, right? That's always the first news, right? And sometimes, right. We're not the first person. So asking me is sometimes harder because the curiosity is always the mother's right to know. Oh, something's wrong here, right? Going after the information sometimes counts, right? But I would say that it usually ends up like this. How can I say it? No, not because of the surprise, but it's precisely because the first curious person to know is the mother. But it's always a joy to have this news. It's a new purpose, right? In life, right? It adds this purpose and such. Were the three of them planned? No, no, no, no. Always. No, always. But they are always wonderful, right? Right. And so we always try to be close to them all the time. And it is the best thing to have a child, right?

Was there any story, for example, curious about the tests, right? For example, your wife was in doubt. Was there any situation like that that you want to share?

No, I don't think there is anything new in this test, right? Especially Isabella, who came now at the end, it was always anguish. She was very anxious, right? Well, and also because we weren't married yet, you know, so it was a situation like, oh, how are we going to do this? And it is. And it was very interesting because it changes. Like I was already a father before, but my current wife was not a mother. She had not been a mother. And so I was, I think, maybe even more prepared than her anxiety.

Yes, she was much more. Right. You had already lived here. I had already lived this. I was calmer, Right, right. With a surprise, right? And I think that this changes her way of thinking and I think that it changes her routine, her life. And how can I say that I expected, I needed a girl, right? Because how am I going to be, right? And now I'm surrounded by women because we have our little dog, Sarah, who is also a girl. So it became a house full of women who are in charge, right? They always are, right? Us, right? Your wife, Isabella and Shah pet at home. I get it, I get it. Hey, Issa. And you, how did you find out about Nicholas arrival?

Nicolas was very planned because in fact, I had a lot of trouble getting pregnant and I needed to undergo treatment. So he's a test tube baby. So when he arrived, it was like that, right away, everything went really well, right? Even though I discovered several problems right before I managed to get pregnant, when I tried for the first time, he had already come, so everything went well. But there's a funny story behind that, right? It's because when you do in vitro fertilization, right? You're going to do a blood test right away, right? But I wasn't. It was going to be like that on Saturday. On Friday I couldn't hold back my desire. I thought, my God, there's no way that between Friday and Saturday there's going to be that much difference. So I ran to the pharmacy and I remember that Friday was the car rotation, huh? And there were 10 minutes left before the rotation. And that was the time I had to rush to the pharmacy, run in, get the test. And we even laughed a lot when he said what the girl at the pharmacy thought was happening. Like that. Running in, getting the test, paying the woman wants the receipt. No, no, no, no, no, no. I ran out and did the test and found out beforehand through the test that it had worked.

So when you took the test, was it this one?

It was this one.

So you took the clear blue test. Did you see the plus sign? Because you were looking for the plus sign. Let's go. Some people take the test looking for the minus sign. It's a confirmation that I didn't get pregnant. But some people look for the test to want the plus. So when you saw the plus there, how did it feel? So it was that feeling of this is happening, you know?

How long had you been trying?

Oh, about a year. Gosh. And it was a year, actually. A year of treatment. Right. So, uh, but it had already been about two years at least.

Okay.

And then a feeling, even though I knew. I remember my husband saying, but Issa, we already knew it would work.

No, but do you want to see it now? Like this? I wanted to. Right. I needed to have that moment to find out through the drugstore test. Perfect. Doctor, look, it's funny. Seeing is believing is still very important for us to reduce the release of cortisol. Right. In our blood. What I mean by this is that even though you did the treatment, there was already another test. You still went to the pharmacy to get a test. And when you saw the plus sign, that is. This is very important information. Yes. In addition to the Claire blue test, there is another thing that I just want to tell the other mothers who are following us. If you want to know the exact day, which is like, it's today, right, Mate, it's today. This is an ovulation test that I didn't know about. Yes. It's a recent product and it lets you know which are your two most fertile days of the month. In other words, if you want to have another child, Doctor, you can already give it to your wife.

I've already done a treatment here.

It's already cut, so that's fine. So, but then do you still want to have a child today? But.

Oh, I think I'm not very prepared yet.

No. So that's why an ovulation test is important, because then you'll know it's today.

Uh huh.

Or it's not today.

Uh huh.

How interesting. Having this information, Doctor, reduces stress.

It certainly is. Right. It makes it easier. And even if it's not certain that you'll be successful, it's a factor that makes it much easier. Right. Of course, sometimes even the woman has one already has some knowledge. Right. Of these moments. Right. But it's a very big contribution.

Yes. The Second pregnancy? Yes, the first one no, because in the second one I already knew I was pregnant. In the first one, no, the first one was like that. It was an intuition. But okay, let's. Let's see this here. What I want to tell you is I want, and to conclude doctor, is the following. Poorly managed stress is a hormone discharge in our body that inflames the cells. Many people ask me how I managed to get pregnant after burnout. And I always answer that I was only able to generate love after I experienced self love. And for that I had to give up a lot of things that could even be really cool. But what I got was a flood of cortisol, right? Bad cortisol, not good cortisol, not good stress. So I would like you to tell us how excessive stress that is poorly managed, that is chronic situations, can lead you to a state of inflammation. And that can, in my humble opinion, make the fertilization process unfeasible, can lead you to a spike in glucose. Can stress really do all of that?

It can for sure, yes. We can't separate mind and body. They are inseparable, right? We are talking here about a hormonal relationship, a relationship of neurotransmitters, a biological relationship. So we look, there are several parameters that change, eh. Skin temperature, blood pressure, heart rate. When we are stressed, we feel that sensation in the stomach, right? We can feel a change in the production of gastric sugol and everything else, right? So all these changes happen in our body and the question is, how am I going to manage this? Right? And it's a complex process because we're talking about life. I have a part of my day that is life. And we sometimes forget that there's another part that is work.

Uh huh.

And this work that as we said, ah, the person even left, they chose right to leave. But this work, it has a character. It's to avoid this stress so we can help manage it, which is linked to some factors that we already know, right? Among them we're talking about demand. So it's not just demand because work is important. The difficulty of work is important. The problem is that we don't always have what we call recognition in this work environment. So all of this is about control factors, right? That we want when we to manage this stress to avoid these effects that lead to illness. Whether some are organic, as we have already mentioned here, and others which are mental disorders with the person that are of the most possible variables. For example, certain situations of stress that are not just, oh, I'm going to get depression, anxiety. Oh, I'm going to have burnout. There are countless situations. There are people who become alcoholics, drug users due to the most possible situations, among others. Right. Phobias, post traumatic stress. Yes. The number is innumerable. But we think, then there is this reward. So what do we put into this scale? Because effort is important. The problem is when you make an effort and you don't see the purpose there. In other words, I don't get a reward for it. I don't see the meaning of what I'm doing, job satisfaction and this reward. And sometimes I hear a lot of.