Dr Joshua Hurwitz REI

Reproductive Endocrinologist & Infertility (REI) Specialist

[Dr Joshua Hurwitz REI @JoshuaHurwitz]

thank you all and to the entire #OBSM team. tonight was super fun, I love getting the word out to everyone who needs it. thanks for my 1st introduction the twitter-verse- many thx josh #obsm

[Dr Joshua Hurwitz REI @JoshuaHurwitz]

epi genetics is the study of how the environment impacts and effects gene expression. in this context, losing wt before pregnancy can greatly change the micro-environment of the womb & placenta #obsm

[Dr Joshua Hurwitz REI @JoshuaHurwitz]

lets talk about EPI-Genetics! #obsm

[Dr Joshua Hurwitz REI @JoshuaHurwitz]

also growing body of evidence that male obesity also plays a role in fetal programming- dudes are not off the hook- it s a team sport. #obsm @fertility_rmact #fertility #obesity @DrJoshuaHurwitz REI

[Dr Joshua Hurwitz REI @JoshuaHurwitz]

2/There is a growing knowledge that programming of the fetus in the womb is influenced by metabolic factors such as obesity that can have lifelong metabolic consequences. #obsm @fertility_rmact #fertility #obesity @DrJoshuaHurwitz REI

[Dr Joshua Hurwitz REI @JoshuaHurwitz]

Great question- there is definitely a genetic & heritable function of obesity but it is not destiny. There are many factors that play into it. #obsm

[Dr Joshua Hurwitz REI @JoshuaHurwitz]

another issue is rare- sometimes there are adhesions and surgical issues that can make c-sections difficult. #obsm

[Dr Joshua Hurwitz REI @JoshuaHurwitz]

thiamine deficiency is also a concern. there may be association with low birth weights for pt's who have had bariatric surgery. pt's should always have their "dream tema" of nutritionists, bariatricians, and OBGYN's watching over them in pregnancy #obsm

[Dr Joshua Hurwitz REI @JoshuaHurwitz]

2/most authorities recommend additonal folic acid, iron and other fat soluble vitamins supplementation over the usual prenatal vitamin.

[Dr Joshua Hurwitz REI @JoshuaHurwitz]

pregnancy after bariatric surgery is very safe. the main issues are absorption and nutrition. this is more of an issue for gastric bypass and less so with sleeve surgery. #obsm

[Dr Joshua Hurwitz REI @JoshuaHurwitz]

when a pt comes to see see me to help conceive who has obesity, i need ot address that- in the best way. if I dint bring it up, that would be wt bias to ignore it #obsm

[Dr Joshua Hurwitz REI @JoshuaHurwitz]

it is so important to bring these topics up- in a very personalized and caring way- so that patients know that you are invested in them, care about them, and will go through a brick wall for them. that is true for mfertility challenges and obesity treatments #obsm

[Dr Joshua Hurwitz REI @JoshuaHurwitz]

my filed of fertility has been in the past- and is still so for many- in the closet so to speak. it is very personal &emotionally initimate. some are initimidtaed to bring it up at all, much like obesity interactions. #obsm

[Dr Joshua Hurwitz REI @JoshuaHurwitz]

In terms of fertility and reproductive medicine, we know that our treatments work less well as wt and BMI increases. There are also commonly wt cut-offs for patients trying to access fertility care and thagt can be considered and perceived as wt bias #obsm

[Dr Joshua Hurwitz REI @JoshuaHurwitz]

I think like everywhere else, there is weight bias in women’s healthcare. I think that healthcare providers know that there are legitimate difficulties and complications surrounding fertility, pregnancy care and obstetrical care that make it more difficult. #obsm

[Dr Joshua Hurwitz REI @JoshuaHurwitz]

absolutely yes. all major complicatiosn of pregnancy are increased with elevated wt's and bmi #obsm

[Dr Joshua Hurwitz REI @JoshuaHurwitz]

In addition to therapists that help patients through the tough journey of infertility, we also have comprehensive nutritional and lifestyle modification team to help all of our patients optimize their health and metabolism for pregnancy.#obsm @Fertility_RMACT @DrJoshuaHurwitz REI

[Dr Joshua Hurwitz REI @JoshuaHurwitz]

Good fertility medical practices will provide comprehensive care for all patients. #obsm

[Dr Joshua Hurwitz REI @JoshuaHurwitz]

Miscarriage risk is also elevated the higher the BMI and wt. #obsm @fertility_rmact #fertility #obesity @DrJoshuaHurwitz REI

[Dr Joshua Hurwitz REI @JoshuaHurwitz]

There is also a much higher incidence of C-sections for delivery and a higher risk of the surgery itself at higher weights. #obsm @fertility_rmact #fertility #obesity @DrJoshuaHurwitz REI