Archive for the ‘Planning for Baby’ Category

How vaccines work

Friday, July 31st, 2015

niam-logoVaccines protect you from diseases that can cause severe illness and even death. Vaccines work with your body’s immune system to help it recognize and fight these infections.

Usually when you are exposed to viruses or bacteria they cause infections that make you sick. To fight this infection, your immune system produces antibodies. These are special disease-fighting cells that attack the virus, destroy it, and make you better. In many cases, once you have made antibodies against a virus, you are then immune to the infection that it causes. This means that you cannot get sick from the same infection. For instance, if you had chickenpox as a child, you are immune to it later in life because your body has produced antibodies against the varicella virus (the virus that causes chickenpox). If you are exposed to the virus again, your antibodies recognize it and destroy it before it makes you sick.

Vaccines work with your body’s natural defenses to help you safely develop immunity to certain diseases. A vaccine uses a small piece of the virus or bacteria that causes the infection. Usually this virus is greatly weakened or it is killed. But it looks enough like the live virus to make your body react and make antibodies to attack the virus in the vaccine. This allows you to become immune to the disease without having to get sick first. For example, after you get the chickenpox vaccine, you will develop antibodies against the varicella virus, but you will not get chickenpox first. This factsheet from the CDC explains the body’s immune response to disease and how vaccines work in much more detail.

There are two main types of vaccines: weakened, live virus or inactivated, killed virus.

Vaccines that use weakened, live viruses include measles, mumps, rubella, rotavirus, flu mist, and chickenpox (varicella). Natural viruses reproduce thousands of times when they infect an individual. But weakened viruses can only reproduce about 20 times. This is not enough to make you sick, so they can’t cause disease. But even a few copies of the virus will cause your immune system to react and to make antibodies against the disease. The advantage of live, weakened vaccines is that typically you only need one or two doses (or shots) to provide immunity. However, live, weakened vaccines cannot be given to people with immune systems that don’t work as well as they should, because even such a small amount of virus could make them sick.

Vaccines that use inactivated or killed viruses include polio, hepatitis A, and the flu shot. The inactivated virus cannot reproduce and therefore cannot cause disease. But the immune system still makes antibodies to protect you against disease. The advantages of inactivated viruses are that the vaccine cannot cause the disease at all, and the vaccine can be given to people with weakened immune systems. The limitation of this method is that several doses of the vaccine are required before you are immune to the disease.

August is National Immunization Awareness month. It is important for people of all ages to protect their health with vaccines. In the upcoming weeks, we will be posting more information about vaccines for women who are thinking about getting pregnant, pregnant women, and babies.

Questions? Send them to AskUs@marchofdimes.org.

Maternal PKU

Friday, July 24th, 2015

newborn-screening-picture1PKU or phenylketonuria is a condition in which your body can’t break down an amino acid called phenylalanine.

In the US, about 3,000 women of childbearing age have PKU. A woman with PKU can have a healthy baby but it is very important that she stay on a special diet to control her phenylalanine intake while she is pregnant. According to MotherToBaby, babies born to mothers with untreated PKU (women who are not on the special diet) are commonly born smaller, have microcephaly (an abnormally small head), intellectual disabilities, behavior problems, facial features similar to those of fetal alcohol syndrome, and have higher risks of heart defects.

Managing PKU during pregnancy

If you have PKU and are planning to get pregnant, it is very important that you talk to your health care provider. Many people with PKU now maintain their special diets throughout life. But if you have not been following your PKU diet, it is best to return to your PKU meal plan at least 3 months before you try to get pregnant.

PKU meal plans are different for everyone because people with PKU can tolerate different amounts of phenylalanine. For this reason, it is very important that you talk to health care providers who are familiar with managing PKU during pregnancy. Blood tests throughout pregnancy can help to monitor your phenylalanine levels and make sure that they are not too high. And your prenatal care provider may order ultrasounds to monitor your baby’s growth.

Will my baby have PKU?

If you have PKU, your baby has a chance to have PKU. Your baby has to inherit a mutation for PKU from both parents to have PKU. Whether or not your baby will have PKU depends on if your partner has PKU or is a PKU carrier. (A PKU carrier has one copy of the PKU mutation but does not have PKU.)

  • If you and your partner both have PKU, your baby will have PKU.
  • If you have PKU and your partner is a carrier, than there is a 50% chance your baby will have PKU and a 50% chance your baby will be a PKU carrier.
  • If you have PKU but your partner does not carry the gene change for PKU, then your baby will be a PKU carrier but will not have PKU.

If you are not sure if your partner is a PKU carrier, there are tests available that can help you find out. A genetic counselor can better help you understand your chances of passing PKU to your baby.

All babies born in the United States are tested for PKU through the newborn screening program. Babies born with PKU are immediately placed on a special diet that significantly reduces the amount of phenylalanine they consume. Babies who have PKU may never show symptoms if they are transitioned to a low-phenylalanine diet soon after birth.

Questions? Send them to AskUs@marchofdimes.org.

 

Silent but dangerous bacteria

Monday, July 20th, 2015

Pregnant woman with doctorAbout 25% of pregnant women carry Group B streptococcus (also called Group B step or GBS). GBS may come and go quietly in your body without any symptoms, so you may not be aware that you are carrying it. GBS may never make you sick and we don’t know exactly how the bacteria is transmitted. But while GBS may not be harmful to you, it can be very harmful to your baby.

How can GBS affect you during pregnancy?

GBS lives in the rectum or vagina and can cause a bladder or urinary infection (UTI). Women who have symptoms can receive antibiotics from their provider. If you don’t have symptoms of an infection, you may not know you need treatment. Without treatment, a uterine infection during pregnancy can increase your chances of:

• Premature rupture of the members – When the amniotic sac breaks after 37 weeks of pregnancy but before labor starts
• Preterm labor – Labor that happens too early, before 37 weeks of pregnancy
• Stillbirth – When a baby dies in the womb before birth, but after 20 weeks of pregnancy

Is there any good news?

Yes, you can be tested for GBS. If you are pregnant, you will be tested for GBS at 35 to 37 weeks of pregnancy. Your provider will take a swab of your vagina and rectum and the sample will be sent to the lab. The process is simple and painless and results will be available in 1 to 2 days. If you go into preterm labor, your provider can use a quick screening test during labor to test you for GBS.

If the test is positive:

You will receive an antibiotic from your provider during labor and birth through an IV, which helps prevent your baby from getting the infection. Remind your health care provider at the hospital when you go to have your baby; this way you can be treated quickly. It may be helpful to make a note and stick it on top of your hospital bag so you remember as you walk out the door. If you have GBS and a scheduled cesarean birth (C-section) before labor starts and before your water breaks, you probably don’t need antibiotics.

With treatment, a woman has only a 1 in 4,000 chance of delivering a baby with group B strep, compared to a 1 in 200 chance if she does not get antibiotics during labor.

If you are worried about GBS, speak with your health care provider. Have questions? We are here; email AskUs@marchofdimes.org.

Cleft lip and palate awareness

Monday, July 13th, 2015

baby with cleft lipI remember seeing a thin scar on my friend’s upper lip, and wondering how she had gotten it. “I was born with a cleft lip,” she said. I became curious about her cleft lip and how it turned into one tiny scar.

A cleft lip is a type of craniofacial abnormality. These are birth defects of the head (cranio) and face (facial) that are present when a baby is born. Another common type is a cleft palate (roof of the mouth). As July is National Cleft and Craniofacial Awareness and Prevention Month, it is a good time to learn more about these birth defects.

How does a cleft lip or palate form?

The lips of a baby form by about 6 weeks of pregnancy. When the lip doesn’t form completely and is left with an opening, this is called a cleft lip. A baby’s palate is formed by about 10 weeks of pregnancy. When the palate doesn’t form completely and has an opening, it’s called a cleft palate. A baby can be born with just one of these abnormalities or with both.

Each year in the U.S., about 2,650 babies are born with a cleft palate and 4,440 babies are born with a cleft lip with or without a cleft palate. The causes of clefts with no other major birth defects among most infants are unknown.

In most cases, cleft lip and cleft palate can be repaired by surgery. Each baby is unique, but surgery to repair cleft lip usually is done at 10 to 12 weeks of age. Surgery for cleft palate usually is done between 9 and 18 months of age. A child may also need more surgery for his clefts as he grows.

My friend had corrective surgery to repair her lip when she was still a baby. Now all that is left is one thin scar above her upper lip leading to her nose, which you can hardly see.

Can these birth defects be prevented?

We are not always sure what causes a cleft lip or palate.  However, there are steps a pregnant woman can take to decrease her chance of having a baby with a cleft lip or palate.

• Before pregnancy, get a preconception checkup. This is a medical checkup to help make sure you are healthy before you get pregnant.
• Take a multivitamin that contains folic acid. Take one with 400 micrograms of folic acid before pregnancy, but increase to one with 600 micrograms of folic acid during pregnancy. Your provider may want you to take more – be sure to discuss this with him.
• Talk to your provider to make sure any medicine you take is safe during pregnancy. Your provider may want to switch you to a different medicine that is safer during pregnancy.
• Don’t smoke.
• Don’t drink alcohol.
• Get early and regular prenatal care.

If you have any question about cleft or craniofacial defects, causes or prevention, read more here or email us at AskUs@marchofdimes.org.

New study looks at link between antidepressants and birth defects

Friday, July 10th, 2015

pregnant woman with MDThe use of certain antidepressants during pregnancy is associated with a higher risk of birth defects, according to a new study. But other antidepressants do not carry the same risk.

The study looked at a specific group of antidepressants called selective serotonin reuptake inhibitors (SSRIs). SSRIs are medications used to treat depression and other mental health conditions. Previous studies gave conflicting evidence about potential links between the use of SSRIs during pregnancy and certain birth defects.

In this study, researchers from the CDC analyzed data from 17,952 mothers of infants with birth defects and 9,857 mothers of infants without birth defects, born between 1997 and 2009.

The researchers found that some birth defects occur about two or three times more frequently among babies born to women who took certain SSRI medications, like Prozac (fluoxetine) and Paxil (paroxetine) early in pregnancy. It is important to note that the actual risk for a birth defect among babies born to women taking Prozac or Paxil is still very low. For example, the risks for a specific heart defect could increase from 10 per 10,000 births to about 24 per 10,000 births among babies of women who are treated with Paxil early in pregnancy. Since these specific types of birth defects are rare, even doubling the risk still results in a low overall chance.

Researchers did not find a link between birth defects and other SSRIs such as Zoloft (sertraline).

“A pregnant woman should be reassured that she can choose a safe drug to treat her depression and not have to go off her medication because she is afraid her baby may develop a birth defect,” Dr. Edward McCabe, Chief Medical Officer of the March of Dimes said. “Not treating depression can be unhealthy for both the mom and her baby. It can cause stress, and stress during pregnancy is associated with early births and low-birthweight babies.”

If you are currently taking an antidepressant and are concerned, do not stop taking the medication until you talk to your health care provider. And if you are planning to become pregnant and are taking an antidepressant, schedule a preconception checkup and discuss what medications may be best for you.

Bleeding during pregnancy – what does it mean?

Monday, July 6th, 2015

bleeding during pregnancyIf you are pregnant and experience spotting or bleeding, it can be very scary. When you see blood, your first thought may be “is my baby ok?” Bleeding and spotting from the vagina during pregnancy is common. Up to half of all pregnant women have some bleeding or spotting.

Bleeding? Spotting? What’s the difference?

Spotting is light bleeding and happens when you have a few drops of blood in your underwear. Bleeding is a heavier flow of blood, enough that you need a panty liner or pad to keep the blood from soaking your underwear or clothes.

Bleeding in early pregnancy

Bleeding doesn’t always mean there’s a problem, but it can be a sign of serious complications. There are several things that may cause bleeding early in your pregnancy, such as having sex, an infection, or changes in your cervix and hormones. You may bleed a little when the embryo attaches to the lining of your uterus (called implantation bleeding). This may occur 10-14 days after fertilization. Although this spotting is usually earlier and lighter than a menstrual period, some women don’t notice the difference, and don’t even realize they’re pregnant.

Sometimes bleeding and spotting in the first trimester can be a sign of a serious problem such as miscarriage, ectopic pregnancy, or molar pregnancy. But keep in mind that bleeding doesn’t always mean miscarriage. At least half of women who have spotting or light bleeding early in pregnancy don’t miscarry.

Bleeding in late pregnancy

Causes of late pregnancy bleeding include labor, sex, an internal exam by your provider or problems with your cervix, such as an infection or cervical insufficiency. It could also be a sign of preterm labor, placenta previa, placental abruption or uterine rupture.

How to tell if the bleeding is dangerous

Bleeding or spotting can happen anytime, from the time you get pregnant to right before you give birth. Bleeding can be a sign of a serious complication, so it’s important you call your prenatal care provider if you have any bleeding or spotting, even if it stops. If the bleeding is not serious, it’s still important that your provider finds out the cause. Do not use a tampon, douche or have sex if you’re bleeding.

Before you call your provider, write down these things:

• How heavy your bleeding is. Is it getting heavier or lighter and how many pads are you using?
• The color of the blood. It can be different colors, like brown, dark or bright red.

Go to the emergency room if you have:

• Heavy bleeding
• Bleeding with pain or cramping
• Dizziness and bleeding
• Pain in your belly or pelvis

Treatment for your bleeding depends on the cause. You may need a medical exam or tests performed by your provider.

Bottom Line

If you are bleeding or spotting at any point in your pregnancy, call your provider right away and describe what you are experiencing. It’s important that your bleeding or spotting is evaluated to determine if it is dangerous to you and your baby.

Have questions? Send them to AskUs@marchofdimes.org.

Shingles, kids and pregnant women – know the facts

Wednesday, June 10th, 2015

Many pregnant women have written to us expressing concern about being exposed to a family member who has shingles. Usually it is their parent or grandparent, or another older adult who has the virus. However, did you know that children can get shingles, too?

When my daughter was in fourth grade, she came home from school with a tiny rash on her back about the size of a quarter, complaining of pain and exhaustion. I had never seen a rash like that before; it was a little clump of tiny bumps. Sure enough, her pediatrician diagnosed it as shingles. I was shocked, as I never associated shingles with kids. Although it isn’t common, it does happen, and the risk of getting singles increases with age. My daughter had a mild case, and after about 2 weeks she was on the mend. She was lucky – it can be very painful and last longer.

What causes shingles?

Shingles (formally known as Herpes Zoster) is caused by the Varicella Zoster virus, the same virus that causes chickenpox. Only someone who has had chickenpox – or, rarely, has gotten the chickenpox vaccine – can get shingles, according to the CDC. The chickenpox virus stays in your body and can re-appear at a later date, often many years later. When it reappears, it does not return as chickenpox – it comes back as shingles.

How common is shingles?

My daughter had chickenpox (the disease) when she was four years old. At that time, the vaccine was not yet available. It is far less common to develop shingles if your child has had the chickenpox vaccine. By vaccinating your child against chickenpox you will decrease her chances of getting shingles later in life.

At least 1 million people a year in the United States get shingles. Shingles is far more common in people 50 years of age and older. It also occurs more in people whose immune systems are weakened because of a disease such as cancer, or drugs such as steroids or chemotherapy.

Can you catch shingles from someone who has shingles?

No, you can’t catch shingles from another person who has shingles. However, a person who has never had chickenpox (or the chickenpox vaccine) could get chickenpox from someone with shingles. However, this is not very common. Shingles is not spread through the air and infection can only occur after direct contact with the rash when it is in the blister-phase. A person with shingles is not contagious before the blisters appear or after they scab over.

If you are pregnant or trying to get pregnant…

• First, get a blood test to find out if you’re immune to chickenpox. If you’re not immune, you can get a vaccine. It’s best to wait 1 month after the vaccine before getting pregnant.

• If you’re already pregnant, don’t get the vaccine until after you give birth. In the meantime, avoid contact with anyone who has chickenpox or shingles.

• If you’re not immune to chickenpox and you come into contact with someone who has it, tell your provider right away. Your provider can treat you with medicine that has chickenpox antibodies. It’s important to get treatment within 4 days after you’ve come into contact with chickenpox to help prevent the infection or make it less serious.

• Tell your provider if you come in contact with a person who has shingles. Your provider may want to treat you with an antiviral medication.

What does all this mean for your child?

• If you think your child may have shingles, contact her health care provider. Prompt treatment may shorten the duration and keep pain to a minimum.

• Get your child the chickenpox vaccine to protect her against chickenpox, and so that she has a far less chance of getting shingles in the future.

Learn more about shingles exposure and chickenpox during pregnancy.

 

If you have questions, send them to AskUs@machofdimes.org.

View other posts in the series on Delays and Disabilities: How to get help for your child.

 

 

Epilepsy and pregnancy

Thursday, May 21st, 2015

speak to your health care providerEvery year in the US, approximately 20,000 women with a seizure disorder give birth. Most of these pregnancies are healthy. But there are a few additional concerns that women who have epilepsy must consider when thinking about getting pregnant.

What is epilepsy?

Epilepsy is a brain disorder in which a person has repeated seizures over time. Seizures are episodes of disturbed brain activity that cause changes in attention or behavior. Epilepsy is a specific type of seizure disorder.

People with epilepsy are usually prescribed medication to help to control seizures. These are known as antiepileptic drugs (AEDs). There are a number of different types of AEDs and they are prescribed depending on age, the type of seizure, and the side effects of the medications. Some individuals with epilepsy may need more than one AED to control their seizures.

Can epilepsy cause problems during pregnancy?

If you have epilepsy and are thinking about getting pregnant, there are a few important things that you need to consider.

  • Women who have epilepsy have an increased chance to have a baby with a birth defect compared to women who do not have epilepsy. This may be the result of the epilepsy or the AEDs used to control seizures. Some AEDs have been associated with an increased risk of cleft lip and palate, neural tube defects, and heart defects.
  • Pregnancy can cause a change in the number of seizures. Most women with epilepsy will have no change in the number of seizures they experience or they will have fewer seizures during pregnancy. A few women will experience more seizures.

Controlling seizures during pregnancy is very important. Having a seizure during pregnancy can cause problems for you and your baby. Seizures during pregnancy can cause:

  • Decreased oxygen to the baby and fetal heart rate deceleration during the seizure.
  • Injury to the baby as a result of any falls or trauma experienced during the seizure. This can include premature separation of the placenta from the uterus (placental abruption) or miscarriage.
  • Preterm labor
  • Premature birth

Should you continue to take anti-seizure medications during pregnancy?

Many women with epilepsy are concerned about taking their AEDs during pregnancy. But according to ACOG, “Because there are serious risks associated with having a seizure during pregnancy and because the potential risk of harm to your baby from taking AEDs is small, experts recommend that seizures be controlled with AEDs, if necessary, during pregnancy. However, the type, amount, or number of AEDs that you take may need to change.”

Will you need any special care during your pregnancy?

One of the most important things that any woman can do to have a healthy pregnancy is to schedule a preconception checkup. If you have epilepsy, it is important to talk to your prenatal care provider as well as your neurologist prior to getting pregnant. Here are some other things to consider:

Before pregnancy:

  •  Review your seizure medications with both your prenatal provider and your neurologist. If changes need to be made, it is better to do this prior to getting pregnant.
  • Take a prenatal vitamin with folic acid. Talk to your health care team about how much folic acid is right for you.
  • Eat a healthy diet, get enough sleep, and avoid cigarettes, alcohol.

During pregnancy:

  • Plan for additional visits to your health care providers. Medication levels will need to be monitored to make sure they stay consistent.
  • Talk to a genetic counselor about prenatal testing.
  • Most women with a seizure disorder can have a vaginal birth.
  • Women with epilepsy are encouraged to breastfeed. Talk to your health care team.

If you have epilepsy, planning and working with your health care team can help to ensure that you have the healthiest pregnancy possible.

Questions?  Send them to AskUs@marchofdimes.org.

 

How much weight should I gain?

Tuesday, May 19th, 2015

During pregnancy, you need to gain a healthy amount of weight to support your growing baby. In this video, Dr. Siobhan Dolan talks about how much weight you should gain and what to do during pregnancy to maintain a healthy weight for you and your baby. It’s important to learn how gaining too much or too little weight can cause problems for your baby including premature birth. Don’t forget to talk to your provider about what is right for you.

Can your meds cause drug withdrawal in your baby?

Friday, May 15th, 2015

pillsNeonatal abstinence syndrome (NAS) is a group of conditions a newborn can have if he’s exposed to addictive street or prescription drugs before birth. If you take drugs during pregnancy, they can pass through the placenta to your baby. After birth, the baby is still dependent on the drug, however, now that the drug is no longer available, the baby experiences drug withdrawal. Today, one of the most common causes of NAS is maternal use or abuse of opioids during pregnancy.

Using these drugs during pregnancy can cause NAS:

• Opioids, including the prescription medicines codeine, hydrocodone (Vicodin®), morphine (Kadian®, Avinza®) and oxycodone (Oxycontin®, Percocet®). The street drug heroin also is an opioid.
• Barbiturates, like phennies, yellow jackets and Amytal®
• Benzodiazepines, like sleeping pills, Valium® and Xanax®

Signs and symptoms of NAS:

• Body shakes (tremors), seizures (convulsions), overactive reflexes (twitching) and tight muscle tone
• Fussiness, excessive crying or having a high-pitched cry
• Poor feeding, poor sucking or slow weight gain
• Breathing fast
• Fever, sweating or blotchy skin
• Trouble sleeping and yawning frequently
• Diarrhea or vomiting  (throwing up)
• Stuffy nose or sneezing

Signs and symptoms of NAS can be different for every baby. Symptoms may appear within a few minutes after birth or as much as two weeks later. NAS can last from 1 week to 6 months after birth.

Testing and treatment:

Your provider can see if your baby has NAS by testing his first bowel movement or urine. Your provider can also use what is called a neonatal abstinence scoring system which gives points for each NAS symptom depending on how severe it is. Treatment can include medicines to manage severe withdrawal symptoms, getting fluids through a needle into the vein, or giving higher-calorie baby formula to newborns that have trouble feeding or slow growth.

How can I prevent NAS?

If you’re pregnant and you use any of the drugs that can cause NAS, tell your health care provider right away. But don’t stop taking the drug without getting treatment from your provider first. Quitting suddenly (sometimes called cold turkey) can cause severe problems for your baby, including death.

If you’re addicted to opioids, medication-assisted treatment (also called MAT) during pregnancy can help your baby. NAS in babies may be easier to treat for babies whose moms get MAT during pregnancy. Medicines used in MAT include methadone and buprenorphine.

Even if you use a prescription drug exactly as your provider tells you to, it may cause NAS in your baby. If you are pregnant or think you may be pregnant, talk to your provider about any drug or medicine you are taking.

Our website has more information on where you can find help.

Have questions? Email us at AskUs@marchofdimes.org.