Posts Tagged ‘prenatal care’

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.

 

Concerns surrounding “keepsake” ultrasounds

Friday, February 20th, 2015

pr_mr_lg_ultrasound1The first ultrasound is one of the most exciting times in pregnancy. Most parents can’t wait for the opportunity to share their baby’s first pictures with family and friends. However, it is important to remember that an ultrasound is a medical imaging technique and should only be done under the supervision of medical professionals, such as your doctor and/or a trained ultrasound technician. “Keepsake” ultrasounds offered by commercial businesses are not recommended.

Ultrasound is the most commonly used tool for viewing a developing baby. Sound waves bounce off curves and shapes within your body and these patterns are then translated into images. Standard ultrasound creates a 2-D image of a developing baby. Some women have an ultrasound during the first trimester to confirm and date the pregnancy—this is called an early ultrasound.  But not all providers offer this. Most doctors perform an ultrasound between 18 and 20 weeks. At this time your provider will check your baby’s heartbeat, muscle tone, movement and overall development.

Although it is always fun and exciting to see your unborn baby on the ultrasound monitor, it is very important to remember that this is a medical procedure. You may have seen places in a mall that offer “keepsake” 3-D or 4-D ultrasound pictures or videos for parents. While ultrasounds have been used for over 30 years and are considered safe for you and your baby, the American College of Obstetricians and Gynecologists, the Food and Drug Administration and the American Institute of Ultrasound in Medicine do not recommend these non-medical ultrasounds. The people doing them may not have medical training and may give you wrong or even harmful information.

In a recent consumer update regarding fetal keepsake images, the FDA warns that “In creating fetal keepsake videos, there is no control on how long a single imaging session will last, how many sessions will take place, or whether the ultrasound systems will be operated properly.” And although there is no evidence that ultrasound may cause harm to an unborn baby, there is also no medical benefit to exposing the baby to unnecessary ultrasound waves only for the purposes of keepsake images.

If you are pregnant, talk to your doctor about when to schedule your ultrasound. He or she will be more than happy to give you pictures to take home with you. You can read more about the different types of ultrasound that your provider may recommend, when they are offered, and what information they may be able to provide here.

Pregnancy in women with congenital heart disease

Monday, February 9th, 2015

heart and stethoscopeMost women who have congenital heart disease and decide to get pregnant will have a safe pregnancy with minimal risks. However, there are many factors that may need to be considered. During pregnancy, your heart has much more work to do. It has to beat faster and pump more blood to both the mother and the baby. If you are a woman who has congenital heart disease, then this extra stress on your heart may be a concern. Considering these issues before pregnancy and being prepared for potential complications can help you feel more confident and more in control throughout your pregnancy.

Preconception planning
The most important thing you can do if you are a woman with congenital heart disease is to talk to both your cardiologist and obstetrician before you get pregnant. This will allow you to understand what risks (if any) are involved for your pregnancy. You can also determine if there are any concerns with your heart that need to be fixed prior to pregnancy—for instance, do you need to alter any medications or have any surgical repairs? Doing all of this before pregnancy will allow you to make sure your heart and your overall health is ready for pregnancy.

Some medications carry a risk for birth defects. These include ACE inhibitors and blood thinners. Therefore, if you are taking these medications and want to have a baby, it is important to talk to your doctor about their safety and potential alternatives that may work for you. However, you should never stop taking any medications without your doctor’s approval.

You may also want to meet with a genetic counselor to review the risks of passing congenital heart disease on to your baby. This risk will vary depending on the cause of the heart disease.

Pregnancy
During pregnancy you and your doctors will want to minimize any risks for both you and your baby. You will need to have regular follow-ups with both your obstetrician and cardiologist. It is important that your doctors work together and coordinate your care. Some women will need to be followed by a maternal-fetal medicine specialist (an obstetrician who manages high-risk pregnancies).

Although most women with congenital heart disease have safe pregnancies, symptoms of heart disease can increase, especially during the second and third trimesters when the heart is working much harder. This may mean additional visits to both your cardiologist and obstetrician.

Typically if you have a personal or a family history of congenital heart disease, your obstetrician will offer you a fetal echocardiogram at around 18-20 weeks of pregnancy. This is a specialized ultrasound that allows your doctor to check out the anatomy of your baby’s heart and look for major structural changes. Not all heart defects can be identified through fetal echo though.

Delivery
It may surprise you to learn that most women with congenital heart disease can have a normal vaginal delivery. You and your doctor will want to discuss pain management options and have a plan in place. You may need additional monitoring both during and after delivery. This can include oxygen monitoring as well as EKGs (electrocardiogram—a test that checks for problems with the electrical activity of your heart).

If you have congenital heart disease work with both your obstetrician and cardiologist so that you can have the best outcome possible. As with most chronic medical conditions, planning for your pregnancy will allow you to make informed decisions about what is best for you and your baby.

 

Thinking of getting pregnant? Get your blood pressure checked.

Friday, February 6th, 2015

blood pressureWhen was the last time you had your blood pressure checked? Nearly one in three adults has high blood pressure or hypertension. And yet, many of us do not even know that we have it. High blood pressure can be especially dangerous for both mom and baby during pregnancy. If you have high blood pressure and are thinking about getting pregnant, it is very important that you talk to your health care provider and get it under control as soon as possible.

Blood pressure is the force of the blood pushing against the walls of the arteries (blood vessels that carry oxygen-rich blood to all parts of the body). When the pressure in the arteries becomes too high, it is called high blood pressure or hypertension.

If you are 20 pounds or more overweight or if you have a family history of hypertension, you are at an increased risk to have high blood pressure yourself.

If you do have high blood pressure, there are a few lifestyle changes that you can make to get it under control, and to help prepare your body for pregnancy:
• Eat healthy foods and reduce your intake of salt, cholesterol, and saturated fats
• Exercise regularly
• Get to a healthy weight
• Don’t smoke or drink alcohol.

Not all medications for high blood pressure are safe to continue during pregnancy. If you are taking any prescriptions to manage your hypertension, make sure you discuss them with your doctor. You should never stop taking any medications without talking to your provider first.

About 8 percent of women have problems with high blood pressure during pregnancy. Although most health problems can be managed with regular prenatal care, pregnant women with high blood pressure are more likely than women without high blood pressure to have these complications:
• Low birthweight: when a baby weighs less than 5 pounds, 8 ounces. High blood pressure can narrow blood vessels in the uterus and your baby may not get enough oxygen and nutrients, causing him to grow slowly.
• Premature birth: birth that happens before 37 weeks of pregnancy. A pregnant woman with severe high blood pressure or preeclampsia may need to give birth early to avoid serious health problems for her and her baby.
• Placental abruption: the placenta separates from the wall of the uterus before birth. It can separate partially or completely. If this happens, your baby may not get enough oxygen and nutrients.

Work with your provider before and during your pregnancy to control your blood pressure. Making a few changes now can help you to have a safer, healthier pregnancy.

Depression during pregnancy: what you need to know

Tuesday, August 12th, 2014

sad woman with coffee mugDepression is a serious medical condition. It is an illness that involves the body, mood and thought. It affects the way a person feels about themselves and the way they think about their life. So many people were shocked and saddened by the news about Robin Williams. But unfortunately, depression is far more common than many of us realize. And regrettably, many people still feel that depression is a sign of weakness and do not recognize it as the biological illness that it is.

As many as 1 out of 5 women have symptoms of depression during pregnancy. For some women, these symptoms are severe. Women who have been depressed before they conceive are at a higher risk of experiencing depression during pregnancy than other women.

Signs of depression
Depression is more than just feeling sad or “blue.” There are physical signs as well. Other symptoms include:
• Trouble sleeping
• Sleeping too much
• Lack of interest
• Feelings of guilt
• Loss of energy
• Difficulty concentrating
• Changes in appetite
• Restlessness, agitation or slowed movement
• Thoughts or ideas about suicide

It may be hard to diagnose depression during pregnancy. Some of its symptoms are similar to those normally found in pregnancy. For instance, changes in appetite and trouble sleeping are common when you are pregnant. Other medical conditions have symptoms similar to those of depression. A woman who has anemia or a thyroid problem may lack energy but not be depressed. If you have any of the symptoms listed, talk to your health care provider.

Treatment options
Since depression is a serious medical condition, it poses risks for you and your baby. But a range of treatments are available. These include therapy, support groups and medications.

It is usually best to work with a team of health care professionals including:
• Your prenatal care provide
• A mental health professional, such as a social worker, psychotherapist or psychiatrist
• The provider who will take care of your baby after birth

Together, you and your medical team can decide what is best for you and your baby.

If you are on medication and thinking about getting pregnant, talk to your doctor. You will need to discuss whether you should keep taking the medication, change the medication, gradually reduce the dose or stop taking it altogether.

If you are taking an antidepressant and find that you are pregnant, do not stop taking your medication without first talking to your health care provider. Call him or her as soon as you discover that you are expecting. It may be unhealthy to stop taking an antidepressant suddenly.

If you or someone you know is experiencing any signs of depression, please talk to your health care provider or someone you trust. Help is available and you can feel better.

Click here to read more News Moms Need blog posts on: pregnancy, pre-pregnancy, infant and child care, help for your child with delays or disabilities, and other hot topics.

Group B strep infection

Friday, July 18th, 2014

Between 35-37 weeks of your pregnancy your prenatal care provider will test you for Group B strep. Group B streptococcus (also called Group B strep or GBS) is a common type of bacteria that can cause infection.

Many people carry Group B strep—in fact about 25% of pregnant women are carriers.  GBS bacteria naturally live in the intestines and the urinary and genital tracts. It is not known how GBS is transmitted in adults but you can’t get it from food, water, or things you touch. An adult can’t catch it from another person or from having sex, either.  Most people do not even know they are carriers since adults usually show no signs or symptoms related to GBS.

GBS, however, can be passed to your newborn during labor and delivery and it can make your baby very sick. Babies with a GBS infection may have one or more of these illnesses:

• Meningitis, an infection of the fluid and lining around the brain

• Pneumonia, a lung infection

• Sepsis, a blood infection

According to the CDC, in the US, group B strep is the leading cause of meningitis and sepsis in a newborn’s first week of life.

There are two kinds of GBS infections:

1. Early-onset GBS: Signs like fever, trouble breathing and drowsiness start during the first 7 days of life, usually on the first day. Early-onset GBS can cause pneumonia, sepsis or meningitis. About half of all GBS infections in newborns are early-onset.

2. Late-onset GBS: Signs like coughing or congestion, trouble eating, fever, drowsiness or seizures usually start when your baby is between 7 days and 3 months old. Late-onset GBS can cause sepsis or meningitis.

The good news is that early-onset GBS infection in newborns can be prevented by a simple test. During your third trimester, your provider will take a swab of the vagina and rectum. Results are available in a day or so. This test will need to be done in each pregnancy.

If you do have GBS, then your provider will give you an antibiotic through an IV (medicine given through a tube directly into your bloodstream) during labor and delivery. Usually this is penicillin (if you are allergic to penicillin, there are other options available). Any pregnant woman who had a baby with group B strep disease in the past, or who has had a bladder (urinary tract) infection during this pregnancy caused by group B strep should also receive antibiotics during labor.

Unfortunately late-onset GBS cannot be prevented with IV antibiotics. Late-onset GBS may be due to the mother passing the bacteria to her newborn, but it may also come from another source, which is often unknown.

Treatment for babies infected with either early-onset GBS or late-onset GBS is antibiotics through an IV.

Currently researchers are testing vaccines that will help to prevent GBS infections in both mothers and their babies.

If you have any questions about this topic or other pregnancy and newborn health issues, please email the Pregnancy and Newborn Health Education Center at askus@marchofdimes.org.

Scleroderma and pregnancy

Friday, June 27th, 2014

June is National Scleroderma Awareness Month. Scleroderma is a group of diseases that result in the abnormal growth of connective tissue. Connective tissue is tissue that supports your skin and internal organs, like your kidneys, lungs and heart. Scleroderma is a chronic condition meaning that it lasts for a long time and can affect many aspects of your life.

If you have scleroderma, your body makes too much of a connective tissue protein called collagen. When too much collagen builds up in your body, it causes your skin and connective tissues to get hard or thick. Scleroderma can lead to pain and swelling in your muscles and joints. There are two main kinds of scleroderma: localized and systemic. Both can be mild to severe, with periods of remission (wellness) and flares (illness).

Localized scleroderma only affects certain parts of your body, like your skin, skin tissues and sometimes muscles. Localized scleroderma doesn’t harm major organs and often gets better or goes away over time without treatment. But sometimes it can be severe and cause lasting skin changes.

Systemic scleroderma can affect the whole body, including your skin, tissues, blood vessels and major organs, like your heart, lungs and kidneys.

If you have scleroderma and you’re thinking about getting pregnant,  you should schedule a preconception checkup with your health care provider. If you have localized scleroderma, it may not affect your pregnancy at all. But systemic scleroderma can cause problems with your heart, lungs or kidneys. These complications are most likely to appear during the first three years of scleroderma symptoms, and can cause health difficulties for you and your baby during pregnancy. For this reason, it’s best not to get pregnant during the first three years of symptoms.

If you have systemic scleroderma, you may be more likely than other pregnant women to have:

• Preeclampsia and other kinds of high blood pressure,

• Poor growth in your baby,

• Premature birth,

• Cesarean birth (C-section).

Right now, there is no specific treatment that stops the body from making too much collagen. However, doctors use several types of medication to control the symptoms. But not all of these are safe to use during pregnancy. Some can cause birth defects if a woman takes them while she is pregnant. That is why it is so important to discuss your condition with your doctor before pregnancy.

During pregnancy a woman with scleroderma may be treated by multiple doctors, including a rheumatologist as well as a high-risk obstetrician. Depending on her individual symptoms, a pregnant woman may need to see a few other providers to treat specific complications. Fortunately though, with today’s medical care, many women with scleroderma can have successful pregnancies.

Planning to become a mom

Friday, May 9th, 2014

pregnant womanHopefully we all remember that Mother’s Day is this Sunday. If you aren’t a mom yet, but are thinking of starting a family soon, there are a number of things that you can do to start getting ready. One of the best things you and your partner can do for your baby is to plan ahead. Having a healthy baby begins well before you get pregnant.

More than half of pregnancies in the United States are unplanned. This means that a lot of women get pregnant without really being ready for it. Babies who are planned are more likely to be born healthy than babies who are unplanned. This is because women who plan their pregnancies are more likely to get healthy before pregnancy. And they’re more likely to get early and regular prenatal care during pregnancy. Doing these things can help you have a healthy baby.

One of the most important things that every woman of childbearing age can do is to take a daily multivitamin with 400 micrograms of folic acid. Folic acid is B vitamin that every cell in your body needs for normal growth and development. If all women take 400 micrograms of folic acid every day before getting pregnant and during early pregnancy, it may help reduce the number of pregnancies affected by neural tube defects by up to 70 percent. All women, even if they’re not trying to get pregnant, should take folic acid.

When thinking about future pregnancies you may want to make a reproductive life plan. This means thinking about if and when you want to have a baby. Ask yourself these questions:

  • How many children do I want?
  • How far apart do I want them to be?
  • How can I get healthy before pregnancy?

Talk about your reproductive life plan with your partner. There are no right or wrong answers and your answers may change during different times in your life. The important thing is to really think about your plan and your family before you get pregnant. On our website we give you some things to think about to help you decide whether you are ready to be a parent, both emotionally and financially.

So to all the moms out there, have a Happy Mother’s Day! And for the moms-to-be, remember, it is never too early to start planning!

Fundal height

Friday, January 3rd, 2014

pregnant womanFundal height is defined as the distance from the top of the uterus to the pubic bone. It is measured in centimeters. As your baby grows, the top of the uterus (the fundus) grows up and out of the pelvic cavity.  At about 12 weeks of pregnancy it can be felt just above the pubic bone.  At 20 weeks, it reaches the navel. At about this time, your health care provider will start to measure your fundal height at each prenatal care visit. He or she will measure from the top of your pubic bone to the top of your uterus.  The measurement allows your provider to see how well your baby is growing.

Your fundal height measurement should roughly equal the number of weeks you’ve been pregnant. For example, if you’re 20 weeks pregnant, your health care provider would expect your fundal height to be somewhere between 18-22 centimeters. It isn’t unusual, however, to measure somewhat smaller or larger than expected.  Individual body types and factors such as a full bladder or carrying multiples, can affect fundal height measurements.  Some medical reasons fundal heights may be greater or smaller than expected include:
   • Fetal growth that is too slow or too rapid
   • Too much or too little amniotic fluid
   • Uterine fibroids
   • A baby prematurely descending into the pelvis or settling into a breech or other unusual position

It is important to remember that fundal height is only a tool for evaluating fetal growth.  It is not an exact science. Typically, fundal height measurements reassure you and your provider about your baby’s steady development. However, there are individual variations and no two babies are exactly the same.  So if your measurements are a bit more or less than what you might expect, don’t worry. However, if you are concerned about your fundal height measurements, make sure you talk to your health care provider.  There are other prenatal tests that can be done to assure you that your baby is doing well and growing as he or she should be.

On bedrest? Here are ways to combat boredom

Monday, December 30th, 2013

bedrestIf you’re pregnant and on bedrest, for all or much of your day, you are not alone.  What can you do to still feel productive and connected to the world during this time?Here are some suggestions:

Let things that don’t matter… go! (or get some pixie dust)

It is next to impossible to have your house run as well as if you were not on bedrest… unless of course you have a Fairy Godmother.  But, in the absence of a magic wand or pixie dust, lower your expectations on how clean or orderly your home will be at the moment. Then you won’t stress about what is not done. In other words, cut yourself a break when it comes to how you usually get things done.  You are giving yourself time off. Think of it as “forced relaxation.”  Once your baby is here, these moments will be few and far between.

Misery loves company and virtual hugs

Log on to Share Your Story, the March of Dimes’ online community. There is a thread specifically for pregnant ladies on bedrest. Just “talking” with other women in the same situation will be supportive and comforting. Get your virtual hugs on a daily basis here!

Hello out there!…Stay in touch

A laptop can be a lifesaver. Now is a great time to try and stay in touch with friends whose friendships often fade due to lack of correspondence. Contact every friend that you have who lives out of state or out of the country. Once the baby arrives, keeping up with friends will be harder to do, so getting a jump on it now could be helpful. Then take the next step and put your address book on your computer to create labels for when you mail invitations, baby announcements or holiday cards.

Learn mini moves

Muscles become weak and atrophy (break down) when your body doesn’t move around. It happens very quickly. Ask your doctor if you can have a physical therapist visit you at home and give you some light exercises to do while you are in bed.  No double leg lifts, sit-ups or crunches please. Isometric exercises (where you tighten and release your muscles) may be just what you need. These minimal movements will help to keep some of your muscles from losing strength. Also, soft, gentle stretches and ankle rolls (moving your toes around in circles) will help with leg circulation and swelling. But, don’t take on any movements or exercises without your doc’s nod of approval first. And, remember, once your baby is here, you can gradually get back to your pre-pregnancy strength and body (after your doc gives you the go-ahead).

Work on your recipe collection

If you cut and clip recipes from magazines and have them stuffed into a drawer to organize “one day,” this may be just the right time. You can create a file on your computer and then have someone scan the recipes for you to upload. Then, organize your computer file by food group so you can easily find a recipe when you want it.

Update the baby book

If you have other children and still have not organized their baby books, this could provide you with the disciplined time to get it done. Keep markers, scissors, glue, tape and stapler on your night table and chip away at updating the book a little at a time. You’ll be so glad to have this keepsake to remember every precious milestone and moment.

Although research has not proved that bedrest is effective, it is still a common method of treatment for cervical insufficiency or other pregnancy problems. Many doctors recommend bedrest for conditions like high blood pressure, bleeding or carrying multiples that increase their risk of going into preterm labor. Whatever the reason for your bedrest, hopefully, your bed will become your new command central and your projects will help the time to fly by quickly.

What has worked for you?  We’d love to have you share your survival strategies.