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"The art of mothering is to teach the art of living to children."
--Elain Heffner
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| Top Questions about Common Pregnancy Problems |
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Here are some of the common pregnancy questions I get about normal and high-risk pregnancy. If you have an idea for a top pregnancy question, email it out to me!
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Am I gaining too much/ too little weight?
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| Women are obsessed with their weight. Pregnancy greatly exacerbates this preoccupation. And we, as physicians, only fuel this, as the first thing you do when you enter our office is hop up on our scale! Extremes of weight are important factors that can complicate pregnancy, however the vast majority of women do not fall into these extremes.
Truly, when it comes to maternal weight and optimizing pregnancy outcome, the more important topic is prepregnancy weight. If you are considering pregnancy and are overweight or obese consider the following facts:
Complications of Obesity and Pregnancy:
-- decreased fertility.
-- increased blood pressure disorders of pregnancy.
-- increased diabetes.
-- increased birth defects when mom's have underlying diabetes.
-- increased miscarriage rates when mom's have diabetes.
-- increased rates of abnormal labor patterns.
-- increased rates of abnormally large babies.
-- increased rates of Cesarean delivery.
-- increased rates of intrauterine fetal demise.
-- increaed rate of Neonatal Intensive Care Unit Admission.
Therefore, if you are overweight or obese strongly consider a period of weight loss prior to conceiving to improve your chances for a healthy pregnancy and baby.
During pregnancy there are established guidelines for optimal weight gain depending upon initial weight classification:
underweight: at least 25 lbs
normal weight: 10-22 lbs
overweight: less than 20 lbs
obese: less than 13 lbs
We all know the benefits of a well-balanced, nutritious diet. In general, pregnant women are more likely to feel better when they eat 4-5 smaller meals daily, especially into the second and third trimester. Sweets and other empty calories should be taken in moderate amounts, despite cravings!
If you are not gaining what you feel to be an appropriate amount of weight, generally there is little to be concerned with, especially early in your pregnancy. You will want to have your fundal height, or uterine size, watched closely by your physician. If there is a size discrepancy, an ultrasound would be indicated to examine the fetus and the amount of amniotic fluid.
Several reasons may be considered if you are gaining too much weight. If early in pregnancy, and you haven't had an ultrasound, you may have twins. Pregnancy in definitely associated with increased cravings, so be cautious. Start by monitoring your diet. In latter stages of pregnancy, you may be gaining weight because of excess fluid retention. Although normal in most pregnancies, this can be a sign of a serious blood pressure disorder so consult your physician. You may be diabetic, which has very important implications for the pregnancy and the delivery.
Generally speaking, women gain weight differently during pregnancy. Babies are excellent thieves and are quite good at stealing what they need! Watch your diet, eat healthy choices, and try not to fixate on numbers.
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I have developed diabetes. What does this mean, and will I always be diabetic?
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Diabetes is one of the most common pregnancy problems, complicating about 5% of pregnancies. The most common risk factors are obesity, ethnicity, family history and personal history of gestational diabetes. There are three types of diabetes that can complicate pregnancy: Type I where the pancreas stops making insulin, which is almost always diagnosed before the pregnancy, and which is a life-long condition. Type II which can be diagnosed for the first time in pregnancy, especially if found early in the pregnancy. This type is directly related to maternal weight, and a strict diet can be enough to manage. Often,however, medical management is required. This type is also a life-long condition, though with adequate diet and exercise it can be managed without medicine in many patients. Finally, gestational diabetes develops, and is exlusively related, to the pregnancy. Specifically, placental hormones fight to keep maternal sugars in the high range, and for some women they cannot keep this in check. Diet is enough for most patients, though some may need medication like glyburide or insulin.
Diabetes can have several implications on the pregnancy. Underlying Type I and Type II diabetes does increase the rate of birth defects and miscarriages, depending on the level of sugar control. Fetuses of diabetics can exhibit the extremes of growth. Often they are very large which has clear implications on delivery trauma to mom and baby. Sometimes, especially if mom has had diabetes for many years, fetuses can actually be dangerously small. For this reason, diabetic patients should undergo intensive ultrasound evalutions during their pregnancies. Finally, when moms have uncontrolled diabetes, with extreme fluctuations in their sugar levels, this can be very dangerous for the baby late in pregnancy and after delivery. Stillbirth rates are increased in these patients, and close surveillence would be warrented, as well as early delivery in some cases.
After the baby is born, women with Type I and Type II diabetes should continue to monitor and manage their sugars. Most women with gestational diabetes will normalize after the delivery of the placenta, entering a "honeymoon" period that can last several years. In a study with up to 28 year follow-up, 50% of women with gestational diabetes will develop Type II diabetes (O'Sullivan JB, 1984).
http://AskAnOB.com/pregnancycomplications/gestationaldiabetes.html
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I am of "Advanced Maternal Age" or, over age 35. I know this is associated with some birth defects. Can you explain?
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It has been well-known for centuries that certain fetal conditions are directly related to maternal age. Specifically, major chromosome disorders, such as Down syndrome, are much more likely to occur the older a woman is when she gets pregnant. Down Syndrome is caused when a fetus inherits an extra chromosome 21. A fetus should get one copy of each chromosome from mom, and one from dad. However, sometimes the maternal egg retains two copies of a chromosome so the fetus ends up with three total. This event is what causes Downs Syndrome, or Trisomy 21. Similar conditions, such as Trisomy 18 and Trisomy 13, are also related to maternal age, but these are much more severe disorders that usually result in the death of the neonate. The reason these conditions are related to maternal age is because women are born with their eggs. Men make new sperm constantly, so sperm do no sit around for 30+ years waiting to make a baby!
Doctors often use a cut-off of 35 years to discuss maternal age and these disorders. There is nothing magical about your 35th birthday that suddenly makes you susceptible to these conditions. In fact, 82% of babies with Trisomy 21 are born to women under 35 years (largely because they have so many more pregnancies and they are less likely to be diagnosed prenatally). But there is a logical reason why this age has been used. It used to be that age was the only factor that was helpful to physicians in establishing a risk for a chromosome disorder. The only way to diagose a chromosome disorder with certainty is an amniocentesis, which is invasive and 1: 250 women who undergo this procedure will lose their pregnancy as a result of complications. At 35 years, the risk of Down Syndrom is about 1 :280 and the risk of the amniocentesis is very similar, so at this age, without any additional information, you would be more likely to diagnose Down Syndrome, than lose pregnancy because of the procedure.
Currently, we have improved ways to establish a baseline risk for moms, other than just using their age. Now we are able to use nuchal translucency (see image at top right), first trimester blood markers, second trimester blood markers, and second trimester ultrasound markers to adjust a woman's baseline risk for a chromosome disorder in her fetus. This may influence whether she would opt to undergo an invasive procedure. Therefore these have become extremely common and important tests.
See below for more information on nuchal translucency and first trimester screening.
These are wonderful topics to email me about, because they are highly individualized and can be quite confusing!
www.AskAnOB.com/DownSyndromeScreening
www.AskAnOB.com/nuchaltranslucency
www.AskAnOB.com/recentadvances/amniocentesis
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Can I still have sex during pregnancy?
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Unless you have certain conditions, you can continue to have sexual intercourse in pregnancy. Those conditions would include: premature rupture of membranes, a short cervix, cerclage placement or significant preterm labor. You may notice that you feel more contractions after having intercourse, especially if you have an orgasm, but this is natural and is not labor. Because semen is filled with prostaglandins, and prostaglandins are what your Obstetrician uses to initiate labor, there is a theoretical risk the intercourse without a condom may stimulate the labor process. In fact, most women who go beyond their due date will hear this from everyone they pass on the street! Nonetheless, unless you are at a significantly high risk for this complication, intercourse is fine in pregnancy.
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Have an idea for "Top Pregnancy Questions?"
Email it out to us today at: info@AskAnOB.com
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