As we follow Yolanda through her pregnancy, she talks about what she is experiencing during weeks 15 through 18. At this stage, the baby is around the size of a pomegranate, and you may be able to tell the sex of the baby. Some symptoms you may be dealing with include leg cramping and swelling of your legs and feet.
Follow our Yolanda throughout her pregnancy as she talks about what she is experiencing. Here she talks about weeks 1 through 14. This is the start of the second trimester, where the pregnant mother may experience an increased appetite, varicose veins, and a stuffy nose.
Stay tuned for the second trimester!
Women with Turner Syndrome (TS) are a distinctive group of women who require specialized medical and obstetrical/gynecological care. TS is found in approximately 1 in 2,500 pregnancies and is the result of the loss or partial loss of an X chromosome. Normally women’s chromosomes are 45XX and with TS it will be 45X. Because of this missing chromosome women with TS can look slightly different and can have an array of possible medical conditions such as:
- cardiovascular disease which could be the result of a congenital anomaly
- abnormal lipids
Pediatricians and pediatric endocrinologists usually follow these patients closely during childhood and adolescence, initiating estrogen to begin puberty and normal development. Conception and pregnancy offer unique conditions which will require individualized intense care by a team of specialists and preconception counseling is a must. Because of the higher risks for various medical conditions, TS patients need to be followed carefully throughout their lives.
The CDC (Centers for Disease Control and Prevention) recently updated its guidelines concerning the testing of pregnant women who have a possible Zika virus infection or exposure. It must always be noted that most people with the Zika virus infection are either asymptomatic or have mild clinical symptoms. Mild clinical symptoms can be an acute onset of a fever, a rash, joint pain, and/or conjunctivitis.
There is new data suggesting that the virus can be detected in the blood and urine for 2 weeks after the infection begins. This testing of the urine and blood for the virus should be performed for:
- Symptomatic pregnant women in less than 2 weeks after the symptoms begin
- Asymptomatic pregnant women in less than 2 weeks after a possible exposure
After this 2-week window, blood testing should begin for the Zika virus IgM antibody, which the body makes in response to a new Zika virus infection. If this is found to be positive, there was definitely an infection and close fetal evaluation should begin.
As always, you should discuss the Zika virus problem with your health care provider so you can get the best possible care.
Let’s look at some Zika virus facts:
At the moment, there are no approved drugs or vaccines for the Zika infection, but scientists are working on a vaccine. Since the infection itself seems to be mild and short-lived, fluids and Tylenol are mostly recommended.
Testing to determine if you have had the virus is mainly confined to pregnant women and symptomatic travelers who have visited the areas where the virus has spread. At this time, testing is done at only a state or federal lab and getting results can take weeks.
3. How It Spreads
The Zika virus is spread by the Aedes aegypti mosquito and through sex with an infected partner. It is important for pregnant women to know the travel history of their sexual partners.
Preventing mosquito bites is the best way to protect yourself from this virus. Use the time-tested methods of bug sprays and cover-ups, and eliminate any standing water where mosquitoes can lay eggs. You should check your window screens and keep the air conditioners on if possible because mosquitoes hate the cold.
Today, the Zika virus is on the mind of almost everyone; pictures of the children affected by the virus are seen constantly in the news. Beginning today, I will try to keep us up to date on the latest information available.
The virus is named after the Zika Forest in Uganda, Africa, where it was first discovered in the late 1940s. Since then it was not considered to be a major problem because it usually caused mild flu symptoms, which soon passed rather quickly. Then last year’s reports came from Brazil about a major invasion of the virus. There were pictures of the many affected newborns that had been infected, and the resulting congenital microcephaly was seen everywhere.
Why is this virus now causing all these problems? Where has it been the last 60-70 years? Some experts believe the virus has mutated, and some think it has always been there, but was quietly going unnoticed.
As the summer approaches and the mosquitoes return, the Zika virus will certainly be a concern in the mainland of our country. Puerto Rico already reported about a 1000 confirmed cases, including approximately 100 pregnant women. With the travel season upon us, the numbers of our family and friends who will be exposed to the virus is staggering, so being aware of the latest information is paramount in our quest to be safe.
Depression and anxiety disorders are a common problem found in pregnant women, with about 10-15% of these women taking a class of medications known as SSRIs (selective serotonin reuptake inhibitors). Prozac and Paxil are two of the medications found in this group. Studies of the children who had been exposed to these medications while in utero have been mixed in their findings.
There is now a new study out of Finland which may shed some new light. It is published in the Journal of the American Academy of Child and Adolescent Psychiatry. The findings showed that the adolescents of women, who took SSRIs during pregnancy, had about 4 times the chance of becoming depressed by the age of 15, as compared to the children of women who suffered anxiety/depressive disorders and did not take the medications during their pregnancy.
I encourage all women who receive prescriptions for SSRIs to discuss with their health care providers the risks and benefits of these medications during pregnancy, before becoming pregnant. It is better to have a plan of care so you can have the best pregnancy for you and your baby.
If you are considering pregnancy or are already pregnant, here are a few of the medications you should not be taking:
- Benzodiazepine sedatives: these are medications used to help anxiety and insomnia; Xanax and Ativan are two of this class
- Statins: used to decrease cholesterol; Lipitor and Crestor are in this class
- Non-contraceptive estrogens
- Warfarin derivatives: anticoagulants (blood thinners)
- Iodinated glycerol: an expectorant
- Vitamin A preparations
- Misoprostol: used to decrease the chance of ulcers when using nonsteroidal anti-inflammatory medications
- Isotretinoin: for acne; Acutane is in this class
Of course this is not the complete list of medications you should not be taking when you are pregnant or considering a pregnancy. Always remember to review all of your medications with your health care provider when pregnancy is part of your plans. If a medication is needed, the safest medication or other form of treatment will be part of that discussion.
We all know that cigarette smoking is a health hazard. In pregnancy, smoking spreads that hazard to the baby as well as the mom. The CDC (Centers for Disease Control and Prevention) provides us with the following information:
- It is reported that 10% of women smoke during the last 3 months of pregnancy
- 50% of women who smoke before a pregnancy will quit during the pregnancy
- 50% of women who stopped smoking during a pregnancy will go back to smoking after their baby is born
- Smoking increases the difficulty to become pregnant
- Smoking increases the risk of spontaneous miscarriages
- Smoking also increases the risk of a premature birth
- This action increases nicotine and decreases oxygen to the developing fetus
- The baby’s placenta may not work as well in mothers who smoke
- Smoking increases the risk of certain birth defects, including cleft lip and cleft palate
If you smoke, please try to stop for your health and the health of your baby.
About 5% of all women have a uterine fibroid and this is the most common of the noncancerous gynecological tumors. Since fibroids can increase risks during a pregnancy, the health care provider follows a pregnant woman with fibroids carefully.
One of the complications can be that the baby is in a position other than head-down near the time of delivery. This can affect the type of delivery advised. Other possible complications associated with fibroids and pregnancy can be pain, preterm delivery, premature rupture of the membranes, and other difficulties.
Because of the great hormonal changes during pregnancy, fibroids can shrink or grow at this time. The changes occur mostly in the first 3 months of the pregnancy. More pregnancy complications have been found when a fibroid is larger than 10 cm.
If you have fibroids and are pregnant, start early discussions with your health care providers about the risks to be concerned about and how is the best way to be followed during your pregnancy.
Over the past 50 years, more women are delaying childbirth for many reasons. Now obstetrical teams are seeing an increase in first births for women aged 40 to 44. Pregnancies can progress beautifully with these women but increased risks have been associated with later motherhood. Some of these risks include:
- Abnormal fetal chromosomes
- Diabetes during the pregnancy
- High blood pressure before and during the pregnancy
- Preterm labor and delivery
- Increased chance of twins
The age of the father is also of concern here. Advanced paternal age is often thought of as being 40 or older at the time of conception. There are studies suggesting that advanced paternal age can be associated with a higher risk for autism spectrum disorders and some gene abnormalities.
If you or your partner is in this age group and are considering a pregnancy, begin a discussion with your health care provider.
The Food and Drug Administration of the United States has recently drafted new guidelines, reassuring pregnant women and nursing mothers that they should include more seafood in their diets. This is because the health benefits far outweigh the risk of the mercury content.
The new suggestions advise eating 8 to 12 ounces of seafood a week, which means 2 to 3 meals per week. The FDA also suggests that young children should also be eating fish 2 to 3 times per week in portions that are appropriate for their age.
Some important facts:
- Fish are loaded with the types of omega-3 fatty acids that are high in DHA, which is important in brain and eye development.
- The FDA suggests that women and children should consume fish low in mercury. These include canned light tuna, salmon, tilapia, catfish, cod, shrimp, and pollock.
- Four fish to avoid because of their high levels of mercury include shark, swordfish, tilefish from the Gulf of Mexico, and king mackerel.
- Almost all fish contain trace amounts of mercury. Mercury in high amounts can harm the brain and nervous system.
…..This testing is supported by the professional societies, including the American College of Obstetrics and Gynecology. It is not a testing program that is offered to all pregnant women at this time, and there are certain indications for considering this program. Now in what circumstances should it be considered? Here are some:
- If the mother’s age will be 35 years or older at the baby’s birth
- Abnormal sonographic findings of the fetus that may point to an increased risk of fetal chromosome abnormalities
- History of a past pregnancy with chromosomal abnormalities
- Abnormal testing results in the current pregnancy that suggest chromosomal problems
…..The testing is a simple blood test of the mother, and it can be taken in the first or second trimester and as early as 10 weeks gestation. It does not replace chorionic villus sampling (CVS) or amniocentesis, and these are the tests to consider if there is a positive non-invasive test result.
…..If there is a positive result, genetic counseling is the next step, and probably the invasive tests will be offered. Also, remember that this test is intended to detect trisomy 21, 18, and 13, and to give information about the X and Y chromosome. It does not eliminate the chance of other chromosome problems that may be present.
.….It is time to bring up the flu vaccine again! October is the start of the flu season, and it can run all the way into the spring. The flu vaccines are available now, and remember, it takes about two weeks to produce the protective antibodies after receiving the vaccine.
…..Pregnant women who get the flu have an increased risk to develop serious complications from the infection, resulting in hospitalizations. Also, with the new moms’ vaccinations, protection is also increased for their infants who are susceptible to influenza-related respiratory illnesses. Let us review a couple of points:
- In the past there was concern about trace amounts of a preservative called thimerosal, which was in some flu vaccines. There are thimerosal-free vaccines now, and the U.S. Centers for Disease Control and Prevention have concluded that the thimerosal used in the vaccine is safe.
- Patients with egg allergies need to discuss this with their medical practitioner before receiving the vaccine.
…..Over the past few years, more pregnant women have received the flu vaccine, with the percentage reaching about 50%. Let us try to raise that number this year and get better protection all around!
…..For more information, view two of my other posts about the flu: Why Should You Get a Flu Shot Each Year? and The Concern of Getting the Flu Shot During Pregnancy – FAQs Answered
…..Morning sickness is a common problem affecting many women during early pregnancy. To try to help with the symptoms, most medical professionals will advise eating several small meals during the day, eating low fat, bland foods, and trying to avoid smells that seem to increase the nausea. Over my many years in practice, I often also advised popcorn, the insides of Italian bread, and ginger pops.
…..If this conservative management does not help, there is a recent FDA (U.S. Food and Drug Administration) approved treatment that may be of help. Diclegis is the first medicine approved for this problem in over 25 years. This combination of two substances was marketed many years ago as Bendectin, and it was removed from the market after a safety scare that was proved to be a false alarm. However, the manufacturer stopped producing it because defending it in court was too costly.
…..Diclegis is a combination of two active ingredients, doxylamine and vitamin B6, and the FDA has granted Diclegis a Pregnancy Category A status, meaning that controlled studies have not shown an increased risk to an unborn baby during pregnancy. For the past few years, the American College of Obstetricians and Gynecologists has recommended this combination as a first-line treatment for morning sickness.
…..There is a set protocol on how to start and use Diclegis. Drowsiness and sleepiness are the most common adverse effects reported by users. These symptoms can be severe, so great caution is necessary. As with all medications, you must have a thorough discussion with your health care provider before entertaining the use of this or any medication.
- Pregnant women should receive the Tdap vaccine with each pregnancy, and the ideal timing is during 27 to 36 weeks of the pregnancy.
- With the preceding plan, there is an increased likelihood of optimal protection against pertussis for the pregnant woman and her infant during the first few months of the baby’s life.
- All women during each pregnancy should receive the vaccine whether or not she has received the vaccine in the past.
- If the pregnant woman has not received the vaccine during the pregnancy, it should be administered immediately after delivery.
- To date there is no data to suggest increased fetal, maternal, or pregnancy risks with the vaccine, but the safety should be closely monitored under the direction of the Food and Drug Administration.
- Although not part of the new immunization schedule recommendations, experts are advising vaccinations for the new baby’s father, siblings, and other caretakers. This is part of the cocooning strategy. Even grandma and grandpa should consider vaccination.
…..As always, discuss all your concerns with your caring medical professional so you can obtain the best care possible for you and your family!
…..Alcohol is a teratogen! A teratogen is a drug or any other substance that can affect the development of an embryo and can lead to birth defects or other developmental problems. Fetal alcohol syndrome (FAS) is a constellation of physical, behavioral, and cognitive abnormalities in children resulting from a mother drinking alcohol during a pregnancy.
…..The Centers for Disease Control and Prevention report that the rates for FAS in the United States range from 0.2 to 2 cases per 1000 live births. A less severe form of this problem, called fetal alcohol spectrum disorders (FASD), might be 3 times this rate.
…..There is always the question about how much alcohol will cause a problem. Will low levels of alcohol consumption during pregnancy cause harm? What do low levels of alcohol mean? Will a small amount be OK?
…..It is important to remind ourselves that FAS and FASD are entirely preventable. These syndromes are not seen if a pregnant woman does not drink alcohol during her pregnancy. It is for this reason that the Surgeon General of the U.S. and the American College of Obstetricians and Gynecologists direct health care clinicians to advise patients to abstain from alcohol completely during pregnancy.
…..Obstetrical health professionals have always told their patients that regular, moderate exercise during pregnancy is beneficial and safe for both the mother and fetus. It is generally agreed that exercise can reduce the common discomforts of pregnancy. Exercise may even help decrease the risks of gestational diabetes and even preeclampsia.
…..The Department of Health and Human Services recommends 2 1/2 hours of moderate aerobic exercise per week. I have always suggested walking a 1/2 hour daily while trying not to get overheated or out of breath. If you are able to carry on a regular conversation during your walk, then you are probably not overdoing it. The problem is not knowing how much is overdoing it, and the guidelines are vague.
…..Should elite athletes continue vigorous programs during their pregnancy? Should overweight or inactive women begin some exercise regime during their pregnancy? Once again, relating to these questions, the problem is that detailed studies with direct answers are scarce.
…..However, new studies are now being undertaken at the Johns Hopkins Bayview Medical Center that may give some direct answers. Recently, two articles were published from their program which showed that even inactive healthy women can exercise moderately during their pregnancy without problems. They also showed that athletes may continue vigorous exercise safely. Their very scientific research continues, and finally, we may have the answers for our patients.
…..Lastly, common sense should always be used: pregnancy is not the time to begin activities that may increase your risk of injury. That means no kickboxing!
When a pregnant woman “breaks her water” usually it is the start of an exciting time of her pregnancy because labor has started or is about to begin. This is fine if the pregnancy is near the due date, but if the water breaks and the pregnancy is not near the due date, then there is a problem. Preterm premature rupture of membranes (PPROM) is a bad problem and is a leading factor in premature births.
- About 12% of births in the US are preterm
- Most pregnancies last about 40 weeks
- Babies born between 32 and 37 weeks are considered preterm, and babies born before 32 weeks are considered early preterm
- About 5% of births in the US are complicated by PPROM
Since the most common outcome of PPROM is delivery of the baby within 1 week of the water breaking, information about this potential complication must be available to everyone.
…..The decision to use any medication during a pregnancy is always made with great care after thorough evaluation by the patient and her health care providers. Selective serotonin reuptake inhibitor (SSRI) use during pregnancy has always been controversial and now even more so due to recent articles on the subject. Here are some important points:
- Depression and anxiety are common in women of childbearing age, and many of these women are being treated successfully with medications, especially the SSRIs.
- Stopping any antidepressant medication before or during a pregnancy can bring about a depressive relapse, especially in women with a history of severe depression.
- Fetal and maternal well-being is paramount in balancing the risks and benefits of antidepressant treatment in pregnancies.
- SSRIs seem to work by boosting serotonin levels in the brain, resulting in mood regulation.
- Prozac (fluoxetine) was the first SSRI antidepressant approved by the FDA, hitting the market in 1988. It quickly became one of the most prescribed medications in the United States.
- Prozac, Celexa (citalopram), and Zoloft (sertraline) are three SSRIs that have been used in pregnancies.
…..Let us end our review of vaginal bleeding in early pregnancy with a few points:
- Early pregnancy bleeding often stops on its own, and the cause is not always determined.
- Vaginal bleeding is a common problem, and observing vaginal sonograms and hCG blood levels is helpful to determine the cause of the bleeding and to assess the chance of a successful pregnancy.
- If the bleeding continues past the third month of the pregnancy, there is an increased chance of problems later on in the pregnancy, such as early rupture of the membranes and preterm (early) delivery.
- This type of bleeding is a cause of great fear and anxiety for a couple, and emotional support from the medical team, family, and friends is imperative!
…..Over the last 30 years, ultrasound has changed dramatically in how we evaluate early pregnancy. Transvaginal sonography has allowed us to assess early gestation with better clarity.
…..The gestational sac is the first visible sign of a normal
intrauterine pregnancy. This should be seen with the transvaginal sonogram by 5 weeks after the last menstrual period. The earliest embryonic structure is the yolk sac, and likewise, this can be seen as early as the end of the 5th week. Evaluating the yolk sac is important because it can point to problems in a pregnancy. If it is not present at this early time, or if the shape is irregular or large, this can be the first sign of a nonviable pregnancy.
…..Near the 6th week from the last menstrual period, the embryo should be seen attached to the yolk sac, and fetal heart activity should be noted between the 6th and 7th week. When the gestational sac is approximately 2 cm, an embryo should be seen, and if it is not identified at this time, a blighted ovum is confirmed.
…..There are specific sonographic signs of a problem pregnancy:
- A small gestational sac around the embryo
- If the embryo does not increase in size by 1 mm per day
- A fetal heart beat at a rate of less than 120 beats per minute after 7 weeks of gestation.
…..Let us end this review on a positive note. If a patient has no abnormal symptoms, normal fetal heart activity, and 7 weeks of gestation has been reached, then there is a 99% chance of a successful pregnancy.
…..The embryo produces a hormone called hCG very early in the pregnancy, and later the placenta also produces this hormone. Repeating or checking the levels of the hCG every 2 to 3 days is helpful when trying to assess the viability of an early pregnancy and to see if it is normal. At a certain hCG level (between 1200 to 1500), a pregnancy should be visualized by a transvaginal sonographic exam. When serial hormone levels are being followed, it is important to use the same laboratory or else there may be different test kits used at the specific lab, and so the results may not be accurate.
…..The hCG level should have a minimum rise of 50% every 2 days, and some practitioners consider a rise of 66% to better reflect a normal pregnancy. I was taught that the levels should double every 3 days, and this is the formula I have always used.
…..All pregnancies are different, and there is some variability in the rise of hCG in normal pregnancies. There are also some specific circumstances that affect this hormone’s levels:
- If the woman is dehydrated when a test is taken, and on the repeat test she drinks more, the test can be affected
- The level of hCG, which rises so dramatically early in the pregnancy, will begin to level off at about 8 weeks
- In twins and other multiple pregnancies, the numbers can have great variability especially if there is a problem with one of the pregnancies
…..I would like to begin a review of one of the most common complications of early pregnancy, vaginal bleeding. This is the number one reason patients will have an emergency visit in the first trimester, and it is a cause of great anxiety to patients and their families. There are a few important facts you should be aware of:
- About 15% of recognized pregnancies will end in miscarriage
- 80% of miscarriages occur in the first trimester
- Trauma, smoking, excessive alcohol use, and advanced maternal age increase the risk of first trimester bleeding
- 25% of pregnant women will report first trimester bleeding or spotting
- 8% of pregnant women report heavy vaginal bleeding
- Of the patients who report bleeding, 75% will have 1 episode, 20% will have 2 episodes, and 10% will have 3 or greater episodes
- The amount of bleeding is the most significant predictor of an impending miscarriage
- Again, advanced maternal age is a significant risk factor for first trimester bleeding and subsequent miscarriage; 50% of pregnancies in women over 40 result in a miscarriage, with abnormal chromosomes in the fetus being a primary factor
- For women under the age of 35, the rate of a spontaneous miscarriage is 2%.
…..Let me give you some information to cover some of the questions that patients frequently ask. This information is from the American College of Obstetrics and Gynecology, the American Medical Association, and the Society for Maternal-Fetal Medicine. It is from the form given to obstetricians to give to their patients.
…..If you get vaccinated during your pregnancy, your unborn starts to get some protection during this period. This also gives the newborn a degree of protection in the first few months of life when their vaccinations have not been begun.
…..Safety, of course, is the main concern of all mothers. Flu vaccines have been given safely to millions of pregnant women for more than 50 years and are endorsed by the above medical societies.
…..The question of mercury in some of the vaccines is always a concern. Thimerosal, a type of mercury, is a type of preservative used in trace amounts in some vaccines and has not been shown to be harmful to a pregnant woman or her unborn child. Also, it does not cause autism. Again, this is from the above mentioned medical societies. Remember, if you are still concerned about being given preservatives during your pregnancy, there are single-dose flu vaccines that are mercury-free, so speak to your medical professional.
…..Lastly, you must begin the discussion about the flu vaccine with your caregiver now. Ask all your questions, become informed, and let us all be protected… and you cannot get the flu from the flu vaccine!
…..The influenza vaccine comes in two types:
- Inactivated, or killed vaccine, which is given by injection with a needle
- Live, or attenuated (weakened) vaccine, which is sprayed into the nostril
…..The influenza viruses are always changing, and so each year scientists try to determine which viruses are going to cause the flu that year. In other words, a new vaccine is put together each year to prevent the flu for that season. It is for this reason that an annual vaccination is recommended. After a person receives the vaccine injection, it takes about two weeks for the protection to develop, and the protection lasts for about a year.
…..Some inactivated influenza vaccines contain a preservative called thimerosal while some vaccines are thimerosal-free. This has been a concern for many, but it has been shown not to be harmful to a pregnant woman or her baby, according to the American College of Obstetrics and Gynecology.
…..The U.S. Department of Health and Human Services recommends that all people 6 months of age and older should get the flu vaccine. Vaccination is especially important for people at a higher risk of severe influenza, including their close contacts. Some of these close contacts can be healthcare workers and children younger than 6 months.
…..You should get the vaccine as soon as it is available for the new season. Even though most influenza occurs from October through May, the flu season can occasionally come earlier, so get the protection as early as possible.
…..A few days ago, the influenza vaccine for the 2012-2013 flu season arrived in my office. In the United States, this season is considered to be October through May. We have already begun to arrange the vaccination for all of our pregnant patients. As a result, it seems to be the appropriate time to have our review of influenza immunization during pregnancy.
…..The American College of Obstetricians and Gynecologists recommends that every pregnant and non-pregnant woman receive an inactivated influenza vaccine. It appears that the most effective way to increase the influenza immunization rates among pregnant women is for the physicians to directly recommend the flu shot to patients. The live, attenuated influenza vaccine is contraindicated for pregnant women, but the inadvertent vaccination of a pregnant woman with the live vaccine has not been shown to be harmful. Therefore it is not an indication for pregnancy termination.
…..Why should we get vaccinated? Influenza, the flu, is a contagious disease caused by the influenza virus, which can be spread by coughing, sneezing, or with nasal secretions. Anyone can get the flu, but the rates of infection are highest among children.
…..The symptoms usually last only a few days and include fever, chills, cough, sore throat, headache, muscle aches, runny nose, and fatigue. Young children, older people, pregnant women, and people with medical conditions that have them in a weakened state can become much sicker and need to be hospitalized. So by taking the flu shot you can protect yourself and those around you.