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.
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.
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.
…..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!