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Asthma
Most women with asthma can have safe pregnancies. If you have had severe asthma attacks before pregnancy, you may have them during pregnancy. Usually you can use the medication you are accustomed to, but discuss the matter with your doctor.
Many women feel better and have fewer problems with their asthma if they increase their fluid intake during pregnancy. Try it you should increase your fluid intake during pregnancy anyway.
Cytomegalovirus
Cytomegalovirus (CMV) is a member of the herpes-virus family and is transmitted in humans by contact with saliva or urine. Day-care centers are a common source of the infection; CMV can also be passed by sexual contact. Most infections do not cause symptoms; however, when symptoms occur, they include fever, sore throat and joint pain.
CMV can affect a developing baby, causing low birth weight, developmental problems, jaundice, enlarged liver, enlarged spleen and anemia.
Diarrhea during Pregnancy
Diarrhea during pregnancy can raise concerns. If it doesn't go away in 24 hours, or if it keeps returning, contact your doctor. He or she may prescribe medication for the problem. Do not take medication for diarrhea without discussing it with your doctor first.
One of the best things you can do for yourself if you experience diarrhea during pregnancy is to increase your fluid intake. Drink a lot of water, juice and other clear fluids, such as broth. (Avoid apple juice and prune juice because they are laxatives.) You may be happier eating a bland diet, without solid foods, until you feel better.
It's OK to avoid solid food for a few days if you keep up your fluid intake. Solid foods may actually cause you more gastrointestinal distress when you have diarrhea. Avoid milk products while you have diarrhea; they can also make it worse.
Epilepsy
Epilepsy can be a serious problem during pregnancy. If you suffer from the disease and become pregnant, call your doctor immediately. Most medication to control seizures can be taken during pregnancy; however, some medications are safer than others.
Dilantin is not recommended during pregnancy because it can cause birth defects. Phenobarbital is often used to control seizures during pregnancy, but some people have expressed concern about its safety. In pregnancy, phenobarbital is used mainly to prevent seizures in women with a history of seizures or at the end of pregnancy to treat pre-eclampsia (toxemia) and to prevent seizures. If you take phenobarbital, do not stop taking it without first checking with your physician. In most cases, doctors will administer the lowest possible amount of phenobarbital to control seizures during pregnancy. Discuss this important issue with your doctor as soon as possible.
Fever
Fever often accompanies illness. A fever, especially a high one, can be serious because your baby relies on you for its temperature control. A prolonged high fever, especially in the 1 st trimester, may affect a developing fetus and cause arm or leg defects.
To bring down a high fever, drink lots of liquids (1 pint of fluid a day for every degree above 98.6F [37C]), take acetaminophen (Tylenol) and dress appropriately to help you cool down. If your doctor prescribes medication for an infection or other illness that may be causing the fever, take it as prescribed.
Fifth Disease (Parvovirus 19)
Fifth disease, also called parvovirus 19, received its name because it was the fifth disease to be associated with a certain kind of rash. Fifth disease is a mild, moderately contagious airborne infection that spreads easily through groups, such as classrooms or day-care centers.
The rash looks like skin reddened by a slap. Reddening fades and recurs and can last from 2 to 34 days. There is no treatment for fifth disease, but it is important to distinguish it from rubella, especially if you are pregnant.
This virus is dangerous during pregnancy because it interferes with the production of red blood cells. If you believe you have been exposed to fifth disease during your pregnancy, call your doctor. A blood test will determine whether you had the virus before. If you have, you are immune. If you have not, your doctor can monitor you to detect fetal problems. He may be able to deal with some fetal problems before the baby is born.
Group-B Streptococcus Infection
Group-B streptococcus (GBS) infection is found in 15 to 35% of all healthy women. GBS in a pregnant woman does not affect the growing fetus, but it is the most common cause of life-threatening infections in newborns. The infection is transmitted to the baby during delivery. GBS can be transmitted from person to person by sexual contact, but it is not considered an STD. It is found in the mouth or lower digestive tract, urinary tract or reproductive organs. In women, GBS is most often found in the vagina or rectum. Most often, if you have GBS in your system, you won't have any symptoms.
We do not have an ideal screening test for GBS, but your doctor may recommend taking a swab of your vagina or rectum toward the end of your pregnancy. The cultured test identifies 90% of all women who will carry the bacteria at the time of birth. (Faster tests that can be used during labor to detect GBS are not as accurate.)
If you become high risk during labor because of your symptoms or if you have had GBS recently or in the past, your doctor tests you at that time. He may administer antibiotics to help prevent transmission of the bacteria to your baby.
Hepatitis
Hepatitis, a viral infection of the liver, is one of the most serious infections that can occur during pregnancy. Your doctor will probably test you for hepatitis antibodies at the beginning of your pregnancy. Hepatitis B is responsible for nearly half the cases of hepatitis in North America. It is transmitted by sexual contact and the reuse of intravenous needles. A woman with hepatitis may experience flulike symptoms, nausea and pain in the liver area or upperright abdomen. The person may appear yellow or jaundiced, and urine may be darker than normal. This form of hepatitis can be transmitted to the baby during birth or while breastfeeding.
If a mother tests positive for hepatitis during pregnancy, the baby may receive immune globulin to treat hepatitis after birth. This is different from the hepatitis vaccine. Hepatitis vaccine is given to prevent hepatitis from occurring. It is now recommended that all newborns receive hepatitis vaccine shortly after birth. Ask your pediatrician if the vaccine is available in your area.
Lyme Disease
Lyme disease is an infection carried and transmitted to humans by ticks, and it crosses the placenta. Complications include preterm labor, fetal death or a rash like illness in the newborn.
The disease appears in stages. In most people, a skin lesion with a distinctive look, called a bull's-eye, appears at the site of the bite. Flulike symptoms appear next, and 4 to 6 weeks later, heart or neurological problems may develop. Arthritis may be a problem much later.
Treatment for Lyme disease includes long-term antibiotic therapy. Many medications used to treat Lyme disease are safe to use during pregnancy.
To avoid exposure to Lyme disease, avoid places that are known to have ticks, such as heavily wooded areas. If you can't avoid these areas, wear long-sleeved shirts, long pants, socks and boots or closed shoes. Keep your head and hair covered with a hat or scarf Check your hair for ticks; they often attach to the hair or scalp.
Rubella (German Measles)
Rubella is a viral infection that causes few problems in a non pregnant woman. It is more serious during pregnancy, especially in the 1 st trimester. There may be no symptoms, or you may have a rash (most common) or flu like symptoms. Rubella infection in a mother to be can increase the rate of miscarriage and cause malformations in the baby, especially heart defects.
One of the blood tests you have at your first or second prenatal visit is a rubella titer. It determines whether you have been vaccinated against rubella or if you previously contracted the disease. Most women have had rubella, but if you haven't, you will be vaccinated after pregnancy to safeguard you in the future.
Sickle Cell Anemia
Sickle cell anemia occurs when a person's bone marrow makes abnormal red blood cells. It occurs most often in people of African and Mediterranean descent.
Sickle cell anemia can cause anemia during pregnancy (see page 54). It can cause abrupt pain in the abdomen or limbs of the pregnant woman, called a sickle crisis. (A sickle crisis can happen at any time in a woman's lifetime, not just during pregnancy.) In addition to a painful sickle crisis, the pregnant woman may suffer from infections more frequently and may even have congestive heart failure. Risks include a higher incidence of miscarriage and stillbirth.
One treatment for sickle cell disease, called hydroxyurea, relieves severe pain. It poses some risk and is not for all sickle cell sufferers. Because we do not know the long-term effects of the drug, women who are pregnant are advised not to use it.
Toxoplasmosis
Toxoplasmosis is a disease caused by the microbe Toxoplasma gondii. It is spread by eating infected raw meat, drinking infected raw goat's milk, eating infected raw eggs, eating food that has been contaminated by insects or by contact with an infected cat or its feces. You can pick up the protozoa from a cat's litter box, from counters or other surfaces the cat walks on, or from the cat itself when you pet it.
Infection in the mother-to-be during pregnancy can lead to miscarriage or an infected infant at birth. Usually an infection in a pregnant woman has no symptoms. An infected baby may appear normal at birth. Between 80 and 90% develop serious eye infections months to years later. Some lose hearing, suffer from mental retardation, experience seizures or have learning disabilities. Babies whose mothers had toxoplasmosis in the 1 st trimester are usually the most severely affected. About 1 in 1,000 babies is born with toxoplasmosis.
To prevent transmission of the microorganism, cook foods thoroughly and use hygienic measures in the kitchen. Get someone else to change the kitty litter. Keep cats off counters, tables and other
areas where you could pick up the microbe. Wash your hands thoroughly after every contact with your cat, and don't nuzzle or kiss it.
Varicella
Herpes is a family of viruses that includes the herpes-simplex virus, herpes varicella-zoster virus and cytomegalovirus (see page 47). The word varicella is used interchangeably with chicken pox. (It is also used to describe the rash seen with chicken pox.) The term herpes zoster is used interchangeably with shingles.
When adults get chicken pox, they can become very ill. The most serious times for you to get chicken pox are during the 1 st trimester and around the time of delivery. The baby can get the virus during delivery, which can cause a serious infection.
Shingles occurs mainly in adults whose immune systems are compromised. During pregnancy, shingles can be a severe illness, with sharp pain and even breathing problems. Exposure during the 1 st trimester, when major organs are developing in the fetus, can cause defects, such as heart problems. Fortunately, it rarely occurs during pregnancy.
ALLERGIES
Allergy sufferers may notice their allergies change with pregnancy. They may improve or get worse. If you have allergies, drink plenty of fluid, especially during hot weather.
You may have to treat your allergy problems differently during pregnancy. Before taking any medication, ask your doctor or pharmacist whether it's safe to take during pregnancy; don't presume it's OK to take it. Asking before you use it is easier than fixing a problem it may cause later.
Nasal Congestion
Some women complain of nasal stuffiness during pregnancy. We believe this congestion occurs because of circulation changes and hormonal changes that can cause mucous membranes of the nose and nasal passages to swell and to bleed more easily.
Do not use decongestants or nasal sprays to relieve stuffiness without first checking with your doctor. Many preparations are combinations of several medications that you should not use during pregnancy. To relieve congestion, use a humidifier, increase your fluid intake and use a gentle lubricant, such as petroleum jelly, in nasal passages. Discuss the problem with your doctor if these remedies don't provide relief
ANEMIA
Anemia is a common medical problem in pregnant women. Women who are anemic don't have enough hemoglobin in their blood. Hemoglobin, the iron-containing pigment of red blood cells, is important because it carries life-sustaining oxygen to all the body's cells.
If you suffer from anemia, you won't feel well during pregnancy.
You'll tire more easily. You may become dizzy. If you're anemic during labor, you may need a blood transfusion after your baby is born. Pregnancy anemia increases the risk of preterm delivery, growth restriction in the baby and low fetal birth weight.
Anemia is a serious but preventable condition during pregnancy.
If you are anemic, your doctor can prescribe a course of treatment to deal with the problem.
BLOOD-SUGAR PROBLEMS
Pregnancy affects your blood-sugar levels; high blood sugar (hyperglycemia) or low blood sugar (hypoglycemia) can make you feel dizzy or faint. Many doctors routinely test pregnant women for blood-sugar imbalances during pregnancy. You can avoid or improve a blood-sugar problem caused by diet by eating balanced snacks and meals, by not skipping meals and by not going too long without eating.
Diabetes is a much more serious blood-sugar condition. Doctors diagnose diabetes through blood tests. If you are diagnosed with diabetes, you may be able to control it through dietary changes. A dietitian can help you. If diet changes alone aren't enough, you may need insulin, which helps the body process sugars. Your doctor or another specialist, usually an internist, prescribes this drug.
HYPOTENSION
It is normal for your blood pressure to change somewhat during pregnancy. It often decreases slightly during the 2nd trimester and increases toward the end of pregnancy.
Hypotension (low blood pressure) during pregnancy can cause dizziness. The problem usually occurs for two reasons. First, an enlarging uterus puts pressure on the aorta and vena cava, major vessels leading away from and into the heart. Supine hypotension, a related condition, occurs when you lie down; it is alleviated or prevented by not sleeping or lying on your back.
Second, rising rapidly from a sitting, kneeling or squatting position causes postural hypotension. Your blood pressure drops when you get up rapidly, as gravity pulls blood toward your feet and away from your brain, making you lightheaded. Postural hypotension happens more often as your pregnancy progresses and you get bigger. You can avoid postural hypotension by rising slowly from a sitting or a lying-down position. See page 261 for discussion of hypertension (high blood pressure).
INCOMPETENT CERVIX
An incompetent cervix describes a condition in which a woman's cervix dilates (stretches) prematurely. It isn't painful and usually the woman doesn't notice it. Membranes may rupture (her water breaks) without warning, and the baby is usually delivered prematurely.
The problem is not usually diagnosed until after one or more deliveries of a premature infant without any pain before delivery. If it's your first pregnancy, you cannot know if you have an incompetent cervix.
Some researchers believe the condition occurs because of previous trauma to the cervix, such as a miscarriage or abortion. It may occur if surgery has been performed on the cervix.
Treatment is usually surgical. A weak cervix can be reinforced by sewing the cervix shut, called a cerclage, or sometimes called a McDonald's suture. At the end of the pregnancy, or when the woman goes into labor, the surgical stitch is removed and the baby is born normally.
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