Recurrent Pregnancy Loss by Dr. Sireesha Reddy

Recurrent Pregnancy Loss

Spontaneous pregnancy loss is a surprisingly common occurrence. Whereas approximately 15% of all clinically recognized pregnancies result in spontaneous loss, there are many more pregnancies that fail prior to being clinically recognized. Only 30% of all conceptions result in a live birth

Spontaneous pregnancy loss can be physically and emotionally taxing for couples, especially when faced with recurrent losses. Recurrent pregnancy loss (RPL), also referred to as recurrent miscarriage or habitual abortion, is historically defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period. Based on the incidence of sporadic pregnancy loss, epidemiologic studies have revealed that 1% to 2% of women experience recurrent pregnancy loss.

CAUSES

Genetic Etiology

Approximately 2% to 4% of RPL is associated with a parental balanced structural chromosome rearrangement, most commonly balanced reciprocal or Robertsonian translocations.

Anatomical Abnormalities

Anatomic abnormalities account for 10% to 15% of cases of RPL and are generally thought to cause miscarriage by interrupting the vasculature of the lining of womb, prompting abnormal and inadequate placentation. Thus, those abnormalities that might interrupt the vascular supply of the lining of womb are thought to be potential causes of RPL. These include congenital uterine anomalies, intrauterine adhesions, and uterine fibroids or polyps.

The uterine septum is the congenital uterine anomaly most closely linked to RPL, with as much as a 76% risk of spontaneous pregnancy loss among affected patients. Other M?ªllerian anomalies, including unicornuate, didelphic, and bicornuate uteri have been associated with smaller increases in the risk for RPL.

The presence of intrauterine adhesions, sometimes associated with Asherman syndrome, may significantly impact placentation and result in early pregnancy loss. Intramural fibroids larger than 5 cm, as well as submucosal fibroids of any size, can cause RPL.

Infectious Causes

Certain infections, including Listeria monocytogenes, Toxoplasma gondii, rubella, herpes simplex virus (HSV), measles, cytomegalovirus, and coxsackieviruses, are known or suspected to play a role in sporadic spontaneous pregnancy loss. However, the role of infectious agents in recurrent loss is less clear. The most pertinent risk for RPL secondary to infection is chronic infection in an immunocompromised patient.

Endocrine Causes

Luteal phase defect (LPD), polycystic ovarian syndrome (PCOS), diabetes mellitus, thyroid disease, and hyper prolactinemia are among the endocrinologic disorders implicated in approximately 17% to 20% of RPL.

Poorly controlled type 1 diabetes mellitus is also associated with an increased risk of spontaneous abortion. Evaluation of endocrine disorders should include measurement of the thyroid-stimulating hormone (TSH) level. Other testing that might be indicated based on the patient??s presentation include insulin resistance testing, ovarian reserve testing, serum prolactin in the presence of irregular menses, antithyroid antibody testing. Therapy with insulin-sensitizing agents for the treatment of RPL that occurs in the presence of PCOS has recently gained popularity.

Thrombotic Etiologies

Both inherited and combined inherited/acquired thrombophilias are common, with more than 15% of the white population carrying an inherited thrombophilic mutation.

The potential association between RPL and heritable thrombophilias is based on the theory that impaired placental development and function secondary to venous and/or arterial thrombosis could lead to miscarriage. Evidence that the transfer of nutrition from the maternal blood to the fetal tissues depends on uterine blood flow, and thus may be affected by thrombotic events occurring there, suggests a role for thrombophilias in pregnancy losses regardless of gestational age.

Appropriate therapy for heritable or acquired thrombophilias should be initiated once the disorder is diagnosed. Therapy is disorder specific and includes

(1) Supplemental folic acid for those patients with hyperhomocysteinemia

(2) Prophylactic anticoagulation in cases of isolated defects with no personal or family history of thrombotic complications

(3) Therapeutic anticoagulation in cases of combined thrombophilic defects.

Environmental Etiologies

Because of its propensity to result in feelings of responsibility and guilt, patients are often particularly concerned about the possibility that environmental exposures may have caused their pregnancy losses.

Three particular exposures-smoking, alcohol, and caffeine-have gained particular attention, and merit special consideration given their widespread use and modifiable nature. Although maternal alcoholism (or frequent consumption of intoxicating amounts of alcohol) is consistently associated with higher rates of spontaneous pregnancy loss, a connection with more moderate ingestion remains tenuous. Studies linking moderate alcohol intake with pregnancy loss have shown an increase in risk when more than 3 drinks per week are consumed during the first trimester or more than 5 drinks per week are consumed throughout pregnancy. It seems logical that cigarette smoking could increase the risk of spontaneous abortion based on the ingestion of nicotine, a strong vasoconstrictor that is known to reduce uterine and placental blood flow. However, the link between smoking and pregnancy loss remains controversial, as some, but not all, studies have found an association. Although still not undisputed, there appears some evidence that caffeine, even in amounts as low as 3 to 5 cups of coffee per day, may increase the risk of spontaneous pregnancy loss with a dose-dependent response. The association of caffeine, alcohol, and nicotine intake with recurrent pregnancy loss is even weaker than their associations with sporadic loss.

Prognosis

Although the diagnosis of RPL can be quite devastating, it can be helpful for the physician and patient to keep in mind the relatively high likelihood that the next pregnancy will be successful. A particular individual??s prognosis will depend on both the underlying cause for pregnancy losses and the number of prior losses. Correction of endocrine disorders, APA, and anatomic anomalies enjoy the highest success rates, approximately 60% to 90%. Patients with a cytogenetic basis for loss experience a wide range of success (20%??80%) that depends on the type of abnormality present. Overall, the prognosis for RPL is encouraging. Even with the diagnosis of RPL and as many as 4 to 5 prior losses, a patient is more likely to carry her next pregnancy to term than to have another loss.

Dr. Sireesha Reddy | Know your doctor

Chickenpox in Toddlers: By Dr. Mohammed Yunus Kafil

Chickenpox in Toddlers:

Chickenpox (varicella), a viral illness characterised by a very itchy red rash, is one of the common infectious diseases amongst children. It is usually mild in children but occasional complications like bacterial pneumonia may occur.

People who have had chickenpox almost always develop lifetime immunity (meaning you are extremely unlikely to get it again). However, the virus remains dormant in the body and it can reactivate later in life and cause shingles.

What causes chickenpox?

Chickenpox is caused by the herpes varicella-zoster virus. It is spread by droplets from a sneeze or cough, or by contact with the clothing, bed linens or oozing blisters of an infected person. The onset of symptoms is 10 to 21 days after exposure. The disease is most contagious a day or two before the rash appears and until the rash is completely dry and scabbed over.

What are the symptoms of chickenpox?

Chickenpox appears as a very itchy rash that spreads from the torso to the neck, face, and limbs. The symptom lasts for 7 to 10 days, the rash progresses from red bumps to fluid-filled blisters (vesicles) that drain and scab over. Vesicles may also appear in the mouth, on the scalp, around the eyes or on the genitals and can be very painful.

This cycle repeats itself in new areas of the body until all of the sores have healed (takes about two weeks). The disease is contagious until all the spots have dried up. Unfortunately, the virus is also contagious for at least one day before the rash breaks out.

When to seek medical advice?

You think your child has chickenpox. A doctor can confirm your diagnosis
Chickenpox is accompanied by severe skin pain and the rash produces a greenish discharge and the surrounding skin becomes red, these are signs of a secondary bacterial skin infection
Chickenpox is accompanied by a stiff neck, persistent sleepiness or lethargy as these are symptoms of a more serious illness such as meningitis or encephalitis. Get medical help immediately
While your child is recovering from chickenpox and gets fever, convulsions, starts vomiting, or feeling drowsy. Get medical help immediately
An adult family member gets chickenpox
You are pregnant, have never had chickenpox and are exposed to the disease. Your unborn child may be at a risk so seek medical advice without delay.

What is treatment for chickenpox?

Chickenpox is extremely contagious. Keep your child at home until all of the blisters have burst and crusted over.

Most cases of chickenpox require little or no treatment beyond treating the symptoms.

The prescription antiviral drug Aciclovir is effective for shortening the duration of chickenpox symptoms and may be recommended for certain people with chickenpox, such as pregnant women, those with a weakened immune system and adults who seek medical advice within 24 hours of the rash appearing.

In addition, your doctor may recommend painkillers and an antihistamine to relieve pain, itching and swelling. Antibiotics are used if a secondary bacterial skin infection arises or if the person with chickenpox develops bacterial pneumonia.

Vaccination for chickenpox:-

IAP(Indian academy of pediatrics) recommends two doses of chickenpox vaccine for children, adolescents, and adults.

Children should receive two doses of the vaccine’the first dose at 15 months and a second dose at 4 and half years.

Kids who are older than 5 years but younger than 13yrars, who have not had chickenpox also may receive the vaccine, with the two doses given at least 3 months apart.

Kids 13 years or older who have not had either chickenpox or the vaccine need two vaccine doses at least 1 month apart.

By

Dr. Mohammed Yunus Kafil | Know your doctor https://www.motherhoodindia.com/dr-mohammed/

Ectopic pregnancy By Dr. Beena Jeysingh

Normally the fertilized egg implants and grows into a baby inside the uterus. Rarely can it implant outside the uterus when it is called Ectopic pregnancy. The commonest site is fallopian tubes and is called Tubal pregnancy. Other sites can be ovary and cervix.
Presenting symptoms can be missing of periods, light vaginal bleeding, lower abdominal pain or giddiness.
Diagnosis is either through ultrasound or monitoring pregnancy hormone levels [b-hcG] in correlation with clinical symptoms.
Early diagnosis and management is important as it can cause heavy internal bleeding. Depending on the condition of patient and stage of ectopic pregnancy the management could be medical or surgical. Laparoscopy is the preferred surgical approach until the patient??s condition does not permit when open method is opted.

By
Dr. Beena Jeysingh | Know your doctor https://www.motherhoodindia.com/dr-beena-jeysingh-2/

Pregnancy Myths By Dr.Beena Jeysingh

Plethora of advices about Do s and Don??ts in pregnancy start flowing in from friends and relatives. Some frequently asked doubts.
Can I travel by flight during first and last trimester?
Yes, surely you can fly in any trimester of pregnancy but airlines limit the weeks of travel as they are worried in last trimester about labour during travel which will cause concern and inconvenience.

Does applying cocoa butter prevents stretch marks?
No, it may cause allergic reactions to sensitive skin.

Can I continue waxing, pedicure, manicure, dyeing hair?
Yes, you can continue enjoying them but a word of caution not to try any new products for fear of allergy and herbal stuff is preferable

Does walking start labour?
No, it makes you feel better but no activity can start labour

Can I drink coffee?
Yes, you can relax with one cup a day, it will not harm your baby

By
Dr.Beena Jeysingh

The Common Cold in Children

Cold is the most common reason for a pediatric office visit. It??s responsible for a child??s absence from school & parent??s staying away from work.

Let us try to understand this common illness in the next few paragraphs.

What causes a Cold?

??Cold? is a group of symptoms caused by a number of viruses.Over a hundred viruses may be responsible. Therefore a child may be affected multiple times each year.

Children under 6 years of age may average 6-8 colds per year. Children in daycare appear to suffer from cold more commonly. The frequency of such episodes may decrease by the time they reach primary school.Episodes of cold may be more in children as they are still developing their immunity.

Colds may occur at any time of the year. Transmission occurs from one person to another directly or due to viruses in the environment. Colds tend to be more contagious during the first two to four days.

Contact ?? Cold virus may survive on the skin for upto 2 hrs & on surfaces (such as door handles, toys ) for upto a day. Infection can spread by touching such objects& then touching the nose, eyes, mouth of the uninfected.

Inhalation– Droplets containing virus or viral particles are released by coughing & during exhalation. However it is not usually transmitted by this route.

What are the symptoms?

Signs & symptoms usually show up a day or two after exposure. Nasal congestion & discharge are the most common symptoms. Discharge can be clear, yellow or green. Fever may be present during the initial phase. Other symptoms include: Sore throat, cough, difficulty in sleeping and decreased appetite. The glands in the neck may be enlarged. Symptoms may continue for up to 2 weeks and are usually worst during first 10 days. A second cold may sometimes superimpose and extend the period of sickness.

What are the complications?

Ear infections, wheezing, sinusitis & pneumonia are the common complications.

Ear infections: If a child develops fever after the initial phase of illness or fever continues for a prolonged period (beyond 3 days) ear infection can be suspected.

Wheezing: Children may develop wheezing even if they have not wheezed before. Colds may worsen asthma.

Sinusitis: If nasal congestion does not improve does not improve over 10 days then sinusitis may be suspected.

Pneumonia: Late onset of fever or prolonged fever may suggest pneumonia, especially if the child has signs of breathing difficulty.

How do you manage?

Treatment of cold is usually symptomatic:

Anti-histamines, decongestants and cough expectorants have been used with adults.
Improve symptoms of nasal congestion. Saline nose drops may be used to thin mucus.
Suction can be used to remove secretions. Adequate amounts of fluids must be taken. Honey can be used in children older than one year. Antibiotics are not effective in treating colds but may be used if complications are suspected.
Vitamin C used preventive may decrease the duration of cold.

How to prevent:

Hand hygiene:

Maintaining hand hygiene either by washing with soap and water or by using alcohol based hand rub.
Avoid contact of child with people who are ill.
Clean surfaces with household cleaner eg. Lysol

Danger Signs:

Seek immediate help in the presence of the following symptoms.

Prolonged refusal of feeds
Excessive irritability or lethargy
Difficulty in breathing or rapid breathing
Fever lasting more than 3 days
Prolonged nasal congestion (more than 10-15 days)
Ear pain & other signs of infection

What is Urinary incontinence Dr. Rubina Shanawaz

Explore insights on urinary incontinence with Dr. Rubina Shanawaz - Motherhood Hospital India.

Do you involuntarily leek urine when you laugh hard or sneeze? To find a solution to this embarrassing situation, read on

Isn??t involuntary leakage of urine a part of having children & growing older??

Though it is caused by repeated childbirths, hormonal changes, there is a solution to this embarrassing predicament which more than 1 in 10 women suffer from but silently endure due to the stigma associated with this condition.

What is the medical term for this condition?

Involuntary leakage of urine during activities such as coughing, sneezing, lifting weights or laughing is referred to as Stress Urinary Incontinence (SUD) where urinary incontinence refers to inability to control urine & stress refers to its precipitating factor.

How common is Urinary incontinence?

Around 1 in 10 women suffer from varying degrees of involuntary leakage of urine. The commonest of these is Stress Urinary Incontinence. Most of the affected women don??t realize there are simple, effective treatment options available.

What causes such involuntary leakage?

The urinary bladder &urethra the tube which brings urine from the bladder to the exterior) are supported by pelvic floor muscles which contract during coughing, sneezing & exercise to prevent leakage. Weakness in these muscles or damage to the bladder neck support can result in leakage

What-is-Urinary-incontinence-by-Dr--Rubina2

This can be a result of:

Pregnancy & vaginal birth(as the same group of muscles support the uterus)
Obesity, Long standing cough/ Constipation
Lifting heavy weights over a long period of time

These can cause an increase in pressure in your abdomen & aggravate the stress on the pelvic floor leading to involuntary leakage.

Genetically Inherited factors:
Women with stress incontinence may also have problems with urinary Urge Incontinence (not able to control urine till reaching the restroom) or incontinence of feces/gas or prolapse (descent of uterus, felt as lump outside vagina). Do not feel embarrassed to mention these problems to your doctor. Pelvic floor problems are more common than depression(1 in 20 women) or hypertension (1 in 3 women)

What are my treatment options? These will depend on the severity of leakage & associated conditions Conservative options include General lifestyle changes:

Aim to drink 1.5 to 2 liters of water per day to pass urine 4 to 6 times/day
Maintaining a healthy lifestyle
High fiber diet to avoid constipation
Cutting out smoking

Pelvic floor exercises (PFC) The importance of these exercises cannot be over emphasized in mainly preventing and treating mild degrees of urinary incontinence. If practiced regularly and for 3 to 6 months at least, upto 75% of women show an improvement in leakage. It is important for all age groups of women right from first pregnancy and childbirth to post menopause. Surgical Options:- These range from daycare procedures like ??mid urethral sling suspension (suspending urethra with tape) to laparoscopic/open Burch colposuspension to bulking agents, depending on the individual patients?? severity of incontinence previous surgeries and other factors. By Dr. Rubina Shanawaz, MBBS, MS(OBG)

Umbilical Cord Care By Dr. Prashanth Gowda

In the womb, the umbilical cord connects the fetus to the mother. After birth, the cord is no longer needed. It is cut, then clamped. The stump of the cord usually dries and falls off the newborn in a 7-12 days or so. Sometimes the stump falls off before the first week. Other times, the stump may stay longer. You may notice a red, raw-looking spot right after the stump falls off. A small amount of fluid sometimes tinged with blood may ooze out of the navel area. It is normal for this to last up to 2 weeks after the stump falls off. If it doesn??t heal or dry completely within 2 weeks, call your doctor.

General care of the umbilicus / belly button:
?? Keep the belly button clean and dry
?? Cleanse belly button with soap and warm water when it gets soiled with urine or stool.
?? Expose the belly button to the air by rolling back the top of the nappy.
?? Do not apply anything over it.

When to call a doctor?
Call your baby??s doctor if you see any signs of an infection. These signs include:
?? Pus (yellowish fluid) that is around the base of the cord and smells bad.
?? Red, tender skin around the base of the cord.
?? Your baby crying when you touch the cord or the skin around it.
?? Fever.

What is an umbilical granuloma?
An umbilical granuloma is an overgrowth of tissue during the healing process of the belly button (umbilicus). It usually looks like a soft pink or red lump and often is wet or leaks small amounts of clear or yellow fluid. It is most common in the first few weeks of a baby??s life.

General Care:
?? Follow the doctor??s instructions for cleaning the granuloma and area around it. Use a clean, moist cloth or cotton swab. Gently lift the stump to clean the navel underneath. Be sure to remove all drainage and clean an inch around the base.
?? Pat the area with a clean cloth and allow it to air-dry. You may have to roll the diaper down below the navel to expose the granuloma to air.
?? Wash your hands well before and after caring for the stump. This will help prevent infection.
?? Watch for signs of infection

How is an umbilical granuloma treated?
If there is an umbilical granuloma and no obvious infection, then your General Physician, pediatrician, midwife or health visitor may suggest salt treatment. This has been found to be an effective and safe treatment which you can do at home.
Other treatment option copper sulphate, silver nitrate treatment will be suggested. This has to be done by a health professional. The health professional who advised the treatment can provide you with the gauze swabs needed (or you can buy extras from a pharmacy if needed).

How to do the salt treatment:
?? Apply a small pinch of table or cooking salt onto the umbilical granuloma.
?? Cover the area with a gauze dressing ??swab?? and hold it in place for 10-30 minutes. This may be easiest to do when your baby is asleep.
?? Now clean the site using a clean gauze dressing soaked in warm water.
?? You should repeat the procedure twice a day for at least two days.
?? If it??s not getting better visit your pediatrician.

By
Dr. Prashanth Gowda, MBBS DNB DCH FIPM

What should I expect from my first prenatal checkup?

When you suspect that you could be pregnant or if you have already got a positive pregnancy test at home, you must see your gynaecologist as soon as possible.

At this first visit, a detailed consultation with your doctor would take place. The aim is to understand details of your health, any problems that may be running in the family and any other issues which may put you or your baby at risk. This visit also gives you information regarding the ??do??s and don??ts?? during your pregnancy so as to protect your health and the baby??s health.

Be prepared for plenty of questions as this helps the doctor to get a clear idea of your health and your family??s health. If you have had any previous pregnancies, then detailed information of each pregnancy is sought by the doctor.

Examination:

Your examination at this visit would include general checkup including blood pressure, height and weight.

Information:

Now is the time to clear your doubts about your pregnancy and what to expect in the next nine months. There will be a lot of information to take in at this first visit.

Discussions and advice:

healthy eating
exercise
travelling and driving
your job
your lifestyle
sex
investigations that are recommended in pregnancy

Investigations:

If warranted, a test to confirm your pregnancy would be done.

Other than this, various tests would be recommended to ensure that you are in the pink of health. Early identification of any abnormalities and their treatment would reduce complications for you and the baby.

Tests would include

Hemoglobin level
Blood group
Blood sugar levels
Thyroid function
Testing for Rubella immunity
Tests for various infections like Syphilis, HIV, Hepatitis B
Complete Urine Examination
Ultrasound scan to confirm pregnancy location and your due date

Prescription:

You would be given a prescription for folic acid which is essential for preventing neural tube defects in the baby. Other vitamin supplements or a prenatal may be prescribed if needed.

What is Urogynaecology? By Dr. Rubina Shanawaz

Urogynaecology is a sub-specialty which integrates the complex and intricate specialities of Urology and Gynaecology, focusing on urinary problems and pelvic floor disorders in women. These problems arise due to the close anatomy of the urinary bladder and urethra with the uterus and vagina. Hence, these issues in women will have to be dealt with keeping in mind the effect of the urinary and reproductive systems on each other in order to ensure complete relief of symptoms.

When will I need to consult a urogynaecologist ?

Are you not able to laugh freely or cough hard for fear of leakage of urine?
Are you not able to travel as you wish due to very frequent visits to the toilet?
Do you have a dragging pain in your vagina and have difficulty passing urine or stools?
Do you feel your vagina has lost its tone after repeated vaginal childbirths?

If your answer to any of the above questions is a yes, you need to visit a urogynaecologist.

What are the common conditions encountered in this field?

Incontinenceandpelvic floor problemsare remarkably common but many women are reluctant to receive help because of the stigma associated with these conditions. There is no more distressing lesion than urinary incontinence. A constant dribbling of the repulsive urine soaking the clothes which cling wet and cold to the thighs, making the patient offensive to herself and her family and ostracizing her from society.

Although countless women are bothered by a loss of bladder control, bowel symptoms, and pelvic discomfort they are often not aware that these problems have a name, much less how common they really are. Pelvic floor conditions are more common than hypertension, depression, or diabetes. 1 in 3 adult women have hypertension; 1 in 20 adult women have depression;1 in 10 adult women have diabetes; and, more than 1 in 2 adult women suffer from pelvic floor dysfunction. Around 1 in 10 women suffer from varying degrees of involuntary leakage of urine (urinary incontinence).?The most common of these is Stress Urinary Incontinence.

Stress Urinary Incontinence (SUI):

Stress Urinary Incontinence (SUI) is the involuntary leakage of urine during activities such as coughing, sneezing,?lifting, laughing or exercising.SUI affects at least 10-20% of?women, many of whom do not realize that there are simple,effective treatment options available.

Other common types of incontinence include

Over active bladder (OAB)

In this condition, there is increased frequency of urination or urge to get up to pass urine more than once at night. Mixed stress and urge incontinence, overflow incontinence, reflex and functional incontinence.

Prolapse:
This condition occurs when there is a descent of the pelvic organs usually asca result of repeated vaginal childbirths. This usually is a descent of the uterus and cervix along with the urinary bladder and rectum or descent of just urinary bladder or rectum alone.

Fistulas :
These occur when there is an inadvertent creation of a false passage between the urinary tract and an abdominal organ resulting in leakage of urine usually following surgery where there is already an anatomical distortion due to endometriosis/ PID/ previous surgeries/ tumours involving bladder wall.

Diagnostic tests and procedures performed include:

Specialty treatments available include:

Laparoscopic/ Abdominal / vaginal / urethral reconstruction
Behavioural modification
Botulinum toxin injections
Pelvic floor re-education
Pessary(for prolapse and incontinence)
Pubovaginal slings
Sacral nerve stimulation
Apical suspension procedures for prolapse

Dr. Rubina Shanawaz MBBS, MS(OBG)

Hypothyroidism in pregnancy

Thyroid hormones regulate metabolism??the way the body uses energy??and affect nearly every organ in the body.Too little thyroid hormone is called hypothyroidism and can cause many of the body??s functions to slow down. Hypothyroidism affects between three and ten percent of adults, with incidence higher in women and the elderly.

Thyroid hormone plays a critical role during pregnancy both in the development of a healthy baby and in maintaining the health of the mother.

What is the thyroid?

The thyroid is a 2-inch-long, butterfly-shaped gland weighing 25-30 g in adults (it is slightly heavier in women). Located in the front of the neck below the larynx, or voice box, it has two lobes, one on either side of the windpipe. The thyroid gland produces, stores, and releases hormones into the bloodstream. The hormones then travel through the body and direct the activity of the body??s cells.

The thyroid gland makes two thyroid hormones, triiodothyronine (T3) and thyroxine (T4). T3 is the active hormone and is made from T4.Thyroid hormones affect metabolism, brain development, breathing, heart and nervous system functions, body temperature, muscle strength, skin dryness, menstrual cycles, weight, and cholesterol levels.

Thyroid hormone production is regulated by thyroid-stimulating hormone (TSH), which is made by the pituitary gland in the brain. When thyroid hormone levels in the blood are low, the pituitary releases more TSH. When thyroid hormone levels are high, the pituitary responds by decreasing TSH production.

Pregnancy

Thyroid hormone is critical to normal development of the baby??s brain and nervous system. During the first trimester, the fetus depends on the mother??s supply of thyroid hormone, which comes through the placenta. At around 12 weeks, the baby??s thyroid begins to function on its own.

The thyroid enlarges slightly in healthy women during pregnancy, but not enough to be detected by a physical exam. A noticeably enlarged thyroid can be a sign of thyroid disease and should be evaluated. Thyroid problems can be difficult to diagnose in pregnancy due to higher levels of thyroid hormone in the blood, increased thyroid size, fatigue, and other symptoms common to both pregnancy and thyroid disorders.

Two pregnancy-related hormones??human chorionic gonadotropin (hCG) and estrogen??cause increased thyroid hormone levels in the blood. Made by the placenta, hCG is similar to TSH and mildly stimulates the thyroid to produce more thyroid hormone. Increased estrogen produces higher levels of thyroid-binding globulin, also known as thyroxine-binding globulin, a protein that transports thyroid hormone in the blood. Overall, only 0.04% T4 and 0.5% T3 are free and functioning.

These normal hormonal changes can sometimes make thyroid function tests during pregnancy difficult to interpret.

What causes hypothyroidism in pregnancy?

Hypothyroidism in pregnancy is usually caused by Hashimoto??s disease and occurs in three to five out of every 1,000 pregnancies.2 Hashimoto??s disease is a form of chronic inflammation of the thyroid gland.

Hashimoto??s disease is an autoimmune disorder. In Hashimoto??s disease, the immune system attacks the thyroid, causing inflammation and interfering with its ability to produce thyroid hormones.

Hypothyroidism in pregnancy can also result from existing hypothyroidism that is inadequately treated or from prior destruction or removal of the thyroid as a treatment for hyperthyroidism.

How does hypothyroidism affect the mother and baby?

Uncontrolled hypothyroidism during pregnancy can lead to

preeclampsia
anemia??too few red blood cells in the body, which prevents the body from getting enough oxygen
miscarriage
low birth weight
stillbirth
congestive heart failure, rarely

Because thyroid hormones are crucial to fetal brain and nervous system development, uncontrolled hypothyroidism??especially during the first trimester??can affect the baby??s growth and brain development.

How is hypothyroidism in pregnancy diagnosed?

Hypothyroidism is diagnosed through a careful review of symptoms and measurement of TSH and T4 levels.

Symptoms of hypothyroidism in pregnancy include extreme fatigue, cold intolerance, muscle cramps, constipation, and problems with memory or concentration. High levels of TSH and low levels of free T4 generally indicate hypothyroidism. Because of normal pregnancy-related changes in thyroid function, test results must be interpreted with caution.

The TSH test can also identify subclinical hypothyroidism??a mild form of hypothyroidism that has no apparent symptoms. Subclinical hypothyroidism occurs in 2 to 3 percent of pregnancies.2 Test results will show high levels of TSH and normal free T4.

If subclinical hypothyroidism is discovered during pregnancy, treatment is recommended to help ensure a healthy pregnancy.

How is hypothyroidism treated during pregnancy?

Hypothyroidism is treated with synthetic thyroid hormone called thyroxine??a medication which is identical to the T4 made by the thyroid. Women with preexisting hypothyroidism will need to increase their pre-pregnancy dose of thyroxine to maintain normal thyroid function. Thyroid function should be checked every 6 to 8 weeks during pregnancy. Synthetic thyroxine is safe and necessary for the well-being of the fetus if the mother has hypothyroidism.

Dietary Supplements

Because the thyroid uses iodine to make thyroid hormone, iodine is an important mineral for a mother during pregnancy. During pregnancy, the baby gets iodine from the mother??s diet. Women need more iodine when they are pregnant??about 250mcg a day.

However, people with autoimmune thyroid disease may be sensitive to harmful side effects from iodine. Taking iodine drops or eating foods containing large amounts of iodine??such as seaweed, pulse, or kelp??may cause or worsen hyperthyroidism and hypothyroidism.To help ensure coordinated and safe care, people should discuss their use of dietary supplements with their health care provider.

To conclude, women with thyroid problems can have a healthy pregnancy and protect their fetuses?? health by learning about pregnancy??s effect on the thyroid, keeping current on their thyroid function testing, and taking the required medications.