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 patientŸ??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 individualŸ??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%Ÿ??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.

By

Dr. Sireesha Reddy | Know your doctor

Pregnancy Myths By Dr.Beena Jeysingh

Plethora of advices about Do s and DonŸ??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

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 patientŸ??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/

 

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 doesnŸ??t heal or dry completely within 2 weeks, call your doctor.

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

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

General Care:
Ÿ?? Follow the doctorŸ??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.
Ÿ?? 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.
Ÿ?? Wash your hands well before and after caring for the stump. This will help prevent infection.
Ÿ?? 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:
Ÿ?? Apply a small pinch of table or cooking salt onto the umbilical granuloma.
Ÿ?? Cover the area with a gauze dressing Ÿ??swabŸ?? and hold it in place for 10-30 minutes. This may be easiest to do when your baby is asleep.
Ÿ?? Now clean the site using a clean gauze dressing soaked in warm water.
Ÿ?? You should repeat the procedure twice a day for at least two days.
Ÿ?? If itŸ??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 Ÿ??doŸ??s and donŸ??tsŸ?? during your pregnancy so as to protect your health and the babyŸ??s health.

Be prepared for plenty of questions as this helps the doctor to get a clear idea of your health and your familyŸ??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.

Hypothyroidism in pregnancy

Thyroid hormones regulate metabolismŸ??the way the body uses energyŸ??and affect nearly every organ in the body.Too little thyroid hormone is called hypothyroidism and can cause many of the bodyŸ??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 bodyŸ??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 babyŸ??s brain and nervous system. During the first trimester, the fetus depends on the motherŸ??s supply of thyroid hormone, which comes through the placenta. At around 12 weeks, the babyŸ??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 hormonesŸ??human chorionic gonadotropin (hCG) and estrogenŸ??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 HashimotoŸ??s disease and occurs in three to five out of every 1,000 pregnancies.2 HashimotoŸ??s disease is a form of chronic inflammation of the thyroid gland.

HashimotoŸ??s disease is an autoimmune disorder. In HashimotoŸ??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
  • anemiaŸ??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 hypothyroidismŸ??especially during the first trimesterŸ??can affect the babyŸ??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 hypothyroidismŸ??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 thyroxineŸ??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 motherŸ??s diet. Women need more iodine when they are pregnantŸ??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 iodineŸ??such as seaweed, pulse, or kelpŸ??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 fetusesŸ?? health by learning about pregnancyŸ??s effect on the thyroid, keeping current on their thyroid function testing, and taking the required medications.

Exercises and yoga poses during pregnancy

Expert advice on pregnancy exercises and yoga poses - Motherhood Hospital India

Always start with a breathing exercise. Close your eyes and breath in through nose and breath out through mouth continue for 3-5 mins

Diaphragmatic breathing

  1. Sit comfortably, with your knees bent and your shoulders, head and neck relaxed.
  2. Place one hand on your upper chest and the other just below your rib cage. This will allow you to feel your diaphragm move as you breathe.
  3. As you breathe in and out feel your hand over the diaphragm move out and in.

Diaphragmatic breathing
Cat and camel

  • Begin on your hands and knees, knees under hips, hands under shoulders
  • Round your back up toward the ceiling, drop your head slightly, tuck in your buttocks
  • Come back to a neutral position
  • Let your belly lower toward the floor creating an arch in your back
  • Keep your head up slightly, with your eyes looking straight ahead
  • Alternate between poses.

Make it easier: For painful knees, fold a towel or blanket under the knees. For painful wrists, place fists instead of palms on the floor.

cat and camel

 

Butterfly pose

butterfly pose

  • Keep the spinal cord and neck straight
  • Breathe natural and easy
  • Bend both the knees
  • Bring the soles of the feet together and place them up to the crotch area
  • Grasp firmly both the paws with your hands
  • Do not allow the heel to be raised
  • Keep the torso above waist including the neck straight
  • Place the elbows on the thighs
  • Inhale deep and press both the thighs downward with the elbows effortlessly
  • Remove your hands from thighs and try to raise the knees without any support; exhale Breath

Kegel’s Exercises

It is done to tone up pelvic floor muscle. It can be done in any position sitting, standing, and lying whichever position you are comfortable. Contract your pelvic floor muscles as you would to stop urine flow for 5 seconds and then relax the muscles for 3 seconds. This muscle fatigues quickly so only do five to ten repetitions at a time. Do not hold breath anytime, breathe normally while doing this. Repeat the set of 10 at least twice a day.

Goddess pose

godess pose

  • Start in Mountain Pose at the front of your mat. Step your right foot a stride length towards the back of your mat. Turn your toes out and your heels in, so your feet land on a 45 degree angle
  • Bend your knees deeply out the sides and sink your hips down to the height of your knees
  • Bring your arms out at shoulder height and bend your elbows so that your fingertips point skyward. Spread your fingertips wide apart from one another and activate the muscles across your back to hold your arms here
  • Engage your core muscles and draw your tailbone in the direction of the floor. Do not hunch forward with your shoulders; keep your spine long and your muscles engaged
  • Stay here for 30 seconds to one minute, then step forward to Mountain Pose
Warrior Pose

warrior pose

Stand with your feet about three feet apart your right foot in front of the left. Hold your arms out to the side with your palms down and arms extended and straight. Turn your right foot out to the side and your left foot in. Lunge forward gently, bending your right knee as you keep your left leg straight. Hold the pose as your legs stretch. Return to the original position then switch legs.

Side stretch

  • Sit on the floor with one leg bend and other stretched.
  • One of the arm extend over the head stretching the side
  • Come back to original position and repeat other side .

Walking

Walking is a great pregnancy workout. It is low impact so it doesn’t jar your knees or ankles. It is a moderate intensity exercise and will help keep your blood sugar stable. It is also probably the easiest exercise to do because it requires no equipment besides some good tennis shoes and you can do it anywhere, you can walk for 30-45minutes per day, but remember only walking is not sufficient.

High-risk pregnancy ensuring the best possible outcome by Dr. Beena Jeysingh

Pregnancy, a nine-month period of caretaking, is a time of happiness and joy for every mother. It also brings along a new set of anxieties. While most pregnancies are uneventful and without any sudden surprises, some pregnancies may be categorised as “high-risk”.

What is a “high-risk” pregnancy?

A “high-risk” pregnancy is one in which the mother, fetus, or both are at increased risk, before, during or after the delivery.

What causes these risks?

Terming a pregnancy as “high-risk” may lead to unnecessary anxiety when the outcome is eventually uneventful. In some cases, the pregnancy can continue smoothly, despite the presence of a significant past medical history. If a risk factor is identified, the mother is informed of the complications associated in a sensitive manner.

Some of the factors that can put women at risk are:

  1. Maternal age:

The age of the expectant mother is an important risk factor. Women under 17 or over 35 years of age are at a higher risk.

  1. Bad Obstetric History
  • A history of three or more miscarriages/complications in earlier pregnancies
  • History of genetic abnormalities in prior pregnancy
  • Rh (rhesus) sensitisation in the previous pregnancy (a dangerous condition which puts the mother at risk, if her blood group is Rh–and the baby’s blood group is Rh+)
III. Medical Conditions
  • Tuberculosis (TB), infections like human immunodeficiency virus (HIV)
  • Non-communicable diseases like diabetes, high blood pressure, epilepsy, thyroid dysfunction, etc.
  1. Risks that may occur during pregnancy:

Even if a person is healthy at the start of the pregnancy, development of the following conditions can put her in the high-risk category:

  • Communicable diseases like chicken pox, rubella, syphilis, toxoplasmosis, etc.
  • Non-communicable diseases like high blood pressure, preeclampsia (caused due to high blood pressure eventually damaging other organs like the kidneys), gestational diabetes (pregnant women who have never had diabetes before but who have high blood sugar levels during pregnancy are said to have gestational diabetes), multiple pregnancy (conception of twins, triplets or quadruplets), antepartum haemorrhage (vaginal bleeding), etc.
  • Complications with the developing fetus like heart disease, skeletal malformations, neural tube defects, etc.
  1. Risks that may develop during labour and delivery:
  • Placental abnormalities, such as placenta accreta (placenta that enters the uterine muscle thus making separation of placenta from uterus)), may be discovered rarely during pregnancy or after delivery.

What are the signs of a high-risk pregnancy?

It is important to learn about issues that you might encounter during the course of your pregnancy. It would be helpful to learn about a few symptoms that could cause concern, like:

  • Frequent contractions of uterus in preterm period
  • Vaginal bleeding
  • Persistent headaches
  • Edema of lower limbs

What should I do if I my pregnancy is categorised as high-risk?

Mothers with chances of a high-risk pregnancy will have regular antenatal check-up and may require to visit the doctor more frequently for routine prenatal screening tests and special tests are done to ensure that the baby is developing well and to keep the mother out of risk.

A specialised multidisciplinary team may be involved to tackle associated complications in mother, if any to help women at “high-risk” to have a safe and healthy pregnancy, and aid in completion of the term of pregnancy.

Who will I be referred to?

Your regular obstetrician will guide you throughout your pregnancy and cross reference as per risk condition will be given to physician or nephrologist or neurologist or any other speciality of medicine.

How can I have a healthy pregnancy?

In order to have a healthy pregnancy, the following are advised:

  • Consult with the doctor before conception:

The mother-to-be’s medical condition will be assessed and she will be advised accordingly. In addition to prescribing supplements for a healthy pregnancy, if required, the existing treatment can be revised/adjusted in preparation for pregnancy.

  • Regular check-ups:

Regular visits to the doctor will help in constant monitoring of the mother’s and the baby’s health. Based on these periodic assessments, the medications can be altered and the expectant mother can be referred to a specialist, if required.

  • Healthy lifestyle habits:

In addition to a healthy diet and appropriate supplements, it is also important to ensure that the mother-to-be gains weight the healthy way. Exercising regularly, avoiding alcohol, tobacco, and the intake of other harmful agents will help in reducing unforeseen risks.

How will I be cared for after the delivery?

Mothers are closely monitored for development of any complications and the newborn is under the care of a neonatologist and need be monitored in a NICU.

by

Dr. Beena Jeysingh

Checklist of Foods to Avoid During Pregnancy

When you are pregnant, hormonal changes lower your immunity and affect your immune system. Your unborn baby is more susceptible to the bacteria, viruses, and parasites that cause food-borne illness.

Food-borne illnesses such as toxoplasmosis, salmonella and listeriosis can cause serious illnesses in mother and baby.Toxoplasmosis may cause flu-like symptoms in the pregnant mother. Listeriosis causes few or no symptoms to the mother but can be transferred to the baby and can lead to miscarriage, still birth, premature birth or may make the newborn very ill. You can reduce the risk of listeriosis by taking simple food hygiene steps at home and avoiding certain high risk foods. Salmonella can cause illnesses such as typhoid fever, paratyphoid fever, and food poisoning.

If you have any concerns about symptoms or illnesses, please consult your doctor. Keep this checklist handy to help ensure that you and your unborn baby stay healthy and safe.

Food to be avoidedReason
Soft CHEESE made from unpasteurized milk, including Brie, feta, Camembert, Roquefort, queso blanco, and queso frescoHot dogs, luncheon meats, cold cuts, fermented or dry sausage, and other deli-style meat and poultryMay contain Campylobacter, E. coli, Listeria, or Salmonella.
Certain kinds of FISH, such as shark, swordfish, king mackerel, and tilefish (golden or white snapper)Contains high levels of mercury.
Unpasteurized JUICEMay contain E. coli.
SALADS made in a store (unwashed vegetables)May contain Listeria. It is essential to make sure that they are washed thoroughly to avoid potential exposure to toxoplasmosis.
Raw or undercooked SPROUTS, such as alfalfa and moong beansMay contain E. coli or Salmonella.
Raw Eggs/eggnog and mayonnaiseUnder cooked/ raw eggs may contain Salmonella.
Caffeine (Coffee/Tea/Aerated drinks, etc)Although most studies show that caffeine intake in moderation is not harmful but there are others reveal that caffeine intake may be related to miscarriages. Caffeine is a diuretic, which means it helps eliminate fluids from the body.
AlcoholPrenatal exposure to alcohol can interfere with the healthy development of the baby. Alcohol consumption during pregnancy can lead to Fetal Alcohol Syndrome or other developmental disorders.

Contact our Nutrition Department to know more about foods that needs to be avoided and included for safe pregnancy.

Pregnant , Stay Healthy By Dr. Faiza Waliullah

Pregnant? Tips for a healthy one!

There are a number of different emotions people go through when they discover they are pregnant. Excitement is perhaps the most common, but it is also natural to experience a bit of anxiety, especially while considering the best things to do for good health of the mother and baby. Often there are many questions, ranging from what food is safe to eat to exercise tips in order to stay healthy. We’ll be answering some of those questions here.

Exercise

It is important that most women take part in regular exercise.Moderate exercise is safe and can benefit both mother and child in most cases. However, you do need to be sensible as to the extent you decide to exercise and ensure you don’t over-extend yourself, especially if you’re not used to regular exercise. The guidelines for physical activity are no different for pregnant women than for the rest of the population – at least 30 minutes worth of moderate-intensity exercise a day.

Diet and dietary supplements

Eating a healthy, balanced diet is really important during pregnancy, and although you may feel hungrier than before, you should avoid eating for two. Gaining too much weight can lead to complications laterand can make it difficult to move around after your baby has been born. The World Health Organization suggests a weight gain of 10-14 kg is ideal for limiting the chance of complications later on.

When planning meals, a third of your plate should be starch-based food, such as bread, pasta, rice and potatoes. This should be eaten with fruits and vegetables, with moderate amounts of protein. Your baby needs plenty of iron, calcium and folic acid from a very early stage of pregnancy, so it is vital you include these in your diet. You’ll find iron in many sources, including red meat, fish, pulses, seeds and green vegetables. Low-fat dairy products are good sources of calcium, while green vegetables and fortified cereals are ideal for folic acid.

While eating fish is very healthy as it contains plenty of vital nutrients, you should be wary of the type of fish you are eating. Some fish contain high levels of mercury, which can affect your baby’s nervous system. Tuna should be limited to two steaks or four medium cans a week, while shark, swordfish and marlin should be avoided. Uncooked shellfish and raw fish should be cut out of your diet, while you should also avoid foods that are rich in vitamin A, such as liver.

Alcohol

During pregnancy, you must avoid alcohol altogether. Alcohol stays in baby’s system much longer than an adult’s as it is unable to process it properly, which can cause serious problems. Heavy drinking while pregnant can lead to fetaldeformities, brain damage and low birth weight, known as fetal alcohol syndrome (FAS). Even light drinking can be problematic and the National Institute for Health and Care Excellence (NICE) guidelines in the UK advise that if you are pregnant, do not drink at all.

Smoking

If you are a smoker and you get pregnant, it is strongly advisable to stop as quickly as you can. As well as damaging your own health, the poisonous chemicals in tobacco can increase your risk of miscarriage or slow down the growth of your baby. It can also bring about early labour and stillbirth. Even after the baby has been born, the chances of it developing chest infections or asthma, or being at risk of cot death are greatly increased if either parent is a smoker.

Medicines

Some medicines (such as paracetamol) are perfectly safe to take while you are pregnant, but there are many medicines where there is insufficient evidence of their possible effects on your baby. This means it is generally advisable to limit your use of medications unless absolutely necessary – even herbal and natural remedies should be checked out with your doctor first. If you are unsure about safety of a medicine, seek advice from a doctor or pharmacist before using it.

Wishing you health & happiness!

Dr. Faiza Waliullah
Motherhood, Hyderabad