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

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
  1. IsnŸ??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.
  1. 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.
  1. 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 donŸ??t realize there are simple, effective treatment options available.
  1. 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 Ÿ??mid urethral sling suspension (suspending urethra with tape) to laparoscopic/open Burch colposuspension to bulking agents, depending on the individual patientsŸ?? severity of incontinence previous surgeries and other factors. By Dr. Rubina Shanawaz, MBBS, MS(OBG)

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.

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

By

Dr. Rubina Shanawaz MBBS, MS(OBG)

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.

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.

Trying to conceive: Expert advice By Dr. Jayashree Murthy

Ÿ??Doctor, we’ve been married for a few years and trying to have a baby but nothing’s happening,” is a line gynaecologists often hear. For couples trying to conceive, there are a few basic rules they should follow.

Know your fertile phase

For a woman who has regular 28-30 day menstrual cycle, the fertile phase would be from day 11 to day 18 (day 11 being the first day of the period). It is important that the couple be together during this period and have intercourse at least on alternate days at this time. If a woman has irregular periods, she could be having the Polycystic Ovarian syndrome (PCOS). In this condition she would not be ovulating regularly. A visit to the gynaecologist will confirm the ovulation status and some ovulation inducing medications will be prescribed by the doctor. Women with PCOS often tend to be overweight, and it would help if she loses weight and tries to achieve an average weight for her height (as per standard charts). This would help regularize the periods and spontaneous ovulation may then happen. Many of these women successfully conceive and go on to have a normal pregnancy.

Folic acid tablets

Folic acid tablets (1 tablet per day) is a must for women planning a pregnancy as it has been established that high levels of Folic acid in the maternal blood at the time of conception reduces certain defects in the fetus.

Live a healthy life

Maintaining a healthy body weight for both men and women is important. In overweight women especially, the extra fat cells cause hormone imbalances and affect the menstrual cycles and fertility. A healthy diet, with plenty of natural foods will help. Fruits and vegetables, those rich in antioxidants are helpful as are dry fruits and nuts which contain high levels of Vitamin E which improve fertility. About three helpings per week of nuts (almonds, walnuts and pistachios) should be consumed.

How long to try before seeking help

It is advised for a couple to try for at least one year (one year of unprotected intercourse) before seeking a doctorŸ??s advice. This much time should be allowed as many couples conceive on their own within this period.
Content Credits: Dr Jayashree Murthy

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

Everything you need to know about PCOS

What is PCOS or PCOD?

Polycystic ovary syndrome (sometimes sadly referred to as disease) is a problem in which a woman’s hormones are out of balance. It can cause problems with oneŸ??s periods and make it difficult to get pregnant. PCOS also may cause unwanted changes in the way you look. If it isn’t treated, over time it can lead to serious health problems, such as diabetes, heart disease and even cancers!

Most women with PCOS grow many small cysts on their ovaries. That is why it is called polycystic ovary syndrome. The cysts themselves are not harmful, but lead to hormone imbalances.

Did you know that symptoms of PCOS persist even when both the ovaries are removed?
The root cause of the problem is the brain, the hormone regulation centre at hypothalamus, with involvement of multiple organs (Multi-system disease).

Some of the symptoms
  • Acne.
  • Weight gain and trouble losing weight.
  • Extra hair on the face and body. Often women get thicker and darker facial hair and more hair on the chest, belly, and back.
  • Thinning hair on the scalp.
  • Irregular periods. Often women with PCOS have fewer than nine periods a year. Some women have no periods. Others have very heavy bleeding.
  • Fertility problems. Many women who have PCOS have trouble getting pregnant (infertility).
  • Depression.

As if it was not bad enough, it increases your chances of developing a big disease later on in life, like full-blown diabetes, autoimmune thyroid disease and even cancers. Today I want to spread the awareness about Bio-cycle study. You can read the whole study in the oxford journal but the conclusion is here: If you have a hormonal imbalance in your 20s or 30s,( like pcos, irregular painful periods, or even something as small as PMS, it significantly increases your chances of developing a big disease of inflammation in the later life(40,s and 50,s) like diabetes, autoimmune thyroid disease and some form of cancers!

The BioCycle Study – Influence of Endogenous Reproductive Hormones on F2-Isoprostane Levels in Premenopausal Women.

The Treatment

The western medicine today, deals with identifying and treating the symptoms around PCOS. But these spot treatment are at best described as bind-aid solutions to a much deeper problem that gets worse not only due to the ignorance of the root cause but also as side-effects of these symptomatic treatments over long periods of time.

If you have been diagnosed with PCOS, chances are you have been prescribed to Birth Control Pills or OCŸ??s (oral contraceptives) for regularising hormone cycles and hence periods and metformin for elevated blood sugars or pre/diabetic conditions. All in an attempt to masking the symptoms BUT they come back in a worse form once synthetic hormones are stopped.

Lets have a look at these two so that you can get to the root of the problem and avoid potential side effects of these.

Birth Control Pill

What it does:

The synthetic hormones in the birth control mask your natural hormonal patterns to prevent ovulation from happening, and therefore prevent pregnancy. The menstrual period you experience on the pill is not an acutal period, but rather a Ÿ??break-through bleedŸ? that occurs from the drop in estrogen. So even though it might be regulating your cycle, once you get off the pill chances are your period will return to the same state is was before and mostly it gets even worse.

Side effects:

Off the several side-effects, one side effect most relevant to PCOS is that it increases testosterone uptake, which can make your androgenic symptoms worse. This means if youŸ??re experiencing hirsutism (hair growth in unwanted places), head-hair loss, or acne, it could potentially get worse with the pill.

Alternative solutions:

Re-establish your monthly ovulation and menstruation through restoring key micronutrients and helping your body to eliminate excess estrogen or other hormones that could be impeding your natural flow. Addressing adrenal fatigue and thyroid issues is also key here. And the great news is – all of these can be achieved via our program.

Metformin (Glucophage)

What it does:

Metformin helps with blood sugar and insulin management by suppressing glucose production by the liver. ItŸ??s commonly used for diabetes and PCOS with insulin resistance.

Side effects:

In a recent study, metformin was found to cause an impairment mental cognition. ItŸ??s more commonly known to cause serious digestive issues like gas, bloating, diarrhea, constipation, and more uncomfortable symptoms.

Alternative solutions:

Address your blood sugar balance through your diet and key supplements as I teach you in the program.

Not only they do not help, they damage your body in the long run!

If you are diagnosed with PCOS and you have been offered a prescription of birth control pills & synthetic hormones, PLEASE STOP!

The advice to lose weight & exercise more does not completely work either. They say that you should lose weight to be healthy but I say that you should be healthy to lose weight. I am sure you can relate to that. I am not here to criticize any system, and each kind of treatment has its own role.

Conclusion

Very often youŸ??ll be told that the only thing you can do is take a pill, but I hope this article has opened your eyes to other possibilities and helped give you your power back when it comes to making informed decisions about treating your PCOS symptoms.

There is no quick fix to treating PCOS. It is a systemic issues that needs to be managed through diet and lifestyle and holistic approach

If youŸ??re ready to get to the bottom of your hormonal imbalances once and for all, let me help you. Your body CAN work for you .Stop suffering. Start feeling good all month long.

My thoughts

I believe it is my responsibility to share what IŸ??ve learnt so that you and many others are not held back by PCOS & hormone imbalances, but rather use it as a way to improve your lives. I want to empower you.
I want you to be the captain of your own ship because I know that if we take the necessary steps, we can improve not only our own lives, but those of our family, community & the world at large.

Ÿ??The journey of a thousand miles begins with a single stepŸ??
I will be glad if you choose to take that first step with me.

Wishing you health & happiness!

Content Credits Dr. Disha Sridhar