Useful Information In Pregnancy
Working In Pregnancy
guidelines are for otherwise healthy women.
These "work during pregnancy guidelines" are an example of how to guage strenuous work in pregnancy.
With these exceptions, employment may be continued to term. In addition, the council recommends careful evaluations to determine if work should be continued by women who have a number of medical conditions or prior obstetric adverse outcomes or complications. These guidelines are in keeping with the earlier recommendations of the American College of Obstetricians and Gynecologists and the National Institute of Occupational Safety and Health, and can be used as a reference when advising women on medical leave from work during pregnancy.
Nutrition in Pregnancy
To produce this guide, I have utilized data supplied by the Society of Obstetricians and Gynaecologists of Canada, I trust you will find it useful
Good nutrition has a positive impact on pregnancy outcome, especially birth weight, neonatal morbidity and mortality, and recovery of the mother. The degree of that impact depends upon the preconceptual nutritional status of the mother.
Ideally, nutrition and education are discussed in preconceptual counselling.
Folic acid supplementation to prevent neural tube defects is a good example of this.
Patients who are at high risk (i.e. those with a past family history of neural tube defects, insulin dependant diabetics, epileptics on Valproic acid and Carbamazepine) all require 4 mg o.d.
Low risk patients require 0.4 mg o.d.
It is recommended to start supplementation about a month prior to conception and to continue for the first three months. If nutrition screening did not occur then, it is important to identify, early in a pregnancy, disordered eating patterns and non-informed vegetarian practices as well as low socio-economic status. Women identified as being at potential risk of nutrient deficiency or food insecurity require additional assessment.
Nutrition Assessment and Counselling
Nutritional assessment and monitoring should be part of every prenatal care plan;
Inquiries as to whether the patient chooses foods from the four food groups as well as smoking and alcohol intake are necessary.
Canada's Food Guide to Healthy Eating suggests pregnant and breastfeeding women need three to four servings of milk products daily.
Non-pregnant women consume an average of 1,900 to 2,200 kcal/day. It is recommended that pregnant women should increase their energy intake by about 100 kcal/day in the first trimester, by 300 kcal/day in the second and third trimesters and by 450kcal/day during lactation.
Calcium, iron and folic acid needs are special nutritional challenges for pregnant women.
Food sources of these nutrients, such as milk products, orange and dark green vegetables and fruit, meat and/or legumes should form an important part of the diet during pregnancy.
When nutritional risk factors have been identified, referral to a dietician would be indicated.
In addition, during subsequent prenatal visits, women at nutritional risk should have their nutritional status re-evaluated.o
Screening for anaemia should be repeated at least once early in the third trimester.
Maternal Weight Gain
Optimal maternal weight gain during pregnancy (varies from 6.8 to 18.2 kg) will depend on the pre-pregnancy weight.
Underweight women and teenagers can be encouraged to gain at the upper end of the range; weight loss in obese women is not recommended during pregnancy.
It must be acknowledged that the issue of ideal weight gain during pregnancy is controversial.
Vitamin Supplementation
Emphasis should always first be placed on improving diet quality.
Some women may benefit from nutrient supplementation (e.g. folic acid).
Adolescents and those with multiple births may require vitamin supplementation.
Initial prenatal nutritional assessment can help reveal evidence of poor nutritional status, and/or dietary practices such as non-informed vegetarianism.
Routine iron supplementation is not an essential component of prenatal care for women who are not anemic. However, maintenance of maternal iron stores are usually assured if low level iron supplementation is provided during the last half of the pregnancy. Serum ferritin has been a useful screening tool to evaluate iron stores in research. However, its use in routine assessment of iron stores is questionable.
Folic Acid
All women should consider a minimum of 0.4 mg of folic acid supplementation after discontinuation of reliable birth control for ten to twelve weeks after LMP.
Women who have had a previous pregnancy affected by a neural tube defect should consider four mg of folic supplementation daily in this same time period.
Intermediate risk women include those with insulin dependent diabetes, epilepsy treated with valproic acid or carbamazepine or women with a first degree relative with a neural tube defect. These women should consider 1.0 to 4.0 mg folic acid supplementation daily.
Screening Test for Downs Syndrome
To produce this guide, I have utilized data supplied by the State of California to all pregnant women 34 yrs and younger, I trust you will find it useful.
For Women Under 35 Years of Age
Every pregnant woman wonders about the health of her fetus (unborn baby) and the possibility of birth defects. The Expanded AFP blood test can help detect some birth defects. This article describes the test for women under 35 years of age at delivery. It is a woman's own decision whether to have the test or not.
The Expanded AFP Screening Program consists of:
The Expanded AFP ( or Triple ) blood test first, followed by diagnostic tests if needed.
The Program helps detect open neural tube defects, abdominal wall defects, Down syndrome and trisomy 18
Who should consider having the Expanded AFP blood test?
All Pregnant Women
Some women need genetic counselling before deciding about this test.
If a woman (or the baby's father) has a medical or family history of inherited conditions, she should discuss the test with her doctor.
A woman with a high risk pregnancy should also talk to her doctor. There may be special tests that should be done in place of, or in addition to, Expanded AFP.
What does the blood screening test involve?
A small amount of blood is taken from the pregnant woman's arm.
Her blood is tested for the amount of AFP(alpha-fetoprotein), HCG (human chorionic gonadotropin), and UE (unconjugated estriol). These substances are made by the mother's placenta and the fetus. At each week of pregnancy there are different amounts of these substances in the mother's blood. (What she eats does not affect these substances.)
When is the blood screening test done?
The blood test can only be done reliably between 15 and 20 weeks of pregnancy. The best time is 16 to 17 weeks.
It is important to know how far along the pregnancy is. Ultrasound is very useful for this purpose.
The result of the blood test is sent to the patient's doctor or clinic within 1-2 weeks.
What does a "screen negative" result mean?
It means that the risk for certain birth defects is low enough that the Program does not consider follow-up tests necessary.
The risk is calculated by measuring the amounts of AFP, HCG, and UE in the woman's blood and also by considering her age.
Since the blood test is just a screening test, there is still a chance that the fetus may have a problem - even when the test result is negative.
What does a "screen positive" result mean?
It means that there is an increased risk for certain birth defects in this pregnancy (such as Down syndrome, neural tube defect, abdominal wall defect, or trisomy 18).
The risk is calculated using the amounts of AFP, HCG and UE found in the woman's blood.
Her age is part of the calculation for the risk of Down syndrome.
Most of the time, however, the reason for the result is not a birth defect. The most common reasons for a "screen positive" result include:
• the due date is earlier or later than thought, or
• there is more than one fetus (twins, triplets), or
• the substances in the blood varied more than usual, without any known pregnancy problem.
To determine the reason for the "screen positive" result, follow-up diagnostic tests are offered and paid for by the Program.
Most women with "screen positive" results will have normal follow-up tests and healthy babies.
If the test is "screen positive", what happens then?
A woman with a "screen positive" result will be called by her doctor or clinic. She will be offered diagnostic services at a State-approved Prenatal Diagnosis Center. When authorized, these are the follow-up services covered by the Program:
- Genetic counseling - A professional counselor discusses the pregnancy and family medical history. Questions are answered to help the woman make decisions about further testing.
- Ultrasound - A picture of the fetus is made using sound waves. This picture shows the age of the fetus and whether there are twins. The advanced ultrasound done at a Prenatal Diagnosis Center can also detect certain birth defects.
- Amniocentesis - a small amount of fluid is taken out of the uterus by experienced, State-approved doctors. The fluid and the fetal cells in it are tested for specific birth defects.
Women may refuse any of these services at any time
What if the follow-up tests show that the fetus has a birth defect?
Information will be given to the woman at the Prenatal Diagnosis Center by a doctor or genetic counselor. They will discuss the type of birth defect that has been found and any available treatments. They will also discuss options for continuing or ending the pregnancy. The woman can then make a decision.
The Expanded AFP Screening Program does not pay for any other medical services after the follow-up tests. Referrals for special support services are available.
Birth Defects Found By The Programme
Down syndrome, open neural tube defects, abdominal wall defects, trisomy 18, and some other birth defects may be found.
Neural Tube Defects (NTDs)
As a fetus is forming, the neural tube extends from the top of the head to the end of the spine.
This becomes the baby's brain and spinal cord. The neural tube is completely formed by 5 weeks after conception.
If there is an opening in the spine, it is called a neural tube defect.
This defect often causes paralysis of the legs.
It may also cause loss of bowel and bladder control.
Frequently, there is water-on-the-brain (hydrocephaly) which requires surgery.
Anencephaly occurs when most of the brain does not develop.
This defect causes the death of the fetus or newborn.
Abdominal Wall Defects
Fetuses with these defects have abnormal openings on the abdomen.
Intestines and other organs are formed outside the body.
Surgery after birth often corrects the defect.
Down Syndrome
Down syndrome is a common cause of mental retardation. It is associated with heart defects as well. Down syndrome is caused by an extra chromosome #21.
Chromosomes are packages of genetic information found in every cell of the body.
Birth defects can occur when there are too few or too many chromosomes.
Down syndrome can occur in the fetus of a woman of any age. However, as a woman gets older, her chances increase for carrying a fetus with Down syndrome.
Trisomy 18
Trisomy 18 is caused by an extra chromosome # 18. Babies with trisomy 18 have severe mental retardation and usually die before birth or in early infancy.
What are the results of the Program?
97% of the cases of anencephaly are found
80% of the cases of open spina bifida are found
85% of the cases of abdominal wall defects are found
50% or more of the cases of trisomy 18 are found
40% to 60% of the cases of Down syndrome are found.
Can the Expanded AFP Screening Program detect every type of birth defects?
There are birth defects which cannot be detected by Expanded AFP Screening. Even when the blood test is "screen negative," there is still a chance the fetus may have a problem.
Each woman should consider her prenatal testing choices carefully
• Women who decide to have the Expanded AFP blood test must sign the consent form and have blood drawn between 15 and 20 weeks
• Women who decide to have amniocentesis, CVS, or early amniocentesis should make an appointment at a State-approved Prenatal Diagnosis Center.
• Women should see a genetic counsel or if they need help deciding between a screening test and diagnostic tests.
• Women can decide to have no prenatal testing.
Each woman should check with her insurance company or prepaid health plan about payment for these choices.
Each Patient is requested to read and sign a form to consent or refuse to participate in the screening program.
Careful seizure monitoring is necessary in epileptic patients as folic acid interacts with many antiepileptic medications.
Food Supplementation
Food supplements may be needed to fill the gaps between dietary intake and requirements.
The choice of food provided needs to be based on respectful consideration of the woman's cultural, religious and dietary background.
Food supplementation and nutrition education should be available to all pregnant women with low incomes, especially teenagers. The experience of the Montreal Diet Dispensary (MDD) shows that the benefits of increased caloric intake and special dietary management during pregnancy are not confined to chronically malnourished women in developing countries, but can also improve the pregnancy performance of high risk mothers in more affluent nations
Postpartum maintenance of maternal nutrition will facilitate breastfeeding.
Vitamin and mineral supplementation during lactation is not routinely required
Morning Sickness
To produce this guide, I have utilized data supplied by the Society of Obstetricians and Gynaecologists of Canada, I trust you will find it useful
Emphasis is placed on intake rather than content until the symptoms have subsided. Suggestions for foods which appeal to pregnant women because of taste and texture are:
SALTY CHIPS, PRETZELS, TART/SOUR PICKLES, LEMONADE, EARTHY BROWN RICE, MUSHROOM SOUP, CRUNCHY CELERY STICKS, APPLES, BLAND MASHED POTATOES, SOFT BREAD, NOODLES, SWEET CAKE, SUGARY CEREAL, FRUITY JUICES, FRUITY POPSICLES, SELTZER, DRY CRACKERS
Fatigue seems to exacerbate nausea and vomiting.
Women should be encouraged to increase their rest while they are symptomatic and to seek assistance in such daily activities as child care.
Pregnant women seem to have an increased sensitivity to odours, probably due to the effect of increased levels of estrogen on the area postrema in the brain. Consequently, aromas of cooking food as well as odours in the workplace may initiate nausea (e.g. perfume, smoke).
The partner should be encouraged to cook.
4) THERAPEUTIC INTERVENTION
a) NON-PHARMACOLOGICAL
Current public information cautions pregnant women to limit the use of all medications except vitamins. Hence, many pregnant women are hesitant to use any drug even when that drug has been proven to have no harmful effects on the fetus. They may, however, be amenable to alternate forms of treatment.
CONCLUSION
Nausea and vomiting are frequent symptoms in pregnant women which can affect their quality of life significantly.
It is recommended that all health practitioners should question women early in their pregnancies about the presence of these symptoms and offer intervention with advice about DIET, LIFESTYLE adjustment and MEDICAL treatment.