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Wednesday, March 12, 2014
- I jog during pregnancy?
- I keep teaching 2 high impact aerobic classes per day?
- I do sit-ups?
- I continue a rigorous exercise program with a personal trainer that I started a few weeks before conceiving?
- I'm diabetic?
- I have developed gestational diabetes?
- I consume caffeine?
- My water has broken at 6 months pregnant?
- I have been on birth control pills during pregnancy?
- I ride amusement park rides?
- I am overly anxious?
- I work at a computer terminal 40 hours per week? (i.e. radiation emitted from the video display tube)
- I drink alcohol?
- I had a lot of alcoholic drinks one weekend before I knew I was pregnant?
- I smoke tobacco?
- smoke marijuana?
- I use cocaine?
- I use heroin?
- I come down with chicken pox?
- I come down with shingles?
- I use permanent hair coloring?
- I take antibiotics?
- I treat a yeast infection with Monistat 7 cream?
- I scoop dog poop or change cat litter?
- I take hot baths?
- I use a sauna?
- I have non-routine dental work?
- I have an ultrasound in early pregnancy?
- I have a vacuum delivery?
- I have an ovarian cyst?
- I had a ruptured cyst that leaked some blood and water?
- I take a pain killer for my headaches?
- I continue to tan in a salon?
- I take the drug [fill in name of drug] to treat a medical condition?
- I consume too much Vitamin A?
- I use a topical Retinol A cream?
- I have weight loss from nausea/morning sickness?
- I work as a flight attendant and fly routinely?
- I've had a cone procedure for cervical cancer?
- I have group B strep?
- Misoprostol is used to induce my labor?
The answer to this question will vary according to individual pregnancies. Generally speaking, exercise in pregnancy is not harmful if you have no existing complications. You will need to maintain good fluid intake and not overdo it. With the increase in uterus size, jogging may become uncomfortable. Women who perform exercises like cycling, walking or swimming tend to exercise longer into their pregnancy. You should speak to your physician before continuing exercise.
Exercise in pregnancy is encouraged, but also in moderation. High impact aerobics are fine in the first trimester, as long as there is no vaginal bleeding. You want to be sure to keep your heart rate below 120. This is a generally accepted safe heart rate when exercising during pregnancy.
There is not a straight medical answer to this question and I would advise you discuss this with your physician. It is probably safe throughout an uncomplicated pregnancy but it is best avoided after the fifth month (or 20 weeks) when the uterus becomes large enough to become a barrier to effective technique.
Although I believe that exercise in pregnancy is great, the goal should be to maintain a level of activity or wellbeing and not lose weight or increase fitness. Most women involved in exercise during pregnancy find that they may have less energy and not be able to maintain the same level of activity as before. Also, as a woman's center of gravity is altered, activity that requires excellent balance can be dangerous. I would encourage you to share your pregnancy with your trainer. He or she can develop a training schedule that is more in line with your pregnancy. I would concentrate on the aerobic exercise rather than the weight training. Also, non-weight bearing exercise (swimming, cycling) rather than weight bearing (running, dance) was shown to be better tolerated and continued in pregnancy. Drink plenty of fluids, eat right and don't remain flat on your back for prolonged periods of time as it will decrease blood flow to you and your baby.
Diabetes should be under control and stabilized before attempting pregnancy. One of the easiest ways to help assure a better outcome is to have good control of your blood sugars in the months prior to pregnancy. Pregnancies in diabetic moms will have more complications than in non-diabetic moms, but this shouldn't persuade you not to attempt pregnancy. Close supervision can significantly reduce your chances of having these complications (but not eliminate them). The best outcomes are those that are managed by a team of caregivers who are well trained in handling pregnant diabetics. This usually involves at least consultation with a perinatologist (an obstetrician with special training in high-risk pregnancies). This specialized approach can lessen the risks. With this approach, a diabetic woman has a good chance (depending on the severity of the disease) of having a less complicated pregnancy than in years past.
Once the diagnosis of gestational diabetes is made (based on an abnormal 3-hour glucose challenge test), the target is to keep fasting glucose levels below 105 mg/dL and post-prandial (after eating levels) less than 120 mg/dL. This is considered strict control and there is evidence to back this up. Typically, a patient will first start on a specialized diet to maintain good control of her blood sugars. If this cannot be done with diet changes alone, insulin therapy is warranted.
The biggest concern for developmental abnormalities is if blood sugars are high at the time of conception. This is more likely with mothers who are diabetic before pregnancy occurs, while gestational diabetes develops from pregnancy. The importance of controlling sugars during the remainder of pregnancy is to prevent very large babies from being born and to prevent stillbirth
Gestational diabetes in pregnancy can lead to large babies, difficult deliveries, and increased cesarean deliveries. Uncontrolled, it can increase the incidence of fetal malformations and fetal distress. If it is only related to pregnancy, it resolves after delivery. The incidence of non-gestational diabetes after pregnancy is 50% in the 20 years following delivery.
The issue of caffeine is a controversial one. There have been claims that caffeine may increase the risk of miscarriage or a low birth weight baby. This seems to only be possibly true for women drinking more than 5 cups of coffee (or its equivalent) a day. A single cup of coffee a day is probably safe, as is decaf.
This is a serious situation and it is critical that you and your physician discuss the pertinent issues. There are 2 critical elements with a broken bag of water at 6 months. First is the increased risk of preterm delivery and the dangers to the baby of extreme prematurity (infection, death, breathing difficulties, and cerebral palsy). Second is the risk of the baby's lungs not forming properly because of lack of fluid. This is called pulmonary hypoplasia. Since amniotic fluid is continuously produced by the placenta and baby, you will most likely have some fluid still surrounding the baby and will not necessarily have a "dry birth". A vaginal delivery is still possible but depends on the health of the baby and if the baby is head down or not.
There have been many women on birth control pills who have continued taking them during the pregnancy and there have been no reproducible effects on the baby. Some people believe that the hormones in the pill could affect the sexual characteristics of the baby, but this has never been proven and is theoretical at best.
Amusement ride warnings for pregnant women are most important for women in the later months of pregnancy. The theoretic risks would be stimulating early labor or injury to the placenta from sudden impact or jarring.
Anxiety is a common feeling of many pregnant women and there seems to be no ill effect of this on pregnancy. It is important to determine when this mild anxiety may be progressing to an anxiety disorder where there can be effects to the health of the mother and the fetus. I would encourage you to raise these feelings with your physician and let him or her help assess any possible implications to yours or the baby's health.
Many studies have investigated the claim that working with video display terminals (VDTs) is a risk factor during pregnancy. Although in the majority of cases there has been no evidence to support a risk to the pregnancy, results have been inconsistent. Overall the studies indicate that VDT operators are not at greater risk than the general population.
Anything that a woman ingests during pregnancy will affect her and her baby. With regard to alcohol, ingestion has been associated with a variety of problems. These include low-birth-weight, stillborn infants and infants with fetal alcohol syndrome (FAS). FAS is a group of disorders involving the central nervous system (CNS), facial malformations, growth deficiency and other anomalies. CNS abnormalities that occur include learning problems, lack of motor coordination, seizure hyperactivity and below average IQ's (mild to severe mental retardation). The facial appearance of the baby is typically small eye slits, short flat broad nose, thin upper lip, and widely spaced eyes. Growth deficiency is noted at birth with most infants having a birth weight, head circumference, and length below the third percentile. These infants rarely catch up after birth since they often experience feeding difficulties during the first several years of life. They will nurse poorly and may have vomiting for the first six months. They will also have difficulty with solid foods. Other abnormalities that frequently occur in the infant with FAS include cardiac, renal (kidney) and joint abnormalities
The effect of alcohol on a pregnancy is related to both the timing and the amount of alcohol consumed. An infant can have Fetal Alcohol Effects (FAE) and exhibit some of the effects of alcohol exposure in utero but not meet the criteria for the diagnosis of Fetal Alcohol Syndrome. Additional information can be obtained from the databases of The National Clearinghouse for Alcohol and Drug Information (NCADI) (301)468-2600 (see the link below).
Fetal Alcohol Syndrome (FAS) has been described in women who have consistent heavy alcohol ingestion (approximately 5 drinks per day) in the first trimester of pregnancy. Although alcohol is best avoided in the first trimester, a weekend binge is unlikely to cause a problem. The risk from occasional alcohol use, even heavy use, in the beginning of pregnancy, is very low, but not zero.
Tobacco use is associated with spontaneous abortions, (miscarriage) ectopic pregnancies (implanting of the embryo outside of the uterus), preterm labor, abruptio placentae (separation of the placenta prior to birth of the baby), placenta previa (placenta in the lower uterus, may cover the cervix) low birth weight infants, premature rupture of the membranes and growth restriction.
Cigarette smoking can affect the pregnant woman in other ways, too. Most women who smoke will have a decrease in their appetite. This can greatly influence their nutritional status. Additionally, smoking increases the metabolism of Vitamin C, which may result in the woman receiving inadequate amount of this necessary nutrient. The risk is directly related to the number of cigarettes the woman smokes. Research has shown that any decrease in the number of cigarettes smoked during the pregnancy will improve the pregnancy outcome. During pregnancy is a difficult time to stop smoking, and many stop-smoking programs are available. In some areas of the country there are special programs for pregnant women who want to stop or decrease their cigarette smoking. Quitting smoking decreases the risks to your own health and your baby's health.
The research studies on marijuana effects on fetal development during pregnancy are based on animal studies and the results are conflicting. Some studies have shown that infants exposed to marijuana will have fine tremors, and irritability. What is known is that marijuana does cross into the fetal circulation and reduces the amount of oxygen available to the growing fetus.
Cocaine use can affect both the mother and the baby. Some complications the mother may experience include cardiovascular problems, pulmonary disease, liver damage, seizures and death. They are also at increased risk for preterm labor and delivery, and have babies with a lower birth weight.
Heroin users are at high risk for malnutrition, anemia, pre-eclampsia (high blood pressure occurring in pregnancy), placental abnormalities, preterm labor, premature rupture of membranes. The infant will often be born addicted to heroin, and will go through withdrawal following birth. These infants are irritable, have a shrill high cry, and may have seizures. They are very difficult to comfort, and which may make it difficult for them to be cared for by their mothers.
When a pregnant woman becomes infected with chicken pox during the first half of pregnancy, there is a small (1-2%) chance of fetal infection with birth defects. It is suggested that the fetus undergo an ultrasound to look for any type of major birth defects. The ultrasound should be repeated throughout pregnancy to look for signs of fetal growth restriction. The fetus is most likely to be affected in the first trimester or at the end of the pregnancy. If the baby develops an infection at birth (from exposure to an infected mother), the baby can become sick as well. Only an active chicken pox infection can cause problems to a developing fetus.
A mother can only be infected if she has not had chickenpox in the past. Even if she has no knowledge of having chickenpox, 35% of mothers may be immune. Immunity can be tested with a blood test. The biggest concern for the pregnant woman with chickenpox is developing varicella pneumonitis, a potentially life-threatening lung infection. Little can be done to prevent this once the chickenpox occurs, but the patient's obstetrician must be notified to monitor her symptoms.
Shingles is a reactivation of a previous infection with chicken pox. It usually is a rash (not like the initial chicken pox rash) limited to a well circumscribed area of the skin. While the initial infection (chicken pox or varicella) can be harmful to the mother and/or unborn baby, shingles isn't.
As far as I know from the research in the literature, there is no evidence to link hair dyes with any birth defects. The most common side effects have to do with possible nausea and vomiting associated with the inhalation of the vapors. Because of this, the dying process should be done in a well-ventilated area. Another concern many women have is that a dye or perm may not take during pregnancy. This may occur since the texture and quality of hair may change during pregnancy.
To be on the safe side, it is best not to use any substance that may affect the growing baby. This is especially important during the first trimester. During this time (first trimester) in the pregnancy the baby is developing all of its organs, and is very vulnerable to the effects of a foreign substance. Following the first trimester, many women continue to dye their hair without any known adverse effects, but generally they will dye their hair less frequently.
Unless you are allergic to the specific antibiotic, most are perfectly safe in pregnancy. There are a few that are contraindicated in pregnancy, but outside of vitamins, they are the most studied and safe medications to be taken during pregnancy. As for any medication, you have to weigh the risks of medicating versus not treating the illness it is indicated for.
Monistat is vaginally administered and is considered safe during all 3 trimesters of pregnancy.
Most of the concerns regarding pet litter in pregnancy centers around cats. They are the hosts of the parasite that causes toxoplasmosis. The parasite can be released in the cats' litter and by poor hygiene, passed on to the cat owner. It is the initial (acute) infection that can harm the unborn baby. As many as 25% of people have evidence of previous exposure which is not known to hurt the unborn baby. This is why pregnant cat owners should exercise good hygiene when cleaning cat litter. The other reassuring news is that is seems only rural, outside cats are at risk of harboring the parasite since they obtain it by eating infected mice. Your best defense is good handwashing and/or using your pregnancy as an excuse to get someone else to do it. I know of no risks to pregnant moms by cleaning up after a dog.
The relationship between hot baths and birth defects is controversial and the early reports described an increased risk of miscarriage and not any reproducible birth defect. The safest answer is always to avoid an exposure. I would not be overly concerned because the relationship between hot baths and pregnancy problems is weak.
There have been conflicting scientific studies regarding the use of saunas and hot tubs during pregnancy. The concern is the possible relationship to neural tube defects like spina bifida. Given the possibility of an adverse effect of the developing fetus, hot tubs and saunas are best avoided during pregnancy. The theory that hot baths (mainly saunas and hot tubs) has any effect on pregnancy is based on a few poorly conducted medical studies. The best advice is to limit bath to warm water and that will not harm the pregnancy in any way.
There is very little danger in any type of dental work during pregnancy. The concerns are basically with the type of anesthetic (local is safe and general is best avoided) and with any medications that will be needed (antibiotics or pain killers). Talk with your obstetrician and see what his/her preference is. Most dentists will require a note or phone call from your obstetrician before proceeding with any type of dental work.
Diagnostic ultrasound is safe at all stages of pregnancy.
The obstetric vacuum is a safe delivery method when used properly. There are case reports of infants with neurological damage after the vacuum was used, but it may be due to the reason the vacuum was used (low fetal heart rate or ominous fetal heart rate tracing) rather than the vacuum itself. One specific injury seen with the vacuum is a cephalohematoma which is a blood clot that can develop between the scalp and the sutures of the skull. This can occasionally result in neurological damage.
Ovarian cysts are common in early pregnancy and their natural history depends on the cause of the cysts. Most of them are called functional cysts and are the remnant that was released to conceive. The cyst (called the corpus luteum) produces progesterone that supports pregnancy. Cysts can sometimes increase in size and rupture or twist (torsion). Pain is the most common symptom.
Many women will develop a corpus luteum cyst early in pregnancy. This cyst develops from the ovulatory cyst then becomes a major source of progesterone production for the first 10-12 weeks of pregnancy. This would be considered a normal finding. It will go away on its own the majority of the time. If the cyst does not go away, or the radiologist is sucpicious that it is not a corpus luteum cyst, it may be necessary to remove the cyst surgically while you are in the early part of the 2nd trimester.
In general, ovarian cysts may complicate pregnancy if they are very large (greater than 10 cm) or if they are expanding during the pregnancy. The possible problems are ovarian torsion, ovarian rupture and pre-term delivery. These are, in general, uncommon problems.
The symptoms you describe are typical of a ruptured ovarian cyst. If there is only a small amount of cyst fluid in your abdomen, there will be no problem. If the cyst that ruptured was the corpus luteum, the structure that provides hormonal support for the early part of the pregnancy, things will be fine if there is enough hormones in your system. If you have no bleeding or cramping in the next several weeks, then there should be no effect from this on your pregnancy or baby.
As far as a remedy for your headaches are concerned, Tylenol (acetaminophen) is considered safe in pregnancy. You should avoid the NSAIDs (non-steroidal antiinflammatory drugs) such as ibuprofen and naproxen.
There is no known pregnancy risk to tanning but there are concerns to your health and possible skin cancer. You are better off avoiding this exposure.
I want to preface this by describing the testing of drugs in pregnancy. The best way to study a drug would be to find two identical groups of pregnant women and give one group the drug to be studied, and give the other a placebo. Very few studies are performed that way in pregnant women looking for side effects. Most of what is done is that a group of women on the drug are looked at to see if there is any increase in adverse outcomes, but because there isn't an identical group to compare them to, these are less valid. Comparing them to the general population isn't the same either. Unfortunately, that is the best data we have. Drugs are given a risk factor category A-E, or X.
There are many other confounding elements that make studying drugs in pregnancy difficult. For one, there is a 2-3% random chance of a defect for every pregnancy, so this makes it difficult to determine if the drug in question was the culprit or nature. The best advice is to consult with your doctor the potential risks versus benefits of any medication. For more information on drugs in pregnancy, click here.
The current recommendation by the American College of Obstetrics & Gynecology is that no screening be done, but that all mothers in labor with any of the above risk factors be given antibiotics, unless a culture taken on admission is negative. The solution would be a reliable rapid screen that could be done on admission to determine the mother's status at the time of labor. Some people are compelled to screen all women, but many feel this only promotes a false sense of security. A screen that is negative this week may be positive at the time of delivery. It doesn't help to detect group B strep early because no treatment is given outside of labor. If a woman were found to be positive at 35 weeks and was treated, there would be no guarantee that she would be negative at delivery.
Last Reviewed: May 28, 2002
Arthur T Ollendorff, MD
Associate Professor of Obstetrics and Gynecology
College of Medicine
University of Cincinnati