17. Hepatitis
Hepatitis is a viral infection of the
liver. It’s near the top of the list of serious infections that affect
a large percentage of our population every year and is one of the most
serious infections that can occur during pregnancy. That’s one reason
all pregnant women are screened for hepatitis B at the beginning of
pregnancy.
When people talk about hepatitis, it can
be confusing. Six different forms of hepatitis have been
identified—hepatitis A, hepatitis B, hepatitis C, hepatitis D,
hepatitis E and hepatitis G. The most serious type of hepatitis during
pregnancy is hepatitis B.
Hepatitis B is responsible for nearly
half the cases of hepatitis in North America. It is transmitted by
sexual contact and the reuse of intravenous needles. A woman with
hepatitis B may experience flulike symptoms, nausea and pain in the
liver area or upper-right abdomen. The person may appear yellow or
jaundiced, and urine may be darker than normal. This form of hepatitis
can be transmitted to the baby during birth or while breastfeeding.
If a mother tests positive for hepatitis
B during pregnancy, the baby may receive immune globulin to treat
hepatitis after birth. This is different from the hepatitis vaccine.
Hepatitis vaccine is given to prevent hepatitis from occurring. It is
now recommended that all newborns receive hepatitis vaccine shortly
after birth. Ask your healthcare provider about it.
18. High Blood Pressure (Hypertension)
Blood pressure is the amount of force exerted by blood against arterial walls. When you have high blood pressure,
your blood vessels narrow, which makes pumping blood through the body
harder. It reduces blood flow to organs in the body. This is
particularly unsafe during pregnancy because blood vessels in the
uterus supply the developing baby with nutrients and oxygen. When
uterine blood vessels are constricted, it can slow passage of nutrients
and oxygen from you to your baby, which may slow fetal development.
If you have high blood pressure before pregnancy, you have chronic hypertension.
Be sure your healthcare provider knows about it. Your condition will
not go away during pregnancy and must be controlled to avoid problems.
It can develop into a serious problem during pregnancy if left
untreated.
Your healthcare provider will keep a
close watch on you during your pregnancy to help avoid problems. High
blood pressure is one of the most common chronic illnesses in older
pregnant women; many older women enter pregnancy with the problem.
If you have chronic high blood pressure,
you have a greater chance of having complications during pregnancy.
Baby may be low birthweight and/or premature. High blood pressure also
has other effects. About 20% of all women who have chronic high blood
pressure before pregnancy develop pre-eclampsia.
If your blood pressure is high when you
get pregnant, you may have more ultrasounds to monitor baby’s growth.
You may want to purchase a blood-pressure monitor to use at home so you
can check your pressure any time.
Most blood-pressure medications are safe to use during pregnancy. However, ACE inhibitors should be avoided.
19. Influenza (Flu)
The flu seems to be a problem every
year because different flu viruses come and go. When an outbreak of
influenza occurs, it can have a greater impact on a pregnant woman
because of her altered immune system.
If you are pregnant when a breakout occurs, you should receive any specific flu vaccine and
the seasonal flu vaccine. You can be vaccinated any time during
pregnancy. Studies show women who receive flu vaccines are less likely
to give birth prematurely, their babies weigh more and infants are less
likely to be hospitalized than those not immunized.
There are ways to protect yourself in
addition to getting a seasonal flu shot. Avoid crowded areas, use a
mask and wash your hands frequently (flu virus can live up to 2 hours
on surfaces like doorknobs and telephones).
If you get the flu, follow your
healthcare provider’s guidelines regarding use of medication. Benefits
of treatment outweigh any potential risk to the baby from medications.
Treatment should begin as soon as possible; don’t wait for lab results.
Pregnant women should receive
antiviral treatment as soon as possible after symptoms
appear—preferably within 48 hours. Tamiflu (oseltamivir) or Relenza (zanamivir)
are prescription antiviral medications. These medications can shorten
the course of the flu and help treat symptoms. Pregnant women who are
suspected of having influenza should receive a 5-day course of Tamiflu
or Relenza, preferably started within 48 hours of the onset of symptoms.
20. Lupus
Lupus is an autoimmune disorder
of unknown cause that occurs most often in young or middle-aged women.
It is a chronic inflammatory disease that can affect more than one
organ system. The most common symptoms of lupus are arthritis, rashes
and fatigue.
Over 1½ million people in the United
States have some form of lupus. Women have lupus much more frequently
than men—about nine women to every man. Nearly 80% of the cases develop
in people between the ages of 15 and 45.
Lupus is diagnosed through blood tests,
which look for suspect antibodies. Blood tests include a lupus antibody
test and an antinuclear antibody test.
Steroids are generally prescribed to
treat lupus. The most common medicines used are prednisone,
prednisolone and methylprednisolone. A small amount of the medication
passes to the baby.
If you use warfarin, contact your
healthcare provider; it should be replaced with heparin as soon as
possible. If you have high blood pressure, you may have to switch
medicines. Don’t take cyclophosphamide during the first trimester.
Azathioprine and cyclosporin may be continued during pregnancy.
All lupus pregnancies should be considered high risk,
although most lupus pregnancies are completely normal. “High risk”
means solvable problems may occur during the pregnancy and should be
expected. More than 50% of all lupus pregnancies are completely normal,
and most of the babies are normal, although babies may be somewhat
premature.
The risk of pregnancy complications is
slightly increased in a woman with lupus. Protein in the urine may get
worse. It’s a good idea to see your rheumatologist every month during
pregnancy. If you begin to have a flare-up or other problem, it can be
dealt with.
If you had kidney damage from previous
flare-ups, be on the lookout for kidney problems during pregnancy. Some
women experience improvement in their lupus during pregnancy and
breastfeeding.
