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A Healthy Pregnancy : Illnesses and Medication

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Knowing how to manage illness and what medications are safe to take is important to protect your own and your baby’s health.

Whether you have a preexisting medical condition, or acquire an illness or infection during pregnancy, always consult your doctor before taking medication or before stopping any prescribed medication.

Preexisting conditions

If you have a condition such as high blood pressure or diabetes prior to pregnancy, your pregnancy will be classified as high risk and you’ll need to be monitored carefully. If you become pregnant while taking medication for a condittion, don’t stop taking the medication, but consult your doctor as soon as possible. You may find that your existing medication is safe, or you may need to change to another type of medication. The most important thing is to control your condition during pregnancy to minimize the risks to you and your baby, which will usually mean continuing with medication.

Diabetes

If you have diabetes and are planning to conceive, you need to get advice on how to manage your condition. Meet with your doctor while you’re thinking about conceiving to discuss the best way to control your blood sugar levels and talk about how diabetes will be managed in pregnancy. Women with diabetes are advised to take a prenatal vitamin with folic acid before trying to conceive and for the first three months of pregnancy. Diabetic women who are overweight may be advised to lose weight before getting pregnant, and they’ll likely be told to monitor their blood sugar more frequently and take their medications on time during their pregnancy. Babies born to diabetic women also have a greater risk of other problems, such as having a large birth weight, respiratory problems at birth, jaundice, and low blood sugar at birth.

As soon as you’re pregnant, you should be referred to an obstetrician who specializes in pregnancy and diabetes where you’ll receive extra care. You will have more frequent prenatal visits, additional scans, and extra blood tests to monitor your blood sugars. You may need diabetes medication and/or insulin injections each day; the dose usually changes throughout pregnancy and needs to be monitored. The better your blood sugar control, the less likely you or your baby is to experience problems during pregnancy.

Since diabetic women have an increased risk of late pregnancy problems such as preeclampsia and premature labor, you may be advised to have an induction of labor a week or so before your due date .

Once in labor, your blood sugar levels will be closely monitored, and you will probably be given an insulin IV. After the birth, your baby’s blood sugar levels will be closely monitored too for around 24 hours. If you’re planning to breast-feed, which is recommended, your insulin dose may need to be changed after the birth.

Diabetes is controlled with daily insulin injections in pregnancy. As the skin on your abdomen becomes taut, you may find it easier to inject into the fatty tissue of the thigh.

Epilepsy

If you have epilepsy, it’s very important to discuss pregnancy with your doctor before you become pregnant, since certain drugs carry a small risk of causing harm to the developing baby. Nonetheless, it’s also important that your epilepsy is controlled, so your doctor will try to ensure that you’re on the lowest possible dose of medication before you get pregnant. When you are pregnant, the anomaly scan at around 20 weeks will check for problems such as cleft palate, which are slightly more common with certain medications. If your condition worsens in pregnancy, contact your doctor.

Continuing with asthma medication is important to keep symptoms under control in pregnancy.

Systemic lupus erythematosus

This is an autoimmune disorder that can affect many parts of the body, including the kidneys, joints, skin, nervous system, heart, and lungs. The condition is more common in women, and particularly in those of childbearing age. Some women find that the symptoms for this condition ease during pregnancy, however for some they can worsen. It’s important to control the condition during pregnancy since it can affect the developing baby, with an increased risk of miscarriage, poor growth, premature labor, and stillbirth. Most medications for lupus are safe to use during pregnancy, but some aren’t, so you need to check with your doctor about whether you need to change your current medication. From around 32 weeks, your baby will be closely monitored and his growth and well-being will be checked. If there are concerns about you or your baby, labor may be induced early, or you may have a planned cesarean.

High blood pressure

If you have high blood pressure that requires medication, check with your doctor that the medication you are on is safe to use during pregnancy. It’s important to continue your medication so that your blood pressure is controlled, because high blood pressure can be dangerous both for you and your baby. Your doctor will frequently check your blood pressure, and will test your urine to check for the presence of protein, because high blood pressure and protein in the urine are symptoms of the condition preeclampsia. Your doctor may also recommend additional scans to check that your baby is growing well.

Thyroid problems

If you have an underactive thyroid gland for which you are taking thyroxine, you’ll need to have a blood test to ensure that your thyroid is functioning well and that you’re taking the correct dose, since sometimes the thyroxine requirement increases in pregnancy. It’s important that you are not lacking in thyroxine, because this may affect the baby. If you are being treated for an overactive thyroid gland, check with your doctor that you’re taking a thyroid medication that is safe in pregnancy. Your thyroid function will be monitored to check that your medication doesn’t need to change.

Bowel disease

Women with inflammatory bowel conditions, such as ulcerative colitis or Crohn’s disease, usually find that their condition improves during pregnancy, although you may relapse after the baby is born. Although it’s unusual for bowel conditions to cause major problems during pregnancy, it is important to check that you are not anemic, which can be a side effect of some bowel conditions, and your doctor may recommend extra scans to check that the baby is growing well.

Infections during pregnancy

When you’re pregnant, your immune system is slightly suppressed. This is necessary to stop you from rejecting the baby, who is genetically half the father’s! This means that you may be slightly more susceptible to common problems such as colds, coughs, a sore throat, or food poisoning, and that the illness may last longer.

If you’re laid low with an illness during pregnancy, take time to rest and recuperate since pregnancy can exacerbate everyday symptoms.

Colds and coughs

Most women get a cough or cold at some stage during their pregnancy. However, you should avoid taking cold medications since these can contain ingredients that are not safe in pregnancy, especially during the first three months (see Cold remedies). Steam inhalations can ease congestion and hot honey drinks help to soothe a sore throat. Saline nasal sprays can also help relieve congestion.

Flu

If you get the flu during pregnancy, call your doctor to get advice or make an appointment. Drink plenty of liquids and get plenty of rest. Don’t take any flu or cold medications without talking to your doctor first. Flu complications can include dehydration and pneumonia, and complications are more common in pregnant women. The US Centers for Disease Control and Prevention recommend that all pregnant women should get flu vaccinations. However, the CDC says they should not get the nasal-spray flu vaccine, which is not approved for pregnant women.

Food poisoning and stomach upsets

A severe episode of food poisoning can cause problems for you and your baby and could trigger an early miscarriage, so it’s vital to practice good kitchen hygiene. If you do develop food poisoning or a stomach upset, try to drink plenty of fluids, and if it continues for more than 24 hours, see your doctor.

Yeast

If you have an abnormal discharge, talk to your doctor since this may be yeast (candidiasis), which is common in pregnancy. A swab may be taken to confirm the diagnosis, and an appropriate local antifungal treatment prescribed. Eating natural yogurt may help restore the bacterial balance in your vagina. Wearing cotton underwear and avoiding tight clothing is also recommended.

Urinary infections

Many pregnant women get urinary infections because the hormone progesterone relaxes all of the smooth muscle, allowing the bacteria that normally live in your vagina to travel up the urethra (the tube that leads to the bladder) where they may cause an infection. The symptoms of an urinary infection may be slightly different in pregnancy. You may have the classic symptoms of burning when urinating and frequent passing of urine, or you may have different symptoms such as back pain, lower abdominal pain, nausea, or vomiting. These are usually easily treated with antibiotics, most of which are safe in pregnancy.

Q: I’m asthmatic. Can I use my inhalers during pregnancy?
A: It’s essential that you keep asthma under control in pregnancy, which means continuing to use your inhalers, since the risks from uncontrolled asthma are greater than any risk from taking asthma medication. If asthma is uncontrolled, it can mean that not enough oxygen gets to the baby, leading to a low birth weight or other problems. One of the best ways to control asthma, in addition to taking medication, is to avoid asthma triggers such as pet fur and dust mites. Use air filters, vacuum often, and damp dust, and use duvet, mattress, and pillow protectors. Sometimes, pregnancy reduces the severity of asthma, but if you feel wheezier than usual, talk to your doctor about reviewing your medication.
Q: Homeopathy seems to be a popular form of therapy. How effective is it and is it safe?
A: Homeopathy works on the principle of treating like with like to stimulate the body’s natural healing mechanisms. There has been debate about the efficacy of homeopathy and the scientific opinion is that there is insufficient evidence to show that homeopathy has any effect beyond that of a placebo. But talk to your doctor before using any homeopathic products or remedies during pregnancy, since homeopathy is an area of complementary and alternative medicine that’s associated with much debate and scientific controversy. If your doctor gives you the okay, a certified homeopath may be able to provide treatment.
Q: What’s the verdict on taking herbal remedies and teas during pregnancy?
A: The US Food and Drug Administration does not regulate herbs and other dietary supplements, and there’s not much research about the health effects of many herbs on pregnant women, so it’s best to avoid them while you’re pregnant, including herbal teas. Decaffeinated black teas are your best bet, but if you want a fruit or ginger tea, read the ingredient label on the package carefully to be sure that no herbs are present. If you want to use an herbal remedy, talk to your doctor first.

What to do

Exposure to chickenpox or rubella

Chickenpox in pregnancy can cause problems for the baby and can be severe in a pregnant woman, possibly leading to pneumonia. If you contract rubella for the first time in early pregnancy, it can cause miscarriage or severe problems in the fetus.

  • If you encounter chickenpox, contact your doctor who can check your immunity. If you aren’t immune, your doctor may advise an injection to protect you from severe chickenpox.

  • Your rubella status is checked at the start of pregnancy. If you aren’t immune, you can be vaccinated after the birth. Meanwhile you need to be extra careful.

  • If you develop chickenpox or suspect rubella because of a rash, contact your doctor immediately, but don’t go to the doctor’s office, where you may spread the infection to other pregnant women.

What’s safe and what’s not

Taking medications during pregnancy

During the first three months of pregnancy, it’s best to avoid all over-the-counter medications. Once you are past the first trimester, some other medications are considered safe, but always consult your doctor if you are in any doubt. The following provides guidance on medications used for treating common pregnancy complaints and minor illnesses.

Antacids

Heartburn and indigestion are common problems in pregnancy, particularly during the third trimester when the increased size of the baby puts pressure on your stomach. Some antacids are safe to use during pregnancy, although you should avoid sodium bicarbonate because it may increase fluid retention. Consult your doctor or pharmacist about which ones are recommended.

Antibiotics

Many antibiotics used to treat infection are safe for use during pregnancy. This includes antibiotics containing penicillin, although there are safe alternatives if you’re allergic to penicillin. The following antibiotics should be avoided during pregnancy:

  • Streptomycin. This can damage the ears of the fetus as it develops and may result in hearing loss in the baby.

  • Sulphonamides. These can cause jaundice in the newborn baby.

  • Tetracyclines. These drugs shouldn’t be taken because they can affect the development of the baby’s bone and teeth and can cause discoloration in the teeth.

Antiemetics

If you have severe nausea and vomiting and natural remedies such as gingersnaps or ginger tea don’t relieve the problem, your doctor may recommend an antiemetic medication that is safe to use during pregnancy.

Antifungal remedies

You should avoid over-the-counter antifungal remedies, including oral and local remedies, for treating yeast. Consult your doctor, who can recommend an antifungal medication that is appropriate for use in pregnancy.

Cold remedies

Remedies for coughs and colds often contain a range of ingredients, such as caffeine, antihistamines, and other decongestants, many of which aren’t safe in pregnancy. Ideally, avoid all cold remedies and instead have steam inhalations and hot caffeine-free drinks. If you need relief, talk to your doctor before using any over-the-counter treatments.

Diuretics

It’s normal to experience some swelling in the hands and feet during pregnancy, and you shouldn’t attempt to deal with this by taking diuretics, including herbal diuretics. If you have sudden swelling in the face, hands, or feet, you should consult your doctor immediately because this can be a sign of preeclampsia

Laxatives

The first step in dealing with constipation is to take dietary measures by increasing your intake of fiber and drinking plenty of fluids. If this isn’t enough to ease constipation, then some over-the-counter laxatives may be safe to take during pregnancy, including laxatives that contain bulking agents. Those containing castor oil may cause uterine contractions. Check with your doctor before taking any laxatives.

Analgesics

The general advice is to avoid all analgesics during pregnancy, especially during the first trimester. Before using pain medication for a common problem, such as a headache or backache, first try natural remedies; massage or a warm bath are often effective in relieving aches and pains. If these aren’t sufficient, call your doctor for advice. Aspirin and anti-inflammatories such as ibuprofen should be avoided throughout pregnancy. The pain medicine codeine can sometimes be used for a short period to treat specific pain, but should only be taken on the advice of a doctor.

Rehydration solutions

If you have a stomach upset resulting in a severe bout of diarrhea that lasts for an extended period, your doctor may recommend a rehydration solution that is safe to use in pregnancy.

Steroids

If you have eczema, or find that this condition develops or worsens during pregnancy, talk to your doctor about appropriate medications. Corticosteroids, which are used to treat eczema, aren’t associated with birth defects, but they are known to cross the placenta, so both topical and oral corticosteroids aren’t recommended during pregnancy.

Steroid inhalers used to treat asthma are safe in pregnancy, and it’s important to control your asthma while you’re pregnant.

Oral steroids may also be prescribed for certain other conditions, and these may be safe to continue with under the guidance of your doctor. Anabolic steroids should not be taken during pregnancy.

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