Your Pregnancy After 35 : Your Health and Medical History (part 4) - Epilepsy, Fifth Disease, Group-B Streptococcus Infection

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14. Epilepsy

Epilepsy can be a serious problem during pregnancy. If you suffer from the disease and become pregnant, contact your healthcare provider immediately. It’s important to control your disease during pregnancy because seizures can affect you and baby in many ways. During pregnancy, hormonal fluctuations can affect your epilepsy, and you may be at higher risk of some pregnancy problems.

One-third of women with epilepsy will see a decrease in the number of seizures they have during pregnancy. One-third will have more seizures, and one-third will see no change at all.

Seizures seldom occur during labor and delivery. More than 90% of all epileptic pregnant women give birth to healthy babies.

If you take medication for seizure control or prevention, tell your healthcare provider before trying to get pregnant or at the beginning of pregnancy. Medication can be taken during pregnancy to control seizures, but some are safer than others.

There are concerns regarding use of anticonvulsant medications in pregnancy. There is also concern regarding polytherapy—when a woman takes several medications in combination. Ask your healthcare provider to put you on the lowest dosage of one anti-epileptic drug. Take your antiseizure medication exactly as it is prescribed.

Some medications may need to be avoided during pregnancy. Most studies show increased risk to baby when a mom-to-be takes valproate, especially in the first trimester. Dilantin is not recommended during pregnancy because we know it can cause birth defects. Phenobarbital may be used to control seizures during pregnancy, but there’s some concern about its safety.

Lamotrigine therapy alone shows no increased risk of problems in baby. Ask about taking large doses of folic acid; it has proved helpful for some women.

If you have morning sickness, tell your healthcare provider. Nausea and vomiting can interfere with your body’s ability to absorb your antiseizure medications.

During pregnancy, kidneys may remove greater amounts of anti-epileptic drugs from your system more quickly than usual. Drug levels could decrease by as much as 50%. It’s important to see your neurologist every month for blood tests to check the levels in your blood. Any dosage adjustments can be made after test results are in.

Seizures during pregnancy can be serious; you may need increased monitoring. If you have questions or concerns about a history of possible seizures, talk to your healthcare provider about them.

15. Fifth Disease (Parvovirus 19)

Fifth disease, also called parvovirus 19, received its name because it was the fifth disease to be associated with a certain kind of rash. Fifth disease is a mild, moderately contagious airborne infection that spreads easily through groups, such as classrooms or day-care centers.

The rash looks like skin reddened by a slap. Reddening fades and recurs and can last from 2 to 34 days. There is no treatment for fifth disease, but it is important to distinguish it from rubella, especially if you are pregnant.

This virus is dangerous during pregnancy because it interferes with the production of red blood cells. If you believe you have been exposed to fifth disease, call your healthcare provider. A blood test will determine whether you had the virus before. If you have, you are immune. If you have not, your healthcare provider can monitor you to detect fetal problems. He or she may be able to deal with some problems before baby is born.

16. Group-B Streptococcus Infection (GBS)

Group-B streptococcus (GBS) is a type of bacteria found in up to 40% of all pregnant women. A GBS infection rarely causes problems in adults but can cause life-threatening infections in newborns. GBS passed to a newborn during birth can cause a blood infection, meningitis or pneumonia in the baby.

GBS can be transmitted from person to person by sexual contact but is not considered an STD. It is found in the mouth or lower-digestive tract, urinary tract or reproductive organs. In women, GBS is most often found in the vagina or rectum. If you have GBS in your system, you may not have any symptoms.

It is recommended that all women be screened for GBS between 35 and 37 weeks of pregnancy. If tests show you have the bacteria but no symptoms, you are colonized. If you’re colonized, you can pass GBS to your baby.

The battle to eradicate GBS is one of the true medical success stories. Before the 1990s, 7500 newborns contracted the infection each year; 30% of those babies died. Today, fewer than 1600 cases are reported each year. Much of the success has been the result of healthcare providers following the 1996 Centers for Disease Control and Prevention (CDC) guidelines, which include the following:

a late prenatal culture (35 to 37 weeks) for vaginal and rectal GBS colonization

an earlier culture (earlier than 35 weeks), based on clinical risk factors

antibiotics prescribed to all carriers—penicillin G is the antibiotic of choice, followed by ampicillin

antibiotics prescribed for any woman who has given birth to a previous infant with proven GBS infection

If you’re allergic to ampicillin or penicillin, other medications are available to treat the problem.

Medical experts have developed recommendations aimed at preventing this infection in newborns. They recommend all women with risk factors be treated for GBS. Risk factors include giving birth to a previous infant with GBS infection, preterm labor, ruptured membranes for more than 18 hours or a temperature of 100.4F (38C) immediately before or during childbirth. In addition, if you’ve had a bladder infection with a positive strep-B urine specimen during pregnancy, you should receive antibiotics at delivery.

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