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Your Pregnancy After 35 : Your Health and Medical History (part 5) - Hepatitis, High Blood Pressure, Influenza, Lupus

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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.

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