Pregnancy Channel - Coastal Perinatal Center

Hypothyroidism in Pregnancy

October 22, 2014/in Pregnancy Channel/by coastal

There are two types of thyroid disease, too much (hyperthyroidism) or too little (hypothyroidism). Both are clinically important, this blog post is about hypothyroidism.

Hypothyroidism in pregnancy is difficult to diagnose clinically. The symptoms of hypothyroidism are the same symptoms of pregnancy: lethargy, fatigue, difficulty sleeping, constipation, anxiety, cold intolerance, loss of hair, weight gain…every pregnant woman can tell you she has had these exact symptoms the minute she found out she was pregnant. I tell my patients that Thyroid gland is like your car’s RPM gage: if it is too low, the engine can’t work, it “sputters” along, acts like there is no gas, and you develop all the clinical symptoms of weight gain, lethargy, etc. If the Thyroid gland is working too hard (hyperthyroidism) then you have the opposite, the RPM gage is in the red zone…clinically there is weight loss, hyperactivity, your heart pumps too fast…

The diagnosis of hypothyroidism can be determined by combining the clinical findings, with a physical exam and blood tests. Some women may have an enlarged thyroid (goiter) that can be palpated by your physician during a physical exam, or you may notice that the area around your “adams” apple is a little larger.

Checking blood tests that include a TSH, FreeT4, can help confirm the diagnosis.
Why is Thyroid Important in Pregnancy?

Thyroid affects both the mother and the baby during pregnancy.

Hypothyroidism is associated with infertility, pre-eclampsia, placental abruption, miscarriage, preterm delivery, low fetal birthweight, and even fetal demise.

Your baby doesn’t make its own thyroid until about week 18-20. Until that time they are entirely dependent upon maternal thyroid. Mothers with Free T4 levels that were extremely low (hypothyroidism) had babies with a high incidence of impaired psychomotor function, and significantly lower IQ.

Screening

Currently ACOG does NOT recommend screening for thyroid disease in low risk women. ACOG issues recommendations, and they don’t always need to be followed. I personally feel the cost of checking for thyroid disease is so low, that it everywoman should be screened! Also, I think thyroid TSH numbers are like cholesterol numbers; most people know their exact number of their cholesterol. You should know your TSH; the goal in pregnancy (and outside of pregnancy too) is less than 2.5. If you TSH is greater than this, then you need to have your FT4 level checked, and that can give a gage of how your thyroid is functioning. If it is low, your brain is telling your thyroid gland to increase production, but your thyroid gland cannot do it, and you need supplemental thyroid.

If your TSH is low, very low for instance less than 0.05, and your FT4 is high, then your brain is telling your thyroid gland to slow down, production, and you may have hyperthyroidism.

In general the TSH and the FT4 should be checked together.

There is an instance in which you have an elevated TSH, and a normal FT4, this is called subclinical hypothyroidism. In this situation, your brain is sensing that you need more thyroid and is telling the gland to increase production, but the gland can’t go above what it is making. Eventually, the gland will “burn out” and the FT4 will go down. Some women are symptomatic with subclinical hypothyroidism. In pregnancy, any TSH greater than 2.5 is abnormal, and should be treated with supplemental thyroid. The most common cause of hypothyroidism is Hashimoto’s thyroiditis. This is a disease where your body confuses the thyroid gland as an “enemy” and makes antibodies against it (Thyroid Peroxidase Antibody, TPO). The reason this occurs is not entirely known; it may occur after a virus, where the body thinks the virus resembles the thyroid gland, so it attacks it, and it may occur after childbirth because of immune phenomenon where some fetal cells may go to the thyroid, and the moms blood attacks it.

Treatment

The goal of treatment is to keep the TSH less than 2.0-2.5, and FT4 in the upper third of normal. The usual medicaltion used is Levothyroxine, and the dose is about 0.1mcg/kg (so if you weigh about 150, that is about 70kg, so the treatment is about 70 mcg/day levothyroxine). Once you start a new treatment, it takes about 4 weeks to see a change in the TSH. TSH and FT4 levels should be followed 4 weeks after to confirm the treatment is correct. In pregnancy the TSH/FT4 should be checked about once/trimester to confirm that treatment is adequate.

In women with pre-existing hypothyroidism, the general rule is that they will need about 50% more medication during pregnancy. Taking your prenatal vitamin with levothyroxine is not recommended as it interferes with thyroxine absorption. They should be spaced apart by 2-3 hours. I usually tell women to take their prenatal vitamin at night, so that they don’t get nauseous during the day (I tried the pill once to see, and yes it made me nauseous too!). One under-recognized disorder, is Iodine deficiency. Your body needs iodine to make thyroid; it’s a building block. In pregnancy the recommended dose is about 250-300 mcg/day. Most prenatal vitamins do NOT have any iodine. Furthermore, salt is “iodized”, to give people a source of iodine, but most people try to stay away from salt because of blood pressure issues etc. It is known that 10-15% of pregnant women in the US have low iodine levels, and need supplementation. If you are unsure, get your level checked, and get a prenatal vitamin with iodine; before making any changes to your healthcare, always discuss it with your obstetrician/doctor.

After delivery, you may return to your pre-pregnancy levothyroxine dose, if you were never on any medications, discuss this with your obstetrician/doctor and they will assess if you need to continue treatment, and if so the appropriate dose. During pregnancy, the dose needed to treat hypothyroidism is always elevated compared to what you need outside of pregnancy, so dose adjustment is important.

This blog post is brought to you by www.VSacharMD.com the world’s first and only non-toxic cosmetic company dedicated to pregnancy. Created by a high risk pregnancy physician who realized that toxins in our environment, food, and daily use products can be harmful to the baby. We created this company to give women a safe cosmeticalternative during, before and after their pregnancy.

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This blogpost is not to be considered medical advice and is for entertainment purposes only, consult your personal

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Ebola and Pregnancy

October 19, 2014/in Pregnancy Channel/by coastal

(image from www.NaturalNews.com)

What is it?

Ebola is a virus that was named after the Ebola river in the Republic of Congo. The Ebola virus is spread from human to human through contact with bodily fluids, and from animal to human contact from consumption of raw meat. An infected person with Ebola may open a door, and the person after them may touch the door handle too. The second person will have Ebola on their hands, but if they put their hands in their mouth, or rub their eyes, they may be infected through the mucous membranes, or if they have a small cut on their hands, the virus can enter through that. Unlike infections like flu or measles, which can be spread by virus particles that remain in the air after an infected person coughs or sneezes, transmission of Ebola from person to person is by direct contact with the blood or body fluids (eg vomitus, urine, stool, and semen) of a symptomatic infected person. This is further complicated by the fact that in patients who die of Ebola virus infection, virus can be detected throughout the body. Ebola virus can be transmitted in postmortem care settings. In men who have been cured of Ebola, the virus can still be found in their semen up to 7 wks later.
The good news is that the likelihood of contracting Ebola is considered low unless there has been this type of specific exposure. There is no evidence of transmission of Ebola virus through

intact skin and the Ebola virus is not spread through routine, social contact (such as shaking hands) with asymptomatic individuals.

Ebola was first found in 1976, at that time it was noted that the survival for anyone infected, was about 50-60%. They did note that the survival rate for pregnant women was much less, at that time 14 out of 15 pregnant women with Ebola died (4% survival).

Signs and Symptoms

The time period from infection to seeing symptoms (incubation period) varies from 2-21 days. We all have different degrees of immunity, and this probably plays a very big role in survival after infection. You are not considered infectious until you have symptoms. The symptoms of acute Ebola infection are: the sudden onset of fever fatigue, muscle pain, headache, sore throat, vomiting, diarrhea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding (e.g. oozing from the gums, eyes, blood in the stools). These symptoms are similar to the regular flu at first, however the severe diarrhea, is a significant difference. There are blood tests to assess if one is infected. During pregnancy, many women reported to the hospital with fetal demise, miscarriage and severe hemorrhage. There are no direct studies of Ebola in pregnancy, and the only information we know is from reviewing past cases of pregnant women with Ebola.

The limited evidence from these outbreaks does suggest that pregnant women are at increased risk of severe illness, complications and death when infected. Reported complications include spontaneous abortion and severe hemorrhage in pregnancy. Infants born to mothers who are in the terminal stage of disease are invariably infected, with high neonatal mortality rates reported. I suspect there are two issues concerning pregnancy. The first is that there is a component of immune suppression in pregnancy which may prevent the mother from attacking the virus compared to non-pregnant women, secondly, the virus probably crosses the placenta, and forms a reservoir, such that the mother cannot fight it, until the baby is delivered, and the virus load decreased. Unfortunately by this time, the mother has lost a great deal of blood, and function that they usually end up with multi-organ failure, and death.

Treatment:

The treatment at this time is supportive: IV fluids, and replacing electrolyte losses secondary to diarrhea, and giving blood products where necessary to treat severe anemia secondary to hemorrhage. There are current vaccine trials in place.

The best treatment is prevention. In the United States, the current cases are in isolation, and as we approach the 21 day incubation period, we will learn if they are infected, or on the way to recovery. In the infected areas, sanitation measures, isolation of infected patients, and attempts for a vaccine are in full force, however this has triggered a separate crisis, in that women who are pregnant cannot go to the hospital/get medical attention because all resources are being used treating Ebola patients. Also the women are scared to go to the hospital for fear of contracting Ebola there surrounded by Ebola patients. Accordingly they are delivering out of the hospital, and there are complications.

How if Affects the Baby

Ebola is associated with miscarriage, intrauterine fetal demise, and if the pregnancy survives to term, the neonate is invariably infected.

No part of this may be reproduced without expressed approval from the author.

This blogpost is not to be considered medical advice and is for entertainment purposes only, consult your personal

doctor before making any changes to your health care regimen.

Constipation and Pregnancy

September 2, 2014/in Pregnancy Channel/by coastal

What is it?

Constipation is abdominal pain associated with difficult and infrequent bowel movements accompanied with passage of hard stools. Unfortunately, about half of you reading this post will experience this during your pregnancy.

Causes:

Hormonal Changes: the hormones of pregnancy slow down intestinal motility and gastric emptying. This helps your body absorb more of the food you eat, which is great for the pregnancy/baby, but creates other issues for mom.

Iron Supplements: These can cause nausea, vomiting, diarrhea, and of course constipation. They are best absorbed when taken with Vitamin C, so take your supplements with a glass of orange/apple/mango… juice. They are absorbed poorly when taken with milk, calcium pills/Tums, or antacids. There are different formulations available that may have less constipation; talk to your provider for the supplement that is best for you.
Hypothyroidism: Not often considered, but is associated with constipation too. Have your TSH (thyroid stimulating hormone) level checked by your provider, if it is elevated, you may have early, or true hypothyroidism. Hypothyroidism is also associated with fatigue, weight gain… many symptoms that mimic pregnancy symptoms. It is difficult to assess if you have hypothyroidism clinically; you need to check the labs.
Dehydration: Because pregnancy is associated with slow gastric emptying, and decreased intestinal motility, you need more water in your diet. Soda, offee, tea, caffeine, energy drinks…all are associated with dehydration. Skip these drinks, and stick with water only, and lots of it. You may spend more time in the bathroom having to urinate, but its better than the alternative!
Diet: You are what you eat! You’ve heard this a million times, and it applies during pregnancy as well. Mind over matter! Your baby did not ask you to eat the cheesecake, or the entire pizza, or the dozen donuts on the way to your doctor’s
office! Cravings have a place in your pregnancy, but so does common sense. Your gut is actually filled with bacteria that help you with digestion of your food. What we have to realize is that there is a delicate relationship between the bacteria in your gut, and the food we eat. Preservatives, artificial processed food, high carbohydrate diets….these all
change the ideal environment in your gut, and that causes changes to these bacteria as well. Some diets cause an overgrowth of the bad bacteria, and these lead to abdominal pain, excess gas and bloating, and possibly diarrhea and/or constipation. These symptoms are often associated with irritable bowel syndrome or IBS. For women, changes in your menstrual cycle alone may cause changes in these bacteria and cause the symptoms of IBS.

Lack of Exercise: Your body is the combination of all its moving parts: if you don’t exercise, your muscles become tagnant. Exercise stimulates your bowels too. Pregnancy should be supplemented with at least 30 minutes of exercise daily; consider it your ultimate daily medicine. Lack of exercise during pregnancy can be associated with excessive weight gain, increased fatigue, gestational diabetes, and of course constipation. At least 30 minutes of mild exercise daily is recommended during pregnancy; walking, swimming, jogging…talk to your doctor about the recommendations for pregnancy and what is safest for you.

How if Affects the Baby

Constipation does not affect your baby.

How if Affects the Pregnancy

Constipation can be annoying, and if not treated early, can be quite painful for the mother. Your bowels are constantly moving in a wave, and it moves the contents with these motions. If you have constipation, the waves keep crashing into a “clogged” outlet and this causes pain. Sometimes the pain can be as severe as that experienced with gallstones, or a ruptured appendix, and treatment involves disimpaction (manual removal of stool from the rectum). The key is to be roactive and prevent constipation from becoming that severe. Normal bowel movements include 1-2 times per day, or once every 2-3 days; everybody has a different definition of normal. But if you have increasing time between bowel movements and they are associated with increased straining, abdominal pain, and hard stools, then you need to be more proactive.

Treatment:

Hydration, hydration, hydration, water, water, water. Carry it in your purse, keep it in your car, drink it all the time!

Diet high in fiber: Insider tip: I tell all my patients, eat Raisin Bran for breakfast! If you have a lactose issue, or don’t like milk, use water or Almond milk. This is a great way to prevent the problem from starting. Lots of vegetables, and fruit, and cut down on processed foods: pasta, pizza, bread…donuts.

Exercise Routinely: If you are inactive, your gut will be inactive, but don’t forget #1, drink lots of water during your exercise regimen.

Supplements: If you need iron supplementation, or you find your prenatal vitamin is constipating, then consider a different formulation. If you split your iron dose in 2-3 doses, the side effects of constipation are minimal.

Metamucil: If you find that you are following all of these recommendations, and are still suffering from constipation, talk to your obstetrician about over-the-counter products such as Metamucil (Pregnancy Category B). These may help soften your bowel movements, promote motility, and decrease the incidence of constipation. Do not take laxative pills for constipation without consulting with your obstetrician first. Although these stimulate the gut, they also can cause uterine contractions.

Probiotics: Gut health is extremely important, and more studies confirm this. Eating yogurt daily, and/or taking a probiotic will keep your gut bacteria in good shape.

This blog post is presented to you by VSacharMD.com the worlds first and only cosmetic company that makes safe non-toxic cosmetics that can be used in pregnancy, or by anyone who wants safe cosmetics. Note this post is for entertainment purposes only, and is not meant to be taken in the place of medical advice. Discuss your condition with your obstetrician. Visit us at VSacharMD.com for more posts and information about our products.

Copyright V.Sachar MD 2014. All Rights Reserved.
No part of this may be reproduced without expressed approval from the author.
This blogpost is not to be considered medical advice and is for entertainment purposes only, consult your personal doctor before making any changes to your health care regimen.

Nausea and Vomiting in Pregnancy

August 25, 2014/in Pregnancy Channel/by coastal

What is it?

Up to 75% of pregnant women suffer from nausea and/or vomiting in pregnancy. It is very, very common, and sometimes eferred to as “morning sickness”. This unfortunate side effect of pregnancy probably occurs secondary to a being very sensitive to the hormones of pregnancy. You can have varying severity of disease from mild intermittent nausea, to severe debilitating disease. The onset occurs at about 4-6 wks gestational age, peaks around 12-14, and subsides by about 20 wks.
A severe persistent form of nausea and vomiting of pregnancy occurs in about 1% of women and is called. Hyperemesis Gravidarum. This occurs when you have at least 3 episodes of nausea and vomiting and lose at least 6.5lbs, or 5% of your pre-pregnancy weight.
There are a few maternal conditions that may present with nausea and vomiting as the primary symptom. These include: ovarian torsion, hyperthyroidism, gastroenteritis, intestinal obstruction, kidney infection, molar pregnancy, appendicitis, pancreatitis, hepatitis…your physician will rule these out first before considering a diagnosis of nausea and vomiting of
pregnancy.

How It Affects the Mother

With nausea and vomiting of pregnancy, there are minimal effects on the mother. Loss of work is common, and treatment centers around avoidance of triggers, dietary modifications, and medication.

Triggers include foods that are high in acidity. Vitamin C containing foods such as orange juice, fruit, pizza, spaghetti sauce, caffeine, carbonated drinks, all can trigger acid release in the stomach which can cause acid reflux. These symptoms are worse while lying down, and can cause vomiting. Avoidance of these foods can be helpful as can proton pump inhibitors (PPI) such as Nexium.

Early treatment of symptoms with lifestyle modifications and possibly medications will result in the most success and least amount of work loss. There are however extreme cases of hyperemesis gravidarum in which the mother cannot tolerate anything orally, and needs an IV to get hydration and nutrition. Treatments that are beneficial in treating nausea and vomiting in pregnancy are as follows ginger, Vitamin B6, Diclectin,, Benadryl (diphenydramine), Zofran. Reglan.

There is up to 15% recurrence of nausea and vomiting with subsequent pregnancy.

How It Affects the Fetus
Most cases of nausea and vomiting of pregnancy are not associated with adverse pregnancy outcome. Hyperemesis Gravidarum involving maternal IV for nutrition has been associated with fetal growth restriction and possible adverse fetal outcome.

Abnormal Pap Smear in Pregnancy

July 28, 2014/in Pregnancy Channel/by coastal

What is an Abnormal Pap Smear?

A Pap smear is a screening test that allows a doctor to look at the cells at the cervix (which is the lower part of the womb) and see if there are precancerous or cancerous cells. This test is usually performed using a speculum. Abnormal Pap smears are now known to be caused by infection with the human papilloma virus (HPV). This is a sexually transmitted virus. There are a number of different strains of HPV, and the strains that are associated with causing cervical cancer have been identified. If one has HPV, most people do not progress to cervical cancer. A similar analogy would be most people who have a cold to not develop pneumonia. Out of most women who get infected with HPV, only a small number of women develop abnormal Pap smears. Out of those, a much smaller number get progressively worse Pap smears that may develop into cervical cancer after 10-15 years. Abnormal

pap smears do not affect the

pregnancy or the baby. Rarely a procedure may be necessary (colposcopy, and/or cervical biopsy) however most procedures can be postponed until after the baby is born. If there is a history of the cervix being excised, frozen (cryotherapy) or a conization procedure then a transvaginal ultrasound is recommended at around 16-20wks to confirm there is no evidence of a short cervix (cervical insufficiency).

Pap smears are graded according to the degree of abnormality. There are three different degrees: Low Grade (LGSIL), High Grade (HGSIL), and Cancer (CIS). The progression from one stage to the other occurs over a number of years. Not all cases progress from one stage to the next; most cases of LGSIL regress to normal over time with no treatment. Management of abnormal Pap smears is dependent upon the patients’ age and degree of abnormality. Colposcopy is performed to rule out the presence of more abnormal cervical cells after an abnormal Pap smear. This procedure is performed using a specific magnifying apparatus, the cervix is carefully examined to ensure there is no evidence of cervical cancer. During this procedure cervical biopsies are often taken. In pregnancy, if necessary colposcopy and biopsies are safe.

LGSIL in a younger patient is managed expectantly with follow up pap smears and colposcopy as opposed to older patients.

Pap smears used to be reviewed by pathologist who based their diagnosis of the abnormal cells in the cervical smear, but with the knowledge that HPV is causative, most pap smears include testing to detect the presence of HPV. Newer tests can detect HPV from a urinalysis; these tests may ultimately replace the Pap smear as a screening test.

How do Abnormal Pap Smears Affect the Pregnancy and Baby?

HPV is not believed to harm the baby, or affect the pregnancy adversely. In rare cases of genital warts (also caused by HPV), a patient may have a large growth of warts called condyloma accuminata. This growth occurs in the vagina, the vuvla, or the rectum. These growths are very delicate, and during vaginal delivery can easily bleed because of the trauma of childbirth. There is a small chance the baby may be exposed to the virus. The baby has a small chance of developing a rare condition called laryngeal papillomatosis.

In some patients, the abnormal Pap smear may progress from LGSIL to HGSIL (slightly abnormal, to very abnormal). Depending upon the age of the patient, and the length of time the the abnormal Pap smear has been present, some patients may undergo a procedure called a LEEP (loop electrosurgical excisional procedure). This procedure is diagnostic, and curative. Using an “electric” knife, the abnormal portion of the cervix is removed. After this procedure usually Pap smears are performed every 4 months for one year to confirm no abnormal cervical cells were left behind. One risk of this procedure is that the amount of cervix removed may impact the ability to carry a baby to term and result in a insufficient (incompetent ) cervix. If you have had this procedure, you will need transvaginal ultrasounds around 16-20 weeks, and if your cervical length is less than 1.5cm, you may benefit from a cervical cerclage.

This procedure is rarely performed during pregnancy. If you are found to be at significant risk for cervical cancer and are pregnant, your doctor will send you to a Gyn-oncologist for their recommendations.
Website: http://www.acog.org/publications/patient_education/bp161.cfm

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Chronic Hypertension in Pregnancy

July 20, 2014/in Pregnancy Channel/by coastal

What is it?

Chronic hypertension affects up to 5% of all pregnancies. If you have a blood pressure of 140/90 or greater AND you are before 20 weeks gestational age, then you may have chronic (pre-existing) hypertension. Because most women of childbearing age are young, they often do not go to their doctor for checkups because they feel “healthy”. Pregnancy involves multiple visits to your medical provider, and it may be here that elevated blood pressure is first noted. If you are noted to have elevated blood pressure (greater than 140/90) and you are past 20 weeks gestational age, then your diagnosis is gestational hypertension, or elevated blood pressure during pregnancy. In this case you will be evaluated 12 weeks after you deliver to determine if your hypertension persists; if it does, then you have chronic hypertension, if it resolves then you had transient hypertension.

Risk factors for developing hypertension include obesity, substance abuse, chronic exposure to toxins, advanced maternal age, pre-existing diabetes mellitus, other medical conditions such as lupus, renal disease, and genetics.

If you have chronic hypertension, you are probably on medication. If you are on angiotensin-converting enzyme inhibitors (ACE) or a similar class (ARB) these medications are teratogens associated with congenital malformations in the fetus and are NOT recommended during pregnancy. You should discuss your medications with your obstetric health care provider as early as possible. Classes of antihypertensives that safe in pregnancy include calcium channel blockers, and beta blockers.

Hypertension is a very dangerous disease both during pregnancy and outside of pregnancy. It is called the “silent killer” because the you, the patient don’t feel ill, or sick, however you may have blood pressure that is elevated. The elevated blood pressure causes damage to the placenta (affecting the baby), can injure your kidneys, brain, and your heart.

How it affects the Pregnancy?

I tell my patients that hypertension is like having really big waves on a beach. Eventually, the force of the big waves crashing on the soft sandy beach, will erode the beach. Similarly, elevated blood pressure damages the delicate placenta. If 50-70% of the placenta gets damaged, the placenta cannot function optimally. Accordingly the baby gets less nutrients, and oxygen. Subsequently the baby will stop growing appropriately, and if the placenta gets further damaged, it may eventually lead to fetal demise, or the placenta getting bruised (abruption). In this case there is bleeding inside the placenta, and there can be severe injury to both mother and baby; this is considered a pregnancy emergency.

Hypertension in pregnancy also places the mother at risk for worsening hypertension, pre-eclampsia and eclampsia. Pre-eclampsia is a condition in which the maternal blood pressure rises and this causes adverse maternal reactions in the maternal kidney, liver and brain. If this condition continues to evolve, a small percent of women may develop

a seizure with convulsions (eclampsia). The only way to treat pre-eclampsia and eclampsia is delivery. If pre-eclampsia occurs before 32 wks, there may be a role for expectant management, as the prematurity of fetal delivery places the baby at risk other sequelae of prematurity. When the pregnancy is complicated by a condition that necessitates delivery, women are given injections of Corticosteroids (Betamethasone/ Celestone), 2 injections 24 hours apart. This medication crosses the placenta and accelerates tissue maturity of the fetus therefore protecting the baby from some of the more severe sequelae of delivering prematurely.

Diagnosis and Treatment

The diagnosis of chronic hypertension is based on the finding of elevated blood pressure over 140/90 before 20 weeks gestational age. If elevated blood pressure is noted after 20 weeks gestation, then the diagnosis is called gestational hypertension. When the elevated blood pressure is accompanied by proteinuria, and elevated liver enzymes, the diagnosis is a variant called HELLP syndrome (Hemolysis, Elevated Liver Enzymes, Low Platelets). Generally this condition warrants immediate delivery, but gestational age always plays a role.

If you have this condition before or during pregnancy, your obstetrician will want to establish baseline values of your kidney function, platelet count, and liver tests. The kidney function is assessed by checking your urine for presence of protein. Both the platelet count and liver tests are blood tests.

Hypertension in pregnancy is treated with Beta Blockers, Calcium Channel Blockers, or diuretics. The goal of anti-hypertensive therapy is to keep the blood pressure below 140-150/90-100. In the past Methyldopa was used, however as the safety profile of the other beta blockers, diuretics and calcium channel blockers in pregnancy has been established, methyldopa is out of favor. One beta blocker in particular, atenolol, is NOT recommended in pregnancy as it is associated with growth restriction (impaired fetal growth).

After delivery, you may need to be reassessed by your primary care physician to see which medication is best for your hypertension. Often women with pre-eclampsia, eclampsia, and gestational hypertension may need treatment for up to 6 weeks postpartum. If they need treatment beyond this time period, the diagnosis of chronic hypertension should be considered.

Recently it has been found that women with pre-eclampsia, eclampsia and the disorders of hypertension in pregnancy are at higher risk for cardiovascular events later on in life. Careful followup with your primary care physician, and awareness of your blood pressure values is important to ensure that you do not become a victim to this “silent killer”.

Copyright 2014 V Sachar MD. All Rights Reserved.
No part of this post may be duplicated without expressed consent by author.

Anemia in Pregnancy

July 7, 2014/in Pregnancy Channel/by coastal

What is it?

Anemia is the most common nutritional problem affecting pregnant women. Anemia itself is not a diagnosis, but is a sign of a problem; there are multiple etiologies of anemia. In pregnancy one of the most common causes of anemia is that there is an increase in blood volume but less red blood cells are made. This results in a dilutional anemia; note however, your hemoglobin level should not go below 11. There are nutritional causes or anemia as well: the most common nutritional cause of anemia is iron deficiency. Iron is needed to carry oxygen in the blood, and this oxygen then supports the mom and the baby. Anemia in pregnancy is commonly attributed to the deficiency of iron, folate,and vitamin B12. Iron-deficiency anemia is the most commonly observed pregnancy-related anemia affecting about 15% to 25% of all pregnancies.

However, folic-acid deficiency anemia occurs in only about 1% to 5% pregnancies worldwide. Other common causes of anemia include folate and vitamin B12 deficiency, chronic liver disease, HIV, chronic renal disease etc. Symptoms associated with anemia may be maternal tachycardia, shortness of breath, being constantly tired, palpitations, lightheadedness ..unfortunately, these symptoms are also consistent with the normal symptoms experienced by women in pregnancy.

Some women with an underlying anemia during pregnancy, consume large amounts of nonnutritional substances: ice, chalk, corn starch, soil, matches, sand, hair, soap…and other similar textured substances. This is called Pica. The exact etiology why they eat these substances is unknown, however it makes the anemia more severe. I have had many patients who were sent to me with a diagnos i s of severe anemia (Hemoglobin around 6-7). Upon further questioning, i realized these women had pica,. They were consuming 20-30 large glasses of ice daily. Only after they stopped eating the substance did their hemoglobin levels rise, along with large amounts of iron replacement. In some situations, because the patient was so close to delivery, they needed blood transfusions.

Some anemias are due to a genetic error in the hemoglobin, these are called hemoglobinopathies. Examples include, sickle cell disease, thalassemia…etc. If you have anemia, your physician will order an iron level, folate level, vitamin b12 level, haptoglobin and a hemoglobin electrophoresis. These tests will help determine if you have a nutritional deficiency, or a genetic problem, or a problem with increased red blood cell destruction. This will guide your physician to the etiology of your anemia and best treatment for you.

How it affects Pregnancy & Baby?

In studies, severe anemia is associated with adverse fetal outcome, and possible preterm delivery. In these studies, the hemoglobin level was around 4-6. Note however, if your hemoglobin is below 11, you still should have the appropriate workup, and follow treatment if necessary. A low hemoglobin puts you at risk for medical consequences if you have severe bleeding in pregnancy (hemorrhage) or if you are at risk for hemorrhage (if you undergo a cesarean section). For instance you may need a blood transfusion. Genetic causes of anemia such as thalassemia, or sickle cell disease, may place the baby for risks of inheritance. If you have a genetic cause for your anemia, you should see a genetic counsellor during by your pregnancy to ensure you are aware of all potential risks to your baby.

Treatment

The treatment depends on the etiology of your anemia. This usually involves, iron, or vitamin B12, or folate. Iron supplementation is associated with some side effects, most notably constipation, nausea vomiting, and diarrhea. The most effective way to take iron supplements is with orange juice and food, not with milk.

If your etiology is pica, then stopping the offending action (through diet) will usually help, along with supplements. A followup hemoglobin level about 4-6 weeks after initiating treatment will demonstrate improvement. If the anemia is severe, and you
are going to deliver within 1-2 weeks, you may need a blood transfusion, or intravenous iron. Your practitioner will assess the severity of your anemia with the risk delivery.

Although extremely common in pregnancy, anemia is usually recognized early, and once an accurate etiology is determined, anemia can be treated without adversely affecting the pregnancy.

Can Your Makeup Cause Your Breakouts & Acne?

June 2, 2014/in Pregnancy Channel/by coastal

Yes it can! In this post, you will learn what causes makeup associated breakouts an acne, how to prevent it, and what your best makeup choices are.

The medical term for makeup associated acne is acne cosmetica. It generally appears like small, white bumps, but can also look like regular acne. Acne cosmetica usually occurs on the chin and cheek and occasionally the forehead too. This type of acne can take months to form, but once it starts it tends to last for years, as the person ends up using more makeup to cover the acne, which in turn leads to more breakouts. Acne can also be aggravated by applying makeup too aggressively, or using a harsh or dirty makeup brush.

Some women may experience allergic reactions to their cosmetics. The difference between acne cosmetica and an allergic reaction, is that the allergic reaction can occur very quickly, within minutes to hours of exposure. The reactions can range from an itching/burning to itching, swelling and even blister formation. These types of reactions are usually caused if you develop any kind of reaction soon after you begin using a new makeup product. If this occurs, it’s probably a good idea to stop using that particular product. Remember it’s not just what you put on your skin it’s what you put in your skin.

Recently the media is in a frenzy over gluten. Gluten is a protein found in wheat and related grains. Why is wheat in your makeup? It is often used as a filler, or bulking agent. Many people are unaware that they are gluten sensitive. Maybe you notice if you eat pizza, you get a little bloated and “uncomfortable” after. This may last the whole day and you may think this is a normal reaction to the food, however this may be a gluten sensitivity. If your makeup has gluten, then you may develop a mild reaction to the makeup. This may show up as puffy, red, sensitive skin, and maybe even mild forms of acne. It is difficult to diagnose this sensitivity

by a medical test; clinically the best way is avoidance; eliminate gluten from your diet (if you have those abdominal symptoms of bloating, pain and upset stomach), and use gluten free makeup. Because gluten sensitivity is quite often undiagnosed, we formulated all of the makeup at VSacharMD.com to be gluten free.

How to Prevent It?

If you think you have acne cosmetica, consider going bare when possible. This may alleviate the irritation on your skin, and give your skin a chance to heal. When applying makeup, use a gentle touch to minimize skin irritation. Use non-comedogenic (doesn’t cause your skin pores to clog), fragrance-free, powder based preparations as liquid based products have more oil, and can clog pores. Don’t sleep in your makeup at night and use a gentle cleanser to remove it. Consider using exfoliating wipes and pads, which are gentle but remove more dead skin than soap does. This will prevent clogged pores and acne.

Mineral makeup is a good choice as it uses natural minerals for color as opposed to artificial colors and dyes which are skin irritants. Some women may find a decrease in their acne just by changing their makeup brands to noncomedogenic brands. If you have skin irritation, and you also have symptoms of gluten sensitivity, consider using makeup that is gluten free.

At www.VSacharMD.com, we formulated our Loose Mineral Foundation and Cream Mineral Foundation with high levels of Zinc Oxide. Zinc Oxide protects against both UVA and UVB harmful rays, and is a proven natural antimicrobial which minimizes the breakout of adult acne. This makes our makeup an effective sunscreen with a natural sun protection factor (SPF) and an antimicrobial that prevents adult acne.

There are many Major Mineral Cosmetic companies that have Bismuth Chloride as one of their ingredients, however we know that this is a skin irritant, and is associated with acne, blemishes, inflammation and allergic reactions. Bismuth Chloride causes skin irritation in up to 80% of users because its molecular crystalline shape causes tiny micro tears in the skin, which are associated with itching, that is much worse with sweating. Bismuth Chloride is also associated with lead, which is a toxic metal.

At VSacharMD.com we complement our foundation with added topical botanicals that are anti-inflammatory, reparative and soothing to your skin. Our entire makeup line is non-toxic, and safe in pregnancy. All of our Mineral Foundations are Vegan, Gluten Free, are made without FD&C dyes, no nanoparticles, no carmine colorants, no BHT, no bismuth chloride, paraben free, free of petroleum-based oils, no alcohols, talc free, and preservative free.

Our cream foundation is hand crafted from the safest, highest quality botanicals, blended from premium crushed mineral pigments. It is specially formulated with topical botanicals such Bisabolol (the active component of Chamomile), Provitamin B5, Allanoitin and Golden jojoba oil, to protect, heal and nourish your skin. Meadowfoam seed oil provides a natural intrinsic sun protection factor (however we do not recommend using this as your only sunscreen). All of our Mineral Cream Foundations are Vegan, Gluten Free, are made without FD&C dyes, no carmine colorants, no BHT, no bismuth chloride, paraben free, free of petroleum-based oils, no alcohols, no nanoparticles, talc free, and preservative free.

One last possible source of acne is your makeup brushes!

There are 2 types of makeup brushes: those made from real animal hair (squirrel, weasel, sable, boar, horse,pony, goat, raccoon, squirrel, dog) and synthetic. At V Sachar MD, we use only synthetic brushes made from Taklon fibres. Taklon brushes are more hygienic than real hair brushes because real hair have an irregular surface which traps powders, dead skin cells, bacteria and chemicals. This can lead to “dirty” brushes which then get your makeup “dirty” as well, which leads to a recurrent cycle. Synthetic fibers\Taklon lack these surface irregularities, accordingly they cause less irritation and acne. Because Taklon is synthetic, animal cruelty is not an issue. At V Sachar MD, we do not support animal testing, and are PETA certified. The best way to clean your brushes, is soap and water, and isopropyl alcohol to disinfect them.

For makeup that is noncomedogenic, looks good and is good for you, go to www.VSacharMD.com.

7 Secrets For Pregnancy!

May 22, 2014/in Pregnancy Channel/by coastal

These are 7 great tips for pregnancy written by Dr. V Sachar.Dr. Sachar is a high risk pregnancy specialist, who has created the world’s first cosmetic line devoted toward safe, non-toxic products for pregnancy. Toxin exposure during pregnancy may be associated with the development of adult diseases later in life.These diseases may have origins early in life from toxin exposure even in utero.

1. Continue to exercise!

Continuing to exercise during pregnancy, better prepares you for your delivery, and regular exercise helps keep your weight gain in check. 30 minutes of exercise on most, if not every day of the week is recommended. Keeping your intensity to a level such that you can easily talk while exercising, will not cause any risk to the baby. Note, during pregnancy, low impact exercise, that does not expose you to injury is only recommended (no rollerblading!); always discuss your exercise regimen with your obstetrician.For more information refer here at Acog.

Safe exercise is recommended, skateboarding is NOT!

2. Don’t eat for the baby!

For the longest time, it was believed that you have to gain 35-40lbs for every pregnancy, regardless of your pre-pregnancy weight. What happened though, is that women who were already obese to start with, were becoming morbidly obese because they thought they had to. The World Health Organization and the American Congress of Obstetricians and Gynecologists have recognized this and recently recommended tailoring women’s pregnancy associated weight gain to their pre pregnancy weight.

Make Healthy Choices During Your Pregnancy

For more information refer here at Acog. Always discuss recommended weight gain with your obstetrician.

3. Limit Your Exposure to Toxins!

Air-pollution, second hand smoke, radiation, and even your makeup are sources of fetal toxins. Your makeup may contain parabens, lead, bismuth chloride, phthalates, and other chemicals which may be toxic to your baby, and/or your skin. Parabens are associated with endocrine disruption and future impaired fertility in the baby, and breast cancer in the mother. The surge of hormones and changes in your immune system can make your skin very sensitive to chemicals commonly found in makeup. Makeup you always used, may now cause acne, rashes, and other inflammatory eruptions. Try to use safe cosmetics that are non-toxic during pregnancy. Refer to www.VSACHARMD.com for more information and to purchase the world’s only non-toxic safe makeup created exclusively for pregnant women!

4. Caffeine Can Be Your Friend!

Many women suffer from carpal tunnel syndrome in the second trimester of pregnancy. This causes numbness and tinging in the hands, and can be very uncomfortable. Generalized pregnancy induced edema occurs around the nerves near your writs and causes compression, and numbness. Caffeine is a natural diuretic and can often control this problem. 1-2 cups a day can benefit those suffering from carpal tunnel, as well as alleviate many headaches and migraines in pregnancy! We recommend discussing this with your obstetrician before using caffeine to treat these 2 conditions.

5. Take Your Prenatal Vitamin at Night!

I have had thousands of women complain of nausea in the morning after taking their prenatal vitamin. They did not have morning sickness type of nausea. Personally, I have tried a prenatal pill too, and had severe nausea 1 hour later! To avoid this, take your prenatal vitamin with your dinner. By the time it starts to get dissolved, you will be asleep, and won’t experience all of the side effects.

6. Heartburn in Pregnancy!

Almost everybody experiences heartburn during their pregnancy. The cause is relaxation of the valve between the esophagus and the stomach AND slowed gastric emptying. These are secondary to the hormones of pregnancy, specifically Progesterone. Avoiding some of the triggers may be the easiest way to treat this condition. Caffeine, tea, tomato sauce (pizza, spaghetti), orange juice, big meals…these may all trigger the symptoms of heartburn. This occurs because the acid from the stomach rises into the lower part of the food pipe, and gives a very uncomfortable burning sensation. If avoiding these foods doesn’t help, try over the counter medications such as Tums. This is a simple fix, but doesn’t always work. If you continue to have persistent heartburn, discuss it with your obstetrician, and they can prescribe effective medical treatment. Note, heartburn, also known as gastric reflux is a major cause of nocturnal asthma. For patients with asthma, with worsening symptoms, treatment of your acid reflux may control your symptoms!

7. Varicose Veins!

Pregnancy is a major risk factor for varicose veins. They can range in severity from a cosmetic irritation, to severe pain. They occur as the pregnancy progresses because the pregnant uterus prevents blood from returning from your legs to your pelvis. It is similar to stepping on a hose; the water backs up, and the hose dilates. The hormones of pregnancy also contribute to varicose veins. Unfortunately, these veins aren’t limited to just your legs, and can occur in the vulva, and be very large and disfiguring. Hemorrhoids are another version of varicose veins! Fortunately there are a few solutions. Elevating your legs whenever possible will help eliminate the force of gravity. The most effective however is medical grade support hose. If you are at risk for varicose veins, be proactive; get support TED hose earlier, go prevent their formation, vs after they have formed. 4For those with painful varicose veins in the vulva, there are support hose for this as well. Discuss this with your obstetrician, and they can give you a prescription. They may be a little expensive, but using these will prevent further varicose veins from developing and alleviate some of the discomfort. For hemorrhoids, a stool softener, high fiber, and lots of water will also help.

Note: Before making any medical decisions in your pregnancy, discuss them with your obstetrician. The views in this blog are for information and entertainment only, not to be taken as medical advice.

Asthma in Pregnancy

May 16, 2014/in Pregnancy Channel/by coastal

What is Asthma?

Asthma is a respiratory condition characterized by an airway that is hyper-reactive to triggers, and these triggers cause inflammation. The triggers can be varied, such as seasonal allergies, cockroaches, pet hair, weather changes, perfume, tobacco smoke, acid reflux, carpet fumes, food allergies…As we grow older, we may acquire new sensitivity to things. The symptoms include shortness of breath, wheezing, difficulty in breathing, daytime and nocturnal cough. The good news is that this condition is generally reversible with medication. The management of asthma revolves around eliminating environmental triggers, education and compliance with therapy.

Asthma in Pregnancy

Generally in pregnancy, 1/3 of patients with asthma get better, 1/3 have the same symptoms, and 1/3 get worse; if you have asthma, there is about a 70% chance your condition will improve or stay the same.

The management of asthma follows the same guidelines as if you weren’t pregnant; most asthma medications are safe for pregnancy, and should not be stopped when you find out you are pregnant! Talk to your obstetrician before you decide to stop any asthma medication.

If asthma is adequately treated, your outcome in pregnancy is good.

Asthma is divided into 3 basic categories, mild, moderate and severe. These are determined by your symptoms and your spirometer. If you have moderate to severe asthma you need a tool to determine how your asthma is. Your spirometer is a key tool that can tell how you are responding to treatment. You should know what your average peak flow rate is. To determine your peak flow take a deep breath and blow as hard as you can into your flow meter. The normal values for women run between 350-550. When you have an asthma attack, using your peak flow meter can give you a measure of how severe your asthma is. For instance, if your normal peak flow is 500, and during an attack, your peak flow is 350, then your Peak flow is (350/500 x 100=70%) 70% of normal. This would put you in the Moderate Asthma category.

Treatment

Asthma treatment during pregnancy is dependent upon your severity and you category. The treatment protocol is called step-wise therapy. Start with the minimum treatment necessary to control symptoms and add additional treatment in a step wise fashion to control more severe disease.

Mild asthma: occasional asthma (up to twice/week) with wheezing controlled with occasional use of an inhaler such as Albuterol or Ventolin. These medications are safe for use in pregnancy.

Moderate asthma: Daily frequent attacks, more than twice weekly nocturnal asthma attacks. PEF between 60-80% of normal. If you are in this category, you may need an inhaled steroid inhaler in addition to your albuterol/ventolin inhaler.

Severe asthma: Continuous daytime symptoms or PEF of 60% or less. This category is most concerning. In this category, you may need long acting albuterol, an inhaled steroid, and additional medications such as oral steroids, a nebulizer and/or other anti-inflammatory medications. People with asthma are at risk for a severe asthma attack called status asthmaticus which can be life threatening. If you have asthma that is not responsive to treatment and/or is getting worse, you need emergency treatment.

Uncontrolled asthma is associated with low birthweight, preterm delivery, low birth weight, perinatal mortality, preeclampsia and congenital anomalies. Well controlled asthma is associated with good outcomes.

The primary objective of asthma treatment is to decrease the number of asthmatic outbreaks. If you need to use your bronchodilator more than twice per week, you may benefit from inhaled corticosteroids. Talk to your doctor about your symptoms, and have your treatment individualized to meet your specific asthma needs in pregnancy.

In recent years, GERD, or acid reflux is known to be an important asthma trigger for nocturnal asthma. The addition of a proton pump inhibitor such as Nexium can alleviate this. Unfortunately TUMS, or Pepcid sometimes aren’t strong enough to completely eliminate the acid production, and stop the reactive asthma. This can be a very important treatment in the overall management of asthma that is resistant to traditional treatment.

For severe outbreaks oral steroids can be used for short durations with a nebulizer. Note, if these are used in the first trimester there is an increased risk of cleft lip and palate.

Well controlled asthma does not additional fetal testing for fetal surveillance. Labor and delivery is not associated with any worsening of asthma symptoms, however labor inducing medications such as prostaglandin F2alpha should be avoided as it is associated with bronchospasm, and may trigger a severe asthma attack.

The treatment of asthma in pregnancy involves both you and your doctor; together with good compliance, excellent outcomes in pregnancy can be achieved.

This post was brought to you by www.VSacharMD.com

We have created the world’s first and only safe, non-toxic makeup for pregnancy. Toxin exposure during pregnancy is now associated with adult onset diseases such as breast cancer, prostate cancer, obesity, Alzheimer’s Disease, polycystic ovarian disease, diabetes and many others. These toxins build up over time, through bioaccumulation. At VSacharMD.com we recognized that regular makeup may have toxins associated with endocrine disruption, skin irritation, and even cause acne. We wanted to give women a safe alternative for their cosmetic needs.