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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.

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.

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”.

For more helpful pregnancy hints, instructional pregnancy videos, upcoming podcasts and to get more information about the world’s first non-toxic makeup exclusively for pregnant women, please go to www.VSACHARMD.com.

Antibiotics in Pregnancy

May 12, 2014/in Pregnancy Channel/by coastal

Several times per week I am approached by a patient regarding which antibiotics are safe for her to use in pregnancy. Usually this question comes from their dentist who wants to perform a dental procedure, and ants to use an antibiotic for prophylaxis. The concern is that some antibiotics are known teratogens. Teratogens cause malformations in the developing embryo or fetus. Teratogens can be antibiotics, viruses, and other substances. Examples of known teratogens include: ACE inhibitors,radiation, cytomegalovirus, rubella virus, alcohol, cocaine, lead etc.

Most of the information regarding safety of antibiotics in pregnancy are obtained from women who took the drug “by accident” or when they didn’t know they were pregnant, and then they were followed to see the outcome of the baby. These are called retrospective studies. Because of safety concerns about risks to the developing baby, pregnant women are excluded from most drug studies. The FDA has assigned a letter category to all drugs that is used to rate a drug’s safety in pregnancy. It is generally accepted that Category A, and B drugs are safe in pregnancy.

An excellent resource from the FDA is here: (http://www.fda.gov/ForConsumers/ByAudience/ForWomen/ucm118567.htm). Known drugs that are teratogens are given a Category X.Frequently encountered infections in pregnancy include, urinary tract infections, pyelonephritits (kidney infection), bladder infection, pneumonia, cold, bronchitis, sinusitis, among others. A few of the commonly used antibiotics include Amoxicillin, Ampicillin, Clindamycin, Erythromycin, Penicillin, Keflex,Augmentin. These are category B.

In May 2011, the American College of Obstetricians and Gynecologists issued a monograph stating that most antibiotics are safe during pregnancy(http://www.acog.org/About%20ACOG/News%20Room/News%20Release/2011/Most%20Antibiotics%20Are%20Safe%20During%20Pregnancy.aspx).

There are many conditions that require that a pregnancy category C drug be taken. This includes anti-seizure medications, and some mood stabilizer medications among other. If you are prescribed ANY antibiotics you should have a discussion with your practitioner to assess the benefit vs risk of taking these medications during pregnancy.

This pregnancy post was presented to you by VSacharMD.com The world’s first and only cosmetic company created by a High Risk Pregnancy Specialist devoted to safe, non-toxic cosmetics in pregnancy. Toxin exposure during pregnancy is associated with the development of diseases later in life such as cancer, diabetes, Alzheimer’s and more. Find more information at www.VSacharMD.com

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