Constipation and Pregnancy

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.


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.


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.

diet fiber


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 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 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.

Abnormal Pap Smear in Pregnancy

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.

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Asthma in Pregnancy

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.


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.

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