Posts

Anemia in Pregnancy

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.

pica

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.

physician

 

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.

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.

 

All Rights Reserved, Copyright 2014
No Part of This Post May Be Reproduced Without Expressed Approval from V Sachar MD

Why is Non-toxic, Safe Makeup in Pregnancy Important?

Congratulations!! You are pregnant! This is one of the most exciting and special times in a woman’s life. Now it’s time to plan for a safe pregnancy.

Everybody is concerned about toxins. Pesticides, cigarette smoke, pollution, bisphenol A (BPA), organic, gluten-free…these phrases are thrown at us countless times per day in magazine ads, news reports and commercials.

What about in pregnancy? What should you do? Does it matter?

In 2004, and 2009, two different studies from the Environmental Working Group examined newborn’s blood, and found over 200+ toxins in newborn’s blood! Some of these toxins were pesticides, Bisphenol A, mercury, some are known to cause cancer, and some are known to be neurotoxic. The babies were exposed in utero to these chemicals directly from the mother’s exposure.

Some of these toxins can have an immediate affect, such as low birth weight. But some cause problems later in the child’s life. There is a phenomenon called bioaccumulation,where small amounts of toxin are absorbed, but as the baby grows, these small amounts build up and become toxic to the child.

poison-1024x874

 

These toxins can come from multiple sources; food, air, and even makeup.

A healthy environment is important during pregnancy. In a recent study released in February 2013, it was found that pregnant women who were living in cities with higher pollution were more likely to give birth to underweight babies. Clearly, exposure to a high toxin burden, can adversely affect your babies growth.

What about toxin exposure through skin? Is your makeup safe for your pregnancy?

In March 2013 the Safe Cosmetics and Personal Care Products Act was introduced in the US Congress. It aims to ensure that all personal care products are safe by establishing a system to assess the safety of makeup and cosmetic ingredients and to phase out the most harmful substances that are suspected of causing cancer, reproductive harm or other adverse health effects. Toxin exposure in makeup has got the attention of the US Government!

Did you know that there is lead in many brands of makeup in the USA today!The lead content comes from the use of dyes to give color. The FDA tested commonly used lipsticks and reported their findings in this detailed report:
http://www.fda.gov/cosmetics/productandingredientsafety/productinformation/ucm137224.htm

This report will surprise you!! There is no safe level of lead. Lead should not be in any of our products. Even though the individual amounts in each lipstick maybe small, a phenomenon of bioaccumulation occurs. This is when repeated levels of low amounts,build up over time, and can become toxic levels. In pregnancy, lead can be transferred to the fetus as early as the first trimester, and is associated with neurodevelopment delay.

We carefully choose every ingredient to ensure that there is no lead in any of our products.

How can a fetus get exposed to toxins in makeup? This is described as transdermal absorption or across the skin absorption.

skin

Figure 1:  Chemical Absorption by Fetus

After the chemicals pass through the skin, they get absorbed into the bloodstream. The mothers blood directly goes to the baby along with nourishment, oxygen etc. The mother’s blood goes to the placenta which is the interface between the mom and the baby. Nourishment, oxygen and other substances get transferred to the placenta, and then from the placenta to the baby via the umbilical cord.

 

fetal-ciculation

 

Figure 2: Fetal blood circulation

Chemicals found in cosmetics have been found to affect both the mother and the baby in a number of ways. Most commonly, they interfere with hormonal balance amounting to what is commonly known as endocrine disruption. This can occur in the mother, and the baby. For instance, in pregnancy, exposure to parabens, and phthalates may be associated with reproductive anomalies in the baby later in life. For the mother, prolonged exposure to certain chemicals such as parabens may be associated with breast cancer. The European Union classifies pthalates as a suspected endocrine disruptor on the basis of evidence that it interferes with hormone function, and as toxic to reproduction on the basis that it may cause harm to the unborn child and impair fertility. As well, Health Canada notes evidence suggesting that exposure to phthalates may cause health effects such as liver and kidney failure in young children when products containing phthalates are sucked or chewed for extended periods. Parabens can mimic estrogen, the primary female sex hormone. They have been detected in human breast cancer tissues, suggesting a possible association between parabens in cosmetics and cancer. Parabens may also interfere with male reproductive functions.

You probably have parabens and a number of other toxins in your makeup, and aren’t even aware! Check the labels of your cosmetic products.

Pregnancy is the most important time to protect yourself agains toxin exposure. Limit yourself from pesticides by washing all produce, don’t expose yourself to pollution and cigarette smoke, and try to choose safe makeup.

Now there is a safe makeup alternative for pregnant women. To give women a choice in their makeup, I have created the world’s only safe, non-toxic makeup exclusively for pregnancy. I have removed potential toxins, lead,allergens, and irritants from our ingredients. This is the world’s safest makeup for the mother AND the baby. We feel that our makeup is the best natural, and toxin free makeup that is safe in pregnancy. Go to www.VSACHARMD.com to get more information.

Herpes Virus Infection in Pregnancy

If someone says the word “Herpes”, everyone cringes. Surprisingly, about 2/3 of you reading this now, may have had HSV 1 (the type that causes cold sores), and about 20% of you may have had the genital type of Herpes (HSV2). Most people who get exposed to herpes are asymptomatic and may not even know they had it. The way we can tell if you have been exposed to this virus before is to measure your immunoglobulins (IGG) against the herpes virus.

Most episodes of HSV during pregnancy are recurrent, and are a very low risk to affect the baby. Transmission occurs through mucous membranes or open or abraded skin. The virus lives in the neurons where it entered near the spine. Recurrent clinical outbreaks occur infrequently, and may involve trauma, UV radiation, change of temperature, pregnancy,stress, immunosuppression or hormonal changes.

Pustules

 

Infection presents with papules, pustules, vesicles and ulcers that last 2-6 weeks

The fetus becomes infected by a virus shed from the cervix or lower genital tract. It either invades the uterus during membrane rupture or is transmitted by contact with the fetus during delivery. Neonatal herpes is caused by both herpes simplex types 1 and 2, although herpes simplex type 2 infection predominates. Most infected infants are born to mothers who have no reported infection.

baby

 

How it affects You/Pregnancy?

The risk of neonatal infection correlates with the presence of HSV in the genital tract, the stage of maternal infection and invasive obstetrical procedures. If the pregnant woman acquires a new infection near the time of delivery the infant has a 30- to 50- fold increased risk of infection due to higher viral load and the lack of protective antibodies. While women with recurrent HSV have less than a 1-percent risk of neonatal infection.

How it affects the mother?

Only 1/3 of newly acquired Herpes infections are symptomatic. The incubation period of 2-10 days followed by eruption that is papular with itching and tingling, which then becomes painful and vesicular. Transient flu-like symptoms are common. Although very rare, life threatening herpes infection may develop in the mother (disseminated disease) with encephalitis, hepatitis and pneumonia may develop. All signs of infection disappear in 2-4 weeks. Many women do not present with the typical lesions, some may have pruritic or abraded areas others may have knife-slit lesions that may sting, or be itchy.

How it affects the baby?

Neonatal transmission occurs during pregnancy in about 5% of cases, during labor and delivery around 85% and after delivery around 10%.

The most concerning HSV infection during pregnancy occurs in those with a primary/first episode infection in early pregnancy. These are associated with an increased risk of preterm labor, IUGR (intrauterine growth retardation), spontaneous abortion or stillbirth. Premature infants account for 2/3 of the cases of neonatal HSV.

Late-pregnancy infection has been associated with preterm labor and delivery. 80% of mothers of infected infants have no reported infection. This often occurs because the mother is unaware that she was infected, or exposed to a partner with HSV. Epidemiologic studies suggest that most sexual transmission of genital herpes occurs when persons shed virus but lack lesions. Both men and women can shed the virus, without visible lesions on their genitals.

Primary/first episode infection during pregnancy is associated with microcephaly and neonatal chorioretinitis; rarely skin lesions. The risk of fetal transmission with HSV primary infection is about 60%. 20% of those with neonatal HSV have long-term neurologic sequelae.

Treatment and Prevention

Specific antiviral medications have been used successfully to attenuate the infection and reduce viral shedding. In those women with a history of prior HSV (recurrent HSV), and recurrent outbreaks, suppressive therapy with daily antiviral treatment has been used successfully to reduce outbreaks, decrease viral shedding, and decrease neonatal HSV.

Antiviral treatment with medication such as Acyclovir appears to be safe in pregnant women.

If women at term with a history of HSV, present with prodromal symptoms of HSV infection such as vulvar burning or itching, and careful examination of the vulva, vagina and cervix should be done to evaluate for the presence of lesions. Cesarean section is indicated for those with only active genital lesions or prodromal symptoms. However even after cesarean section, some infants are born with HSV. Postnatal treatment with antiviral medications are
given for neonatal herpes infection.

This post was presented to you by VSacharMD.com The World’s first and only cosmetic company devoted to safe, non-toxic cosmetics in pregnancy. Toxin exposure in utero is associated with adult diseases as the child grows such as cancer, diabetes, and more.Prevent exposure to toxins by using safe, non-toxic cosmetics.

Copyright 2014 V Sachar MD. All Rights Reserved.