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Pregnancy-Related Problems

Pregnancy is a natural phenomenon and should not be considered a disease. However, this is a critical period for both the mother and the child. The woman's body undergoes a number of changes during this period to adapt to the needs of the growing child and occasionally these can be detrimental to the health of the mother. For the foetus, a healthy environment in the mother's womb is of obvious importance during this most important period, when his body is undergoing development. Many mothers are confused regarding the processes occurring in their bodies during pregnancy and also what is right for them and the child.

One of the most important questions in the mother's mind is whether she is pregnant or not. A missed period is fairly suggestive of the possibility of pregnancy. However, there can be other causes for this or it may simply be delayed. Further, many women have irregular periods and in these circumstances it becomes almost impossible to rely on this symptom. In any case most women would rather find out if they are pregnant much earlier. Pregnancy test kits are available with all pharmacies and even in some of the supermarkets. The urine test picks up pregnancy about 9 to 12 days from conception but can sometimes be unreliable and so confirmation is advisable. Pregnancy can also be confirmed by blood tests that are available with all pathology laboratories. These are generally positive from about 8 days to 11 days after conception. Both the urine and blood tests are based on determining the presence of high levels of beta hCG, a hormone the full name of which is beta human chorionic gonadotrophin.

SYMPTOM WORRIES

First time mothers are also worried about what symptoms are to be expected with the onset of pregnancy. Everyone is aware of nausea and often vomitting usually most prominent in the morning.

Pregnancy is usually said to be span three trimesters of three months each and nausea and vomitting usually subside as the pregnancy enters the second trimester.

These are often very troublesome symptoms and can become quite difficult to manage. When vomitting is severe, the condition is known as hyperemesis gravidarum ≠ emesis being vomitting, hyper referring to excessive and gravidarum to the pregnancy. This condition can be life threatening and may even warrant medical termination of the pregnancy in extreme cases.

Management of the nausea and vomitting can be tricky. This is because drugs are best avoided throughout pregnancy but especially so in the first trimester.

This is the period when the foetus is developing maximally and any untoward side effects of a drug can lead to severe malformations in the child. Many of these women develop transient fancies for unusual foods and they should be encouraged to eat whatever they can retain. A lot of coaxing may have to be done.

Quite a few of them are able to retain food later in the day though they may find even the sight or smell of food provoking nausea in the mornings. Pyridoxine is vitamin B6 and this has been found to offer some relief in such cases and it may be tried by either oral or injectable route in women not responding to common sense attempts to get around the vomitting.

DISORDERS

Also, the doctor should not lose sight of the fact that some of them may have underlying medical disorders rather than the pregnancy alone to account for the undue vomitting. The list of medical disorders that could contribute to vomitting is almost endless but important conditions include acid disorders involving the stomach such as ulcer or gastritis, liver and kidney disorders, use of medicinal or other drugs, etc.

Unusual fatigue is another symptom that is quite common and should be considered as part and parcel of normal pregnancy. This is usually most prominent in the earlier months and is attributed to various changes taking place in the body of the mother to accommodate growth of the child. Both the blood pressure and the blood sugar tend to be decline a little. Also, the haemoglobin falls a little because of dilution of blood. All these as well as the hormonal changes taking place probably contribute to this exhaustion. However, in some mothers the fatigue may be due to concurrent medical illnesses or correctable factors such as anaemia or diabetes and a medical opinion to rule out such conditions is advisable when fatigue is unduly prominent.

Increased frequency of urination is another common symptom. Sometimes this occurs because of associated infection but in most cases this symptom occurs even in the absence of infection. A feeling of shortness of breath, palpitations, distension of the abdomen, change in bowel habit and swelling of the feet are also very often complained of in normal pregnancy.

HEARTBURN

Heartburn is another very common complaint. The use of medicinal drugs during pregnancy is a very vexing question. In general, it is best to avoid use of any drug during pregnancy if at all possible. There are obvious exceptions to this, one of which is the use of iron tablets to counter anaemia. The reason for the recommendation to avoid drugs during pregnancy is obvious to all -- one wants to avoid harm to the developing foetus from the action of drugs. There have been many horror stories of foetal malformations. The most famous was the birth of many children with undeveloped limbs from the use of a drug called thalidomide.

However, there are many occasions when refraining from use of medicinal drugs is more harmful than the potential harm to the foetus. For example high blood pressure in the mother is more harmful to the mother and child both than the potential side effect form use of a relatively safe anti-hypertensive drug.

Similarly, the need to control diabetes by insulin is imperative as compared to any safety constraints.

The Food and Drugs Administration (FDA, US) is the most well-organised and respected organisation when it comes to approving and monitoring drugs from point of view of their applications and safety.

DRUG RANKING

The FDA has devised a system of ranking of drugs denoting their probable safety during pregnancy. It is mandatory for the ranking to be marked on the inserts in the drug package. Category "A" drugs are those with the highest safety levels for use during pregnancy. This ranking is generally allotted only to drugs that have been in use since many years and have not been reported to cause any untoward effects till date.

Many of the vitamins are included in this category. Incidentally, vitamin B6 which is recommended in the management of nausea and vomitting or pregnancy has been assigned this safest category. Folic acid is another vitamin regularly prescribed to pregnant women and this too is a category "A" drug.

The dose considered safe of each drug in this category is also indicated. This is important as exceeding this safe dose could again push the drug out of this category. Many people are fond of taking unusually high doses of vitamins and this fact is of particular relevance for women following this practice.

Category "B" drugs are those which are probably safe on account of extensive use in pregnant females in the past and for whom there have been no significant reports of foetal abnormalities. Many important drugs such as insulin, paracetamol, prednisolone and ampicillin belong to this category.

Incidentally, the artificial sweetener aspartame used by some diabetics in lieu of sugar has also been assigned this category of probable safety.

Drugs that are considered less safe but which are still recommended in pregnancy provided the potential benefits outweigh the potential harm to the foetus are assigned category "C." In other words, these drugs are to be used in pregnancy only if the medical condition is serious enough to warrant their use and if no alternative is present in the safer categories. Some of the antibiotics like ciprofloxacin belong to this category.

Category "D" drugs are substantially more toxic to the foetus and are not recommended during pregnancy. If a woman is already on any of these drugs before planning a pregnancy the recommendation is to switch over to a safer drug or to postpone pregnancy. If a serious enough illness occurs during pregnancy in which there is no medical choice but to prescribe a drug from this category, it is always prescribed with the informed consent of the parents. This can be a very hard decision for the parents as well as the doctor. Drugs in this category include those used to treat cancers.

Phenytoin which is widely used in the treatment of epilepsy is another such drug.

Finally, there is category "X" which is basically for drugs which are never recommended for use during pregnancy in view of well known harmful effects to the foetus. Thalidomide is a prime example as is Accutane, a drug used in treating certain severe types of acne.

Courtesy : Gulf Today


Health Issues for Women(Previous Features)





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