Iron deficiency:
The U.S. Preventive Services Task Force (USPSTF) recommends screening for iron deficiency in pregnant women without symptoms of anemia (38). Iron deficiency while pregnant may contribute to lower birth weight and may lead to poor mental development of the child (6). Iron supplements should be given to iron deficient pregnant women but excessive iron from supplements can be harmful (6). Vegetarian women are also at higher risk of iron deficiency (7).
Breast feeding:
Breast feeding an infant is highly recommended and supported by the U.S. Preventive Services Task Force (USPSTF) instead of using formula or cow’s milk. Look here to find out why. Pump breast milk to provide breast milk to the infant when the mother cannot be with the baby. When breast milk cannot be used for any reason, use a formula with hydrolyzed whey. Look here to find out why: Baby Formula, Breast Feeding, and Nutrition.
Alcohol:
Primary care physicians are recommended to screen all adult patients for the misuse of alcohol. The primary goal for alcoholics is complete abstinence. Intervention options include behavioral therapy and therapy with health professionals which specialize in abuse. Medications are available which can either reduce the craving, or medication which causes an adverse physical reaction if alcohol is combined with it. Alcoholism treatment medications should not be used routinely in pregnancy due to potential risk of fetal harm. These medications which curb craving include nalmefene, also known as Revex, which is category B (animal studies revealed no fetal harm) has been found to be effective for the prevention of relapse (12). Another anti-craving agent is naltrexone (category C with embryocidal effect at high dose in animal studies) which showed a significantly greater rate of abstinence than placebo (13). Agents which cause aversion reactions after drinking alcohol include Antabuse (disulfiram) and calcium carbimide which are category C (fetal harm reported early in pregnancy). These agents were also found to produce a greater than 50% rate of abstinence rate in outpatient alcoholics over a 9 year period and were tolerated well long term (14). An abrupt discontinuation of alcohol may not only lead to a life-threatening withdrawal syndrome, it may place patients at higher risk of stroke. To find out why, look here. On the other hand, alcohol use in select cases may help non-alcoholics achieve several long term health benefits.
Bacteria in the urine:
At a gestation of 12-16 weeks, the U.S. Preventive Services Task Force (USPSTF) recommends testing for asymptomatic bacteruria in pregnant women with a urine culture since good evidence supports a reduced risk of urinary tract infection and a low weight at birth. The USPSTF states that a positive test with over 100,000 colonies per ml should be treated. (45)
Chlamydia and gonorrhea:
The U.S. Preventive Services Task Force (USPSTF) recommends that pregnant women 24 years old or younger or those at high risk should be screened for chlamydia and the same population 25 years old or younger should be screened for gonorrhea. High risk is considered by the USPSTF as history of STD (sexually transmitted disease), or have new or multiple sexual partners with inconsistent condom use whether pregnant or not. For women not at increased risk, the USPSTF recommends against routine screening for chlamydial and gonorrhea infection for all women aged 25 and older, regardless of pregnancy status. The USPSTF also notes that a higher prevalence of infection is seen in African-American women, Hispanic women, incarcerated populations, military recruits, and patients at public STD clinics. These patients may also be given higher priority to screen for chlamydial and gonorrhea infection. (37)
Folic acid:
Folic acid is the most important of all prenatal vitamins. If any woman is able to become pregnant, the U.S. Preventive Services Task Force (USPSTF) recommends a daily supplement of folic acid at a dose of 0.4-0.8 mg per day to prevent the possibility of neural tube defects (44).
Hepatitis B:
All women who become pregnant are recommended by the U.S. Preventive Services Task Force (USPSTF) to be tested for hepatitis B infection at the first prenatal visit (1st visit to the obstetrician after becoming pregnant) because the transmission of the virus to the baby can potentially be prevented (19).
Antibody testing:
The U.S. Preventive Services Task Force (USPSTF) recommends Rh blood typing with antibody testing during the first prenatal care visit and a repeat Rh antibody test for women who are Rh negative between 24 and 28 weeks gestation only if the father is not known to be Rh negative (21). If a woman is Rh negative, the baby may develop a severe anemia related to Rh disease which destroys the fetal red blood cells, and this can be prevented by giving the mother Rh immune globulin at 28 weeks (22).
Tobacco abuse:
Avoid tobacco abuse and quit tobacco use as soon as possible by using a combination of several methods to assist in cessation. For instance, combine nicotine replacement with at least one additional method such as an exercise program, hypnosis, or formal counseling such as support groups. The recommendation to counsel patients to stop smoking, stop using tobacco products, and provide methods of cessation is reinforced by the U.S. Preventive Services Task Force (USPSTF) (25). Many resources are available to assist in smoking cessation such as the online sites http://smokefree.gov/, http://www.cdc.gov/tobacco/campaign/tips/quit-smoking/ and the free phone number for free help 1-800-QUIT-NOW.
Gestational Diabetes
Gestational diabetes is the medical term used to describe diabetes mellitus that presents during pregnancy and disappears after the baby has been delivered. The American Diabetes Association estimates that approximately 4% of women who are pregnant will develop gestational diabetes. This condition requires very specialized care for the remainder of the pregnancy in order to protect the health of both the mother and child. (62)
During pregnancy some women develop a resistance to insulin that results in gestational diabetes. Insulin is the hormone that draws sugar from the bloodstream into the cells where it is burned to supply energy at the cellular level. Without the sugar the body is forced to burn fat for fuel. This has a significant negative effect on both the mother and baby. The extra sugar in the bloodstream also causes complications in the health of the mother and child.
Because of the significant negative effects for both mother and child current standard treatment in pregnancy calls for a screening test after the 1st trimester. Women who are greater risk for gestational diabetes will undergo a 5 hour glucose tolerance test. The screening test is a simple blood test that is drawn to look for the presence of too much sugar in the blood. The five hour glucose tolerance test (GTT) is a much more complex test. (63)
During a five hour GTT the woman is given between 8-16 ounce of a high sugar drink and then urine and blood is tested at 30 minute intervals for the next 5 hours. This test looks at how the woman’s body handles the extra sugar load, how much insulin is secreted and how much sugar is left in the blood stream and spills into the urine.
It is important for women to understand and recognize the symptoms of gestational diabetes for those whose condition develops after the screening test has happened. These symptoms can be very subtle, such as an increased amount of thirst, more trips to the bathroom, hungrier and blurred vision. All of these symptoms are caused by increased blood sugar but can also be attributed to other underlying medical conditions. (64)
Because the sugar isn’t absorbed into the cells the mother also experiences greater fatigue than she would have just being pregnant. As the kidneys try to filter out the excess sugar, take out more water the woman also gets dehydrated. She becomes thirsty from the dehydration and visits the bathroom more frequently because of the increased water intake.
Some of these symptoms are also those of pregnancy. Some women may believe that they are going to the bathroom more frequently because of the weight of the baby over the bladder. However, thirst isn’t a symptom of pregnancy. Between the 20th and 24th week the woman’s energy level also returns so she shouldn’t feel fatigued at this point. When the woman is suffering from gestational diabetes she may feel some relief from the fatigue but then it returns in full force as she doesn’t have energy because of the insulin resistance.
Researchers have found that babies who suffer from gestational diabetes have negative effects in later years. Left untreated the condition causes complications during the delivery and for the mother. For these reasons it is very important to identify and treat gestational diabetes as early as possible. A simple fasting blood sugar is enough to rule out the condition. (65)
Women who have higher risk factors, such as family history of diabetes, obesity, lack of exercise or a previous pregnancy with gestational diabetes should have a five hour glucose tolerance test to rule out the possibility and prevent medical complications.
Chocolate consumption in pregnancy:
Chocolate and pregnancy complications: To investigate whether chocolate’s possible cardiovascular benefits may prevent pre-eclampsia, researchers looked at 2,291 women who delivered a single infant, and asked them about how much chocolate they consumed in their first and third trimesters. The researchers also tested levels of theobromine, used as a biomarker for chocolate consumption, in infants’ umbilical cord blood. Women who consumed the most chocolate and those whose infants had the highest concentration of theobromine in their cord blood were the least likely to develop preeclampsia. Women in the highest quarter for cord blood theobromine were 69% less likely to develop the complication than those in the lowest quarter. Women who ate five or more servings of chocolate each week in their third trimester of pregnancy were 40% less likely to develop pre-eclampsia than those who ate chocolate less than once a week. A similar, but weaker, relationship between chocolate consumption and preeclampsia risk was seen in the first trimester, with women eating five or more servings of chocolate each week at 19% lower risk than those who ate chocolate less than once a week. (56)
Chocolate and risk of complications in pregnancy:
Researchers examined whether regular chocolate consumption during pregnancy is associated with reduced risks of pre-eclampsia and gestational hypertension. A total of 2,508 women who had hospital delivery records available were included in this study. The researchers found that a higher chocolate intake in the first or third trimester was associated with a lower risk of pre-eclampsia and in the first three months of pregnancy with a lower risk of high blood pressure. Of those who developed pre-eclampsia, 37.5% did not consume chocolate regularly, compared to 19.3% of women who had normal blood pressure and 24.2% of those with high blood pressure. Women who reported regular chocolate consumption had a 45% reduced risk of pre-eclampsia during the first trimester (odd ratio [OR] 0.55) and a 46% reduction during the the third trimester (OR 0.56). (57)
Yoga during pregnancy:
During pregnancy, regular yoga practice was shown to have beneficial effects in a study of 335 women who were between 18 and 20 weeks of pregnancy. They were divided into two groups: the yoga group (n=169) practiced for an hour per day, and the control group (n=166) walked 30 minutes twice a day. Both groups practiced every day from the time they enrolled in the study to when they gave birth. The primary measurements for comparison were the baby’s birth weight and week of pregnancy at which birth was given. For the women who practiced yoga, birth weights of 2,500 grams or more were higher, preterm labor was lower, intrauterine growth retardation (IUGR) and pregnancy induced hypertension (PIH) associated with IUGR was also lower in the yoga group. (58)
Yoga and complications of pregnancy:
Performing yoga in a high-risk pregnancy has shown that yoga can potentially be an effective therapy in reducing hypertensive related complications of pregnancy and improving fetal outcome. The study included 68 high-risk pregnant women who were randomized into two groups: yoga and control. The yoga group received standard care plus one-hour yoga sessions, 3 times per week from the 12th to the 28th week of pregnancy. The study showed significantly fewer pregnancies with induced hypertension, preeclampsia, gestational diabetes and intrauterine growth restriction (IUGR) cases in the yoga group. There were also significantly fewer Small for Gestational Age (SGA) babies and newborns with low APGAR scores, used to quickly evaluate a newborn’s physical condition, in the yoga group. (59)
Dangers of processed and cured meats:
Some cohort studies have shown that consumption of certain meats either by the pregnant mother, or by the child may result in an increased risk of childhood cancers. In the studies below, the odds ratio was used to calculate risk. Odds ratio is the odds of an event occurring in the exposed group compared to the odds of it occurring in the group which is not exposed. An OR of 1 means that both groups have the same odds. An OR of 1.5 means that the risk is 50% greater. An OR of 2 means that the risk is doubled, and so forth.
A cohort study examined the relationship between maternal consumption of meats cured with sodium nitrate on the risk of brain tumors among their children. Nitrites, preservatives used in meat to combat botulism (a form of food poisoning), combine with amines naturally present in meat to form carcinogenic N-nitroso compounds. These compounds have been associated with cancer of the oral cavity, urinary bladder, esophagus, stomach and brain. The researchers interviewed mothers of 549 children under age 20 with a primary brain tumor diagnosed during 1984-1991 and 801 children without cancer. Researchers found an increased brain tumor risk in offspring of mothers with relatively high consumption levels of nitrite from cured meats during their pregnancies; OR = 2.1 for eating at least twice a day compared to not eating. Increasing average daily grams of cured meats or mg of nitrite from cured meats also increased risk (P for each <0.005), however, nitrate from vegetables did not have the same effect. Finally, researchers found that prenatal vitamins taken throughout pregnancy decreased the risk of cancer in offspring (OR=0.54). This study suggests that exposure to N-nitroso compounds, found in cured meats, during pregnancy may be associated with brain tumors in children. (60)
A study analyzed the possible relationship between a pregnant mother’s diet and the child’s risk of childhood cancer. The study compared 234 cancer cases (including 56 acute lymphocytic leukemia, 45 brain tumor) to 206 randomly selected control cases in Denver. The authors found that children whose mothers consumed one or more hot dogs per week during pregnancy had twice the normal risk of developing brain tumors (OR = 2.3). The odds ratio is the ratio of the odds of an event occurring in one group to the odds of it occurring in another group and an OR of 1 means it equally occurred in both groups. Among children, eating hamburgers one or more times per week was associated with risk of lymphocytic leukemia (OR = 2.0) and children who consumed one or more hot dogs per week were also at higher risk of brain cancer (R = 2.1). Hot dogs contain nitrites that are used as preservatives, primarily to combat serious food poisoning know as botulism, which form compounds associated with cancer. This study suggests that pregnant women may want to cut hot dogs and other processed meats such as bologna, sausage, pepperoni and other packaged luncheon meats out of their diets. (61)
Probiotic supplements and atopic dematitis:
Atopic dermatitis (eczema) is a long-term (chronic) skin disorder that involves scaly and itchy rashes that is the most common allergy in babies and small children. In this review, researchers looked for trials testing whether or not probiotic supplements use during pregnancy and early life can prevent this type of dermatitis in infants and young children. Probiotics are “friendly bacteria” naturally found in yogurt. Probiotic tablets or liquid supplements can be used by pregnant women or by babies. The reviewers found 14 studies, mostly done between 2007 and 2011. They found a roughly 20% reduction in the rate of atopic dermatitis ((RR = 0.79). The results suggested that probiotics have a moderate role in the prevention of atopic dermatitis. It does not appear to matter at what time the probiotics are consumed (pregnancy or early life) nor who consumed them – child, mother or both. (66)
Iodine deficiency and children:
Iodine requirements during pregnancy may affect children: Iodine deficiency reduced intelligence in infants and children and thus is of critical importance during pregnancy. While the maximum safe dose is no more than 1 mg, this upper limit might be increased given than the Japanese consume 25 times the median iodine consumption in the US, without adverse effects. More insight might be gained from studies using 3 mg- 6mg iodine which are used to treat fibrocystic breast disease. (67)
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