Dr. Silvio Aladjem Answers Your Questions ~ August/2014

The doctor is in!

Imperfect Women is partnering with Dr. Silvio Aladjem to bring you this column featuring Dr. Aladjem answering your questions of medical interest related to pregnancy. We are excited to bring you this feature and hope that you are able to benefit from it.

Question from J. L. –  I am 37 years old. My first pregnancy was years ago when I was 25 years old. Since that time I was diagnosed with high blood pressure and I have had some heart problems. I am considering getting pregnant again but I am concerned because of my history.

Dr. Aladjem:  Women with hypertension can tolerate pregnancy if the hypertension is under control. What type of heart problems do you have? Is this the result of your hypertension or is there another cause? That is important to know. I would suggest that you first talk to your cardiologist and he/she can give you a realistic advice in terms of whether your heart is in a condition to tolerate pregnancy. Your cardiologist may want to order an echo-cardiography, if you haven’t had one yet, to assess the heart function. If your doctor is not a cardiologist, by all means seek one for his/her advice.

I would also strongly suggest you seek the opinion of a Maternal Fetal Medicine specialist. These are obstetricians with special training in pregnancies complicated by other medical problems. Between the cardiologist and this specialist they should be able to tell you if getting pregnant is realistic for you.

Your current medication for high blood pressure may have to be reviewed. Some medications, like ACE Inhibitors, can’t be taken during pregnancy since it may affect the infant.

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J.V. –  I have been told that I have 2 blood clotting disorders, MTHFR and Antithrombin 3 and I am pregnant. How do these two disorders affect my pregnancy and what is the best treatment for it.

Dr. Aladjem: What you have is a genetic predisposition in which your blood may abnormally clot. If that were to happen a very dangerous complication is a pulmonary embolus, when a clot, usually from your legs, travels to the lungs.

The treatment is prevention of clotting by receiving a medication to avoid abnormal clotting. Usually a medication known as Low Molecular Weight Heparin is given daily by injection. How much is given will be determined by your doctor based on your weight and other considerations. An oral medication known as Coumadin cannot be given during pregnancy since it crosses to the baby and may result in abnormal bleeding in the baby. After delivery you will have to continue on medication for some time and your doctor will decide for how long. If you do not breast feed, than you can be on oral Coumadin. But if you do breastfeed, you will have to continue on injection for some time since the breast milk would carry the drug Coumadin and affect the newborn.

This is a genetically inherited predisposition. Should you have brothers or sisters, it would be prudent to tell them and they should have some testing and see if they too carry the gene. If they do, their doctors may suggest to take aspirin prophylactically, and if a sister gets pregnant she should know if she carries the defect to be treated just like you will be.

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L.M. – I have always avoided having excessive sugar in my diet. I have been using artificial sweeteners for coffee, tea and sometime in cooking. I am pregnant now. Is it safe to use during pregnancy?

Dr. Aladjem: In general the use of artificial sweeteners, with some exception, is safe during pregnancy. Equal and Nutrasweet are approved by the FDA as being safe in pregnancy. Some scientists still object to the use of these chemicals during pregnancy, but there have been no studies in humans that directly address this issue. For a long time saccharin (Sweet’N Low) was considered unsafe because of some animal studies. This particular sweetener is used much less today. I think it would be prudent to avoid it. The newer sweetener, Splenda, has not had any bad publicity and no association with abnormalities have been reported. I do not believe the FDA approved it for pregnancy. I would stick to those approved by the FDA, Equal and Nutrasweet.

If you are a fan of “Diet Pop” I would suggest you read the label and see what sweetener it has in the formula, and avoid it if it is a sweetener that is not approved.

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You can read more of Dr. Aladjem’s posts here.

Do you have a question for Dr. Aladjem that you would like to see answered in our next “Ask Dr. Silvio Aladjem” feature? Please submit your questions below.

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This column is for the purpose of education and information only. It is not medical advice and should never be used instead of your doctor’s or other health care professional’s advice. Please note that you will find the answer to your question identified by your initials only and confidentiality will be maintained.

Dr. Silvio Aladjem, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem is published extensively in Scientific Medical Journals and wrote several textbooks in the specialty.