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. P. – Other than be under monitoring my a doctor, is there anything someone who has high blood pressure (on medication advised to be okay for pregnancy) do differently while trying to get pregnant and while pregnant?
Dr. Aladjem: Keeping your blood pressure within normal range is the most important thing you can do. Regular exercise will also help, like walking or stationary bicycle for example. Also controlling your weight (your doctor can tell what your ideal weight should be) helps, since extra weight is a factor in high blood pressure. Should you be a smoker, you should stop. I know, it’s easier said than done, but it can be done. Millions of people have stopped smoking. Besides when you smoke, the baby smokes. It adversely affects the infant. Certain malformations have been attributed to smoking, even second hand smoking.
During pregnancy the most important thing to do other than controlling your blood pressure, is being aware of the possibility of superimposed preeclampsia. Ask your doctor as to what to watch for.
Question from A.N. – What is preeclampsia and how does it affect pregnancy?
Dr. Aladjem: Preeclampsia is a disease unique to pregnancy. It is characterized primarily by high blood pressure, exaggerated reflexes (like knee jerk) and in severe cases seizures, just like in epilepsy. The most common early signs of preeclampsia are swelling of the hands, feet or face, and sudden weight gain, although such findings do not automatically make the diagnosis of preeclampsia. Headaches are common, sometimes changes in the vision like blurring, and even temporary loss of vision, abdominal pain, primarily in the upper right quadrant of the abdomen and protein in the urine and/or decrease output of urine. An early sign of potential seizures is pain in the area of the stomach. Some doctors erroneously interpret such pain as a sign of stomach ulcer.
Preeclampsia usually happens after the 20th week of pregnancy. It is also more common during the first pregnancy, although it can happen in any pregnancy.
Preeclampsia is a serious condition for the mother and for the baby. If not treated aggressively it can get out of hand. Together with bleeding and infections, preeclampsia is one of the three most common potential causes for maternal and fetal mortality.
Babies may stop or slow down their growth before birth and are born smaller than normal. They are known as “growth restricted”. One of the severe complications of preeclampsia, in addition to seizures, is a condition known as “abruption placenta”. This means that the placenta separates itself from the uterus before the birth of the child, causing severe maternal bleeding and many times death of the baby. Furthermore this condition may also affect the clotting system of maternal blood (HELLP syndrome) and the consequences may be dire since the mother may start bleeding internally and this may threaten her life. Kidney and liver problems may also occur in preeclampsia.
We don’t know what causes preeclampsia. While treatment has improved over the last two decades or so, the only cure is delivery of the baby. That’s why many women with this condition deliver prematurely.
Prenatal care has made important advances in the management of preeclampsia, by early detection of a rise in blood pressure and initiating an early aggressive treatment in order to avoid seizures and other complications.
There are other conditions which may raise the blood pressure (so called gestational hypertension) or preeclampsia may complicate an existing chronic hypertension in which case is known as “superimposed preeclampsia.”
There are certain conditions that predispose a patient to preeclampsia: advanced age (40 or older), a history of preeclampsia (family or yourself in prior pregnancy) obesity, diabetes, multiple pregnancy (twins, triplets or so), prior kidney disease or prior hypertension and lupus being the most common.
Since many times preeclampsia establishes itself too early to be able to deliver the infant, doctors try to control preeclampsia and postpone delivery as much as possible. This is not always possible, but with very early diagnosis of preeclampsia, hospitalization and close observation and treatment, primarily to avoid seizures and control high blood pressure, one can gain enough weeks to make delivery feasible. It’s not perfect but it’s an improvement over the past. Sooner or later, the cause or causes of preeclampsia will be elucidated and effective treatment will become available.
Another rare circumstance where preeclampsia may establish itself very early in pregnancy is a condition known as “molar pregnancy”. Briefly, in a molar pregnancy, the placenta develops into an abnormal mass of cysts full of fluid resembling a bunch of grapes, hence the name of “Hydatidiform mole”. When it happens it occurs in the first 12 weeks of pregnancy. Sometimes preeclampsia develops as a complication of such an abnormal pregnancy. The name of “mole” refers to being a “mass” or “tumor” and has no relation to a mole (animal).
In the meantime, it is important for a pregnant woman to be informed about potential problems, even if the risk is low, since early detection of any problem will minimize the damage and allow for better outcome. I am a firm believer that knowledge is power which allows us to take necessary steps to correct or control the events. “I don’t want to know because it is not going to happen to me” is not a smart attitude. It is more likely that the well informed woman will do better than those that refuse to be educated about pregnancy complications. I believe it is an unfortunate state of affairs in our society not wanting to learn about problems in pregnancy. We are avid readers of medical problems, go to the doctor because we have a running nose, take antibiotics for a cold, but when it comes to pregnancy we are bewildered when something is not right and the mother feels guilty because she had a problem in pregnancy.
I would like to thank and congratulate you for asking this basic question. I wish more people would want to know about all possible aspects of their pregnancy.
Question from M.K. – I am 24 weeks pregnant. I am a diet freak, watch my line and what I eat, I exercise every day. I am 25 in my first pregnancy. Can I continue on the diet and exercise while pregnant?
Dr. Aladjem: This is a very broad question. Particularly if you are a “diet freak” as you call yourself. I have no idea what type of exercises you are doing which limits my ability to give any advice.
My suggestion to you is that you should talk to your doctor and ask him/her for a referral to a certified dietician who specializes in pregnancy. You and her together should be able to work up a diet that should not be deficient and at the same time satisfies your needs. You can tell her what type of exercise you are doing and she will be able to figure out the replacement calories you need.
In any event, understand this: 1) as pregnancy progresses you will gain weight and 2) as pregnancy progresses your ability to perform exercises that requires too much work will be difficult for you, and some may be unsafe with the growth of the abdomen as you approach the end of the pregnancy, Your stability may leave much to be desired and therefore some exercises should not be attempted.
In regards to your diet, in particular, I’d like to emphasize that for a normal pregnancy you need good nutrition. You cannot avoid gaining weight if you want your pregnancy to be normal. Depending on your weight and height, you will probably gain a minimum of 20 pounds. Your doctor can tell you what would be an ideal weight gain during pregnancy for you. You’ll take care of the extra pounds after delivery.
Think of the pregnancy as a period where everything for you changes until after delivery. Your baby needs a good maternal diet. As for exercise during pregnancy in general unless they are strenuous and extreme or your pregnancy is not normal, there is no problem.
Question for C.B – For the past year I have been receiving IUI treatment (total of 2 times). I was told that I had abnormalities such as antibodies that could be attacking the fetus and deficiency in B vitamins that might be causing me to not get pregnant and/or miscarry. Is there anything I can do besides take vitamins and do I have a chance in overcoming this situation so I can get pregnant?
Dr. Aladjem: The information you provide me with, is not sufficient to give you an answer. There are number of vitamins B: B6, B9, B12, and so forth, each one with a different purpose. I doubt that you have a deficiency in all. Please be more specific. What type of Vit. B deficiency do you have and how was it diagnosed? In regard to you second question, what type of antibodies are we talking about? Do you have an autoimmune disease, like antiphospholipid syrndrome, celiac disease, Crohn’s disease, or something else? Do you have an Rh problem? Once I have some clarification from you, I will try to answer your questions
You can read more of Dr. Aladjem’s posts here.
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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.