Posts tagged ‘early pregnancy’

Before Baby

Often, patients who come see me ask whether I deliver babies.  Indeed I do!  And it’s always nice to build a relationship with patients before they get pregnant so that they are more comfortable with me during the 9 months we’ll spend caring for mom and baby.

In addition to what usually happens during an annual gynecologic visit, good pre-pregnancy care deserves special consideration.  The peroid of thime before you get pregnant is the best time to improve control of any chronic medical conditions you may have (high blood pressure, asthma).  A doctor should talk to you about any medications you may be taking which pose a potential risk to a developing fetus.

One medication is routinely recommended for all pregnant women.  Folic acid (folate) supplementation should begin prior to conception.  Ideally, it should begin at least 2-3 months prior to trying to conceive.  Most women require 400 micrograms (mcg) of folic acid to prevent a specific birth defect (Spina Bifida, which can cause a child to be unable to walk).

Some women require more folic acid (800-4000 micrograms) depending on their risk factors for delivering a baby with spina bifida.  These risk factors can include certain medications (especially anti-seizure drugs), certain medical conditions, and a prior history of a child or other family member with spina bifida. 

Prenatal vitamins usually contain 400-800 micrograms of folic acid in combination with other vitamins and minerals.  You can bring your prenatal vitamin (in the bottle) to your doctor’s visit to review whether it contains everything you’ll need during pregnanty.  Alternatively, ask your healthcare provider to recommend a prenatal vitamin or other supplements for you.

Good pre-pregnancy care also includes certain blood tests.  A test may be required to determine whether a prospective mother is immune to Rubella (also called “German measles”) and Varicella (a.k.a. “Chicken pox”).  That’s because both of these disease can cause birth defects if the virus that causes them is contracted during pregnancy.  Immunizations are available for both Rubella and Varicella and should be administered to non-immune women several months prior to attempting to get pregnant.  Neither vaccine is administered during pregnancy.

Testing for infections, including HIV (Human immunodeficiency virus), gonorrhea, chlamydia, and tuberculosis may be a good idea for women who are at risk for these conditions.  A conversation with your doctor can help him or her determine whether you are at risk and require screening.

It’s always a good idea to maintain a healthy weight.  This is espceially important before and during pregnancy.  Managing your weight before you get pregnant may help reduce your risk of diabetes and blood pressure problems during pregnancy.  Avoiding excess weight gain during pregnancy can make for an easier delivery and a faster return to your pre-pregnancy body.   A healthy diet and regular exercise will help you manage your weight.  Advice  from a doctor, nutritionist, or weight-loss counselor may help if you’re having trouble.

Lastly (and perhaos most importantly) avoiding alcohol, cigarettes, illicit drugs and other toxic substances is of tremendous importance when you are pregnant.  All of these substances can seriously impair maternal health.  They may also contribute to to an increased risk of miscarriage, preterm birth, low birth weight, and (in the case of alcohol) low I.Q. and birth defects.  The best time to stop using these substances is before conception.  Again, assistance from a doctor or substance-abuse program may help.

It’s a good idea to schedule a visit with your gynecologist to discuss the best way to prepare for a healthy pregnancy.

For some great resources on pre-pregnancy health and pregnancy planning, check out these links from the American College of Obstetrics and Gynecology.

June 29, 2011 at 7:48 pm Leave a comment

Buyer Beware – Suspect Supplements and Hurtful Herbals

As an obstetrician/gynecologist, one of the things I do is take care of pregnant women.  And, while this blog is dedicated to gynecology, I thought I’d share with you a cautionary tale about my recent care of a woman in her first trimester of pregnancy.

She was asked to try a remedy for morning sickness.  The remedy  is described on its own website as  “a safe, non-addictive, FDA registered natural remedy containing 100% homeopathic ingredients formulated to relieve nausea (morning sickness) during pregnancy.” 

I was asked to look at the product to determine if it was safe for my patient.  At the bottom of a website with abundant testimonials and positive reviews, I found a list of ingredients.  5 of the 7 ingredients were safe and nontoxic.  These were:

Two ingredients posed serious potential health risks (regardless of pregnancy status).  These were:  

  • Nux Vom (Nux Vomica– derived from the Strychnine tree).  That’s right, I said strychnine.  As in the stuff they use in rat poison and gopher bait.  While very small doses of strychnine cause an increase in bowel motility, which can releive nausea, larger doses can cause neurological toxicity, seizures, and death.
  • Nat Phos (Sodium Phosphate — another salt) Oral phosphates were widely used in bowel preparations for colonoscopy. They have been withdrawn in the United States because evidence suggests that sodium phosphate causes serious kidney damage, a condition called phosphate nephropathy

I told my patient that I had serious concerns about the safety of the ingredients listed on the website.  I told her that, although the remedy is very unlikely to cause injury in the small amounts in which it is administered (it is sprinkled on foods throughout the day), I could not recommend that she take it when safe alternatives exist. 

And, just to clarify, I am not recommending for or against the use of this (or any other product) on this blog.  I am sharing this anecdote to remind you to share with your healthcare provider ANY vitamins, nutritional supplements, herbal or traditional medicines you desire to take. 

That’s because only a medical professional, who is familiar with your medical history and has an inventory of the other medications you may be taking, is qualified to help you determine whether a particular product is safe for you.  He or she can determine whether the product interferes with other medicines you may be taking .  Your healthcare provider may also have valuable instructions on how to take the product safely (i.e. on an empty stomach, not with grapefruit or acidic juices, etc.)

Vitamins and nutritional supplements are not governed by the same strict set of rules which regulate drugs and medications.  While an herbal remedy, supplement or nutritional product may be registered with the FDA, this should not lead you to believe that a particular product is safe for you (or anybody else).

And, as for morning sickness, my advice to the patient was that peppermint tea, ginger ale, and ginger candies were likely just as effective and by no doubt safer than many of the specialty products marketed to relieve the gastrointestinal suffering of pregnant women. I also recommended small, frequent meals of bland, starchy foods. 

As for over-the-counter treatments, I often recommend vitamin B6, which is safe and non-toxic.  I often recommend this in combination with doxylamine  (found in Unisom), an antihistamine which can alleviate nausea (especially when combined with vitamin B6), although it does cause drowsiness.  

If that’s not enough, I said, call me for a prescription.

February 4, 2011 at 7:26 pm 1 comment

Linda M. Nicoll, MD

Welcome to my blog! Here you will find information about minimally invasive gynecologic surgery as well as some more general information about common gynecologic disorders such as endometriosis, ovarian cysts, fibroids, infertility, and pelvic pain.

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