Is Your Pregnancy High Risk?

Your pregnancy may be treated as high risk if :

1. you are over 35 years old and are therefore at increased risk of giving birth to a child with a chromosomal anomaly;
2. you are under 17 and are therefore at increased risk of experiencing intrauterine growth restriction;
3. you are carrying more than one baby and are therefore at risk of experiencing a number of pregnancy-related complications, including preterm labor;
4. you have a chronic health condition such as diabetes, heart problems, or a blood-clotting disorder that has the potential to affect your pregnancy;
5. you have a history of gynecological problems such as pelvic inflammatory disease (PID), endometriosis, or large symptomatic fibroids;
6. you have a history of miscarriage, ectopic pregnancy, stillbirth or premature birth;
7. you have an STD, including HIV, that could be transmitted to your baby during pregnancy or at the time of birth;
8. you are pregnant as a result of assisted reproductive technologies (something that may put you at increased risk of having a multiple pregnancy);
9. you have had two or more second-trimester abortions (which may increase your chances of having problems with an incompetent cervix);
10. your mother took DES during her pregnancy (which may increase your odds of having difficulty carrying a pregnancy to term);
11. you conceived while using an IUD (something that increases your chances of experiencing a miscarriage);
12. you have a child with a genetic disorder or are a carrier for a genetic disorder (something that may increase your risk of giving birth to a child with that particular genetic disorder).

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

Preterm birth

Preterm birth is the leading cause of neonatal death in multiples. Although the mere fact that you are carrying multiples puts you at increased risk of experiencing a pre-term birth, there are other factors that add to your risk. You’re at increased risk if

■ you have had abdominal surgery during the current pregnancy (for example, an appendectomy);

■ you have an abnormal uterine structure;

■ you have fibroids (benign uterine tumors);

■ you are experiencing emotional or physical stress;

■ you have high blood pressure;

■ you develop a high fever during pregnancy;

■ you have a kidney infection;

■ you are outside of the optimal age range (that is, if you are under 16 or over 35);

■ you are a DES daughter (your mother took diethylstilbestrol — DES — when she was pregnant with you);

■ you have been diagnosed with placenta pre-via;

■ you have been diagnosed with poly hydramnios;

■ you haven’t gained enough weight;

■ you have previously experienced premature labor or delivery;

■ you have been experiencing unexplained vaginal bleeding;

■ you are a smoker.

Although cerclage (a surgical procedure in which the cervix is stitched shut to prevent it from dilating prematurely) was once considered to be an effective means of preventing premature labor, most doctors no longer agree with its routine use in women carrying multiples. These days, cerclage is performed only on women with weak cervixes — a condition that the medical profession charmingly refers to as cervical incompetence. (As you probably realize, this is just a less-than-diplomatic way of saying that the cervix is unable to withstand the weight of the developing fetus, or fetuses, and opens prematurely.)

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

What causes a multiple birth

Twin pregnancies result from either the fertilization of two separate eggs by two separate sperm (a process that results in dizygotic, or fraternal, twins) or the separation of a single fertilized egg into two fetuses (a process that results in monozygotic, or identical, twins). Higher-order multiple pregnancies involve fraternal twins, identical twins, or a combination of both types of twins.

Here are some basic facts about multiples:

■ Twins occur naturally in 1 out of every 90 births; triplets in 1 out of every 10,000 births; and quadruplets in 1 out of every 650,000 births.

■ Fraternal twins occur more often in certain families and in certain ethnic groups (the rates are 1 in 70 in African Americans and 1 in 300 for women of Chinese descent with whites falling in between). The incidence of fraternal twins also increases with maternal age, weight, height, and parity (that is, the number of pregnancies a woman has had).

■ Identical twins occur in approximately 4 out of every 1,000 births and are unrelated to maternal age, race, or parity.

■ Fraternal twins typically look no more alike than any other pair of siblings. They can be either of the same sex or one of each sex.

■ Identical twins have identical features: hair, eye color, blood type, and so on. If, however, one twin developed more rapidly in uterus than the other one, they may not look identical at birth.

■ Identical twins have similar handprints and footprints, but they do not share the same fingerprints. (This was good news to one family of identical twins who had to rush their babies off to FBI headquarters to get them re-fingerprinted so that they could figure out who was who!)

■ Some identical twins are known as “mirror twins” because one is virtually a mirror image of the other (for example, a birthmark that appears on the left arm of one appears on the right arm of the other, one is left-handed and the other is right-handed, and so on).

■ Identical triplets can also occur, but they are extremely rare.

■ It is possible for fraternal twins to be conceived by two different fathers, a process known as super fecundation.

■ Scientists believe that approximately one in eight natural pregnancies starts out as a twin pregnancy — even though only 1 out of every 90 births results in the birth of twins. This is one reason why many caregivers routinely do ultrasounds to confirm that there are no other viable fetuses left in the uterus when they suspect that a patient is miscarrying.

■ It is possible to miscarry one multiple and go on to carry the others to term. It is also possible to have a combination ectopic and uterine pregnancy (that is, one or more babies implant in the fallopian tubes and the others in the uterus). Fortunately, this is rare.

■ Although most twins are born within minutes of one another, sometimes days — even months — can elapse between the births of twins.

■ Often, it isn’t immediately obvious at birth whether same sex twins are identical or fraternal. If the parents want to know for medical reasons, blood from the umbilical cord is drawn and analyzed for type, Rh factor, and so on. If the results are still inconclusive, parents can choose to opt for DNA testing — highly accurate.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

How a multiple pregnancy is diagnosed

The increased use of ultrasound has made it possible for the vast majority of parents to find out in advance whether there’s more than one baby on the way. This wasn’t the case a decade or two ago, when it wasn’t unusual for as many as 40 percent of multiple pregnancies to be undiagnosed prior to labor and delivery.

Even if you haven’t had an ultrasound, certain red flags may alert you and your caregiver to the possibility that you may be carrying twins. These are the warning signals:

■ Fraternal twins tend to run in your family.

■ You have been taking fertility drugs.

■ You experienced excessive nausea and vomiting during the first trimester.

■ Your uterus is growing more quickly or is larger than what would be expected at a particular point in your pregnancy.

■ You notice more fetal movement in this pregnancy than in previous pregnancies (assuming, of course, that this is your second or subsequent pregnancy).

■ More than one fetal heartbeat is heard.

If your caregiver suspects that you may be carrying multiples, he will likely send you for an ultrasound. Early ultrasound can detect more than 95 percent of multiple pregnancies.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

Fifteen Reasons to Quit Smoking Before You Start Trying to Conceive

1. Smoking makes you less fertile.

Women who smoke are 30 percent less fertile than other women.

2. Smoking increases the odds that you will experience a miscarriage.

Smokers are almost twice as likely to miscarry as nonsmokers.

3. Smoking increases the likelihood that your baby will be stillborn.

Babies of smokers are twice as likely to be stillborn as babies of nonsmokers.

4. Smoking causes birth defects.

Smoking 10 cigarettes per day increases the odds that you will give birth to a baby with cleft palate and cleft lip by 50 percent.

5. Smoking disrupts the flow of oxygen to the baby.

Your baby receives less oxygen because nicotine restricts the flow of blood through the blood vessels in the placenta.

6. Smoking can harm the lungs of your developing baby.

Exposure to secondhand smoke while in the womb can leave your baby more susceptible to respiratory disorders and infections during early childhood.

7. Smoking increases the odds that you will give birth prematurely.

Babies who are born prematurely tend to experience more health problems than those who are carried to term.

8. Smoking increases the odds that you will experience certain types of pregnancy-related complications.

Women who smoke during pregnancy are also more likely to experience placental abnormalities and bleeding.

9. Smoking reduces the likelihood that you will eat properly during pregnancy.

Smoking acts as an appetite supressant, and if you’re less hungry, you’re less likely to seek out the nutrient-rich foods that your body needs to grow a healthy baby.

10. Smoking interferes with the absorption of vitamin C.

Because vitamin C plays an important role in iron absorption, smoking can indirectly contribute to iron-deficiency anemia.

11. Smoking can interfere with breastfeeding.

Because smoking can decrease the quantity and quality of breast milk, smoking can lead to early weaning.

12. Smoking is linked to a number of childhood health problems.

Children who are exposed to secondhand smoke are more likely to develop asthma, bronchitis, and ear infections. And, according to some brand-new research, they are also more likely to be obese.

13. Smoking increases the odds that your baby will experience serious, even fatal, health problems during infancy.

Babies who are exposed to secondhand smoke are more likely to die of SIDS and to develop certain types of childhood brain cancers.

14. Smoking is linked to childhood behavioral problems.

A recent study found that the toddlers of mothers who smoked during pregnancy were four times as likely to be diagnosed with behavioral problems as the toddlers of nonsmokers.

15. Smoking increases the odds that your baby will develop lung cancer later in life. Children who are exposed to secondhand smoke are at greater risk of developing lung cancer than children who are not exposed to secondhand smoke.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

Getting ready to get pregnant : Do you skip meals regularly?

If you’re in the habit of skipping meals, your body could be missing out on such important nutrients as folic acid, iron, and calcium. It’s particularly important to ensure that your diet contains adequate quantities of folic acid. Studies have shown that women who consume at least 0.4 mg of folic acid each day reduce their chances of giving birth to a child with a neural tube defect (for example, anencephaly or spina bifida) by 50 percent to 70 percent. Other studies have indicated that folic acid may help to reduce the risk of miscarriage as well as the odds that you will develop high blood pressure during pregnancy. There’s even some evidence that, when combined with an adequate intake of iron, folic acid may offer your baby-to-be a measure of protection against childhood leukemia.

To increase your intake of this important nutrient, you should consume foods that are naturally high in folic acid, such as oranges, orange juice, honeydew melon, avocados, dark green vegetables (broccoli, Brussels sprouts, romaine lettuce, spinach), asparagus, bean sprouts, corn, cauliflower, dried beans, nuts, seeds, bran cereals, whole-grain products, wheat germ, and fortified breakfast cereals. You should plan to talk to your doctor or midwife about whether it would be a good idea for you to take a folic acid supplement as well. (Most women find that it is difficult to get enough folic acid through diet alone.)

Because neural tube defects can occur very early on in pregnancy, it’s important to ensure that you have adequate levels of folic acid in your diet before you start trying to conceive. That’s why most doctors recommend that you consume adequate amounts of folic acid throughout your childbearing years. After all, nearly half (49 percent) of pregnancies are unplanned.

It’s also important to ensure that your diet contains sufficient quantities of iron. During pregnancy, a woman’s iron needs double. The extra iron is required to create additional red blood cells that carry oxygen from your lungs to all parts of your body as well as your growing baby.

If you find that you are tired all the time, it could be because you’re low on iron. Try boosting your iron intake by consuming iron-rich foods, such as whole-grain and enriched cereals, lean meats, dried peas and beans, dark green vegetables, and dried fruits. Because vitamin C helps your body absorb iron, consume these iron-rich foods with a glass of orange juice or other foods that are high in vitamin C, such as melons, strawberries, grapefruits, raspberries, kiwi, broccoli, tomatoes, sweet potatoes, and so on Finally, you’ll also want to ensure that your diet contains an adequate amount of calcium. A woman who is calcium-deficient prior to and during pregnancy may end up giving birth prematurely to a calcium-deficient baby. Just don’t go overboard in the calcium department: consuming more than 2,500 mg of calcium per day from supplements and food sources (e.g., milk, yogurt, cheese) puts you at increased risk of developing a urinary tract infection and it can make it more difficult for your body to absorb other important nutrients such as iron, zinc, and magnesium.

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004

The age issue to Having a Baby (part 2)

If you decide to put your baby-making plans on hold for the foreseeable future, but you’re still hoping to become a mother someday, it’s important that you take steps now to safeguard your future fertility. Here are the key points to keep in mind:

■ Choose a birth control method that is fertility enhancing.

The birth control pill (a.k.a. “the Pill”) gets top marks from fertility experts because it changes the consistency of your cervical mucus, making it more difficult for bacteria to pass through the mucus and into your uterus and tubes. The Pill also serves up some added benefits on the fertility

front: it helps to prevent ovarian cysts, halt the progression of endometriosis (a condition that can lead to fallopian tube scarring), to decrease the incidence of ovarian and uterine cancer, and to restore a normal hormonal balance in women who don’t ovulate. Of course, it doesn’t provide you with protection against sexually transmitted diseases, so that’s something you’ll want to keep in mind if you haven’t quite settled upon Mr. Right yet. A birth control method you might want to steer clear of until your baby-making days are behind you is the intrauterine device (IUD): it has been linked to an increase incidence of pelvic inflammatory disease — a major cause of infertility in women.

■ Pay attention to any gynecological red flags.

If you notice an unusual discharge from your breasts or detect any unusual menstrual bleeding, see your gynecologist sooner rather than later. The sooner you seek treatment for any hormonal imbalances or other gynecological health problems, the less likely these problems are to take a toll on your future fertility.

Continue…

Source : The Unofficial Guide to Having a Baby. Second Edition . Ann Douglas and John R. Sussman, M.D. 2004