Your Maternity Journey Vol. 2

Preparing for Pregnancy: Common Concerns

Deciding whether to get pregnant is a major life decision that should not be taken lightly. In addition to career and family concerns, you may have health or fertility issues. Whatever your situation, the smart first step is to schedule a pre-pregnancy appointment with an OB/GYN. This is an opportunity to share concerns regarding fertility, medical issues, or family health history with your doctor. From there, depending on your situation, you may be referred to a fertility specialist, geneticist, endocrinologist, or other specialist.

Age

Women are at their most fertile in the decade from their late teens to their late twenties. Fertility starts to decline around age 30 and that decline accelerates in your mid-thirties. There are several reasons why it’s harder to get pregnant after 35:

• Women release fewer eggs as they age, and a higher percentage of those eggs have abnormal chromosomes.
• Older women are at higher risk for fibroids and endometriosis, which can interfere with their ability to conceive.
• High blood pressure is more common as we age, which raises a woman’s risk of developing preeclampsia during pregnancy.
• Older women have a higher risk of miscarriage, still birth, and multiple pregnancies. While there’s nothing “unhealthy” about having twins or triplets, such pregnancies do have a higher risk of preterm birth.

If you are over 35 and have not gotten pregnant after 6 months of trying, talk with your OB/GYN about an infertility evaluation. For women ages 40 or older, a fertility evaluation is recommended before trying to get pregnant.

Genetics

If you or your partner have a family member with a genetic disease or abnormality, ask your doctor about genetic carrier screening. Different genetic screening tests may be recommended based on ethnicity, since genetic disorders are sometimes more common in specific groups. A simple blood test can determine whether you or your partner are a "carrier" for certain inherited diseases, such as Tay-Sachs disease, cystic fibrosis, or sickle cell anemia. Being a carrier means that while you don’t have a particular genetic disease yourself, your DNA contains a genetic mutation associated with that condition. Most genetic diseases only occur if the child inherits the defective gene from both parents. If you have a family history for a particular genetic disorder, your doctor may recommend that you meet with a genetic counselor before proceeding to carrier screening. The counselor can help you interpret your screening results and make informed decisions about pregnancy.

Endometriosis

Endometriosis is a condition in which the endometrium—the tissue lining the inside uterus—grows in areas outside the uterus, such as the ovaries and fallopian tubes. Endometriosis most commonly manifests as painful periods and painful intercourse. This tissue outside of the uterus can sometimes negatively impact fertility. If you have endometriosis and require help from infertility specialists, your pregnancy may be considered high risk and require additional monitoring.

Pre-existing Conditions

Certain pre-existing conditions will automatically put your pregnancy in the high-risk category. If that is the case, you will require extra monitoring. Thanks to MarinHealth’s special relationship with UCSF Health, our labor and delivery staff work closely with UCSF Health perinatologists, who are available 24/7 for consultation. Our high-risk MarinHealth OB/GYN patients work with UCSF maternal-fetal medicine specialists, who offer state-of-the-art ultrasound examinations, consultations, prematurity prevention efforts, and management of unexpected pregnancy complications. Common conditions that may put a pregnancy in the high-risk category include:

• Type 1 and Type 2 diabetes
• Cardiovascular conditions, including high blood pressure
• Thyroid problems
• Clinical depression and other mental health issues
• Autoimmune diseases such as lupus or arthritis
• Lymphatic disorders
• Asthma or other lung problems
• Obesity
• Neurological problems
• Kidney disease
• Inflammatory bowel disease
• Cancer
• Fibroids

The decision to get pregnant is a highly personal one, especially in a situation where your own health could be compromised. If you have a pre-existing condition that could complicate pregnancy, talk with an OB/GYN so you can make the most informed decision possible. MarinHealth Medical Network has many expert OB/GYNs. Find one now.

Pregnancy No-Nos. What’s Real and What’s Not?

Medical science has progressed quite a bit since your grandmother’s day, when some pregnant women felt free to have a smoke or a martini while others subsisted on carrot sticks and celery to avoid weight gain. By the time your mother was expecting you, women knew that cigarettes, alcohol, and poor food choices were not good for them—not to mention their growing babies! But there is still a certain amount of confusion about what to avoid and why.

Exercise

Exercise is good for you and your baby. It can help you get better sleep and avoid excess weight gain and stiff, sore muscles. It can even brighten your mood if you’re feeling blue. Just a few caveats:

• If your pregnancy is considered high-risk, talk to your doctor. Certain conditions require that you take it easy while you are expecting.
• If you didn’t exercise before you became pregnant, this is no time to start training for a triathlon. Ask your doctor about incorporating a gentle fitness routine into your day.
• Respect your changing body. Discuss your fitness routine with your doctor to see if you should make any modifications as you move into your second and third trimesters.
• Once pregnant, consider avoiding sports where there is a fall risk like skiing or horseback riding.

Yoga

Yoga is beneficial both physically and emotionally, as long as you don’t do any heated yoga, such as Bikram. Tell your yoga instructor you are pregnant and he or she will provide modifications for twists and poses that require lying on your stomach. If head and handstand were not already part of your practice, this is not the time to work them in. Wait until after you have your baby and your center of gravity is back to normal.

Seafood

Sorry, no raw sushi for you! Seafood is rich in vitamins and minerals that are beneficial for mother, but raw fish and raw oysters can expose you and your baby to bacteria, parasites, and high levels of mercury. Avoid shark, swordfish, tile fish, and mackerel, all of which contain mercury, and limit tuna intake to no more than one can per week. And skip the smoked salmon, which can cause food-borne illnesses.

Meat

Raw and undercooked meat and eggs carry a risk of listeriosis and toxoplasmosis, conditions that can cause serious illness, severe birth defects and even miscarriage. Make sure all eggs and meat are thoroughly cooked, especially deli meats and cured meats like sausage. For example, grilled ham and cheese or pepperoni pizza are safe because they are cooked, but cold cuts are unsafe as they can cause foodborne illness such as listeriosis and toxoplasmosis.

Cheese

Soft or artisanal cheeses made with unpasteurized milk may contain the bacteria Listeria and are not safe for pregnant women. However, as you know, calcium is important for mothers and babies. The good news is you can consume cheese and yogurt made from pasteurized milk.

Produce

Be sure to wash and peel fresh produce. Avoid fruits and veggies that have been pre-cut in the store—you can do that safely at home yourself and you’ll know you’re using a clean knife. In recent years, we have seen several produce recalls due to bacterial contamination. Pay attention to these recalls!

Sex

Sex is typically safe until your water breaks, but ask your doctor if you have a high risk pregnancy.

Flu Shots

Studies have shown that pregnant women who get the flu are at greater risk for pneumonia, miscarriage, premature birth, low birth weight, and even birth defects. There is no live virus in the flu vaccine and it cannot give you the flu. It’s well worth taking the vaccine to help keep you and your baby safe.

Going to the Dentist

The fear that an oral cleaning poses a risk of infection during pregnancy has been debunked. There is no reason to skip your checkup or postpone necessary dental work. Do let your dentist know that you’re expecting, as pregnancy hormones can make you more susceptible to swollen and bleeding gums, and be sure to avoid dental x-rays.

Smoking

You don’t really need this lecture, do you? Studies show that babies born to mothers who smoked during pregnancy have a lower birth weight and are at a greater risk for learning disabilities. They are also more likely to take up smoking in their teenage years and start smoking earlier.

Alcohol

The dangers of drinking alcohol while pregnant are well documented. Babies of mothers who drink during pregnancy are at risk for fetal alcohol syndrome (FAS), a life-long condition that limits human potential. The symptoms include low birth weight, learning disabilities, behavior problems, and lagging patterns of growth and development milestones. It is not known what amount or frequency of alcohol in pregnancy causes FAS, so it is best to avoid it altogether.

Hot Tubs, Saunas, and Steam Rooms

Like heated yoga, hot tubs, saunas and steam rooms raise your body temperature. Research indicates this could increase your baby’s risk for birth defects and double your risk of miscarriage during the first trimester.

Caffeine

Caffeine can travel through the placenta and increase your baby’s heart rate. However, most current research indicates that women can safely consume up to 200 mg of caffeine per day—about one 12oz cup of coffee.

Kitty Litter

If you normally clean the litter box, you’re officially off the hook. Cat waste is full of bacteria and parasites, including Toxoplasma gondii, which can cause miscarriage and stillbirth. This parasite can also cause seizure disorders and mental disabilities in babies.

Hair Dye

Most research indicates the chemicals found in both semi-permanent and permanent dyes are safe to use during pregnancy, but it’s best to wait until the second or third trimester.

Skin Care

It’s time to reexamine your beauty routine, as many of your favorite skin care products may be off the table during pregnancy and breastfeeding. This includes retinoids and high doses of salicylic acid, such as in oral medications or chemical peels.

When in doubt, just check with your OB/GYN to make sure a particular food, product or activity is safe for both you and baby.