What to expect when you're expecting (194 page)

Keep your vaginal and perineal areas meticulously clean and irritation free. Wipe front to back after using the toilet to keep fecal bacteria from entering your vagina or urethra (the short tube through which urine is excreted from the bladder). Wash daily (showers are better than baths), and avoid bubble bath and perfumed products—powders, shower gels, soaps, sprays, detergents, and toilet paper. Also, stay out of pools that aren’t properly chlorinated.

Some practitioners recommend eating yogurt that contains active cultures or taking probiotics while you’re on antibiotics to help restore the balance of beneficial bacteria. Ask your practitioner; some probiotics are definitely more potent than others.

Keep your resistance high by eating a nutritious diet, getting enough rest and exercise, and not letting your life get too stressful.

UTIs in the lower part of the urinary tract are no fun, but a more serious potential threat is that bacteria from an untreated UTI will travel up to your kidneys. Kidney infections that aren’t treated can be quite dangerous and may lead to premature labor, low-birthweight babies, and more problems. The symptoms are the same as those of UTIs but are frequently accompanied by fever (often as high as 103°F), chills, blood in the urine, backache (in the midback on one or both sides), nausea, and vomiting. Should you experience these symptoms, notify your practitioner immediately so you can be treated promptly.

“I think I have a yeast infection. Should I go get some of the medication I usually use, or do I need to see the doctor?”

Pregnancy is never a time for self- diagnosis or treatment—not even when it comes to something as seemingly simple as a yeast infection. Even if you’ve had yeast infections a hundred times before, even if you know the symptoms backward and forward (a yellowish, greenish, or thick and cheesy discharge that has a foul odor, accompanied by burning, itching, redness, or soreness), even if you’ve treated yourself successfully with over-the-counter preparations in the past—this time around, call your practitioner.

Bacterial Vaginosis

Bacterial vaginosis (BV) is the most common vaginal condition in women of childbearing age, affecting up to 16 percent of pregnant women. A BV condition, which occurs when certain types of bacteria normally found in the vagina begin to multiply in large numbers, is often accompanied by an abnormal gray or white vaginal discharge with a strong fishlike odor, pain, itching, or burning (though some women with BV report no signs or symptoms at all). Doctors are not exactly sure what causes the normal balance of bacteria in the vagina to be disrupted, though some risk factors have been identified, including having multiple sex partners, douching, or using an IUD. BV is not transmitted during sexual contact but is associated with sexual activity (women who have never had sexual intercourse are rarely affected).

During pregnancy, BV is associated with a slight increase in such complications as premature rupture of the membranes and amniotic fluid infection, which may lead to premature labor. It may also be associated with miscarriage and low birthweight. Some doctors test for BV in women who are at high risk for preterm delivery, but no clear evidence indicates that treating such high-risk women reduces the incidence of prematurity. That said, treating symptomatic BV with antibiotics is effective at relieving symptoms. Some research has also suggested that treatment may reduce the complications associated with preterm births triggered by BV and may decrease the number of days these babies spend in the NICU.

How you will be treated will depend on what kind of infection you have, something only your practitioner can determine via lab tests. If it does turn out to be a yeast infection, which is very common in pregnancy, your practitioner may prescribe vaginal suppositories, gels, ointments, or creams. The oral anti-yeast agent fluconazole (Diflucan) may also be prescribed during pregnancy, but only in low doses and for no longer than two days.

Unfortunately, medication may banish a yeast infection only temporarily; the infection often returns off and on until after delivery and may require repeated treatment.

You may be able to speed your recovery and prevent reinfection by keeping your genital area clean and dry. Do this by practicing meticulous hygiene, especially after going to the bathroom (always wipe from front to back); rinsing your vaginal area thoroughly after soaping during a bath or shower; skipping irritating or perfumed soaps, and bubble baths; wearing cotton underwear; and avoiding tight pants or leggings (especially those that aren’t cotton). In general, let the area breathe whenever you can (sleeping without underwear, if possible).

Eating yogurt containing live probiotic cultures may help keep those yeast bugs at bay. You can also ask your practitioner about using an effective probiotic supplement (many on the market aren’t effective). Some chronic yeast infection sufferers find that cutting down on the sugar and baked goods made with refined flour helps, too. Do not douche, because it upsets the normal balance of bacteria in the vagina.

“I’ve got a stomach bug, and I can’t keep anything down. Will this hurt my baby?”

Just when you thought it was safe to come out of the bathroom, you’re back with a bug (good-bye morning sickness, hello stomach flu). And if you’re still in your first trimester when the bug hits, it could be hard to differentiate the symptoms from those of morning sickness.

Luckily, having a stomach virus won’t hurt your fetus, even while it’s hurting your stomach. But just because the virus isn’t bugging baby doesn’t mean it shouldn’t be treated. And whether your tummy is turning from hormones, a virus, or from egg salad that sat on the lunch cart too long, the treatment is the same: Get the rest your body’s aching for, and focus on fluids, especially if you’re losing them through vomiting or diarrhea. They’re much more important in the short term than solids.

If you’re not urinating frequently enough or your urine is dark (it should be straw-colored), you may be dehydrated. Fluid needs to be your best buddy now: Try taking frequent small sips of water, diluted juice (white grape is easiest on the tummy), clear broth, weak decaffeinated tea, or hot water with lemon. If you can’t manage to sip, suck on ice chips or a Popsicle. Follow your stomach’s lead when it comes to adding solids—and when you do, keep it bland, simple, and fat-free (white rice or dry toast, low-fiber cereal, applesauce, bananas). And don’t forget that ginger’s good for what ails any sick stomach. Take it in tea or in flat ginger ale (best if there’s actually ginger in it) or another ginger beverage, or suck or chew on some ginger candies. Remember, too, to supplement when you can. Getting your vitamin insurance is an especially good idea now, so try to take your supplement when it’s least likely to come back up. Don’t worry, however, if you can’t manage to keep it down for a few days or so; no harm done.

If you can’t get anything down, talk to your practitioner. Dehydration is a problem for anyone suffering with a stomach bug, but it’s especially problematic when you need to stay hydrated for two. You might be advised to take some rehydration fluid (like Pedialyte, which also comes in a soothing freezable form).

Check with your practitioner before you open up your medicine cabinet looking for relief. Antacids like Tums and Rolaids are considered safe to take during pregnancy, and some practitioners may okay gas relievers, but be sure to ask first. Your practitioner may also say you can take certain antidiarrheal medicines, but probably only after your first trimester is safely behind you (see
page 511
). As always, check with your practitioner before taking anything, just to play it safe.

And sick tummies, take heart: Most stomach bugs clear up by themselves within a day or so.

“A friend who is pregnant said to stay away from certain dairy products because they can make you sick when you’re expecting. Is this true?”

More bad news for adventurous eaters. Unpasteurized milk and cheeses made from unpasteurized milk (including some mozzarella, blue cheese, Mexican cheeses, Brie, Camembert, and feta) can sometimes make you sick, and that extremely unlikely possibility becomes slightly more likely when you’re expecting. These foods, along with unpasteurized juices, raw or undercooked meat, fish and shellfish, poultry, eggs, unwashed raw vegetables, and hot dogs and deli meats, can very occasionally contain Listeria. These bacteria can cause serious illness (listeriosis), especially in high-risk individuals, including young children, the elderly, those with compromised immune systems, and pregnant women, whose immune systems are also somewhat suppressed. Though the overall risk of contracting listeriosis is extremely low—even in pregnancy—the potential of its causing problems in pregnancy is higher. Listeria, unlike many other germs, enters the bloodstream directly and therefore can get to the baby quickly through the placenta (other food contaminants generally stay in the digestive tract and may only pose a threat if they get into the amniotic fluid).

Listeriosis is hard to detect—partly because symptoms can appear anytime between 12 hours and 30 days after contaminated food is eaten, and partly because the symptoms (headache, fever, fatigue, muscle aches, and occasionally nausea and diarrhea) are similar to those of flu, and some can even be mistaken for pregnancy side effects. Antibiotics are needed to treat and cure listeriosis. Untreated, the illness can cause serious complications for mom and baby.

So, clearly, it’s important to prevent infection in the first place by staying away from the risky foods that might possibly carry Listeria, especially now, even if it means that your taco salad comes without the fresh queso. See
page 116
for more tips on food safety and the prevention of food-borne diseases. Keep in mind, though, that the risk of contracting the infection from day-to-day eating is extremely low, even among expectant diners, so don’t stress about the queso you’ve sprinkled or the smoked turkey you’ve gobbled up until now.

“Though I’ve given all the cat-care chores over to my husband, just the very fact that I live with cats makes me nervous about toxoplasmosis. How would I know if I came down with it?”

Chances are you wouldn’t. Most people who are infected show no symptoms at all, though some do notice mild malaise, slight fever, and swollen glands two or three weeks after exposure, followed by a rash a day or two later.

But chances are, too, that you wouldn’t come down with the disease in the first place. If you’ve lived with cats for a long time, it’s very likely that you’ve already become infected and have developed antibodies to the virus that causes toxoplasmosis.

If you turn out not to be immune, and you do experience the symptoms of toxoplasmosis, you’ll probably be tested. (Don’t try to test yourself, however, since home tests for toxoplasmosis are highly unreliable.) In the unlikely event that the test comes back positive, you’ll probably be treated with antibiotics to reduce the risk of transmitting the infection to your baby.