What to expect when you're expecting (199 page)

Genetic counseling (if you haven’t had it already) will be able to determine whether your baby is at risk for being born with CF or not (“not” being the much more likely scenario). If your spouse isn’t a carrier for CF, there’s very little chance that your baby will be affected by it (though he or she will be a carrier). If your spouse is a carrier, there’s a 1 in 2 chance that your baby will be affected; prenatal testing can let you know for sure.

Since you’re breathing for two now, your doctors will be keeping a close watch on your pulmonary care—especially as your growing uterus leaves less room for your lungs to expand. You’ll also be monitored for pulmonary infection. Some women with severe lung disease may find that their condition can get a little worse while they’re pregnant, but only temporarily. In general, pregnancy doesn’t seem to have any negative long-term effect on CF at all.

Pregnancy isn’t easy no matter what, and it’s certainly more challenging for women with CF. But that cuddly reward—the beautiful baby you’re working so hard for—can make all those challenges more than worthwhile.

“I was diagnosed with chronic depression a few years ago, and I’ve been on low-dose antidepressants ever since. Now that I’m pregnant, should I stop taking the meds?”

More than one out of ten women of childbearing age battles with bouts of depression, so you’re far from alone. Luckily for you and all the other expectant moms who share your condition, there’s a happy outlook: With the right treatment, women with depression can have perfectly normal pregnancies. Deciding what that treatment should consist of during pregnancy is a delicate balancing act, however, especially when it comes to the use of medications. Together with your psychiatrist and prenatal practitioner, you’ll need to weigh the risks and benefits of taking such meds—and not taking them—while you’re growing a baby.

Maybe it seems like a simple decision to make, at least at first glance. After all, could there ever be a good reason to put your emotional well-being over your baby’s physical well-being? But the decision is actually a lot more complicated than that. For starters, pregnancy hormones can do a number on your emotional state. Even women who’ve never had an encounter with mood disorders, depression, or any other psychological condition may experience wild emotional swings when they’re expecting—but women with a history of depression are at greater risk of having depressive bouts during pregnancy and are more likely to suffer from postpartum depression. And this is especially true for women who stop taking their antidepressants during pregnancy.

What’s more, untreated depression isn’t likely to affect only you (and those you’re close to), it’s also likely to affect your baby’s health. Depressed mothers- to-be may not eat or sleep as well or pay as much attention to their prenatal care, and they may be more likely to drink and smoke. Any or all of those factors, combined with the debilitating effects of excessive anxiety and stress, have been linked in some studies to an increased risk of preterm birth, low birthweight, and a lower Apgar score for babies. Treating depression effectively, however—and keeping it under control during pregnancy—allows a mother-to-be to nurture her body and her developing baby.

So what does all this mean for you? It means you might want to think twice (and consult with your physician, of course) before you consider tossing your antidepressants. And in doing your thinking—and your consulting—you and your doctor will also want to consider which antidepressant best suits your needs now that you’re expecting, which may or may not be the same one (or ones) you were using preconception. Certain meds are safer than others, and some aren’t recommended for pregnancy use at all. Your doctor can give you the most up-to-date information, because it’s ever-changing. What is known right now is that Wellbutrin is often a good choice during pregnancy. Prozac, Paxil, Zoloft, and other selective serotonin reuptake inhibitors (SSRIs) carry very little risk to the baby and can therefore also be good choices. Studies do show that pregnant women on Prozac might be somewhat more likely to deliver prematurely, and newborns exposed to Prozac and other SSRIs in the womb may experience short-term withdrawal symptoms (lasting no more than 48 hours), including excessive crying, tremors, sleep problems, and gastrointestinal upset immediately after birth. Still, researchers caution that these risks shouldn’t keep pregnant women from taking Prozac (or other SSRIs) if their depression can’t be treated effectively in other ways, because untreated depression carries its own risks, many with long-term effects.

Your prenatal practitioner—along with your mental health care provider—will be able to steer you toward the best medications for you during pregnancy, so discuss the options with both of them.

Remember, too, that nonmedicinal approaches can also sometimes help manage depression. Psychotherapy may be effective on its own or in conjunction with medication. Other therapies that can sometimes be helpful when used along with medication include bright light therapy and CAM approaches. Exercise (for its release of feel-good endorphins), meditation (which can help you manage stress), and diet (keeping blood sugar up with regular meals and snacks and getting plenty of omega-3 fatty acids may help give your mood a boost) can also be beneficial additions to a treatment program. Talk to your practitioner and mental health care provider to see if these options have a place in yours.

“I’m a diabetic. How will that affect my baby?”

There’s lots of good news for pregnant diabetics these days. In fact, with expert medical care and diligent self-care, you have about the same excellent chances of having a successful pregnancy and a healthy baby as any other expectant mom.

Research has proven that the key to managing a diabetic pregnancy successfully—whether the diabetes is type 1 (juvenile-onset diabetes, in which the body doesn’t produce insulin) or type 2 (adult-onset diabetes, in which the body doesn’t respond as it should to insulin)—is achieving normal blood glucose levels before conception and maintaining them throughout the nine months following it.

Whether you came into pregnancy as a diabetic or you developed gestational diabetes along the way, all of the following will help you have a safe pregnancy and a healthy baby:

The right doctor.
The OB who supervises your pregnancy should have plenty of experience caring for diabetic mothers-to-be, and he or she should work together with the doctor who has been in charge of your diabetes. You’ll have more prenatal visits than other expectant moms and will probably be given more doctor’s orders to follow (but all for a very good cause).

Good food planning.
A diet geared to your personal requirements should be carefully planned with your physician, a nutritionist, and/or a nurse-practitioner with expertise in diabetes. The diet will probably be high in complex carbohydrates, moderate in protein, low in cholesterol and fat, and contain few or no sugary sweets. Plenty of dietary fiber will be important, since some studies show that fiber may reduce insulin requirements in diabetic pregnancies.

Carbohydrate regulation is typically not as strict as it used to be because fast-acting insulin can be adjusted if you go over your limit at one meal or another. Still, the extent of your carbohydrate restriction will depend on the way your body reacts to particular foods. Most diabetics do best getting their carbohydrates from vegetable, grain (whole is best), and legume sources rather than from fruits. To maintain normal blood sugar levels, you’ll have to be particularly careful to get enough carbohydrates in the morning. Snacks will also be important (even more important than they are for the average mom-to-be), and, ideally, they should include both a complex carbohydrate (such as whole-grain bread) and a protein (such as beans or cheese or chicken). Skipping meals or snacks can dangerously lower blood sugar, so try to eat on schedule, even if morning sickness or indigestion are putting a damper on your appetite. Eating six mini meals a day, regularly spaced, carefully planned, and supplemented as needed by healthy snacks, is your smartest strategy.

Sensible weight gain.
It’s best to try to reach your ideal weight before conception (something to remember if you plan another pregnancy). But if you start your pregnancy overweight, don’t plan on using your nine-month stint for slimming down. Getting enough calories is vital to your baby’s well-being. Aim to gain weight according to the guidelines set by your physician (slow and steady does it best). Your baby’s growth will be monitored using ultrasound, because babies of diabetics sometimes grow very large, even if mom’s weight is on target.

Exercise.
A moderate exercise program, especially if you have type 2 diabetes, will give you more energy, help to regulate your blood sugar, and help you get in shape for delivery. But it must be planned in conjunction with your medication schedule and diet, with the help of your medical team. If you experience no other medical or pregnancy complications and are physically fit, moderate exercise—such as brisk walking, swimming, and stationary biking (but not jogging)—will likely be on the workout menu. Chances are that only very light exercise (leisurely walking, for instance) will get the green light if you were out of shape prior to pregnancy or if there are any signs of problems with your diabetes, your pregnancy, or your baby’s growth.

Precautions you may be asked to take when exercising probably won’t differ much from safe exercise tips for any pregnant woman: Have a snack before your workout; don’t exercise to the point of exhaustion; and never exercise in a very warm environment (80°F or higher). If you’re on insulin, you’ll probably be advised to avoid injecting it into the parts of the body being exercised (your legs, for example, if you’re walking) and not to reduce your insulin intake before you exercise.

Rest.
Getting enough rest is very important, especially in the third trimester. Avoid overdoing it, and try to take some time off during the middle of the day for putting your feet up or napping. If you have a demanding job, your doctor may recommend that you begin your maternity leave early.

Medication regulation.
If diet and exercise alone don’t control your blood sugar, you’ll likely be put on insulin. If you end up needing insulin for the first time, your blood sugar can be stabilized under close medical supervision. If you were taking oral medication before you conceived, you might be switched to injected insulin or an under-the-skin insulin pump during pregnancy. Since levels of the pregnancy hormones that work against insulin increase as pregnancy progresses, your insulin dose may have to be adjusted upward periodically. The dose may also have to be recalculated as you and your baby gain weight, if you get sick or are under emotional strain, or if you overdo your carbs. Studies show that the oral drug glyburide may be an effective alternative to insulin therapy during pregnancy for some mild cases.

In addition to being sure your diabetes medication is on target, you’ll need to be extremely careful about any other medications you take. Many over-the-counter drugs can affect your insulin levels—and some may not be safe in pregnancy—so don’t take any until you check with both the physician who is overseeing your diabetes and the one taking care of your pregnancy.

Blood sugar regulation.
You may have to test your blood sugar (with a simple finger-prick method) at least four or as often as ten times a day (possibly before and after meals) to be sure it’s staying at safe levels. If you have type 1 diabetes, your blood may also be tested for glycosylated hemoglobin (hemoglobin A1c), because high levels of this substance may be a sign that sugar levels aren’t being well controlled. To maintain normal blood glucose levels, you’ll have to eat regularly, adjust your diet and exercise as needed, and, if necessary, take medication. If you were insulin-dependent before pregnancy, you may be more subject to low blood sugar episodes (hypoglycemia) than when you weren’t pregnant, especially in the first trimester—so careful monitoring is a must. And don’t leave home (or go anywhere) without packing the right snacks.

Urine monitoring.
Since your body may produce ketones—acidic substances that can result when the body breaks down fat—during this close regulation of your diabetes, your urine may be checked for these regularly.

Careful monitoring.
Don’t be concerned if your physician orders a lot of tests for you, especially during the third trimester, or even suggests hospitalization for the final weeks of your pregnancy. This doesn’t mean something is wrong, only that he or she wants to be sure everything stays right. The tests will primarily be directed toward regular evaluation of your condition and of your baby to determine the optimal time for delivery and whether any other intervention is needed.

You will probably have regular eye exams to check the condition of your retinas and blood tests and urine collections every 24 hours to evaluate your kidneys (retinal and kidney problems tend to worsen during pregnancy but usually return to prepregnancy status after delivery if you’ve been taking care of yourself throughout pregnancy). The condition of your baby and the placenta will likely be evaluated throughout pregnancy with stress and/or nonstress tests (see
page 348
), biophysical profiles, and ultrasound (to size up your baby to be sure it’s growing as it should be and so that delivery can be accomplished before the baby gets too big for a vaginal delivery). And because there’s a slightly higher risk of heart problems in the babies of diabetics, you’ll get a detailed ultrasound of the fetal anatomy at 16 weeks and a special ultrasound of the fetal heart (fetal electrocardiogram) at about 22 weeks to make sure everything’s going well.

After the 28th week, you may be asked to monitor fetal movements yourself three times a day (see
page 289
for one way to do this, or follow your doctor’s recommendation).