What to expect when you're expecting (200 page)

Because diabetics are at somewhat higher risk for preeclampsia, your doctor will watch you closely for early signs of that condition, too.

Elective early delivery.
Women who develop gestational diabetes, as well as women with preexisting mild diabetes that is well controlled, can carry to their due date safely. But when mom’s normal blood sugar levels have not been well maintained throughout pregnancy, or if the placenta deteriorates early, or if other problems develop late in pregnancy, her baby may be delivered a week or two before term. The various tests mentioned above help the physician decide when to induce labor or perform a C-section—late enough so the fetal lungs are sufficiently mature to function outside the womb, but not so late that the baby’s safety is compromised.

Don’t worry if your baby is placed in a neonatal intensive care unit immediately after delivery. This is routine procedure in most hospitals for infants of diabetic mothers. Your baby will be observed for respiratory problems (which are unlikely if the lungs were tested and found to be mature enough for delivery) and for hypoglycemia (which, though more common in babies of diabetics, is easily treated). You should be able to get your baby back soon so you can start nursing, if that’s your plan.

“I have epilepsy, and I desperately want to have a baby. Can I have a safe pregnancy?”

With the right precautions, there could definitely be a healthy baby in your future. Your first step—preferably before you take care of the conception part—is to get your condition under the best possible control, with the help of your neurologist and the doctor you’ve chosen for your prenatal care. (If you’ve already conceived, getting that help as soon as possible in your pregnancy is crucial.) For best pregnancy results, close supervision of your condition and possibly frequent adjustment of medication levels will be necessary, as will communication between your doctors.

Most women find that pregnancy does not exacerbate their epilepsy. Half experience no change in their disease, and a smaller percentage find that seizures actually become less frequent and milder. A few discover, however, that their seizures become more frequent and severe.

As for how epilepsy affects pregnancy, expectant moms with epilepsy may be slightly more likely to experience excessive nausea and vomiting (hyperemesis), but they aren’t at higher risk for any serious complications. There seems to be a slight increase in the incidence of certain birth defects in the babies of epileptic mothers, but these appear to be more often caused by the use of certain anticonvulsant medications during pregnancy than by the epilepsy itself.

Discuss with your doctor ahead of time the possibility of being weaned from your medications prior to conception. This may be possible if you’ve been seizure-free for a period of time. If you have been having seizures, it’s important to try to get them under control as soon as possible. You will need medication to do this, but it may be possible to switch to a less risky drug than the one you’ve been taking. Taking one drug appears to cause fewer problems in pregnancy than multidrug therapy and is the preferred way to go. And it’s important not to stop taking a necessary medication for fear of hurting your baby; not taking it—and having frequent seizures—may be more dangerous.

Helping Others with Epilepsy

For more information on epilepsy and pregnancy, check out epilepsyfoundation.org. To help yourself in the future or help other moms with epilepsy, ask your doctor about registering with the Antiepileptic Drug Pregnancy Registry, (888) 233-2334 or aed pregnancyregistry.org. Their goal is to determine which therapies are associated with an increased risk. You will also receive a packet of information about preconception planning and prenatal care.

A detailed structural ultrasound is recommended for anyone on seizure medicine, and certain early pregnancy screening tests may also be ordered. If you’ve been taking valproic acid (Depakene), the doctor may want to look specifically for neural tube defects, such as spina bifida.

Important for all pregnant women with epilepsy is getting plenty of sleep and the best nutrition, and maintaining adequate fluid levels. Vitamin D supplements may also be recommended, since some epilepsy medications can interfere with metabolism of the vitamin. During the last four weeks of pregnancy, a vitamin K supplement may be prescribed to reduce the risk of hemorrhage, another condition that babies of women taking seizure medications are at slightly greater risk for.

Labor and delivery aren’t likely to be more complicated because of your epilepsy, though it is important that anticonvulsant medication continue to be administered during labor to minimize the risk of a seizure during delivery. An epidural anesthesia can be used to manage labor and delivery pain.

Breastfeeding your baby shouldn’t be a problem, either. Most epilepsy medications pass into the breast milk in such low doses that they are unlikely to affect a nursing baby.

“I was diagnosed with fibromyalgia a few years ago. How will this impact my pregnancy?”

The fact that you’re aware of your condition actually gives you a head start many women don’t have. Fibromyalgia, a condition that affects 8 to 10 million Americans each year and is characterized by pain, burning sensations, and achiness in the muscles and soft tissues of the body, often goes unrecognized in pregnant women, possibly because the fatigue, weakness, and psychological stress it causes are all considered normal signs of pregnancy.

Making the Most of Your Meds

If you rely on oral medications to control a chronic condition, you may have to do a little adjusting now that you’re expecting. For instance, if morning sickness has you down in the first trimester, taking your meds right before going to bed in the evening—so that they can build up in your system before the morning upchucking begins—may keep you from losing most of your medication through vomiting. (Check with your doctor first, because some medications must be taken at certain times of the day.)

Something else that you’ll have to keep in mind—and that your team of doctors will have to keep an eye on: Some medications are metabolized differently during pregnancy. So the dosage you’re used to isn’t necessarily the right dosage now that you’re expecting. If you’re not sure whether your dosing is correct now that you’re pregnant, or if you have a hunch you’re not getting enough medication—or you’re getting too much—let your doctors know.

You’re probably already used to being frustrated by fibromyalgia and the lack of available information about it and effective treatment for it. Prepare to become even more frustrated because, unfortunately, there’s probably even less known about the effect of pregnancy on fibromyalgia and vice versa. From what is known, there is some substantially good news: Babies born to women with fibromyalgia are not affected in any way by the condition. Beyond that, some recent studies and plenty of anecdotal evidence have suggested that pregnancy can be extra tough on a woman with fibromyalgia. You may feel more tired and stiff and experience aches and pains in more parts of your body than an expectant mom without fibromyalgia (though some lucky women do feel better during pregnancy, so you can definitely hope for that). To keep your symptoms to a minimum, try to reduce the amount of stress in your life as much as possible, eat a well-balanced diet, exercise moderately (but never overdo it), and continue doing safe stretches and conditioning exercises (or yoga, water exercises, and so on) that may have helped you before your pregnancy. Women with fibromyalgia do typically gain 25 to 35 pounds during the first year of having the condition, so that during pregnancy, excessive weight gain can be a problem (not to say that you’ll balloon up, but you may have trouble staying within the recommended weight gain guidelines). And since the condition is usually treated with antidepressants and pain suppressants, you’ll need to make sure your doctor and prenatal practitioner are in contact with each other and only keep you on medications that are safe for use during pregnancy.

Chronic Fatigue Syndrome

Fortunately, having chronic fatigue syndrome (CFS) in no way interferes with having a normal pregnancy and a healthy baby. Unfortunately, that’s about all scientists know for sure about the effects of CFS on pregnancy. No studies have been done yet, so the little that is known comes from anecdotal evidence, which tends to suggest that CFS affects different women differently during pregnancy. Some moms-to-be note their symptoms actually improve during pregnancy while others say they get worse. It may be hard to tell, since pregnancy is physically exhausting for all women, even those not dealing with CFS.

If you’re pregnant with CFS, it’s important that the doctor who has been caring for your condition knows about your pregnancy and the practitioner you’ve chosen for your prenatal care knows about your CFS. Together, incorporating strategies that have helped you in the past, they will be able to help you cope with your CFS while you’re nurturing your baby-to-be.

“I’ve had hypertension for years. How will my high blood pressure affect my pregnancy?”

With more and more older women conceiving, more and more are also conceiving with chronic hypertension, a condition that becomes more common with age. So you’ve got lots of company (even if you developed your hypertension earlier on in life).

Your pregnancy is considered high risk, which means you’ll be putting in more time at the doctor’s office and putting more effort into following doctor’s orders. But all for a very good cause. With well-controlled blood pressure, and carefully monitored self-care and medical care, you’re likely to have the best payoff of all—a safe pregnancy and a healthy baby.

All of the following can help increase the odds of a successful pregnancy:

The right medical team.
The practitioner who supervises your pregnancy should have plenty of experience caring for mothers-to-be with chronic hypertension and should be joined on your pregnancy care team by the doctor who has been in charge of your hypertension.

Close medical monitoring.
Your practitioner will probably schedule more frequent visits for you than for other expectant mothers and may order many more tests—but, again, that’s time well spent. Having chronic hypertension increases your risk of developing preeclampsia during pregnancy as well as some other pregnancy complications, so your practitioner will pay particular attention to your well-being during your 40 weeks.

Relaxation.
Relaxation exercises are soothing for every expectant soul, but particularly for those with hypertension. Research has shown that these exercises can actually lower blood pressure. Check out—and practice—the one on
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, or consider using a meditation CD or even taking a class.

Other alternative approaches.
Try any CAM techniques recommended by your practitioner, such as biofeedback, acupuncture, or massage.

Plenty of rest.
Since both emotional and physical stress can send blood pressure up, don’t overdo anything. Take frequent rest breaks during your day, preferably with your feet up. If you work at a high-stress job, rest might not do the trick—you may want to consider a leave of absence or cutting down on hours or responsibilities until after the baby arrives. If you have your hands full at home with other children, get as much help as you can handling the load.

Blood pressure monitoring.
You may be asked to keep track of your own blood pressure at home. Take it when you’re most rested and relaxed.

Good diet.
The Pregnancy Diet is a smart place to start, but modify it with the help of your practitioner to fit your needs. Eating plenty of fruits and vegetables, low-fat or nonfat dairy products, and whole grains may be especially helpful in keeping your blood pressure down.

Adequate fluid.
Remember to drink at least eight glasses of fluid a day, which should help relieve any mild swelling of your feet and ankles. In most cases, a diuretic (a drug that draws fluid from the body and is sometimes used in the treatment of hypertension) is not recommended during pregnancy.

Prescribed medication.
Whether your medications will be changed or not during pregnancy will depend on what you’ve been taking. Some medications are considered safe for expectant moms; others are not.

“I have irritable bowel syndrome and was wondering if being pregnant will make my symptoms worse.”

Since pregnancy seems to affect irritable bowel syndrome (IBS) differently in different women, there’s no way to predict how it will affect you. Some women report being entirely symptom free while they’re expecting; others find their symptoms get somewhat worse during their nine months.

One reason why it’s so hard to pinpoint the effect of pregnancy on IBS—and vice versa—is that bowels are almost always impacted (so to speak) by pregnancy. Expectant women are more prone to constipation (a symptom of IBS, too), though some pregnant women find themselves with looser stools more often (also a symptom of IBS). Same for gas and bloating, which typically worsen when you’re expecting, whether or not you have IBS. And since the hormones of pregnancy wreak havoc on all parts of the body, even IBS sufferers are left guessing: A woman who is normally diarrhea-predominant might suddenly find herself dealing with constipation, while a woman who is usually stopped up might find it’s become easy—too easy—to move her bowels.

To keep your symptoms manageable, stick to the techniques you’re used to using to combat IBS during other times in your life: Eat small, more frequent meals (good advice for any pregnant woman); stay well hydrated (ditto); eat a high-fiber diet to improve digestion (double ditto); avoid spicy foods; avoid excess stress; and steer clear of foods or drinks that make your symptoms worse. You might also want to consider adding some probiotics (in the form of yogurt or yogurt drinks with active cultures, or in powder or capsule form) to your diet. They’re surprisingly effective in regulating bowel function and they’re safe during pregnancy. Check with your practitioner.