are you in favor of giving contraceptive to teenagers?

Wednesday, January 28, 2009

pregnancy mistakes even smart women make

Misinformation, no matter how well-meaning, can be dangerous for you and your unborn child.


With the wealth of medical knowledge that's out there for everyone to access, it's a wonder that people still engage in patently non-healthy behavior. Millions of individuals still smoke cigarettes, for instance, despite overwhelming evidence against their use. Even the more prudent make the occasional health-care "mistake"--over-flossing, for instance (dentists recommend doing so only once every other day), or thinking that only children need vaccination (adults do, too).

Part of the problem is that there is simply too much information coming in--and too fast!--to be absorbed. Many times media reports are either vague or ambiguous at best or, at worst, clash glaringly with conventional medical knowledge.

For most laymen, interpreting medical jargon, research scientists and anyone else who sends out health-related signals is like trying to figure out a Rubik's cube. A pregnant woman cannot escape the confusion and is, perhaps because of situational anxieties, more prone to misinformation than ordinary individuals, especially when every woman in her life--mother, grandmother, sister, aunt, cousin, in-law and friend--is anxious to dispense advice on the healthy, "proper" way of going through pregnancy and labor.

My advice? Talk to your obstetrician. No issue should be too simple or too complicated to discuss. Ask her all your questions and explore with her all your concerns. You and your doctor are a team. Your goal is to make sure you deliver a healthy baby. The only way that can happen is if you work together and communicate regularly.

Pregnancy no-no's
For starters, we've listed a few choices and decisions we discourage pregnant women from taking: A healthy pregnancy they surely will not make. Check to see if any of the items apply to you and then go see your doctor so you can both figure out what to do about them.

1. Taking preconception folic acid for granted. Folic acid is essential for the healthy development of baby's nervous system. This occurs during the first 45 days of life, at a time when a woman doesn't even know yet that she's pregnant. If you're planning on having a baby, be sure to take a multivitamin supplement containing folic acid once you begin trying to conceive.

2. Stopping medications for pre-existing diseases. A lot of women think that all prescription drugs are teratogenic (can cause birth deformities), and the reflex is to stop taking them once the stick turns blue. This decision often does more harm than good, especially for women with pre-existing diabetes, seizure disorders or psychiatric illnesses, which have to be kept in check. The best thing to do is to ask the doctor for advice on continuing versus stopping the medication.

3. Thinking that morning sickness is always normal. Nausea and vomiting in pregnancy, which occur in 70 percent to 85 percent of women, are traditional signs of a healthy pregnancy. Severe and persistent vomiting unrelated to other causes and leading to weight loss of at least 5 percent of pre-pregnancy weight, however, is not. It strongly suggests hyperemesis gravidarum, a condition that can lead to dehydration, vitamin and mineral deficiencies, and a low birth weight. The truth is that pregnant women don't have to "grin and bear it." Many medications can help alleviate morning sickness.

4. Not screening for chromosomal abnormalities. A lot of women think that having children with chromosomal abnormalities (e.g., Down's syndrome) occurs only in pregnant women over 45, who carry a one-in-30 risk of having a Down's baby. The truth is, these abnormalities occur sporadically and, while age-related, may still strike the offspring of young women. Screening is widely available, and all women should be aware of this option.

5. Eating for two. Average weight gain during pregnancy should only be about 25 pounds. Putting on a lot more weight will increase your chances of hypertension, gestational diabetes and having a big baby (and a more difficult delivery, of course!).

6. Decreasing activity. Engaging in mild to moderate exercise is still best. It keeps you fit and prepares you for the rigors of delivery. Ask your doctor to prescribe an exercise regimen for you.

7. Suffering through low-back pain. The condition called sacroiliitis is very common in pregnancy due to the laxity of the lower back ligaments and postural changes. Physical therapy and simple exercises can help relieve sacroiliitis.

8. Abstaining from sex. Except in cases of preterm labor (or a history of preterm deliveries) and bleeding due to a diagnosed placental abnormality, it is safe to engage in sexual activity--as long as it's not too acrobatic--at all stages of pregnancy.

9. Missing the blood work. Asian women are particularly predisposed to gestational diabetes, so it's important to be screened for this condition.

10. Shunning pain relief, especially epidural anesthesia, during labor. Evidence has shown that being given an epidural doesn't necessarily lengthen labor, as was previously thought.

11. Thinking that Lamaze will work miracles. The Lamaze technique is not guaranteed to work for everyone, so don't count on pain-free labor.

12. Asking the universe for twins. Multiple pregnancies, compared to ordinary single-baby pregnancies, bring a lot more complications.

13. Asking for a C-section. A C-section will involve more difficult, more painful recuperation than vaginal delivery, believe it or not.

14. Not taking prenatal vitamins and iron. Iron is the only mineral that must be supplemented in pregnancy, but some women stop taking their iron supplement when they begin to experience side effects like nausea or constipation. A simple solution to the problem is to take the iron pill at bedtime, and increase the fiber in one's diet or take stool softeners. 16. Fretting about breast-feeding. While breast-feeding is best for babies, a woman has the right to decide whether to breast-feed or not. She should not feel guilty if she cannot breast-feed for any reason or produce milk immediately after delivery. It's perfectly normal not to have milk until the third to the fifth day, so giving a temporary bottle at this time will not cause nipple confusion.

Saturday, January 24, 2009

Pregnancy nutrition: Foods to avoid during pregnancy

More foods can affect your health or your baby's than you might realize. Find out what foods to avoid during pregnancy.

You want what's best for your baby. That's why you add sliced fruit to your fortified breakfast cereal, put extra veggies in your favorite recipes and eat yogurt for dessert. But do you know what foods to avoid during pregnancy?

Start with the basics in pregnancy nutrition. Understanding what foods to avoid during pregnancy can help you make the healthiest choices for you and your baby.

Avoid seafood high in mercury

Seafood can be a great source of protein and iron, and the omega-3 fatty acids in many fish can help promote your baby's brain development. In fact, research suggests that skimping on seafood during pregnancy may contribute to poor verbal skills, behavioral problems and other developmental issues during childhood. However, some fish and shellfish contain potentially dangerous levels of mercury. Too much mercury may damage your baby's developing nervous system.

The bigger and older the fish, the more mercury it may contain. The Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) encourage pregnant women to avoid:

  • Swordfish
  • Shark
  • King mackerel
  • Tilefish

So what's safe? Some types of seafood contain little mercury. Although concerns have been raised about the level of mercury in any type of canned tuna, the FDA and EPA say pregnant women can safely eat up to 12 ounces (340 grams) a week or two average-sized portions of:

  • Shrimp
  • Canned light tuna (limit albacore tuna and tuna steak to no more than 6 ounces or 170 grams a week)
  • Salmon
  • Pollock
  • Catfish
  • Cod

Avoid raw, undercooked or contaminated seafood

To avoid ingesting harmful bacteria or viruses:

  • Avoid raw fish and shellfish. It's especially important to avoid oysters and clams.
  • Avoid refrigerated smoked seafood, such as lox. It's OK to eat smoked seafood if it's an ingredient in a casserole or other cooked dish. Canned and shelf-stable versions also are safe.
  • Understand local fish advisories. If you eat fish from local waters, pay attention to local fish advisories — especially if water pollution is a concern. Larger game fish contaminated with chemical pollutants may potentially harm a developing baby. If advice isn't available, limit the amount of fish from local waters you eat to 6 ounces (170 grams) a week and don't eat other fish that week.
  • Cook seafood properly. Cook most fish to an internal temperature of 145 F (63 C). The fish is done when it separates into flakes and appears opaque throughout. Cook shrimp, lobster and scallops until they're milky white. Cook clams, mussels and oysters until their shells open. Discard any that don't open.

Avoid undercooked meat, poultry and eggs

During pregnancy, changes in your metabolism and circulation may increase the risk of bacterial food poisoning. Your reaction may be more severe than if you weren't pregnant. Rarely, your baby may get sick, too.

To prevent food-borne illness:

  • Fully cook all meats and poultry before eating. Look for the juices to run clear, but use a meat thermometer to make sure.
  • Cook hot dogs and warm processed deli meats, such as bologna, until they're steaming hot — or avoid them completely. They can be sources of a rare but potentially serious food-borne illness known as listeriosis.
  • Avoid refrigerated pates and meat spreads. Canned and shelf-stable versions, however, are OK.
  • Don't buy raw poultry that's been pre-stuffed. Raw juice that mixes with the stuffing can cause bacterial growth. Frozen poultry that's been pre-stuffed is safe when cooked from its frozen state.
  • Cook eggs until the egg yolks and whites are firm. Raw eggs can be contaminated with the harmful bacteria salmonella. Avoid foods made with raw or partially cooked eggs, such as eggnog and hollandaise sauce.

Avoid unpasteurized foods

Many low-fat dairy products — such as skim milk, mozzarella cheese and cottage cheese — can be a healthy part of your diet. But anything containing unpasteurized milk is a no-no. These products may lead to food-borne illness.

Unless these soft cheeses are clearly labeled as being made with pasteurized milk, don't eat:

  • Brie
  • Feta
  • Camembert
  • Blue cheese
  • Mexican-style cheeses, such as queso blanco, queso fresco and panela

Also, avoid drinking unpasteurized juice.

Avoid unwashed fruits and vegetables

To eliminate any harmful bacteria, thoroughly wash all raw fruits and vegetables and cut away damaged portions. Avoid raw sprouts of any kind — including alfalfa, clover, radish and mung bean — which also may contain disease-causing bacteria.

Avoid large quantities of liver

Liver is OK during pregnancy, but don't overdo it. Liver is high in vitamin A, and too much vitamin A may cause birth defects.

Avoid excess caffeine

Caffeine can cross the placenta and affect your baby's heart rate. Some studies suggest that drinking too much caffeine may be associated with a small decrease in birth weight or an increased risk of miscarriage and stillbirth. In fact, a large 2008 study suggests that 200 milligrams (mg) of caffeine a day — about a 12-ounce cup (354 milliliters) of brewed coffee — during pregnancy may slow fetal growth.

Because of the potential effects on your developing baby, your health care provider may recommend limiting the amount of caffeine in your diet to less than 200 mg a day during pregnancy.

Avoid herbal tea

Although herbal tea may be soothing, avoid it unless your health care provider says it's OK — even the types of herbal tea marketed specifically to pregnant women. There's little data on the effects of specific herbs on developing babies. And large amounts of some herbal teas, such as red raspberry leaf, may cause contractions.

Avoid alcohol

One drink isn't likely to hurt your baby, but no level of alcohol has been proved safe during pregnancy. The safest bet is to avoid alcohol entirely.

Consider the risks. Mothers who drink alcohol have a higher risk of miscarriage and stillbirth. Too much alcohol during pregnancy may result in fetal alcohol syndrome, which can cause facial deformities, heart problems, low birth weight and mental retardation. Even moderate drinking can impact your baby's brain development.

If you're concerned because you drank alcohol before you knew you were pregnant or you think you need help to stop drinking, talk with your health care provider.

Friday, January 16, 2009

pregnancy test

Q. How soon after conception is a pregnancy test effective?

A. Regulated by the Food and Drug Administration, pregnancy tests have come far since the early to mid-1900's when toads, rats and rabbits were used in testing. Now, over-the-counter home pregnancy kits provide privacy and fast results, and can detect pregnancy as early as six days after conception, or one day after a missed menstrual period. This gives an early advantage for vital prenatal care.

Q. How do pregnancy tests work?

A. All pregnancy tests are based on the presence of a hormone, human chorionic gonadotropin (HCG), that the pregnant woman produces after conception. The first self tests of the 1970's used ring, or "tube agglutination," tests consisting of prepackaged red blood cells to detect HCG in urine. A ring at the bottom of the tube indicated a positive result. Sensitive to movement and human error, ring tests are now rarely used.

Today's brands, such as e.p.t. and First Response, contain monoclonal antibodies that detect minute traces of HCG. These antibodies are molecules coated with a substance that bonds to the pregnancy hormone, if it's present, to produce either a positive or negative result. (Each test manufacturer uses a different "trade secret" chemical formula for the bonding substance.) The user collects urine and combines it with the antibodies provided in the package. The test is timed, and a color change indicates the result.

Q. How accurate are home pregnancy tests?

A. Although most manufacturers claim 99 percent accuracy in laboratory tests, inaccurate results may be more frequent in actual use, due to such factors as improper use of the test, using a product past its expiration date, exposure of the test to the sun, and cancers. The procedures outlined in the instructions must be followed exactly for results to be accurate.

Whitehall Laboratories markets the newest one-step brand, Clearblue Easy. It gives results in three minutes and informs the user when the test hasn't been done properly. This new testing method, called rapid assay delivery system, combines a biochemical process with monoclonal antibodies in one pen-like instrument.

Whatever the result or the brand used, most manufacturers recommend repeating the process a few days later to confirm the results. After conception, a woman produces a minimal amount of HCG. The strength of each test varies, and although a woman may be pregnant, the test may not pick up the amount of HCG hormone present the first time.

Adapted from the Office on Women's Health in the Department of Health and Human Services

Thursday, January 8, 2009

am i pregnant?

"Am I pregnant?" is probably the most common health question women ask. The signs and symptoms of early pregnancy are easy to recognize, particularly if this is not your first pregnancy. No matter how many times you get pregnant, the signs and symptoms of early pregnancy are the same. However, this does not mean that you will experience every pregnancy the same way. For example, during one pregnancy, you may experience incredible breast pain or nausea and vomiting, while during another pregnancy you might not experience these symptoms at all. The simple fact is that each pregnancy, just like each newborn, is different. So, don't count on having the same symptoms or the same intensity of symptoms during consecutive pregnancies.

Early Pregnancy Signs and Symptoms

  • Swollen, tender, or sore breasts and/ or nipples – Often this is the first physical sign of pregnancy. In fact, some women know when they are pregnant based on this sign alone. The reason breasts and/ or nipples are often sore, swollen, or tender during early pregnancy is because the breasts are undergoing changes to prepare for breastfeeding. The reason for this is the increased production of the hormones estrogen and progesterone that occurs and the breasts and/ or nipples are often particularly painful during a first pregnancy.

  • Fatigue or unusual tiredness – Early pregnancy is time when a woman’s body is working very hard to keep up with the changes that occur. This means increased hormone production, as well as the fact that the heart is pumping harder and faster due to the escalation of blood flow – necessary to bring nutrients to the growing fetus. Increased progesterone production is the primary reason for the extra fatigue most pregnant women experience early in their pregnancy. Progesterone, known to cause sleepiness and a natural central nervous system depressant, is the reason this occurs. Another reason for fatigue and unusual tiredness during early pregnancy are the emotional extremes experienced often during pregnancy. It’s not uncommon for a pregnant woman to burst into tears for no apparent reason other than the hormonal fluctuations that occur during this time. This symptom is also a sign to get more sleep before your baby arrives when you’ll need your energy to care for your newborn baby.

  • My Period is Late, Am I Pregnant? – The most common reason for missing your period is pregnancy and this is often the first sign that makes you suspect pregnancy. Only a pregnancy test followed by a pelvic exam, can tell you positively whether you are pregnant. Once your health care provider rules out pregnancy as the cause of your late or missed periods, the next step is usually to rule in or out several other possible explanations for absence of menstruation or amenorrhea.

  • Light bleeding and/or cramping – The most common reason for light bleeding during early pregnancy is implantation. Implantation bleeding occurs when the fertilized egg implants itself in the uterine lining and usually occurs about 10 to 14 days after conception. Bleeding caused by implantation is very light, often the only sign you might notice that indicates implantation has occurred is a small (can be as small as a pinhead followed by no further bleeding) spot of blood left on your panties.

    Cramping that is similar to menstrual cramps occurs very early during pregnancy and happens when the uterus begins to expand to make room for the embryo to develop into a fetus that continues to develop for a total of 40 weeks gestation when your baby is born.

  • Morning sickness – Nausea during pregnancy can occur with or without vomiting. While morning sickness is most common between weeks four and eight during pregnancy, many women experience this symptom beginning about two weeks from their date of conception.

    Morning sickness is a misnomer since it can, and often does, occur at anytime of the day or night. The most common reason for this symptom seems to be the rapid rise in estrogen, produced by the fetus and placenta. Another trigger for nausea is odors. During pregnancy, a woman’s sense of smell increases considerably and can make almost anything from everyday household odors, foods, perfume, and smoke, to name a few, trigger a bout of morning sickness or nausea and vomiting.

    The most common foods to trigger morning sickness are coffee during the first weeks of pregnancy, meat, dairy products, and spicy foods. However, it’s essential to understand that literally anything can trigger nausea and/ or vomiting during pregnancy. In fact, I personally know someone who became nauseated during one of her pregnancies every time she passed a microwave in operation.

  • Running to the bathroom – During the first trimester of pregnancy, it’s easy to believe you might have to “move” into your bathroom since it seems you are constantly running to make to the bathroom. The growing uterus causes frequent urination during pregnancy. The first and third trimesters of pregnancy are typically when the most intense frequent urination happens.
While the signs and symptoms of early pregnancy listed above are the most common, other symptoms can, and often do, occur in pregnancy. Other pregnancy symptoms include:

  • Headaches – Headaches that occur during pregnancy are often intense and caused by increased hormone levels.

  • Mood swings – Don’t think you’re crazy if you suddenly develop atypical mood swings or if you are unusually emotional during pregnancy, these are very normal reactions during pregnancy. Many times, pregnant women burst into tears for reasons that are unclear to anyone, including the pregnant woman. Another symptom caused by increased hormone levels.

  • Feeling weak, faint, or dizzy – Caused by the circulatory system as dilation of the blood vessels occur. Low blood sugar, early in pregnancy, also triggers these symptoms.

  • Increased basal body temperature or BBT – Your basal body temperature is your temperature immediately upon rising in the morning. BBT normally increases during ovulation and decreases when menstruation occurs. However, when pregnancy takes place increased basal body temperature continues after menstruation is late. BBT is a good indicator of pregnancy for women who have used it, either to prevent pregnancy or when trying to get pregnant.

  • Constipation – Food digests slower than usual during pregnancy due to increased progesterone production. Slower digestion sometimes causes constipation during pregnancy.

I have one or more of these symptoms, does that mean I am pregnant?

Not necessarily, sometimes these signs and symptoms mean that you’re sick or that menstruation is about to begin. Another point to remember is that while these symptoms are common during pregnancy, sometimes none of these symptoms occurs.

If you experience the signs and symptoms of pregnancy, buy a home pregnancy test and see your doctor – either to begin prenatal care and confirm your pregnancy or to determine the cause of your symptoms if you’re not pregnant.

Tip: Keep track of your periods. Mark the first day, as well as the last day, of your period on a calendar – day one of the menstrual cycle is the day your period starts and is the basis for determining due dates during pregnancy.

Source: MayoClinic.com, Early Signs and Symptoms of Pregnancy: Things You Might Notice Before You Start Prenatal Care, accessed 07/23/06