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The number of women smokers has increased significantly. How does this affect the pre and post-natal period? What can be done to help a woman wean herself of cigarettes during her pregnancy? If she is unable to, what are the possible consequences?

Smoking is dangerous to the health of the baby and also for the pregnant woman. It is advisable to quit smoking before conception or as early in pregnancy as possible.
Problem that can happen to the developing baby involves craniofacial abnormalities I e birth defects of the face ,mouth and lips. There is a higher risk of growth retardation and preterm delivery. Nicotine in tobacco products can damage a developing baby’s brain and lungs also.
Smoking can cause difficulty in conceiving , subfertility or infertility.
Even second hand smoke is now classified as a group A carcinogen. That means it’s known to cause cancer in humans.

Harmful effects on the mother

  • Smoking increases mother’s heart rate and her blood pressure. It increases the carbon monoxide in her blood stream thereby decreasing the oxygen levels in her blood which means the baby also gets less oxygen and thereby harmful consequences. It is important to protect your baby even during breast feeding.
  • Miscarriage & stillbirth
  • Small placenta
  • Intrauterine growth retardation
  • Ectopic pregnancy-Nicotine causes contraction in the fallopian tubes thus preventing fertilized eggs from reaching the uterus resulting in ectopic pregnancy.
  • Placental abruption: Smoking is a major risk factor for complication related to the placenta.This is a condition in which the placenta separates from the uterus before delivery of the baby .It requires immediate admission and may be early delivery of the baby depending upon the severity of bleeding.

Smoking increases mother’s heart rate and her blood pressure. It increases the carbon monoxide in her blood stream thereby decreasing the oxygen levels in her blood which means the baby also gets less oxygen and thereby harmful consequences. It is important to protect your baby even during breast feeding.
Miscarriage & stillbirth
Small placenta
Intrauterine growth retardation
Ectopic pregnancy-Nicotine causes contraction in the fallopian tubes thus preventing fertilized eggs from reaching the uterus resulting in ectopic pregnancy.
Placental abruption: Smoking is a major risk factor for complication related to the placenta.This is a condition in which the placenta separates from the uterus before delivery of the baby .It requires immediate admission and may be early delivery of the baby depending upon the severity of bleeding.

How to wean a woman from smoking?

Quitting smoking is tough but the women needs to be convinced that it is very much possible with the support and guidance of your doctor and of course self help.Quitline coaches are available to help you develop a quit plan and provide support. Healhcare activities to educate pregnancy women or women who are planning a pregnancy about the harm of tobacco use and very helpful in motivating women to quit smoking. Even second hand smoking affects pregnant women in the same way as smoking by themselves so it is important to avoid second hand smoking also.
Quitting smoking at any stage of your pregnancy has health benefits for both mother & baby. Avoiding smoking increases oxygen availability to the baby’s lungs and help them to develop well .There is no safe amount of smoking. E-cigarettes are also not harmless. The nicotine in e -cigarette is harmful for developing babies.

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The First Trimesters – Nutrition Do’s and Don’ts for Health Conscious Moms to be

It is important to maintain a healthy diet during pregnancy.

Your body needs additional nutrients, vitamins, minerals and some 300-350 extra calories each day during pregnancy.

A diet lacking in nutrients, poor eating habits may lead to some pregnancy problems. Similarly over eating or eating all the wrong things may lead to excess weight gain and may also increase your risk of gestational diabetes.

So choosing a healthy, nutritious diet will help ensure that you and your baby both are healthy.

When A non medical friend’s daughter, who was eight weeks pregnant ordered spring rolls at a restaurant, another one of my friends reacted as if she had ordered a double whiskey . “You can’t have Chinese food when you’re pregnant!” she shouted! When I asked her why she thinks so, she said she thought that one cannot have Chinese food during pregnancy. Well, then what do Chinese woman eat during their pregnancy! Actually it is ajinomoto in big quantity which cannot be taken, and Chinese food is safe.

Yes, certain foods can lead to pregnancy problems and one should know about them.

From conception onwards it is very important to have folic acid.

Vitamin D is another important thing needed during pregnancy.

Iron and Calcium along with some minerals is also needed. Protein and fibre in diet is also important.

Legumes are great sources of folate (folic acid), fiber and many other nutrients. Folate is a vitamin that reduces the risk of neural tube defects in the growing baby.

Fruits are a good source of many vitamins and fibre. Fibre helps in reducing the problem of constipation often bothering a pregnant lady.

Green leafy vegetables are a good source of iron. Avocados contain high amounts of fibre, folate and potassium. Potassium helps to relieve leg cramps that are common in pregnant women.

Sweet potatoes are an excellent source of beta-carotene, which is important for the growing fetus.

Whole eggs are a good source of protein (the white part) along with many nutrients in the yellow part. You can have two eggs daily. Chiken and fish give you lot of protein as does paneer for vegetarians.

Dairy products like milk, yoghurt should be consumed in sufficient quantity as it is good source of protein and calcium..

Dry fruits like almonds and walnut are good for pregnant women but make sure to limit your portions.

Drinking water is very important during pregnancy. It may also help prevent constipation and urinary tract infections which are comparatively more common during pregnancy.

Some foods are to be avoided during pregnancy.

Raw fish and shelled fish, Raw or undercooked meat and raw eggs must be avoided as they may lead to infection if contaminated.

Pregnant women should limit their caffeine intake to one or two cups of coffee. High caffeine intake during pregnancy is bad. Try to have decaffeinated coffee. Also reduce tea intake to two to three cups. Green tea should not be taken during pregnancy.

Pregnant women should not drink alcohol as it increases the risk of miscarriage, stillbirth.

In the second and third trimesters the nutrients, iron and calcium are given in tablet form also along with the good diet.

HIGH RISK PREGNANCY

 

 

Pregnancy is a normal physiological process, a phase of life to be enjoyed and to be cherished. However, pregnancy is also a stressful condition for the body, both physically, mentally, and can be emotionally challenging. While most pregnancies go smoothly, a few underlying health issues or some new development can make it high risk, requiring special care, rest, investigations, etc.

 

High risk pregnancy is one in which due to some factors there is a greater risk to the baby or the mother or both.

 

Some factors which make the pregnancy high risk are;

 

  1. MATERNAL AGE – Pregnancies at the extremes of age like teenage pregnancy or beyond the age of 35 are at higher risk of developing complications. There is a higher chance of miscarriage and birth defects, especially if you are above the age of 35. Mothers who are more than 35 years of age are also at risk of developing gestational diabetes, pregnancy-induced hypertension, preterm labor.

 

  1. PRE EXISTING MEDICAL CONDITIONS – If you already have any pre-existing medical condition like diabetes, high blood pressure, heart disease, kidney disease etc., you are at a higher risk of developing complications during pregnancy. Some of these problems worsen in pregnancy. You will require expert handling during pregnancy and at the time of delivery. Some of these problems may impact fertility as well. These issues may also require expert medical control even at the time of conception. Some of them may also need a change in medication before pregnancy occurs. For example, if you are suffering from diabetes, your sugars need to be well controlled before you get pregnant as very high sugar level at the time of pregnancy can lead to abnormal babies.

 

  1. PREVIOUS BAD OBSTETRIC HISTORY – if you have had past abortions, preterm deliveries ( delivery before 37 weeks), stillbirth, intrauterine death ( baby died inside the womb) , etc., your pregnancy will require expert handling and intensive care. The care should ideally start before pregnancy. You may need further investigations to understand the cause of such a loss, folic acid supplement, treatment of any pre-existing medical condition, etc. During pregnancy; you may need rest, injections, and supportive therapy.

 

  1. ISSUES DURING THE CURRENT PREGNANCY –Certain conditions which develop during the current  pregnancy will increase the risk in this pregnancy, like developing high blood pressure, gestational diabetes (developing diabetes in the pregnancy), twins, low lying placenta, etc. These pregnancies require extensive care and multidisciplinary approach.

 

WHAT CAN YOU DO?

  • Consult an expert gynaecologist before you get pregnant

 

If you are planning to become pregnant, you should definitely talk to an experienced gynecologist with expertise in high-risk pregnancy cases.

She may advise you to attain a healthy weight before pregnancy begins and may ask you to start having folic acid along with a prenatal vitamin every day. You should stop smoking and alcohol before you get pregnant.

If you possess a medical concern, the doctor might adjust your treatment or change your treatment to prepare you for pregnancy. For example, there are certain blood pressure medicines which are safe in pregnancy while others are not.

You will require certain tests to ensure that you are in good health to get pregnant like haemoglobin, blood sugar, thyroid etc. Appropriate medicines will be started according to the reports.

You may require certain tests based on your previous pregnancy history.

Besides that, the gynecologist will explain in detail about the risks for you and the baby.

 

  • Treat your pre-existing medical condition

If you already have a medical issue such as lupus, kidney disorder, high blood pressure, heart disorder or diabetes, it is vital that you plan a pregnancy only after you have made sure that these underlying medical problems are getting proper treatment and you are in the best health for getting pregnant. For example, if you have diabetes, make sure that the sugar levels are controlled or if you have hypertension, ensure that it is controlled suitably. This will ensure best possible outcome in pregnancy.

 

  • Test for genetic disorders and birth defects

At the very beginning of your pregnancy, have a detailed discussion with your gynecologist regarding the tests available to rule out any abnormalities in the baby.  Some non-invasive tests and ultrasounds help in the early detection of any problem. Folic acid can help lower the risk of some forms of birth defects if taken before or during your early pregnancy.

 

  • Prevent complications you have developed before

Pregnancy-associated complications such as birth defects, preterm labor, or preeclampsia are quite unpredictable in the case of a first pregnancy. But you can take some precautionary measures for preventing recurrence in your subsequent pregnancies. For example, aspirin can be started early if you have had preeclampsia, progesterone can help decrease preterm birth risks. Certain lifestyle changes like healthy diet can also make a difference.

 

  • Improve your lifestyle

Take the following lifestyle measures to lower your high-risk pregnancy possibilities:

 

Have a healthy diet

You would require more iron, calcium, folic acid, and other important nutrients during pregnancy. Please ensure that you maintain all these nutrients in your diet.

Avoid risky substances

You must quit smoking altogether. Fully avoid substances such as illegal drugs, alcohol, and tobacco. Discuss with your gynecologist regarding any prescribed or non-prescribed supplements or medications that you are currently taking.

Check your weight

Proper weight gain can aid in supporting your baby’s health and growth. Consult your doctor regarding the ideal amount of weight gain and try to maintain your weight within that limit.

Go for regular prenatal visits

Regular visits help in the monitoring of your health and the baby’s growth. Problems, if any, can be detected early. Timely detection and early treatment can make a world of difference in the outcome of pregnancy. Remember, A stitch in time saves nine. The doctor may recommend visiting an expert in pediatrics, maternal-fetal medicine, genetics, etc. as per your condition.

 

  • Sensible use of technology

If you require Assisted Reproductive Technology (ART), consider the number of embryos to be transferred. IVF can result in multiple pregnancies which can cause S

  • Choose your gynaecologist and place of delivery

All high risk pregnancies require expert and trained obstetrician. Correct guidance, requisite tests, appropriate treatment can make a difference to pregnancy outcome. You should share all details with your gynaecologists and follow the instructions. Maintain regular contact with your gynaecologist is a must.

The hospital which you choose for delivery should be adequately equipped with a very good nursey back up .

SIGNS AND SYMPTOMS THAT YOU MUST NOT IGNORE

If you have a high-risk pregnancy and you develop any of the following signs and symptoms, you should visit a gynecologist with expertise in high-risk pregnancy cases.

 

  • You fall unconscious., in this case, you would not be able to take any step. Therefore, you need to inform your partner or friend, beforehand, what to do, if such a situation arises.
  • You experience vaginal bleeding.
  • You experience a burning sensation or pain while urinating.
  • You experience persistent nausea or vomiting.
  • You have signs of dizziness.
  • You experience chills or fever.
  • You experience intolerable pain in the pelvis or cramping in your lower abdomen.
  • Fluid leakage takes place from the vagina
  • You have persistent back pain or pelvic pressure.
  • You find that your baby’s movements have stopped or are less than normal (less foetal activity).
  • You develop symptoms of pre-eclampsia such as an extreme headache, vision issues like blurring or dimness, or a sudden swelling of the face, feet, or hands.
  • During pregnancy, you must be essentially careful and look out for any abnormal signs.
  • You develop unhealthy thoughts of harming the baby or yourself.


Dr. Madhu Goel
Associate Director
Fortis La Femme, Greater Kailash.

Routine antenatal care in Pregnancy

So, the 2 lines on the pregnancy rest finally appear….. You are pregnant; congratulations and welcome to the antenatal journey.

It is a good idea to consult a gynecologist as soon as you miss your period and not wait till 3 months are over, as believed earlier, because certain precautions as detailed by her can prevent miscarriages, if they are not inevitable.
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