COVID -19 Risks During Pregnancy

According to the physicians at the Mayo Clinic, the overall risk to pregnant women is low, however, women who are pregnant or were recently pregnant are at increased risk for severe illness with COVID-19. Severe illness means that you might need to be hospitalized, have intensive care or be placed on a ventilator to help with breathing. Pregnant women with COVID-19 are also more likely to deliver a baby before the start of the 37th week of pregnancy (premature birth) and might be at increased risk for problems such as pregnancy loss.

In addition, pregnant women who are Black or Hispanic appear to be disproportionately affected by infection with the COVID-19 virus. Pregnant women who have underlying medical conditions, such as diabetes, also might be at even higher risk of severe illness due to COVID-19.

Some research suggests that pregnant women with COVID-19 are also more likely to have a premature birth and cesarean delivery, and their babies are more likely to be admitted to a neonatal unit.

If you think you have COVID-19 symptoms or you’ve been exposed to someone with COVID-19, contact your health care provider. It’s recommended that you get tested for the COVID-19 virus.

COVID-19 Vaccines and Pregnancy Recommendation

The American College of Obstetricians and Gynecologists (ACOG) updated their guidance to doctors January 26,2022, and recommends that all eligible persons, including pregnant and lactating moms, receive a COVID-19 vaccine or vaccine series. The mRNA COVID-19 vaccines are preferred over the Johnson & Johnson/Janssen COVID-19 vaccine. ACOG recommends that pregnant and recently pregnant women up to 6 weeks postpartum receive a booster dose of COVID-19 vaccine following the completion of their initial COVID-19 vaccine or vaccine series.

Johns Hopkins Medicine views all authorized COVID-19 vaccines as highly effective at preventing serious disease, hospitalization and death from COVID-19.

The Federal Drug Administration and the Centers for Disease Control and Prevention (CDC) recommend pregnant and lactating women consult with their doctors about getting the vaccine. The CDC recommends when considering whether or not to be vaccinated, pregnant women and their healthcare providers should consider the level of COVID-19 community transmission, the patient’s personal risk of contracting COVID-19, the risks of COVID-19 to the patient and potential risks to her fetus, the efficacy of the vaccine, the side effects of the vaccine, and the lack of data about the vaccine during pregnancy.

Preventing COVID-19 During Pregnancy

In general, pregnant women can be more susceptible to infections, so it’s important to take precautions so you don’t expose yourself to COVID or other illnesses. Actions include hand washing, social distancing, wearing masks and avoiding situations where you can be exposed to people who are sick.

Sources:

• Centers for Disease Control
• American College of Obstetricians and Gynecologists (ACOG)
• John Hopkins Medicine
• U.S. Food & Drug Administration

Keyword tags: COVID-19 During Pregnancy, Coronavirus, COVID vaccinations

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Spotting During Pregnancy Versus Bleeding

Vaginal bleeding during pregnancy is any discharge of blood from the vagina. It can happen anytime from conception (when the egg is fertilized) to the end of pregnancy.

Light bleeding, or spotting, during pregnancy is common, especially during the first trimester. It is considered spotting when you notice a few drops of blood occasionally in your underwear, or if you wipe yourself with tissue and see a little blood on the paper. There should not be enough blood to fill a panty liner.

Bleeding is a heavier flow of blood. With bleeding, you will need a liner or pad to keep the blood from soaking your clothes. Whether you are bleeding or spotting, it is best to contact your healthcare provider and describe what you are experiencing.

What Causes Spotting During Pregnancy?

Implantation bleeding is a common cause of spotting early on in pregnancy. Implantation bleeding happens when the fertilized egg attaches to the uterine lining.  This can trigger a few days of light bleeding or spotting. This spotting occurs before a woman even knows she is pregnant and is often mistaken as a pending period. Bleeding that occurs after the day a woman expects her period is typically too late to be considered implantation bleeding, and is more likely related to early pregnancy in general.

Another common cause of spotting is a cervical polyp (a harmless growth on the cervix), which is more likely to bleed during pregnancy due to higher estrogen levels. This may occur because there is an increased number of blood vessels in the tissue around the cervix during pregnancy.  As a result, contact with this area (through sexual intercourse or a gynecological exam, for example) can cause bleeding.

Even without the presence of a cervical polyp, there are a few things that may cause some spotting in the couple days after:

• Sexual intercourse
• Gynecological exam, such as a vaginal ultrasound
• Heavy lifting/excessive exercise

When to Worry About Spotting During Pregnancy?

Spotting or bleeding during pregnancy is not expected and may be abnormal, but it is not always a cause for concern. However, it is important to contact your healthcare provider to discuss the symptoms you are experiencing. The good news is that 50% of women with bleeding during pregnancy go on to have a healthy pregnancy and a healthy baby.

Any spotting or bleeding in the second or third trimesters should be reported to your healthcare provider immediately. In the first trimester, spotting is somewhat more common, but should also be reported to your doctor or midwife.

Call your obstetrician especially if you notice heavy bleeding similar to a menstrual period to make sure the bleeding is not a result of pregnancy complications, such as an ectopic pregnancy. Abnormal bleeding in late pregnancy may be more serious because it can signal a complication with you or your baby. Call your doctor as soon as possible if you experience any bleeding in your second or third trimester. Your healthcare provider will most likely check for cervical polyps, and make sure your cervix is closed.

To help manage your spotting during pregnancy and to increase the probability of continuing with a healthy pregnancy, your healthcare provider may encourage you to do the following:

• Bed rest or more naps
• More time off your feet
• Staying well hydrated
• Limit your physical activity
• Elevate your feet when possible
• Avoid lifting items over 10 pounds

Remember, the good news is the majority of women who experience spotting during pregnancy go on to have a healthy pregnancy. However, do not let this fact keep you from contacting your healthcare provider. It is important to discuss spotting and bleeding with your doctor.

Want to Know More?

• Sharp Pain During Pregnancy
• 7 Common Discomforts of Pregnancy
• Warning Signs of Miscarriage

Compiled using information from the following sources:

1. Mayo Clinic Guide to a Healthy Pregnancy, New York, NY: HarperCollins Publishers Inc.

2. Obstetrics and Gynecology: The Essentials of Clinical Care. New York, NY: Thieme New York

3. Danforth’s Obstetrics and Gynecology, Ninth Ed. Scott, James et al., Ch. 17

4. Williams Obstetrics, Twenty-Second Ed. Cunningham, F. Gary et al., Ch. 51

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Additionally, there may be an increased risk of adverse pregnancy outcomes, such as preterm birth, among pregnant people with COVID-19. Therefore, if you are pregnant, be mindful about reducing your risk of getting sick. If you are caring for children, you can teach them everyday steps (such as proper hand washing) to help them stay healthy and, in turn, help protect yourself and your family.

If I have COVID-19, will it spread to my baby during pregnancy?

According to the CDC, only a few newborns have tested positive for COVID-19 shortly after birth. It is unknown if these newborns got the virus before, during, or after birth. Most newborns who tested positive for COVID-19 had mild or no symptoms and recovered.

National Institutes of Health research has shown that the cells of the placenta don’t allow SARS-CoV-2 to travel to a developing baby. Because of this, the chance that your baby will be born with COVID-19 is very low.

The NIH supports research on the placenta, including a study using magnetic resonance imaging (MRI) to see what happens when SARS-CoV-2 tries to enter the placenta’s cells.

Take steps to protect yourself from COVID-19

There is no way to ensure you have zero risk of infection, so it is important to understand the risks and know how to be as safe as possible. In general, the more people you interact with, the more closely you interact with them, and the longer that interaction, the higher your risk of getting and spreading COVID-19.

Here are preventive steps you and people you live with can take:

• Limit close contact interactions with other people as much as possible.
• When going out or interacting with others outside your immediate household,
  • Wear a mask, especially when other social distancing measures are difficult to maintain. Note that wearing a mask is not a substitute for other everyday prevention actions like washing hands frequently and avoiding close contact with other people.
  • Avoid others who are not wearing masks or ask others around you to wear a mask, if possible.
  • Stay at least 6 feet away from others outside your household.
  • Wash your hands with soap and water for at least 20 seconds. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.
• Avoid activities where taking protective measures may be difficult and where social distancing can’t be maintained.

Don’t skip your healthcare appointments during and after pregnancy.

• Visit your healthcare provider for all recommended appointments. If you need help finding one, contact your nearest hospital clinic, community health centerexternal icon, or health department.
• Talk to your healthcare provider about
  • How to stay healthy and take care of yourself and your baby.
  • Any questions you have about the best place to deliver your baby. Delivering your baby is always safest under the care of trained healthcare professionals.

If you’re concerned about going to your appointments because of COVID-19, ask your healthcare provider what steps they’re taking to separate healthy patients from those who may be sick.

• Some healthcare providers may choose to cancel or postpone some visits.
• Others may switch certain appointments to telemedicine visits, which are appointments over the phone or video.
• These decisions may be based on the situation in your community as well as your individual health risks.

Get recommended vaccines and a 30-day supply of your medicines

Getting the recommended vaccines during pregnancy can help protect you and your baby.

• Get vaccinated against influenza (or flu).
  • Flu and COVID-19 are both respiratory illnesses that can spread from person to person. They can affect breathing and have similar symptoms, but they are caused by different viruses (read more about similarities and differences between flu and COVID-19). It is unknown how these two viruses may interact during the upcoming flu season.
  • There is no vaccine available to protect against the virus that causes COVID-19.
  • You should protect yourself against flu by getting vaccinated. Others living in your household should also get vaccinated to protect themselves and you.
• Get the whooping cough (Tdap) vaccine during pregnancy to protect your baby against whooping cough, which can also present with similar symptoms to COVID-19.

Ask your doctor and pharmacy to give you at least a 30-day supply of the medicines you need.

Call your healthcare provider if you have any health concerns

These concerns may include:

• You think you have COVID-19 (call within 24 hours).
• You think you are experiencing depression during or after pregnancy.
• You have any questions related to your health.

Don’t delay getting emergency care because of COVID-19

Call 911 or go to your local emergency department.

If you are going to the emergency department, call and tell them that you are pregnant and are having an emergency. They should have a plan to protect you from getting COVID-19.

If someone else is driving, call while you’re on the way. If you need to drive yourself to the emergency department, call before you start driving.​

Information on the coronavirus comes from:

Centers for Disease Control

National Institute of Health

Want to Know More?

• Stay Healthy While Pregnant with COVID-19
• COVID-19 and Breastfeeding
• Newborns Risks from Mothers with COVID-19

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Symptoms of lightning crotch during pregnancy

Lightning crotch can feel a little different from person to person, but most often this pregnancy symptom manifests as:

• Sharp, shooting pain in the vagina or pelvic area that lasts only for a moment
• Stinging or a pins-and-needles sensation in the same region
• Brief but intense pelvic pain that’s stronger and shorter than menstrual cramps

What causes lightning crotch?

Experts think this pain is related to your baby growing larger and dropping down into your pelvis before birth (a process called engagement). With your baby’s head lower in your pelvis, there’s more pressure on your cervix and the nerves around the lower part of the uterus.

What can you do for relief?

Unfortunately, there’s not much you can do when Lightning crotch hits, other than grin and bear it. Here are a couple of things you can try for relief:

• Change positions in an effort to get baby off your nerves (literally) — so stand up if you’re lying down or sitting, or sit down if you’ve been standing.
• Wear a belly support garment or belt to help lighten the load on your pelvis.

How is lightning crotch different from other pelvic pain during pregnancy?

While there are different types of pelvic pain in pregnancy, they can feel similar. Lightning crotch pain can feel a lot like round ligament pain but there are key differences:

• Round ligament pain is more common in the second trimester as your uterus grows, but lightning crotch pain generally happens at the end of the third trimester.
• Round ligament pain may feel like it’s radiating out towards your hip bones, and can vary from a sharp pain to a dull ache. Lightning crotch usually feels like a sharp pain or electric jolt in the pelvis or vagina.

Other back pain or nerve-related pain can also feel similar, especially sciatica. The sciatic nerve goes from the lower back down the legs via the pelvis, and when it gets pinched you can also have shooting nerve pain. Here’s how to tell the difference:

• Sciatica can happen anytime during pregnancy, while lightning crotch pain happens late in the third trimester.
• You can feel sciatica anywhere along the sciatic nerve (back, buttocks, and leg) and it’s usually one side. You won’t feel it in the groin or vagina like lightning crotch.

Is lightning crotch a sign of labor?

Lightning crotch pain doesn’t mean you’re going into labor. That said, it can seem like labor pain, especially if it’s your first pregnancy. Here are the main differences:

• Labor contractions are regular and repeating, and get closer together over time. Lightning crotch is random.
• Labor often comes with menstrual-type lower back ache or pain which lasts a long time.

Is lightning crotch dangerous?

Though lightning crotch can be jolting and disruptive, it’s usually nothing to worry about. If the pain lasts more than a minute at a time or you have any other symptoms like dizziness, bleeding or other fluid from the vagina, fever, bad headaches, call your doctor right away. These could be a sign of something serious.

Are there ways to prevent lightning crotch?

• Wear a supportive belly band to reduce the pressure on your lower uterus.
• Stay active and take plenty of desk breaks. Walking and swimming are good options.
• Try a warm bath or massage to relax your muscles and joints.
• Shift your position when you feel a jolt.

The good news is that this pain comes and goes quickly, and you won’t have to deal with it for long.

Want to Know More?

Back Pain During Pregnancy

Hip Pain During Pregnancy

Pregnancy Pains

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Symptoms of migraines during pregnancy

A migraine usually starts out as a dull ache and then eventually becomes a throbbing, constant, and pulsating pain in the temples, in front of the head, or base of the head. Migraines are sometimes accompanied by nausea, sensitivity to light, vomiting, dizziness, and “auras,” which are spots or lines that can occur across one’s vision. The pain can sometimes make it difficult to focus, and symptoms can be debilitating.

Are migraines dangerous during pregnancy?

The only danger is when your headache may be a sign of something else. You should ALWAYS call your health care provider when:

• Your headache is accompanied by a fever
• Your headache persists for more than a few hours or returns frequently
• You are experiencing blurred vision

It is ALWAYS important to let your health care provider know when you are experiencing any headaches and the details about them.

Migraine triggers during pregnancy

Hormonal change is a common trigger for women with migraine. During pregnancy, oestrogen levels increase sharply, while progesterone levels decrease and rise again towards the end of the pregnancy.

Overall migraine improves during pregnancy especially during the second and third trimesters. This improvement may be due to the increased oestrogen levels and increased levels of natural pain-killing hormones (endorphins).

These hormones are several times higher during pregnancy, and though the relief from migraine attacks they provide might last the whole pregnancy, the levels settle back down after delivery, normally allowing migraine attacks to return.

However, not everyone will see an improvement in their migraine, especially in the early weeks of pregnancy. For some women, their migraine is unaffected. Some women experience worsening migraine during pregnancy although this is rare.

During breastfeeding, stable oestrogen levels continue to be protective against having headache again after pregnancy.

However you are affected, it can help to identify any migraine attack triggers that you have, such as lack of sleep, stress, missed meals and dehydration. Keeping a headache diary may help pinpoint your triggers so you can avoid those things. Log when the headache happened, what “triggered” it, and how long it lasted. Common triggers include but are not limited to:

• Stress
• Chocolate
• Cheese
• Coffee
• Weather
• Hormones

Natural Remedies for pregnancy migraines:

During the first three months the symptoms of pregnancy can make your migraine worse. Morning sickness can mean that you feel like eating and drinking less which can cause low blood sugar and dehydration. If you are not careful this can make your migraines worse. You should try to eat small frequent meals and drink frequent small amounts of water to prevent this. You will also be helping reduce any pregnancy sickness. Other remedies may include:

• Dark Room — Often, a migraine can make you sensitive to bright lights. Find a dark room, and turn off any electronics.
• Nap — Lying down to take a short nap can help alleviate migraines. Many people report that an hour nap is often enough to stop the pain.
• Cold Pack — While lying down, place a cold pack or damp towel on your head. The cold should constrict blood vessels in your head and help alleviate the pain.
• Relaxation Techniques — Talk to your doctor about relaxation exercises that are safe during pregnancy. Relaxing the muscles around your back, neck, and head can release the pressure causing the migraine.
• Take care of yourself — Sometimes, migraines can be set off by dehydration, tiredness, not eating well, or lack of sleep. Try to maintain a healthy, balanced lifestyle, which can help mitigate the symptoms of migraines.

How to Treat Migraines when naturally doesn’t work

Sometimes, a migraine might continue to plague you, even after you have tried the above remedies. If the pain persists, you can take Tylenol; however, it is important to avoid Aspirin and Ibuprofen. These are not safe to take during pregnancy. If the migraines become a constant nuisance, you may want to talk to your doctor about alternative medications that are safe to take during pregnancy. You can learn more about which medications are safe during pregnancy here.

If you currently take pain medication for migraines, it is best to discuss with your doctor whether it is safe to continue using. It is best to avoid using any herbal remedies to alleviate migraines during pregnancy, as many have not been tested, and some have been shown to lead to complications.

Want to Know More?

• Role of Vitamin B in Pregnancy
• Pregnancy and Headaches

Compiled using information from the following sources:

1. Migraine Trust

2. Bid MC: Migraine and Pregnancy and Breastfeeding

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• Infections causing COVID-19 in newborns born to mothers with COVID-19 are uncommon.
• Some newborns have tested positive for the virus that causes COVID-19 shortly after birth. It is unknown if these newborns got the virus before, during, or after birth from close contact with an infected person.
• Most newborns who tested positive for the virus that causes COVID-19 had mild or no symptoms and recovered. However, there are a few reports of newborns with severe COVID-19 illness.
• Preterm (less than 37 completed weeks gestation) birth and other problems with pregnancy and birth have been reported among women who tested positive for COVID-19 during pregnancy. It is unknown whether these problems were related to the virus that causes COVID-19.

Caring for newborns when mom has COVID-19

Decide if your newborn is rooming-in with you in the hospital

CDC recognizes that the ideal setting for the care of a healthy, full-term newborn during the birth hospitalization is within the mother’s room (“rooming-in”). Current evidence suggests that the risk of a newborn getting COVID-19 from its mother is low, especially when she uses appropriate precautions before and during care of the newborn, such as wearing a mask and practicing hand hygiene.

If you are diagnosed with or test positive for the virus that causes COVID-19, you should discuss with your healthcare provider the risks and benefits of having your newborn stay in the same room with you. This conversation should begin during prenatal care if possible. Having your newborn stay with you in the same room has the benefit of facilitating breastfeeding and maternal-newborn bonding. Potential risks may include giving the virus to the newborn, although current evidence suggests the risk of a newborn getting COVID-19 from their mother is low if precautions are taken. After discussing, make an informed decision of whether your newborn is staying in the same room with you while in the hospital.

Take precautions when having your newborn stay in the same room with you, if you are in isolation for COVID-19

If you are in isolation for COVID-19 and are sharing a room with your newborn, take the following precautions to reduce the risk of spreading the virus to your newborn:

• Wash your hands with soap and water for at least 20 seconds before holding or caring for your newborn. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.
• Wear a mask when within 6 feet of your newborn.
• Keep your newborn more than 6 feet away from you as much as possible.
• Discuss with your healthcare provider about using a physical barrier (for example, placing the newborn in an incubator) while in the hospital.

If your isolation period has ended, you should still wash your hands before caring for your newborn, but you don’t need to take the other precautions. You most likely won’t pass the virus to your newborn or any other close contacts after your isolation period has ended.

• If you had symptoms, your isolation period ends after
  • 10 days since symptoms first appeared, and
  • 24 hours with no fever without fever-reducing medications, and
  • Other symptoms of COVID-19 are improving
• If you never had symptoms, your isolation period ends after
  • 10 days since the date of your positive COVID-19 test

Take precautions at home if you are in isolation for COVID-19

If you are still in isolation for COVID-19 and have returned home, take the following precautions until your isolation period has ended:

• Stay home to separate yourself from others outside your home.
• Consider isolating from other household members within your home who are not infected.
• Have a healthy caregiver who is not at increased risk for severe illness provide care for your newborn.
  • Caregivers should wash their hands for at least 20 seconds before touching your newborn. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.
  • If the caregiver is living in the same home or has been in close contact with you, they should wear a mask when they are within 6 feet of your newborn for the entire time you are in isolation and for two weeks after you completed isolation.
• If a healthy caregiver is not available, you can care for your newborn if you are well enough.
  • Wash your hands with soap and water for at least 20 seconds before touching for your newborn. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.
  • Wear a mask when within 6 feet of your newborn and other people during your entire isolation period. The mask helps prevent you from spreading the virus to others.

Others in your household and caregivers who have COVID-19 should isolate and avoid caring for the newborn as much as possible. If they have to care for the newborn, they should practice hand hygiene and wear a mask.

Do not put a face shield or mask on your baby

A face shield could increase the risk of sudden infant death syndrome (SIDS) or accidental suffocation and strangulation. Babies move frequently. Their movement may cause the plastic face shield to block their nose and mouth, or cause the strap to strangle them.

There are also no data supporting the use of face shields among babies for protection against COVID-19 or other respiratory illnesses.

CDC recommends all people 2 years of age and older wear a mask in public settings and when around people who don’t live in their household. CDC does not recommend use of face shields as a substitute for masks for the general public, including pregnant or breastfeeding mothers.

Ensure safe sleep for your baby

Safe sleep is an important part of keeping babies healthy.

During the COVID-19 pandemic, parents of babies may experience increased stress and fatigue that could affect their ability to ensure that their baby is sleeping safely. Help reduce your baby’s risk of sudden infant death syndrome (SIDS) and other sleep-related deaths by doing the following:

• Place your baby on his or her back for all sleep times – naps and at night.
• Use a firm, flat sleep surface, such as a mattress in a crib covered by a fitted sheet.
• Have the baby share your room but not your bed. Your baby shouldn’t sleep on an adult bed, cot, air mattress, couch, or chair, whether he or she is sleeping alone, with you, or with anyone else.
• Keep soft bedding, such as blankets, pillows, bumper pads, and soft toys, out of your baby’s sleep area.
• Do not cover your baby’s head or allow your baby to get too hot. Signs your baby may be getting too hot include sweating or his or her chest feeling hot.
• Don’t smoke or allow anyone to smoke around your baby.

Learn more about how to reduce the risk of SIDS.

Bring your baby for newborn visits

Ideally, newborn visits are done in person so that your baby’s healthcare provider can

• Check how you and your baby are doing overall.
• Check your baby’s growth and feeding.
• Check your baby for jaundice.
• Make sure your baby’s newborn screening tests were done (including a bloodspot, hearing test, and a test for critical congenital heart defects) and do any repeat or follow-up testing, if necessary.

Make sure to call and notify your baby’s healthcare provider before visiting if you or your baby have COVID-19.

Source:  Center for Disease Control:

Want to Know More?

After the Delivery

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What causes fetal arrhythmia?

Fetal arrhythmia has been linked to a number of possible causes. In some cases, healthcare providers may not be able to pinpoint the source, especially if the abnormal rhythm is transient.

It is possible that high levels of caffeine consumption may cause heartbeat irregularities, but currently, only case studies have been performed. It is suggested that pregnant women limit their caffeine intake to 200mL of caffeine a day–roughly the amount found in one cup of coffee.

Also, arrhythmia may, at some point in development, be normal. During the second trimester, the baby’s heart may begin to beat irregularly as the electrical pathways of the heart mature. This is natural, and not a cause for alarm unless the irregularity lasts for a considerable period of time.

Some arrhythmias may indicate a structural abnormality of the heart, in which case your healthcare provider will run further tests and take any appropriate action necessary. If the baby’s heart rate is consistently high, your doctor may prescribe you medication that is passed through the placenta to the baby to help regulate the heartbeat.

Should I be concerned about arrhythmia?

The causes of arrhythmia are still relatively unknown. However, based on the information that doctors do have, it appears that most arrhythmias are not life-threatening to you or your baby and will resolve themselves.

In the unusual circumstance that the arrhythmia is more severe, the baby may be born with a heart irregularity that is managed throughout his or her life. There is a remote chance that fetal death may occur while in the womb or during delivery.

Next Steps

Your health care provider’s first step will be to monitor the heart rate and well-being of your baby. However, there may be questions about the condition that warrants further investigation. In these rare cases, your healthcare provider may refer you to a fetal cardiologist for further evaluation.

Want to Know More?

• Most Common Pregnancy Complications
• Understanding a High-risk Pregnancy

Compiled using information from the following sources:

1. DiLeo, G. (2002). The anxious parent’s Guide to Pregnancy (p. 108). New York City: Contemporary Books.

2. Fetal Arrhythmia/Dysrhythmia. (n.d.). Retrieved August 15, 2014.

3. Stephenson, E. (2010, March 19). Heart Rhythm Problems (Arrhythmias).

4. Srinivasan, S. & Strasburger, J., Overview of Fetal Arrhythmias.

5. Weber, R., Stambach, D., & Jaeggi, E. (2011, January 8). Diagnosis and management of common fetal arrhythmias.

6. Zaidi, A., & Ro, P. (n.d.). Treatment of Fetal and Neonatal Arrhythmias.

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Pregnancy Discomfort #1. Morning Sickness

More than 60% of women will experience morning (and all day and night) sickness. The feeling of wanting to throw up (nausea) is not uncommon. Each woman is different; some will only feel the urge to vomit, and some will actually vomit. Remarkably, researchers still cannot reliably pinpoint what actually causes morning sickness.
Most women will experience this charmer for only the first trimester, while others will have the feeling they’re riding a 5-star rollercoaster throughout their entire pregnancy. The good news is that some research shows that women who experience morning sickness have children with higher IQs…feeling better about it already?

How Can You Avoid or Treat Morning Sickness:

1. Eat foods rich in protein. Protein helps ease morning sickness.
2. Invest in products that contain ginger which is clinically proven to reduce morning sickness and safe for both mom and baby. Whether ginger drops, ginger ale, ginger capsules or ginger tea, ginger can help.
3. Make sure to take your daily dose of Vitamin B6. Again, clinically proven to reduce nausea associated with morning sickness. The recommendation is 25mg up to three times per day to keep the throw up at bay! (Remember, the max daily is 100mg!)
4. Drink lots of fluids. Staying hydrated during this time period may be a challenge but it’s a must and will make you feel better.
5. Don’t get out of bed too quickly in the morning. Sitting up too quickly can wreak havoc on your equilibrium…slow and steady wins the race.

If you have severe morning sickness, aka hyperemesis gravidarum, speak with your doctor about your options as you don’t want to get dehydrated or malnourished as this can cause more serious issues. Your doctor may suggest an over-the-counter remedy, an anti-nausea medication, and/or a strict nutritional guide (LOTS of bland, easy to digest foods).

Pregnancy Discomfort #2. Lack of Energy/Lethargy / Fatigue

Another common symptom of pregnancy is how tired you feel, especially during your first and third trimesters (the second trimester is usually the “honeymoon” so enjoy it!). More than half of pregnant mamas experience this symptom. Most women feel like finding a hiding spot to curl up and take a nap.

Let’s not forget, your body is producing new hormones and making a lot of changes to prepare for human creation, it takes a lot of work! You’re also producing more blood to carry nutrients to the baby causing increased effort for your heart and other organs. Mental and emotional stress are also reasons you may be feeling exhausted.

You may have difficulty sleeping later in your pregnancy due to multiple bathroom trips, leg cramps, and heartburn.
Fatigue can be a symptom of anemia, particularly from being iron-deficient. Your body needs iron to make hemoglobin, the substance in red blood cells that enables them to carry oxygen to your tissues and to your baby. According to the American College of Obstetricians and Gynecologists (ACOG), your need for iron doubles to 27 mg during pregnancy due to the needs of the baby, the additional blood produced by your body, and the blood loss that will occur during delivery. Most prenatal vitamins contain enough iron to support this increased requirement (with the exception of gummies). To get enough through food, eat iron-rich foods like red meat, poultry, fish (2-3 servings per week max), dried beans, peas, iron-fortified cereals, and prune juice.

Since ACOG recommends limiting caffeine intake (200mg a day is considered the upper limit), what can you do to make it through the day? Here are some tips on how to beat the sleepy time blues!

How Can You Avoid or Treat Fatigue During Pregnancy?

To reduce lack of energy and pregnancy fatigue:

• If possible, take several cat naps. We recommend a quality pregnancy pillow that provides great support.
• Get up and walk around to get yourself moving!
• Go to bed early, mama!
• Reduce chances of the need to pee waking you up by drinking fluids earlier in the day and avoid drinking at least 2 hours before bed.
• Minimize nighttime heartburn by not eating right before bed (2-3 hours prior).
• Stretch your leg muscles before bedtime to avoid leg cramps and include potassium-rich foods, like bananas, peaches, kiwis, potatoes, and leafy greens in your diet.
• Exercise, unless your health care provider has advised against it. It can improve your mood and energy level. 30 minutes of walking 3+ times a week can help.
• Try to eat every 3-4 hours and make sure to include carbohydrates, protein, and fat in every meal and snack.
• Stick to high-fiber carbohydrates (whole grains, starchy vegetables, fruit) and minimize sweets and refined grains.
• Avoid caffeine if possible (200 mg is considered the max each day).
• Drink plenty of fluids, ESPECIALLY water.
• Reduce stress. Ok, not so easy to do, but spend time on things that you find relaxing. Don’t be afraid to ask for help if you are overstressed. Talk to your healthcare provider for resources- you can even try meditating!

Pregnancy Discomfort #3. Heartburn

The only burn you should feel is from the Extended Triangle Pose position during prenatal yoga! It can help relieve indigestion by the way.

Heartburn during pregnancy is a doozy with more than 50% of women experiencing this symptom, especially during the second and third trimesters. It is not usually a sign of a serious problem, but it can be quite uncomfortable and even painful. Gastroesophageal reflux is often called “acid reflux” or “heartburn.”

Indigestion is also common during pregnancy and can occur with heartburn. Also known as “dyspepsia,” indigestion is just another name for an upset stomach. If you feel full, gassy, or bloated, you have indigestion!

Heartburn occurs when gastric acid from your stomach is pushed up toward your esophagus (the pipe between your mouth and your stomach). This causes a burning sensation behind your breastbone or one that starts in your stomach and seems to rise up. You may also have a sour taste in your mouth or a feeling that vomit is rising in your throat (as we said, pregnancy is amazing, except when it’s not!). It’s important to treat heartburn, as many times it will cause you not to eat properly due to the pain, and if you’re not eating, your baby is not getting the proper nutrition.

How Can You Avoid or Treat Heartburn During Pregnancy?

1. Eat 6 small meals throughout the day instead of 3 regular meals. This can prevent your stomach from becoming too full.
2. Don’t eat too close to bedtime (2-3 hours before)
3. Propping up your pillow to elevate your head above your stomach (gravity can help!). You can purchase a foam wedge that can get you at a good angle to avoid heartburn.
4. No spicy foods or other trigger foods such as chocolate, fried foods, and caffeine.
5. If you’ve tried other ways and nothing seems to work, there are antacids that are deemed safe to take. Before self-medicating, talk to your doctor to confirm what is safe. Calcium carbonate antacids are typically okay.

Pregnancy Discomfort #4. Constipation: Save the pushing for labor!

Don’t worry, you’re not alone- over 70% of women experience this discomfort at some point or another during their pregnancy. There are a few different things that cause constipation during pregnancy:

1. Thanks to your hormonal “free-for-all,” your digestive tract slows down (relaxes) to help you absorb all the vitamins and minerals that your new houseguest requires.
2. The expanding uterus puts pressure on the intestines around it, causing further delays.
3. The increased iron found in your prenatal vitamins could be causing a major backup too! Talk to your healthcare provider about other options (such as taking smaller doses throughout the day).

How Can You Avoid or Treat Constipation During Pregnancy?

1. Eat foods high in fiber. Try to do this from the beginning as a preventative measure. Good foods include split peas, black beans, lentils, lima beans, almonds, avocados, berries, oat bran muffins, oatmeal, and more.
2. Drink at least 8 glasses of water each day. Staying hydrated is a must to keep things moving along!
3. Take a pregnancy-safe probiotic to help maintain healthy digestion.
4. Get exercise! Gentle exercise can help get your bowels moving and your system regular.
5. Try a prenatal vitamin with special gentle iron to reduce the instance of constipation.

Pregnancy Discomfort #5. Insomnia: I can’t stay asleep no matter what I do!

You’re not alone! According to the National Sleep Foundation’s 1998 Women and Sleep poll,78% of women report more disturbed sleep during pregnancy than at other times.
The term insomnia includes having a hard time falling asleep and/or staying asleep.
Hormonal changes are one of the biggest reasons for fatigue and sleep issues during pregnancy. These changes may have an inhibitory effect on muscles, which may result in snoring, and in heavier women increases the risk of developing sleep apnea. In addition, your new level of hormones may be partly responsible for the frequent trips to the little girls’ room during the night. These interruptions, as well as those caused by nausea, heartburn, and other pregnancy-related pains, can result in loss of sleep. Emotional turmoil and stress about delivering a 7-9 lb human being are also to blame for insomnia.
Some of the common sleep issues that occur or are made worse during pregnancy are:

• Insomnia
• Restless legs syndrome (RLS)
• Sleep apnea
• Nocturnal gastroesophageal reflux (nighttime GERD)/heartburn

How Can You Avoid or Treat Insomnia During Pregnancy?:

• Plan and prioritize sleep time.
• Try to exercise about 30 minutes each day unless directed not to by your healthcare provider.
• Sleep on your left side to improve blood flow and nutrients to your fetus and kidneys and avoid lying on your back for extended periods of time.
• Use a pregnancy pillow to prop you in a comfortable position
• Drink plenty of fluids during the day, especially water, and reduce the amount you drink 2 hours before bedtime.
• Stop eating spicy, acidic, or fried foods, and eat frequent smaller meals throughout the day.
• Snoring is common during pregnancy, but if you’re having pauses in your breathing, get checked for sleep apnea. Also, have your blood pressure and urine protein checked—especially if you have swollen ankles (a.k.a. cankles) or headaches.
• If you have Restless Leg Syndrome, it may be due to iron or folate deficiency so get tested.
• If you can’t sleep, don’t force yourself- try to read or meditate to relax.
• Use a nightlight instead of turning on the lights in the bathroom which will help you get back to sleep faster.
• Try meditation to settle your brain and calm your nerves.  Go online for some great mediation options.

Don’t be afraid to talk to your healthcare provider about sleep issues. It may be an alert to a nutritional deficiency or a respiratory issue (sleep apnea) that your doctor will want to check for. They may also have helpful suggestions!

Pregnancy Discomfort #6. Bleeding Gums & Tooth Pain

Issues with oral health during pregnancy are overshadowed by some of the more obvious symptoms, but this is not one to ignore! A recent survey by Cigna Insurance Company found that 75% of pregnant mamas experience some type of oral health issue during their pregnancy. The symptoms included bleeding gums, toothache, and increased tooth sensitivity.

Only 57% of the women actually visited a dentist during their pregnancy. It’s important to visit your dentist during pregnancy because any infection in the oral cavity can have a negative effect on the health of your baby.

The most common oral discomfort pregnant women encountered were bleeding gums. This is primarily due to the hormonal changes during pregnancy which make the gums sensitive to the presence of plaque. Bleeding gums, if left untreated, can lead to periodontal disease (gingivitis). Many studies state that periodontal disease can be a potential risk for low birth weight babies. Bleeding gums can also lead to a gingival recession which can cause sensitivity to hot and cold temperatures and make teeth more susceptible to decay at the gum line. Your dentist can give you suggestions on treatment and gentle tooth care.

How Can You Avoid or Treat Bleeding Gums During Pregnancy?:

• Consistently and meticulously brush your teeth and floss. But be sure to be gentle, as flossing can cause bleeding on already sensitive gums.
• Visit the dentist/hygienist every 3 months during pregnancy and continue with this frequency until finished nursing.
• Eating healthy and taking prenatal vitamins are also an important factor in maintaining both oral and general health during pregnancy; getting proper nutrition is imperative.

Pregnancy Discomfort #7. Headaches and Migraines

Headaches during pregnancy can be a result of hormonal changes, tension, congestion, constipation, lack of sleep, dehydration, low blood pressure, low blood sugar, and even caffeine withdrawal. In some cases, it is caused by preeclampsia.

Preeclampsia (also called Toxemia)
A strong headache in the second or third trimester may be a sign of preeclampsia or high blood pressure during pregnancy. Preeclampsia is an uncommon condition affecting about five to ten percent of pregnancies. Headaches that are a result of preeclampsia are consistent, persistent, and throbbing. Mamas with preeclampsia may also have complaints of blurry vision or seeing spots, weight gain (more than one pound per day), pain in the upper right abdomen, and hands and face getting swollen. If you get a headache that is out of the norm or you’re experiencing any of these symptoms, you should call your doctor or midwife right away.

How Can You Avoid or Treat Headaches During Pregnancy?

• Posture plays an important role. Try to stand up and sit up straight.
• Get plenty of rest and practice relaxation exercises (de-stress!)
• Exercise (daily 30-minute walk)
• Eat frequent and well-balanced meals
• Foods can often be a trigger for headaches or migraines. Keep a food diary and avoid foods that set off headaches, such as chocolate, caffeine, dairy, meats with preservatives, etc.
• Stay hydrated by drinking at least 8 cups of water a day (dehydration can be a trigger)

If you have a headache or a migraine, you can try to relieve it by:

• Applying a compress to your head or neck
• Eating more frequent meals to avoid low blood sugar & drink more water
• Massage your head (or have someone to do it for you)
• If you are sensitive to light and/or sound, try blocking these out or minimizing (sunglasses, earphones to block noise)
• Take a dose of acetaminophen (if your doctor approves)

If you experience headaches that become worse or come on suddenly, headaches that are different than normal, headaches that are accompanied by vision changes, sudden weight gain, pain in the upper right abdomen, or swelling in the hands and face, contact your healthcare provider immediately as this could be a sign of preeclampsia.

Compiled using information from the following sources:

1. Koren, G., Madjunkova, S., & Maltepe, C. (2014). The protective effects of nausea and vomiting of pregnancy against adverse fetal outcome-A systematic review. Reproductive Toxicology. Elsevier Inc. https://doi.org/10.1016/j.reprotox.2014.05.012

https://www.sciencedirect.com/science/article/pii/S0890623814000975

2. Nulman, I., Rovet, J., Barrera, M., Knittel-Keren, D., Feldman, B. M., & Koren, G. (2009). Long-term Neurodevelopment of Children Exposed to Maternal Nausea and Vomiting of Pregnancy and Diclectin. Journal of Pediatrics, 155(1). https://doi.org/10.1016/j.jpeds.2009.02.005

https://www.sciencedirect.com/science/article/pii/S0022347609001176

The post Common Discomforts of Pregnancy appeared first on American Pregnancy Association.

What are the Reasons to Have a Blood Transfusion During Pregnancy?

There are two primary reasons you may need a blood transfusion while pregnant. These include the development of severe anemia close to your due date, or hemorrhaging at some point during your pregnancy.

Iron-Deficiency during pregnancy

Once a hemoglobin estimate has been performed, a medical professional can diagnose the extent of your anemia. For patients diagnosed with severe anemia, it is important to determine the causes and the best course of treatment.

While it may be difficult to pinpoint exact causes of anemia, particularly if a combination of factors has resulted in anemia, sometimes the frequency of anemia in a given region may give a clue as to its cause. For instance, in areas where malaria is common, the course of treatment will be tailored to take into account the possibility of malaria. Your doctor will prescribe antimalarials possibly in combination with another treatment.

If you have a hemoglobin count lower than 7 g/dl and are 34 weeks along in your pregnancy or more, the possibility of transfusion will be discussed. A hemoglobin measure lower than 5 g/dl greatly increases your risk of mortality. It is crucial you receive a transfusion before very severe anemia develops. In addition, it is imperative that severe anemia is effectively treated before labor. Often, relatives who are willing to donate blood are asked to provide the transfusion.

Hemorrhage

Hemorrhaging is bleeding excessively in an urgent situation. This bleeding can lead to severe anemia. A transfusion is often required in order to counteract excessive blood loss. Hemorrhaging can occur at any time during pregnancy. If you experience a miscarriage or ectopic pregnancy, it can lead to hemorrhaging early in your pregnancy.

It is also possible to experience hemorrhaging after your 24th week of pregnancy. You are probably more familiar with the possibility of hemorrhaging during delivery and immediately following delivery, known as intrapartum hemorrhaging and postpartum hemorrhaging respectively. While doctors will try to prevent the need for a blood transfusion, under some conditions it is absolutely necessary to save you and your baby’s life.

Having a Blood Transfusion During Pregnancy

Most often, the transfusion required for pregnant and recently pregnant women only involves red blood cells. It is less likely platelets and plasma will be needed. In order to receive the transfusion, a small tube will be inserted into a vein in your hand or arm.

The transfusing blood will move through a drip into your body. Each bag contains approximately 1/3 of a liter of blood and takes an estimated 3 hours to fully transfuse. In some cases, this rate of transfusion can be expedited.

What are the Side Effects of a Blood Transfusion While Pregnant

You will be closely monitored during any blood transfusion while pregnant by a health care professional.
Minor side effects include:

• Headache
• Fever
• Rash/itchiness

These side effects can be alleviated by medication and typically get better in one day.

More serious complications include the following:

• Difficulty breathing
• Severe headache
• An abrupt drop in blood pressure that may be characterized as life-threatening

Once you experience side effects, the transfusion will be halted, and your current situation will be assessed before proceeding. Under conditions of massive transfusion or multiple transfusions, more severe pregnancy complications may arise.
These complications include:

• Hypothermia
• Hyperkalemia – electrolyte imbalance involving low potassium levels
• Hypocalcemia – low calcium levels
• Coagulopathy – clotting factors are diluted leading to weakened or impaired coagulation
• 2, 3-DPG depletion – depletion of a blood component that regulates how easily oxygen is moved from hemoglobin into tissue
• Jaundice
• Infection
• Alloimmunization
• Transfusion Reactions

When these severe side effects are experienced, a medical team will intervene.

Blood Transfusions During Pregnancy: Final Notes

If you’re asked to undergo a blood transfusion, make sure to get a full understanding of all of the options available to you. If it is an emergency situation, a doctor will likely make an educated decision for you. You can decline a blood transfusion or change your mind about receiving one at any time, but be aware that under some circumstances a blood transfusion may be the only way to keep you alive. If you have any questions about your options or concerns about the safety of blood transfusions, you can ask your healthcare professional.

Want to Know More?

• How to Treat Iron Deficiency Naturally During Pregnancy
• Pregnancy Nutrition

Compiled from the following sources:
Cohen, Wayne R. (2000). Postpartum Hemorrhage and Hemorrhagic Shock in Cohen, Wayne R. (Ed.), Complications of Pregnancy, 5^th edition (812-3). Philadelphia, PA: Lippincott Williams & Wilkins.
MacDonald, R. (1977). Red cell 2,3-diphosphoglycerate and oxygen affinity. Anaesthesia, 32(6). Retrieved from: https://www.ncbi.nlm.nih.gov
Royal College of Obstetricians and Gynaecologists. (2009, Feb. 20). Blood transfusion, pregnancy, and birth – information for you. 
Royal College of Obstetricians and Gynaecologists. (2009, Feb.). Blood transfusion, pregnancy, and birth – information for you.
Walraven G. Treatments for iron-deficiency anemia in pregnancy: RHL practical aspects (last revised: 20 June 2007). The WHO Reproductive Health Library; Geneva: World Health Organization.

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