Alcohol-dependent women who suddenly cease drinking may experience withdrawal symptoms that could be threatening to the mother, particularly if she has a history of withdrawal delirium or seizures. An additional concern is that alcohol withdrawal may also cause fetal distress. If a woman is experiencing alcohol withdrawal symptoms, inpatient detoxification is recommended. Most programs treat alcohol withdrawal in pregnant women with benzodiazepines. Benzodiazepines were previously thought to increase birth defects however, recent studies have not supported this claim. Pooled data from cohort studies show no association between brief fetal exposure to benzodiazepines and the risk of major malformations or oral cleft (31,32). However, benzodiaz-epines can cause neonatal hypotonia, hypothermia, and mild neonatal respiratory distress when taken in late pregnancy or around the time of delivery (33).
The controversy arises because medical science hasn't defined an absolute safe level of alcohol intake during pregnancy. Scientific data shows that daily drinking and heavy binge drinking can lead to serious complications, although little info is available about occasional drinking. The American College of Obstetricians and Gynecologists and the Food and Drug Administration recommend avoiding any amount of alcohol. If you think you may have a drinking problem, don't feel uncomfortable talking to your practitioner about it. Special questionnaires are available to help your doctor identify whether your drinking is excessive enough to pose a risk to you and the fetus. If you think you may have a problem, discussing this questionnaire with your practitioner is crucial to your baby's health and to yours.
An essential aim of public health is prevention. Primary prevention of developmental disorders can be defined as an intervention to prevent the origin of a developmental disorder - for example, by rubella vaccination, or by correction of an aberrant lifestyle such as alcohol abuse. Moreover, primary prevention of developmental disorders can be achieved when a chemical substance is identified as a reproductive toxicant and either is not approved for marketing, or is approved with specific pregnancy labeling, restricted in use or removed from the market. This is in contrast to secondary prevention of developmental disorders, which means the prevention of the birth of a child with a developmental defect - usually by abortion. In this context, tertiary prevention indicates an early detection of a metabolic disorder so that, for example, in the case of phenylketonuria (PKU) as an intervention a special diet low in phenylanaline is indicated to prevent mental retardation (phenylpyruvic...
The main section of the book, Chapters 3 and 4, is about pregnancy. Pregnancy is usually thought of in terms of three trimesters and the development of the baby in this time. This book will look at the 'psychological stages' of pregnancy. How might you feel in those early weeks What sorts of worries do newly pregnant women have How do they cope with morning sickness or cut down their alcohol intake The middle of pregnancy can be a somewhat different time emotionally. Most women have accepted the pregnancy and are getting used to their new identity of 'pregnant woman'. The focus therefore shifts away from the internal to the external How can I prepare for this baby How will my life change As pregnancy draws to a close, some of the fears of early pregnancy may return. Predominantly these tend to be fears about labour and giving birth. As the pregnancy comes to an end, it is time to disengage from former responsibilities and reinvest in the new future.
Ven though you're pregnant and your body is already undergoing miraculous changes, your day-to-day life goes on. How will you need to change your lifestyle in order to make your pregnancy go as smoothly as possible What things in your life don't need to change, or need to be modified only slightly You have a lot to consider your job, the general level of stress in your life, what medications you take, whether you smoke or drink alcohol regularly, and what to do about routine things like going to the dentist or hairdresser. If you're like most normally healthy women, you'll probably find that for the most part, your life can go on largely as usual.
People who drink heavily also tend to h ave a poor diet. Not only does alcohol deplete their B vitamins, for example, but they tend not to e at properly. And, since alcoholic drinks are h igh in calories, they are fattening, too. Also, beware succumbing to the temptations of binge drinking as a misguided remedy for stress.
Another 1970s development underscoring this point was the advent of government agencies (and their semi-public and private disciples) chartered to address social problems made visible by the revolutions of the 1960s. Sociologists coined the term moral entrepreneurs to characterize bureaucracies such as the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism in tandem with the growing roster of institutions, private programs, and academics deploring teenage drinking, drugs, pregnancy, mental illness, and a host of largely manufactured crises to compete for dwindling 1970s funding.26 The fact that most of the excesses of the 1960s were ebbing on their own in the 1970s, particularly among younger ages, was an inconvenience to politicians' and agencies' campaigns especially since reductions in teen pregnancy and birth rates appeared to have been in response to liberalized opportunities that provided new education pathways for poorer young women...
Miranda trained as a nurse in 1985 and as a midwife in 1990. She has worked in a number of hospital and community midwifery settings before completing her MSc in Midwifery at Nottingham University. The post of Consultant Midwife in Leicester has enabled Miranda to concentrate on providing specialised services for particularly vulnerable groups and lecture on public health, teenage pregnancy and vulnerable groups, drugs and alcohol abuse, sexual health and child protection.
When trying to determine if your baby has colic, the first thing to do is rule out illness as the cause for the crying. Colicky babies have a healthy sucking reflex and a good appetite. Usually, babies who are ill won't have the same strong sucking reflex, and they'll drink less milk. Colicky babies usually like to be cuddled and handled. Ill babies may not like to be handled despite their fussiness. Colicky babies may spit up from time to time, but if your baby is actually vomiting or otherwise seems sick, you should call your child's doctor. Even if your baby doesn't have symptoms of illness,
Normal pregnancy nutritional guidelines focus on several dietary elements. Major topics include caloric intake, macronutrient proportion, vitamins and minerals, and alcohol consumption. The energy requirements of the fetus must be met to ensure proper development and provide for postpartum lactation without causing excessive maternal weight gain. The energy standard to support a pregnancy has been debated heavily and will be explored in the GDM nutritional therapy section below. The American College of Obstetricians and Gynecologists advocates several basic concepts for a balanced diet for pregnant women. They suggest eating three to four servings of fruits and vegetables, nine servings of whole grains for energy, three servings of dairy for calcium, and three servings of meat to reach daily protein requirements. Vitamin supplementation to achieve daily nutrients, as an adjunct to a healthy diet, is encouraged when recommended by the woman's physician. Certain foods should be avoided...
In Chapter 3 there was discussion of how to manage drinking and smoking in pregnancy. Clearly, some women and or their partners will need the support and guidance of a specialist drug advisory service if they are regular users of non-prescribed drugs or heavy drinkers. These behaviours can have very serious consequences for the development of your baby and your pregnancy will definitely need to be monitored closely.
Drinking because he felt he might soon lose his job as a bank manager because 'he couldn't hack it any more'. He said that heavy drinking was almost part of the job and everyone did it. Grant was stuck in a situation where until he was willing to stop drinking he wasn't able to begin to identify the problems that led him to hide behind alcohol use. He wanted to return to his partner but he couldn't stay sober long enough to sort anything out.
A common survey scam is to employ problem inflators that rope expanded age groups, harmless behaviors, rare behaviors, and speculative behaviors to grossly expand teen-problem numbers. We will see many, many, many of these. An example among hundreds is the junk survey by Kaiser Family Foundation and Joseph Califano, Jr.'s Center on Addition and Substance Abuse (CASA) whose media-friendly design wildly exaggerated how many teens have sex after using drugs or drinking alcohol.
This is term used to describe babies who are smaller than what they should be at their gestational age. The most common cause is a problem in the placenta and this impairs the delivery of nutrition and oxygen to the baby. Smoking and excess alcohol consumption can lead to this. Birth defects and genetic disorders can also cause IUGR.
A low cholesterol diet and limited alcohol consumption should be considered prior to conception. Literature suggests that although pregnancy does not predispose to gastrointestinal disorders such as cholecystitis or pancreatitis, pregnancy does increase the risk of cholelithiasis and biliary sludge5. Alcohol abuse
Theophylline is one of the methyl xanthines. The action of this asthma medication is described in Chapter 2.3. These xanthines are well absorbed from the gastrointestinal tract they cross the placenta, and cause increased fetal activity and a significant increase in its heart frequency. In animal studies, extremely high doses of caffeine (200 mg kg per day) caused minor development anomalies of the phalanges. For this reason, in 1980 studies were conducted in the USA, with the support of the health authorities, consumer organizations, and coffee and cola manufacturers, on whether caffeine-containing drinks could also cause birth defects in humans. Unlike the animal studies mentioned, adults usually do not consume more than 3-6 mg kg of caffeine daily. Fxtensive epidemiological studies in several countries gave no indication for any reproductive toxicity or teratogenicity under these conditions (Browne 2006, Castellanos 2002, Christian 2001). A meta-analysis involving about 50000...
The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions showed that the number of American adults who abuse alcohol increased from 13.8 million (7.41 ) in 1991-1992 to 17.6 million (8.46 ) in 2001-2002 (National Institute on Alcohol Abuse and Alcoholism) (14). The accessibility of alcohol and its status as a legal substance is cause for concern because women who are unaware of their pregnancy may continue drinking. According to a cross-sectional study of 13,417 women, 45 reported consuming alcohol during the 3 mo before finding out they were pregnant, whereas 5 reported consuming six or more drinks per week (15). Risk factors for frequent drinking during the periconceptional period included being one or more of the following unmarried, a smoker, white non-Hispanic, 25 yr of age or older, or college-educated (15). A role of health care providers is to educate women of childbearing age to consider the effects of drinking in cases of unknown pregnancy. Efforts to...
The effects on young children of exposure to moderate amounts of alcohol (about one standard drink or less a day ) through breast milk are not clear. One study reported adverse effects on infants' sleep and gross motor development (35), whereas another study did not identify motor deficits in exposed toddlers (36). Nevertheless, women with substance and alcohol use disorders should be advised not to consume alcohol if nursing. An additional negative effect of maternal alcohol consumption is that it may slightly reduce milk production.
Megaloblastic anaemia is usually caused by deficiency of folic acid or vitamin B12 (cyanocobalamin), but more rarely may be drug-induced or associated with myelodysplastic syndrome. It is also possible to see a non-megaloblastic macrocytic picture in liver disease, hypothyroidism and alcoholism. Excessive alcohol consumption3,4
I Eat more and healthier foods, including more fruits and vegetables, beans, meat, fish, I Take Iron tablets every day as explained by the health worker. I Rest when you can. Avoid lifting heavy objects. I Sleep under a bednet treated with Insecticide. I Do not take medication unless prescribed at the health centre. I Do not drink alcohol orsmoke.
(g) Smoking, drug addiction, and alcoholism. Physiologic problems may have been present. Pregnant patients who indulge in this category may have major physiologic problems. There is the possibility that the patient may not consume sufficient quantities of nutritious foods and, in addition, can cause major problems to the fetus.
(1) Anything that depresses good nutritional intake should be evaluated. This type of depression may be caused by nausea or vomiting, food fads or lack of finances, smoking or alcoholism, or personal or social problems. If a problem is identified, it should be reported to the charge nurse or physician for appropriate referral to the correct people who can relieve or eliminate the problem.
Goverde HJM, Dekker HS, Janssen HJG e t al. Semen quality and frequency of smoking and alcohol consumption an explo rat ive s tudy. International Journal of Fertility 1 995 40 135-8. Kreset DM. Declining sperm counts. British Medical Journal 1 9 9 6 3 1 2 45 7-8. Olsen J, Rachootin P, Schiodt A et al. Tobacco use, alcohol consumption, and infertility, International Journal of
And stimulants, the ingestion of tainted foods and the prevalence of 'organic poisons' such as syphilis and tuberculosis. Although Nordau argued that degenerates would ultimately breed themselves out of existence, his book provoked anxiety and stimulated a public debate because the 'causes' he highlighted were so clearly visible in the modern world.6 They can be divided into environmental factors (low-quality, industrially produced food opiate and tobacco consumption) and hereditary ones (syphilis, tuberculosis and alcoholism were all thought to be hereditary). Of all these, syphilis caused the most concern, so that even a moderate commentator like J.W. Ballantyne was spurred into rhetorical mode when he came to consider the effects of syphilis on the unborn child. In his book Expectant Motherhood (1914), he wrote that syphilis brings long-continued disease to the mother and is a 'death warrant' for the unborn child 'even if the syphilitic child in the womb comes into the world alive,...
Untreated pheochromocytoma is associated with increased fetal and maternal morbidity and mortality. The maternal mortality rate was 48 before 1969 and 26 in the 1970s, and subsequently it fell to 17 87-89 . Since 1990, approximately 85 of cases have been diagnosed antenatally, perhaps because of increased awareness 84 . In one series, antenatal diagnosis reduced the maternal mortality and the fetal loss rate to less than 1 and 15 , respectively 88 . A hypertensive crisis may be precipitated by abdominal palpitation 84 , drugs, including metoclopramide 87 , or labor. Pheochromocytoma should be actively sought for in patients who have affected family members with von Hippel-Lindau or multiple endocrine neoplasia 2 syndromes 90 . The lack of proteinuria in pheochromocytoma may differentiate pheochromocytoma from hypertension associated with preeclamp-sia. Other potential differential diagnoses include anxiety, cocaine use, pulmonary embolism, and alcohol withdrawal 84 .
A miscarriage may be triggered by several reasons, which greatly depend on the health status of both the mother and the fetus. Miscarriage may also be related to unhealthy lifestyles such as excessive alcohol intake and smoking. If three consecutive miscarriages occur, this condition is known as habitual (recurrent) miscarriages.
'Fetus education' was a feature of Chinese obstetrics in ancient times. This was based on the belief that various lifestyle influences from the mother (including diet, work, sexual activity and emotional state) could affect the fetus's forming constitution. This is of course borne out by modern research which shows that various lifestyle habits such as diet, smoking, alcohol consumption and so on do affect the constitution of the fetus deeply. The main difference from the ancient Chinese views on 'fetus education' is that modern Western views concentrate mostly on factors which affect the fetus adversely, while ancient Chinese gynaecologists believed that by manipulating her diet and environment and paying attention to her emotional life, the expectant mother could affect the fetus positively as well.
A lack of DHA supplied to the fetus and neonate via the mother can lead to a variety of long-term problems and conditions, such as hyperactivity, dyslexia, depression, alcoholism, drug addiction and schizophrenia. The decline in fish consumption has led to a reduction in the amount of DHA in the maternal diet. (For food sources see Second trimester above.)
Although a causal relationship between depression and substance abuse has not been clearly elucidated, the connection between depression and substance abuse (especially smoking and alcohol use) is of note. Depression during pregnancy is significantly associated with prenatal substance abuse. Finnish studies have found substance abuse to be co-morbid with depression in 6.4 of women (56). Also, in a recent US study of 186 pregnant women, 8 were found to have both psychiatric illnesses and substance abuse disorders (57). More critically, a study of1014 women of low SES showed depressive symptoms (as per CES-D scores 16) to be significantly associated with smoking, as well as alcohol and cocaine use (57a). Alcohol consumption, smoking, and street drug use have been clearly associated with neonatal morbidity and mortality when used or consumed in even small to moderate amounts during pregnancy (9).
Michelle Goldie trained as a midwife in Leicester and currently works as a specialist midwife in substance and alcohol misuse at the University Hospitals NHS Trust, Leicester. In addition, she works in the maternal medicine clinic, has a research interest in respiratory disease and pregnancy and has published research presented at the American Thoracic Society.
More likely to have reached a more senior position within her chosen career and therefore be more financially secure. She may also have taken the opportunity to have accessed and implemented pre-conceptual advice, such as taking folic acid, reducing her alcohol intake and stopping smoking.
Inappropriate hyperinsulinemia, either absolute or relative, is the initiating cause of hypoglycemia in diabetes mellitus. Hyperinsulinemia is the rule in diabetes mellitus, both Type 1 and Type 2, because of the therapeutic delivery of insulin into the peripheral rather than portal circulation and because of the empirical algorithms used to administer insulin. Absolute hyperinsulinemia, due to excessive levels of circulating insulin because of an excess of dosage or irregularity of absorption, causes hypoglycemia more frequently during the hours preceding meals or in the first morning hours. Relative hyper-insulinemia is due to other conditions such as delayed or inadequate diet (especially as far as the range of carbohydrates is concerned), physical exercise, renal failure, excessive alcohol consumption, delayed gastric emptying. In these conditions usually hypoglycemia occurs after meals.20
About 30 years ago, a clinical picture that has been well-known for centuries (and was noted during the gin epidemic in England between 1720 and 1750) was rediscovered . Alcoholism during pregnancy causes a specific complex of congenital organic and functional developmental defects known as fetal alcohol syndrome (FAS) (Jones 1973, Lemoine 1968, Rouquette 1957). The milder version, in which there is primarily functional damage, is referred to as fetal alcohol effects (FAE). There is still debate regarding the terminology (Aase 1995). At the center of all functional alcohol damage to the fetus are the effects on the central nervous system, referred to as alcohol-related neurodevelopment disorder (ARND). Alcohol is ihe most widely used teratogen, and causes birth defects more often than any medication. Refraining from alcohol during pregnancy is the most effective way to prevent birth defects. Prenatal damage as a result of chronic alcoholism comes about primarily because of the direct...
In 1997 the Royal College of Obstetricians issued a press release which stated that there are no proven adverse effects on pregnancy outcome when women consume less than 15 units of alcohol per week during pregnancy. Florey et al. (1992) put the safe level at less than 10 units of alcohol per week. The fact is that there has been and will continue to be much controversy and debate over establishing what is a safe level of alcohol consumption. Affected babies may show signs of alcohol withdrawal at birth and therefore be irritable, jittery, have feeding problems and elicit a highpitched cry. Babies demonstrating such symptoms should therefore be meticulously examined to exclude conditions such as atrial and ventricular septal defects and should be referred to a paediatrician for assessment. retardation. Alcohol consumption has been associated with reduced fertility in women (Jensen et al. 1998) The research states that for someone who is well nourished and is not a heavy drinker...
Poisoning with methanol during pregnancy can secondarily damage ihc fetus, if the acidosis is of long duration. Although methanol crosses the placenta, the fetus seems to be relatively well-protected at first owing to its slower metabolism of methanol into its toxic metabolites like formaldehyde. The classical therapy with intravenous ethanol exposes the fetus to alcohol, and is therefore not totally harmless because of the possible neurological consequences seen with binge drinking and tocolysis with alcohol (Nulman 2004). This is why fomepizol has been suggested more recently as an alternative antidote (Velez 2003). At any rate, neither with methanol nor with ethylene glycol intoxication should (alcohol) therapy be withheld because of a prcgnancy (Tencnbein 1997). A report on a case of methanol intoxication during late pregnancy describes a healthy newborn after the treatment of the mother with ethanol, hemodialysis, and alkalinization (Hantson 1997), In another case report, the...
Clinical data on the effects of maternal alcohol consumption on the fetus are the most widely researched and understood compared to other substances of abuse. In utero exposure to alcohol is associated with a range of disorders from physical malformation to cognitive deficits. Prevention efforts begin with health care providers advising women to take appropriate measures to avoid unintentional pregnancy if they are consuming alcohol.
Most of the studies have been done by laboratory protocol. Mothers serving as their own controls were given vodka in orange juice, which they had to consume in 10 minutes. Except in the case of alcoholics, this is not generally how alcohol is consumed. Blood and milk levels were drawn and the infants fed promptly. The infants receiving alcohol sucked less well. Vodka, which is tasteless and odorless, was reportedly detected hy smell in the milk by adult
Studies now support that alcohol should be avoided during pregnancy to prevent the possibility of fetal alcohol syndrome, which includes growth retardation, mental deficiency, and craniofacial or musculoskeletal abnormalities. It is now believed that as little as one to three ounces of alcohol per day may be dangerous.
Cleft palate and lip probably occur as the result of a number of factors. In some cases, genetics appear to play a role. It's likely that the susceptibility for developing the condition is inherited, probably through several different genes. Factors to which the fetus is exposed early in pregnancy may also be involved. Recent research indicates that binge drinking (five or more drinks at one time) of alcohol during the first three months of pregnancy increases the risk for a cleft defect in an infant. Some cases occur as a part of a syndrome involving additional birth defects. Prevention and Prenatal Testing To help prevent cleft palate and lip (and other birth defects), pregnant women should avoid drinking alcohol, and they should make sure they are getting proper nutrition and prenatal care. Prospective parents who have cleft lip or palate should be aware that, in some cases, their children might have a significantly increased risk for the condition. Parents who have a child with a...
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