Maternal Weight Gain Ebook

Pregnancy Diet Plan

Pregnancy Diet Plan

The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.

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Pregnancy Without Pounds

This proven program will get you through your pregnancy in better shape than most other women in as little as 27 minutes a day and with minimal effort. It contains all the information that I believe will Help you to look and feel like I did barefoot and beautiful! Inside you will learn Exactly how to avoid unwanted pounds, overcome your food cravings, care for your skin, dress to kill and look like one Hot Mama. Ive also put together Fifty simple, yet extremely effective pregnancy-friendly exercises and stretches to keep you and your body looking and feeling Great (includes 3 different fitness programs depending on Your fitness level)!

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24 body weight changes after pregnancy

Weight increases suggest that pregnancy may not have a significant influence on body weight for a sizable percentage of women. However, approximately 20 of the women studied experienced a 5 kg or greater weight increase after pregnancy 44, 46-48 . In the NMIHS, almost 16 of women were more than 6.4 kg heavier by 10-18 months postpartum. Therefore, use of the mean value to assess body weight increases after pregnancy fails to adequately reflect the population at risk 44 .

13 Reproductive stages

Primordial germ cells arc present in the embtyo at about 1 month after the first day of the last menstruation. They originate from the yolksac-entoderm outside the embtyo. and migrate into the undifferentiated primordia of gonads located at the medio-ventral surface of the urogenital ridges. They subsequently differentiate into oogonia and oocytes, or into spermatogonia. The oocytes in postnatal life are at an arrested stage of the meiotic division. This division is restarted much later after birth, shortly before ovulation, and is finalized after fertilization with the expulsion of the polar bodies. Thus, all-female germ cells develop prcnatally and no germ cells are formed afterbirth. Moreover, during a female lifespan approximately 400 oocytes undergo ovulation. All these facts make it possible to state that an 8-weeks' pregnant mother of an unborn female is already prepared to be a grandmother Final morphological and functional development occurs at different times during...

Cardiorespiratory System

Glioma Nasal

The proper circulatory pathways must also be established following birth in order to ensure adequate pulmonary blood flow. The normal increase in pulmonary blood flow after birth may be prevented by a failure of pulmonary vascular resistance to fall, as in persistent pulmonary hypertension of the newborn, or in congenital heart disease, where there is an obstruction of systemic venous blood flow into the lungs as occurs in pulmonary atresia. Furthermore, oxygen transport to the tissues may be inadequate because systemic arterial supply is reduced by myocardial failure, or by congenital heart lesions in which left ventricular output is impaired, as with severe aortic stenosis or aortic atresia. Figure 1.17. Choanal atresia results from blockage of one or both choanae and may present shortly after birth with cyanosis which is relieved when the infant cries. Unilateral choanal atresia may present later in life with the inability to breathe through one side of the nose. Narrowing occurs...

Prenatal Care To Reduce Medical Risk

The focus of the services offered during prenatal care is to identify medical risks and attempt to reduce their impact on the pregnancy both for the mother and her fetus. This can be enhanced and expedited if a thorough preconceptional consultation has occurred, but needs to be detailed at the first visit after pregnancy has commenced. The major goal of subsequent prenatal care visits is to determine the health status of the fetus and the pregnant woman and to initiate a plan of care for the remainder of the pregnancy and peripartum period that will maximize the chances of a healthy outcome for both. At the first visit after pregnancy has commenced, a similar history is taken as outlined in Table 1-2 if it was not done as part of the preconceptional consultation. For the woman who had a preconceptional consultation, the history is updated to reflect any changes that have occurred in the interim. Particular attention should be placed on confirming the duration of the pregnancy. This is...

Summary on early growth delay

Damm's study showed that even non-obese glucose-tolerant women with previous GDM are charaterized by the metabolic profile of Type 2 diabetics, i.e. insulin resistance and impaired insulin secretion. Hence, the combination of this finding together with the significantly increased risk for development of diabetes indicates that all women with previous GDM should have a regular assessment of their glucose tolerance in the years after pregnancy.

The Chinese viewpoint on preconceptual care

Ren Mai Woman

Eastern thinking has always maintained that a woman should take special care of herself during her periods and after childbirth. She should avoid heavy physical work and overexposure to cold and damp. This care extends not just to physical considerations but to her diet and emotional state as well

Nutrients for the fetus

The principal metabolic nutrients in the fetus are glucose and amino acids. Glucose (including its metabolic product lactate) serves as the principal energy substrate in the fetus for maintenance of basal metabolism, energy storage in glycogen and adipose tissue, and energy requirements of protein synthesis and growth. Amino acids, while primarily providing the structural basis for protein synthesis and growth, also serve as oxidative substrates for energy production, especially when glucose is deficient. Fatty acids also are taken up by the fetus, where they are primarily used for structural components of membranes and for growth of adipose tissue. In humans, fatty acid oxidation occurs readily after birth, even in preterm infants, indicating that the lack of marked fatty acid oxidation in the fetus is primarily due to the ready supply and oxidation of glucose, lactate, and amino acids. Hormonal regulation of metabolic substrate utilization and growth in the fetus and the effects in...

42 Substandard Maternal Nutrition and Increased Maternal Weight Loss

As loss of appetite is often associated with depression, untreated depression during pregnancy may result in substandard maternal nutrition and lower-than-normal maternal weight gain. Studies have shown that intrauterine growth retardation (IUGR) and low neonatal birthweights have been linked to inadequate maternal nutrition and or low maternal

Patent Ductus Arteriosus

The ductus arteriosus is a blood vessel connecting the main artery leading to the lungs (pulmonary artery) with the main artery carrying blood to the body (aorta). Normally the ductus narrows and closes in the first few hours or days after birth. In the premature infant, however (especially those with respiratory distress syndrome), the ductus stays open and the baby's lungs get too much blood, making breathing more difficult.

47 Poor Neonatal Behavioral Development

Recent investigations have shown that infants born to depressed mothers tend to exhibit excessive crying, lower orientation scores, inferior excitability, and few expressions of interest shortly after birth, indicating the possibility of neurodevelopmental consequences of maternal depression in the newborn (66,67).

Stress on the Parents

In the first few weeks after birth, feeding an infant can be exhausting for any parent. Breast-feeding round-the-clock can be extra tiring for the mother, especially if she had a difficult birth or is having trouble getting her milk flow established. Because human milk is digested more quickly and easily than formula, breast-fed babies generally eat more frequently, wake more frequently at night, and begin to sleep through the night later than bottle-fed infants. Although they tend to sleep less overall, breast-fed infants can be taught to sleep for longer periods at night by using the techniques discussed in Chapter 9, Breast-Feeding. With bottle-feeding, the father, another relative, or a paid helper can share round-the-clock feeding duties or take them over entirely if the mother needs rest.

Emotions Embarrassment and

Studies do suggest that breast-feeding women tend to be less interested in sexual activity in the first few months after birth. Fatigue may be a factor, along with the feeling some women get of being physically used up by breast-feeding all touched out. Others complain of vaginal dryness caused by low estrogen during lactation, a problem that can be helped by using a lubricant.

What do the contractions feel like Learning new skills for pregnancy and birth

As well as preparing for labour, it may also be a time for beginning to consider what changes you are to face as a couple how will your life be different It really can be difficult to imagine what it will be like when the baby arrives but this should not discourage you from beginning the discussion. Prospective parents tend to worry about the tasks of caring for a baby, for example, how often should I change a nappy Most people haven't changed a nappy before having a baby and it can seem complicated before you've tried but, rest assured by the end of first few days, you will feel like an expert after so much practice Parents don't go to health visitors in the weeks after birth saying 'I still can't change a nappy ' They are much more likely to present with problems about who is changing the nappies. Consequently it does no harm to begin now to think about how things are going to be different after the baby is born.What aspects of your life now do you particularly value and what do you...

553Improving Compliance to IOM Recommendations

In 2000, Abrams et al. 72 conducted a systematic review of available observational data published between 1990 and 1997 on weight gain and maternal and fetal outcomes. Not surprising, this review showed that pregnancy weight gain within the IOM recommended range was associated with the best outcome for both mothers and infants. However, this review also found that most women were noncompliant with these guidelines many women were gaining excessive amounts of weight. Researchers speculated many reasons for these findings, including environmental temptations, inactivity, and prepregnancy restrictive dieting. They also reported that many women were not given appropriate targets for weight gain. The Women and Infants Starting Healthy study also found that from pregnant women studied in the San Francisco Bay area (excluding women with preterm birth, multiple gestation, or maternal diabetes), 50 of obese women were given advice by their physician to overgain, 35 of underweight women were...

Progeny of STZinduced diabetic animals

With regard to the progeny of diabetic animals as models of insulin-deficient diabetes, it should be recalled that the intrauterine metabolic fuel milieu is untoward for the fetus. Fetal pancreatic beta cells are vulnerable to hyperglycemia and to changes in other metabolites. The inflicted injury persists after birth, resulting in mild, insulin-deficient diabetes and is propagated into successive generations.54 STZ-induced diabetes was produced either by a low (30mg kg) or high (50 mg kg) dose of STZ on day 1 of gestation, and created mild or severe maternal diabetes, respectively, resulting in a reduction in the maternal betacell content.55,56 The characteristics of mild and severe STZ maternal diabetes, and its effect on the fetus, is shown in Table 12.3. Mildly diabetic mothers are moderately hypoinsulinemic and hyperglycemic, whereas severely diabetic mothers are insulin deficient, markedly hyperglycemic and hyperlipidemic, with low body weights.

Further Observations On Energy Costs

To test whether energy-sensitive adjustments in gestational metabolism occur in women other than those studied in the Gambia and England, researchers from the United Kingdom conducted a retrospective analysis of data on basal metabolic rate and fat deposition in 360 pregnancies from 10 studies in a wide range of nutritional settings (14). The energy costs of pregnancy varied widely between different communities. Total costs were correlated with prepregnancy fatness and pregnancy weight gain. Marginally nourished women conserved energy by suppressing metabolic rate and by gaining little fat. They also delivered smaller babies.

221 Antihistamines blocker

Seizures starting 4 hours after birth, whose mother had received 150 mg hydroxyzine per day for anxiolysis. The newborn's plasma levels paralleled those of its mother 6 hours after birth. The authors interpreted the seizures as withdrawal symptoms. The neurological development was uneventful at the age of 6 months (Serreau 2005).

Micrognathia Infant Pictures

Eruption Cyst Infant

Natal teeth present at birth. Teeth that erupt after birth are neonatal teeth. These teeth have a familial pattern of occurrence and are more common in certain races such as American Indians and Eskimos. Neonatal teeth may occur in association with syndromes.

2639 Aminoglycosides in tuberculosis

Streptomycin (a first-line drug in the non-pregnant patient) and kanamycin, amikacin, and capreomycin (second-line drugs) are contraindicated during pregnancy because of their ototoxic properties. Inadvertent use does not require termination of pregnancy or invasive diagnostic procedures, but hearing tests should be performed after birth.

Sarah C Couch and Richard J Deckelbaum

Summary Obesity in pregnancy is associated with numerous maternal and neonatal complications including difficulty conceiving, increased risk of miscarriage, fetal anomalies and mortality, higher rates of gestational hypertension, gestational diabetes and preeclampsia, and an increased risk of cesarean section and delivery related complications. Nevertheless, more women are entering pregnancy with excessive weight and are gaining weight above the Institute of Medicine (IOM) recommendations during pregnancy. Weight loss is not recommended during pregnancy however, overweight and obese women should be advised to aim for a moderate weight loss prior to conception and during the postpartum period. Strategies for achieving moderate progestational and postpartum weight loss include a low-calorie, low-fat diet and at least 45 min of daily physical activity. Benefits to mother and child are achieved with even a moderate weight loss. Importantly, health care professionals should counsel women...

610calorie recommendations and weight gain during pregnancy

Weight gain during pregnancy after bariatric surgery is variable, as with any pregnancy. There are no published guidelines for pregnancy weight gain in bariatric patients. Therefore, the guidelines set forth by the Institute of Medicine should be used (Table 6.2) 28 . The postoperative BMI should be used to determine the appropriate weight category.

2648 HIV prophylaxis and therapy

Zidovudine, also known as azidothymidine (AZT), is a pyrimidine analog used in the treatment of HIV-1 and HIV-2 Infections. AZT Is a nucleoside reverse transcriptase inhibitor (NRTI). Pharmacokinetic studies indicate that AZT crosses the placenta fetal AZT levels are found to be similar to or higher than maternal levels. The administration of zidovudine monotherapy to the mother (and to the infant after birth) rapidly became standard practice once it had been shown to reduce mother-to-child transmission by two-thirds (AIDS Clinical Trial Group, protocol 076, 1994). In combination with other antiretroviral drugs such as lamivudine and, recently, with HAART, the risk of perinatal transmission has decreased even more and Is presently around 1-2 .

Breast Feeding Summary

The effects on suckling rats of amiodarone obtained from breast milk were investigated in a study published in 1992 (27). No effect on neonatal weight gain was observed, but treatment did result in a decrease in maternal weight gain compared to controls. Accumulations of both amiodarone and its metabolite, desethylamiodarone, were demonstrated in neonatal lung and liver.

22 gestational weight gain recommendations

In 1995, the World Health Organization (WHO) Collaborative Study on Maternal Anthropometry and Pregnancy Outcomes 4 reviewed information on 110,000 births from 20 different countries to define desirable maternal weight gain. The range of gestational weight gain associated with birth weights greater than 3 kg was 22-31 lb (10-14 kg). Comparing the WHO weight ranges with the IOM's recommended weight ranges for women with low and normal prepregnancy BMI, the WHO's ranges are slightly lower than the IOM's ranges (10-14 kg versus 12.5-18 kg low BMI and 11.5-16 kg normal BMI ).

Hyaline Membrane Disease

Subcostal And Intercostal Retractions

These twin premature infants with severe hyaline membrane disease developed respiratory distress soon after birth. Note the glistening, gelatinous appearance of the skin due to edema severe nasal flaring and intercostal, subcostal, and xyphoid retractions because of the pliability of the chest wall. This reflects die stiffness of the lungs and worsens over the first two to three days. Clinically, the infants have tachypnea with a see-saw pattern of breathing and an expiratory grunt. Figure 1.90. These twin premature infants with severe hyaline membrane disease developed respiratory distress soon after birth. Note the glistening, gelatinous appearance of the skin due to edema severe nasal flaring and intercostal, subcostal, and xyphoid retractions because of the pliability of the chest wall. This reflects die stiffness of the lungs and worsens over the first two to three days. Clinically, the infants have tachypnea with a see-saw pattern of breathing and an expiratory...

Maternal and paternal factors associated with fetal growth

Within the aforementioned parameters, however, the maternal environment during pregnancy has profound affects on in utero fetal growth. There is a strong correlation between maternal height and weight and fetal growth. In general, the taller and heavier a woman is prior to conception, the more her infant will weigh at birth.5 These correlations are more robust in nulliparous as compared with multiparous women.6 Similarly, there are also significant increases in birthweight related to maternal weight gain during gestation.6 The interaction of maternal pregravid weight and weight gain on fetal growth are interesting relative to the underlying physiology

Fetal glucose carbon contribution to glycogen formation

Age (days after birth) Age (days after birth) Figure 9.2 Liver glycogen in various species before and after birth. Hepatic glycogen content in several species is shown to increase with gestational age, decrease precipitously during the immediate postnatal period, and increase again with a normal neonatal diet. (From Shelly.63)

Neill Epperson and Jennifer Ballew

Postpartum depression (PPD) or, simply, postpartum are the most commonly used lay terms for describing major depressive disorder occurring in the postnatal period. Whether the disorder occurs de novo, is a relapse of a previous depressive episode, or has its origin in the antepartum period, depression after childbirth is associated with significant maternal and infant morbidity and, in worst cases, mortality. With most epidemiological studies demonstrating a prevalence of 10-13 , PPD is one of the most common complications of childbirth (1,2). Yet, the pathogenesis, natural history, and treatment of the disorder have been shrouded in mystery and myth as society and science has imbued motherhood with a cloak of sanctity that cuts both ways. Attempts to protect mothers and their offspring from unnecessary intrusions or potential harm have unwittingly limited detection of PPD in the clinical setting and the investigation of its pathogenesis and treatment in the scientific arena.

The Blues and Depression

It's estimated that baby blues strike about 50 percent of all new mothers in the first week after birth, and they strike many fathers and adoptive mothers as well. Usually lasting only a few days, the blues may bring anxiety, sadness, irritability, and insomnia. You may swing from joy to weepiness and back again for no apparent reason. Don't let these feelings worry you. They are normal and will pass.

Neonatally STZadministered rats nSTZ

Among the syndromes resembling mild Type 2 diabetes as a consequence of reduced beta-cell mass are rats which received neonatal STZ injection (nSTZ), either at the time of birth45,46 or 2 days after birth.46,47 It should be stressed, however, that these animals, although non-obese, do not represent a true Type 2 diabetes, but rather a model of limited insulin deficiency with little, if any, peripheral or hepatic insulin resistance. It is of interest to mention the results of nSTZ injection into spontaneously hypertensive SHR rats. These insulin-resistant rats, which are used as a model of human essential hypertension, are prone to develop hypertensive cerebrocar-diovascular disease with aging.51 Diabetes was induced by i.p. injection of 75 mg STZ 2 days after birth and the animals were mated with untreated male SHR rats at 4-5 months of age.

Personal experience at the Juan A Fernandez Hospital

The most frequently associated maternal pathologies were urinary infection and hypertension. Hospitalization during gestation was required for 48.6 of the patients. Gestational age at delivery was 37 weeks in 74 of the population. Cesarean sections were performed in 51.3 of the cases. There were four intrauterine death. Neonates were vigorous at 1 and 5 min after birth in 88 and 93 of the cases, respectively.

Fetal Risk Summary

In a comparison of 20 pregnant women treated with either acebutolol or methyldopa for mild to moderate hypertension, no differences between the drugs were found for pregnancy duration, birth weight, Apgar scores, or placental weight (5). In addition, no evidence of bradycardia, hypoglycemia, or respiratory problems was found in the acebutolol-exposed newborns. In an earlier study, however, 10 newborns exposed to acebutolol near term had blood pressures and heart rates significantly lower than similar infants exposed to methyldopa (7). The hemodynamic differences were still evident 3 days after birth. Mean blood glucose levels were not significantly lower than those of similar infants exposed to methyldopa, but transient hypoglycemia was present 3 hours after birth in four term newborns (5). The mean half-life of acebutolol in the serum of newborns has been calculated to be 10.1 hours, but the half-life based on urinary excretion was 15.6 hours (7). The manufacturer cites the...

Human immunodeficiency virus HIV and Acquired

Current evidence suggests that an HIV positive mother in good health and without symptoms of the infection is unlikely to be adversely affected by pregnancy. However, 1 in every 6 babies born to HIV positive mothers are likely to be infected. HIV positive mothers may also pass on the virus through breast milk. If you're HIV positive, talk to your doctor about your own health and the options open to you, or contact the organisations listed on page 143 for advice and counselling. It is possible to substantially reduce the risk of transmitting HIV to your baby during pregnancy and after birth (see box page 54).

Autoimmune GDM and the risk of developing postpartum DM1

After delivery, the autoimmune process directed against beta cells may follow different pathways (1) the restoration of normal glucose tolerance when pregnancy is over (2) the appearance of DM-1 shortly after pregnancy and (3) slow deterioration of the insulin secretory capacity due to the continuous progression of autoimmune destruction of the residual population of beta cells, resulting in a long subclinical period (LADA). Already in the first study on ICA in GDM, three out of five ICA-positive gestational diabetic women developed classical DM-1 A shortly after pregnancy.36 Additional studies have

Pregnancy and diabetes before the discovery of insulin

In the pre-insulin days, and for some time after, death of the mother during or soon after pregnancy from uncontrolled diabetes was the major risk. But maternal mortality was high for many reasons unrelated to diabetes, and retrospective analysis of data from England and Wales between 1850 and 1937 shows that poor interventional obstetric care with increased risk of puerperal sepsis was more important than social or economic deprivation.10 The maternal mortality rates for Scandinavian countries were much lower, and it is now clear that this was due to better overall obstetric management in the prevention of sepsis in the USA maternal mortality between 1921 and 1924 was 6.8 per 1000 births, in England and Wales 3.9 per 1000 births and in the Netherlands only 2.5 per 1000 births.8 These differences at national level have been widely discussed, but must be borne in mind when considering the isolated effect of maternal diabetes over those years.

Jane Scullion BAHons RGN MSc

Not all mothers start pregnancy in the best of health, and others develop problems as they go along. The latest Confidential Enquiry into Maternal Deaths Report for 2003-2005, Saving Mothers' Lives, shows that more of our mothers died from pre-existing, or new, medical conditions aggravated by pregnancy than from the big obstetric killers of the past such as haemorrhage, sepsis and pre-eclampsia. These so-called 'indirect' maternal deaths have outnumbered those from causes directly related to pregnancy for more than 10 years. And each death is just the tip of the iceberg of severe morbidity and complications. In the last Saving Mothers' Lives report more women died from cardiac disease than from any other cause, including the leading 'directly' associated cause thrombo-embolism, and deaths from acquired heart disease brought on by unhealthy lifestyles and obesity are increasing at an alarming rate. These findings show that whilst the lessons for the management of common obstetric...

Hearing Tests for Children

The technique most commonly used to screen a newborn's hearing today is called an otoacoustic emissions (OAE) test. This test can be performed shortly after birth as part of the routine newborn screening process. But because some newborns fail due to wax or debris in the ear canal, it's best to wait until just before discharge from the hospital to perform this test on a newborn.

Skin changes in pregnancy

Increased pigmentation of the skin is very common in pregnancy and found in 90 of expectant women (Fitzpatrick et al 1979). The exact causes are uncertain but are almost certainly linked to hormonal changes. The nipples and areola generally darken, as may the face, vulva, perineum and perianal region, and the linea alba on the anterior abdominal wall becomes the linea nigra. Stretch marks may also appear on the breasts, abdomen, thighs and buttocks. These will fade to silver after pregnancy.

General nutritional guidelines for pregnancy

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...

103classification of diabetes

Type 1 diabetes requires exogenous insulin for survival and is diagnosed primarily in persons less than 30 years of age. Type 2 diabetes, which accounts for almost 90 of diabetes cases, was previously known as adult-onset or non-insulin dependent diabetes. Insulin resistance rather than insulin deficiency and obesity are associated with type 2 diabetes. GDM is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The definition applies if medication or MNT is used in treatment or the condition persists after pregnancy. It does not exclude the possibility that the diabetes may have existed prior to pregnancy.

2138 Cytotoxic anthracydine antibiotics

There are at least 20 case reports on epirubicin in combination therapy, including two exposures during the first trimester which ended in spontaneous miscarriage. Regarding the other pregnancies, there was 1 abortion, 1 stillbirth and 1 child who died shortly after birth. Furthermore, there were cases of intrauterine growth restriction, premature births, and a transient leukopenia (Ring 2005, Gadducci 2003, Giacalone 1999, M ller 1996, Goldwasser 1995).

6 Bipolar Disorder And The Postpartum Period

The pathophysiology of bipolar exacerbation during the postpartum period is not understood. Proposed contributors to the destabilization of mood include disturbances in the hypothalamic-pituitary-thyroid axis and major withdrawal of steroid hormones after birth (112-115). The changes in reproductive hormone status are considered important in regulating mood, and rapid and steep decline in estrogen after delivery may trigger mood changes in vulnerable women regardless of their diagnosis (110,116). The efficacy of hormone replacement therapy for bipolar disorder during the postpartum period has not been adequately assessed (112,113). Women with bipolar disorder have a high risk of symptom emergence that can occur within a few days to weeks after childbirth (4-6,16). Additionally, postpartum women are approximately seven times more likely to be hospitalized for a first bipolar episode and two times more likely to be hospitalized for a recurrent bipolar episode when compared with...

122nutritional status of the mother

The nutritional status of an HIV-infected woman prior to and during pregnancy influences both her own health and the health of her unborn child 8 . The nutritional challenges for the HIV-infected pregnant woman are threefold. First, during pregnancy, just as in the uninfected woman, maternal metabolism is altered by hormones in preference of the developing infant, and nutrients are directed to the placenta, the mammary gland, and the infant 9, 10 . Additionally, HIV infection can prompt micronutrient deficiencies and lean body mass depletion because of decreased nutrient intake, malabsorption, and increased utilization and excretion of nutrients resulting in undernutrition 11 . Finally, HIV infection affects nutritional status through an increase in resting energy expenditure (REE) 12-14 . For women who are malnourished, an energy-protein supplement during pregnancy may improve pregnancy outcomes by improving maternal weight gain and reducing the risk of perinatal mortality 15, 16 ....

132 recommendations for weight gain during pregnancy

Guidelines for weight gain during pregnancy aim to promote adequate, but not excessive, weight gain for optimal fetal development. Weight gain is highly correlated with infant birth weight making optimal weight gain during pregnancy important to fetal outcomes 1 . For a thorough discussion of optimal weight gain for pregnancy, the reader is referred to Chap. 2, Optimal Weight Gain, in Part 1 of this book. In brief, the Institute of Medicine (IOM) developed guidelines for maternal weight gain based on aggregate data examining fetal outcomes and associated maternal conditions 1 . These guidelines, adapted by both the American College of Obstetrics and Gynecology (ACOG) and the American Dietetic Association (ADA), use maternal body mass index (BMI, kg m2) prior to conception (Tables 13.1, 13.2) as a starting point for recommended weight gain during pregnancy 1-4 . Although these guidelines are available to women during pregnancy, educational programs regarding how to follow these...

3 Course Of Illness In Pregnancy

Most pregnant women with schizophrenia are single and live in poverty, often in poor housing, often estranged from their immediate and extended families (16). Severity of illness over the course of pregnancy varies. It is not known whether changes associated with pregnancy and lactation significantly alter the course of schizophrenia symptoms. For women with chronic severe psychiatric illness across diagnoses, there is a slight but significant reduction in rates of contact with psychiatric services and admissions during pregnancy compared with periods before and after childbirth (17). Although many women experience a lessening of symptoms, some become more delusional, deny the pregnancy, and may try to harm the fetus (18). About 25 of pregnancies are electively terminated in this population (4).

Excessive fetal growth

A number of factors have been associated with excessive fetal growth. Besides maternal glucose intolerance, a positive association with birthweight has been reported for maternal age, ethnicity, parity, pre-pregancy weight, pregnancy weight gain, male gender, and gestational age at birth, while a negative association has been found with maternal hypertensive disorders and smoking.19,20 In one multivariate analysis of all of these factors only maternal third trimester glucose values and pre-pregancy body mass index were found to be independently associated with birthweight percentile among infants of insulin-requiring Type 2 and gestational diabetic

21717 Eye nose and ear drops

The carbonic anhydrase inhibitors brinzolamide, dorzolamide, and for systemic application, acetazulatnide, which are used for glaucoma therapy, have not been systematically studied. A new born of 34 weeks' gestation was tachypnoic, and a combined respiratory-metabolic acidosis, hypoglycemia, and hypokalemia was diagnosed. Its mother had been treated with 750 mg azetazolamide daily during the 3 days prior to delivery. There was 2.9pg ml in the blood of the newborn when this was measured 5 hours after birth - almost a therapeutic concentration (3-10 ig ml). There was no substance detectable on day 11. Further development of the child was uneventful (Ozawa 2001). There were no birth defects or postnatal disorders observed in the newborn of 12 women using, on average, 500 mg azetazolamide daily for idiopathic increased intracranial pressure. Nine of them were exposed during the first trimester (Lee 2005).

Chinese viewpoint

The Dai Mai channel links the Kidneys with the uterus. To the Chinese, if there is a constitutional deficiency of the Kidneys because of excessive sexual activity or excess childbirth, this may injure the Kidneys and lead to deficiency of Jing and Blood. After pregnancy, Jing and Blood accumulate to nourish the fetus via the Bao Mai channel. If the Kidneys are lacking, the fetus cannot maintain its position.

8 Antipsychotic Medications In Pregnancy

With respect to side effects, in the second trimester ofpregnancy there is a physiological drop in blood pressure, which may add to the orthostatic hypotension effects of some antipsychotic drugs (clozapine, quetiapine). Constipation, which is common in pregnancy, may be worsened by medications with anticholinergic side effects (olanzapine, clozapine). The sedation induced by some antipsychotics (olanzapine, quetiapine, clozapine) must also be taken into consideration, especially after childbirth (39).

9 Antipsychotic Effects On Pregnancy Outcomes

Malformations in infants, but the rate is probably artificially elevated because it represents only those pregnancy outcomes that were spontaneously reported to Novartis. The company recommends monitoring blood glucose and lipids during pregnancy, especially in women who are obese, glucose intolerant, or who have a family history of diabetes. The effect on the course of labor is uncertain there has been one report of neonatal convulsions 8 d after birth and one report of floppy infant syndrome. There is the theoretical possibility of idiosyncratic drug-induced agranulocytosis in the fetus neonate and not in the mother. There have been no reports of developmental delays, but the Company recommends low doses during pregnancy because the plasma concentration of clozapine is higher in the fetus than in the mother, and it also recommends against breast-feeding.

Postpartum Depression

During the postpartum period, 10 -15 of women will present with more significant depressive symptoms, or PPD (P. J. Cooper et al. 1988 Cox et al. 1993 Kumar and Robson 1984 O'Hara et al. 1984). In contrast to postpartum blues, PPD is more pervasive and may significantly interfere with a mother's ability to function and to care for her child. Depression most commonly develops insidiously during the first 1-3 postpartum months, although some women report the acute onset of symptoms shortly after childbirth (P.J. Cooper et al. 1988). A significant subpopulation of women actually experience the onset of depressive symptoms during pregnancy (Josefsson et al. 2001).

Getting fit all over again

After pregnancy, restoring strength to your abdominal muscles is especially important. In some women, pregnancy causes the abdominal or rectus muscles to separate a little, as shown in Figure 13-1. The medical term for this separation is diastasis. Doing abdominal exercises to restore their strength and draw them together is important. After pregnancy, your abdominal muscles may be separated a bit, one side from the other. After pregnancy, your abdominal muscles may be separated a bit, one side from the other.

Perinatal Infection

The immediate and long-term effects of perinatal infection are a major problem throughout the world. Perinatal infection is relatively common among the over 4 million births per year in the United States but the incidence is dependent upon the organism. One percent of newborn infants excrete cytomegalovirus. Fifteen percent are infected with Chlamydia trachomatis one-third develop conjunctivitis and one-sixth, pneumonia. One to eight per 1,000 live births develop bacterial sepsis. In utero or perinatal infection with herpes simplex virus, Toxoplasma gondii and varicella-zoster virus occurs in about 1 per 1,000 live births and the sequelae may be severe. In-utero acquired infection may result in resorption of the embryo, abortion, stillbirth, malformation, intrauterine growth retardation, prematurity, and the numerous untoward sequelae associated with chronic infection. Infection acquired at or soon after birth may lead to death or persistent postnatal infection. Some infections may be...

Clinical manifestations

The clinical manifestations of neonatal hypoglycemia in IDM and IGDM are not specific, and there is no pathogno-monic sign. Symptoms may be neurologic (tremor, jitteri-ness, high-pitched cry, eye-rolling, convulsions), respiratory signs (cyanosis, tachypnea, apnea), cardiac-related (tachycardia, cardiomegaly, cardiac failure), digestive (refusal to feed), or metabolic (hypothermia, sweating), alone or in combination. However, many infants, even those with very low plasma glucose levels, are asymptomatic, probably because of the initial brain glycogen stores, although the exact biochemistry is still unclear. The characteristics of neonatal hypoglycemia in IDM are very early onset (first hour after birth) generally asymptomatic, non-recurrent and good response to i.v. glucose.9 However, some cases have been reported even after the first 24 h.13 There is no well-defined method for predicting which new-borns will have severe hypoglycemia, so all IDM and IGDM must be screened after birth....

Delay in Lactogenesis

Tain situations (as listed in Table 3-2), invites us to gain a better understanding of the specific biochemical or hormonal nature of lactogenesis that may lead to a delay in lactogenesis. We do know that high breastmilk sodium levels on or before the third day after birth are significant for impending breastfeeding problems and for lactation involution (Morton, 1994 Humenick et al., 1998). Although the reasons for lactogenesis delay are not always clear, it does appear that lactogenesis is susceptible to outside influence and is thus fragile.

72 Fetal Effects ofMethamphetamine

Unusual behaviors, such as abnormal reflexes and excessive irritability, have been identified in methamphetamine-exposed neonates (68). It is unclear if prenatal methamphetamine exposure is neurotoxic to the developing brain and to what extent a good psychosocial environment after birth can compensate for methamphetamine-associated deficits. A pilot study of 13 methamphetamine-exposed children indicated lower scores on measures ofvisual motor integration, attention, verbal memory, and long-term spatial memory and smaller subcortical volumes on magnetic resonance imaging (70). As with cocaine, methamphetamine dependence in pregnant women is best managed in an inpatient treatment setting with follow-up substance abuse treatment.

Methodological considerations

Table 50.1 Follow-up studies on the incidence of abnormal glucose tolerance after pregnancy in women with previous gestational diabetes Table 50.1 Follow-up studies on the incidence of abnormal glucose tolerance after pregnancy in women with previous gestational diabetes

83 Methadone Treatment

NAS is characterized by CNS, gastrointestinal, and respiratory dysfunction. If pharmacological treatment is indicated, neonatal abstinence syndrome is treated with tapering doses of diluted opium or morphine solutions. Signs and symptoms ofNAS include muscle spasms, irritability, high-pitched crying, diarrhea, disturbed sleep and feeding, vomiting, hiccups, stuffy nose, sneezing, and breathing problems. The duration ofthese symptoms is typically 1-2 wk. NAS associated with methadone typically lasts longer than heroin-associated NAS. NAS can be treated safely in the hospital after birth (78).

183 postpartum weight retention

The most consistent and strongest determinant of weight loss during lactation is pregnancy weight gain 11, 12 . Other factors that have been shown to influence postpartum weight loss, albeit inconsistently, include prepregnancy weight, age, parity, race, smoking, exercise, return to work outside the home, and lactation. While the impact is modest, the portfolio of evidence suggests that breastfeeding results in a faster rate of postpartum weight loss than formula feeding 13 . The average difference in weight loss by 12 months postpartum between lactating and nonlactating women is about 0.6-2.0 kg (1.3-4.4 lb) 13 .

Screening for diabetes in pregnancy

In 1994, a court in Alberta tried a 1988 case5 in which a macro-somic baby suffered Erb's palsy after shoulder dystocia. During pregnancy the family doctor had failed to implement the universal screening policy for gestational diabetes that had been recommended by the Alberta Medical Association and the Society of Obstetricians of Canada. He also overlooked maternal glycosuria and significant maternal weight gain. He then failed to recognize fetal macrosomia on manual palpation and failed to request an ultrasound scan. The court found that his care was negligent in that he failed to follow guideline recommendations and that he failed to recognize clinical signs.

Toddler Vaginal Secretions

Vaginal Deformities Humans

Clitoral hypertrophy giving the appearance of ambiguous genitalia. Potentially life-threatening adrenal abnormalities must be ruled out. Clitoral hypertrophy is the result of increased androgen stimulation as a result of a luteoma of pregnancy. This resolves after pregnancy. There was no adrenal anomaly in this infant.

198effects of postpartum depression on motherinfant interaction

Postpartum depressed mothers displayed significantly lower contingent responsiveness and higher negative contingent responsiveness to their infants 34 . Recently Paulson et al. 35 found that mothers depressed at 9 months after birth were 1.5 times more likely to engage in less positive enrichment activity with their child such as reading, singing songs, and telling stories. Forman et al. 36 reported that at 6 months postpar-tum depressed mothers were less responsive to the infants, experienced higher levels of parenting stress, and perceived their infants more negatively than nondepressed mothers. Since a mother constitutes the infant's primary social environment during the first months of life, the effects of postpartum depression on the rapidly developing baby is of great concern and merits closer scrutiny and study.

Osteogenesis Imperfecta Type Ii

Musculoskeletal Pain Rsi

Type II osteogenesis imperfecta which is perinatally lethal. Death occurs before or shortly after birth. The lethal form is autosomally dominant but they are mostly new mutations. Rarely it is autosomally recessive. Note the markedly abnormal skull (which is soft and impressionable) and short limbs due to osteogenesis imperfecta. The damage to the neck and abdomen was present at birth. Figure 2.64. Type II osteogenesis imperfecta which is perinatally lethal. Death occurs before or shortly after birth. The lethal form is autosomally dominant but they are mostly new mutations. Rarely it is autosomally recessive. Note the markedly abnormal skull (which is soft and impressionable) and short limbs due to osteogenesis imperfecta. The damage to the neck and abdomen was present at birth.

19124The Role of DHA in Neurotransmission

In a study of 865 Japanese women Miyake and colleagues 75 investigated risk of postpartum depression related to dietary fatty acid intake. Again, the EPDS was used to evaluate postpartum depression and diet history questionnaires were self-administered to measure dietary fatty acid intake. There were no significant relationships between dietary fish consumption or n-3 fatty acid intake and postpartum depression. Likewise, Browne et al. 76 investigated maternal fish consumption and plasma DHA status after birth in relation to postpartum depression diagnosed using the Composite International Diagnostic Interview. There were no associations between maternal fish consumption during pregnancy or maternal DHA status following delivery and depressive symptoms in the postpartum period.

497 Atypical neuroleptics

Clozapine has a half-life of up to 25 hours. With a daily dosage of 50 mg clozapine, a concentration of 63.5 ig l was reported in the colostrum on the day after birth the maternal serum level was 14.7 ng l. One week later, with a dosage of lOOmg daily, the concentration of the drug in the milk had risen to 115.6 ig l the maternal serum level was 41.4 ig l (Barnas 1994). This represents an M P ratio of 2.8. Based on this, an infant would take in 17.3 ig kg daily, or about 1 of the maternal weight-related dosage. In two of the case studies collected by the manufacturer, sleepiness in the intake. Levels rapidly fell to almost pre-dose levels by 2 hours. A relative dose of on average 0. l o, and at maximum 0.4 o, was calculated. The child was fully breastfed from 8 weeks after birth, and was normally developed at 4.5 months (Lee 2004B).

4101 Immunosuppressive and immune antineoplastic agents

Tacrolimus is used for immunosuppression after liver transplant, and is reported on in 25 full-term pregnancies. The first milk samples after birth were measured at 0.6 ig l, which suggests that the infant would receive less than 0.1 ng kg daily. This represents a relative dosage of about 0.1 . Because the babies were not breastfed, there are no observations of any possible effects available (fain 1997). A single case is reported where the mother received 0.1 mg kg per day throughout pregnancy. Milk levels were measured sequentially. The maximum was measured at 1 hour post-dose, at 0.57 ig l. This was estimated to be 0.06 of the maternal dose, or 0.02 absorbed by the infant based on the poor oral bioavailability (14-32 ) (French 2003). A 29-year-old woman was exclusively breastfeeding her healthy 3-month-old infant while on tacrolimus 4mg daily plus other drugs relevant to her transplant. The milk-to-blood ratio was 0.23, and average tacrolimus concentrations in milk were 1.8 g l. The...

4114 Thyroid hormones and thyroid receptor antibodies

Thyroid receptor antibodies (TRAb) can result in transient neonatal thyroid disease by transfer through milk from mothers treated for thyrotoxicosis, Serum TRAb concentration in neonates decrease continuously with time after birth. The calculated half-life for offspring-serum and breast-milk TRAb was calculated as approximately 3 weeks and 2 months, respectively. Transient neonatal thyroid disease may be worse and more prolonged during breastfeeding as a consequence of TRAb in breast milk flomhage 2006).

Gestational diabetes and the relationship to Type 2 diabetes

Patients who are diagnosed with diabetes or glucose intolerance in pregnancy, and who then return to normal glucose tolerance after pregnancy are known to be at high risk of developing Type 2 diabetes. Estimates of the risk vary between 10 and 50 within 5 years of the pregnancy, depending on the racial group and diagnostic criteria used for gestational diabetes. This would suggest that there is likely to be a similar etiology in gestational diabetes and Type 2 diabetes, with the pregnancy associated insulin resistance precipitating hyperglycemia during pregnancy. It also suggests that the molecular genetics for gestational diabetes will considerably overlap with Type 2 diabetes in the same population.

Composition of Term and Preterm Milk During the First Month of Lactation

Human milk is a good source of vitamin A (200 IU dl), which is present mainly as retinol (40-53 ng dl). Required for vision and maintenance of epithelial structures, vitamin A is at highest levels in the first week after birth and then gradually declines. Deficiency of vitamin A is a serious health problem for young children in many developing countries, leading to blindness through damage to the corneal epithelium (xe-rophthalmia) and to increased morbidity from infectious diseases. The prolongation of even partial breastfeeding provides an important source of vitamin A to children in developing countries (Bates & Prentice, 1994). Vitamin K. Vitamin K, which is required for the synthesis of blood-clotting factors, is present in human milk in small amounts. A few days after birth, a baby normally produces vitamin K in sufficient quantities by enteric bacteria. However, neonates are susceptible to vitamin K deficiency until ingestion of copious amounts of breastmilk can...

Hip Dysplasia Dislocation in Infancy

The doctor will check the baby's hips shortly after birth and then at routine checkups until he is walking normally. In mild cases, the hip joint moves excessively when manipulated. In moderate cases, the thighbone, or femur, slips out of the hip socket when manipulated but can be put back in. In severe cases, the head of the thighbone remains outside of the hip socket.

2323 Multiple Micronutrient Supplementation

The evidence for benefits of multiple micronutrient supplementation in pregnancy from randomized trials has been equivocal to date. In a trial in semirural Mexico, Ramakrishnan et al. randomized pregnant women to receive daily iron supplementation (60 mg) either alone or in combination with multiple micronutrients these supplements contained several vitamins and minerals (vitamins A, B-complex, C, D, E, and folic acid iron, zinc, and magnesium) at doses of one to 1.5 times the Recommended Dietary Allowance (RDA) levels. Multiple micronutrients did not confer any additional benefit on maternal weight gain during pregnancy 18 , maternal hematological status 19 , or infant birth weight or length 20 , compared with iron-only supplementation.

Successful Pregnancy in Women with Type 1 Diabetes From Preconception Through Postpartum Care

Using 2002 birth data 1 , it is estimated that diabetes affects an estimated 8 of the more than 4 million pregnancies that come to term annually in the United States. Identifying women who require aggressive monitoring and treatment of their diabetes to minimize both maternal and fetal complications during and after pregnancy is a significant challenge for physicians and the health system because almost 75 of pregnancy-related diabetes occurs in women with gestational diabetes or undiagnosed type 2 diabetes.

Nutritional Disorders

Intrauterine Growth Retardation Pictures

The gastrointestinal tract of the newborn must process a relatively large amount and variety of foods soon after birth. The average term infant takes about 540 cc (18 ounces) of food daily by two weeks of age. In adults, correcting for body surface area, this would equal approximately 10 liters of fluid per day. In proportion to its size, the premature infant processes an even greater load. The infant's diet must contain the appropriate quantity of protein, carbohydrates, fats, minerals, vitamins, trace elements and water. The complexity of this task is especially obvious in the premature infant where the child's nutritional reserves are limited and the margin for error is small. Advances in perinatal medicine have resulted in the increased survival of smaller and smaller infants. This poses several special considerations when designing a nutritional plan for these infants, including the need for rapid growth, the immature functional development of the gut, and the presence of...

84 nutrient needs of the pregnant adolescent

Important assessment data that need to be collected and evaluated to comprehensively develop educational approaches for pregnant adolescents can be categorized as follows (1) determining the quality, quantity, and rate of weight gain in pregnancy (2) evaluating current dietary intake to determine the adequacy of nutrient and energy intake during pregnancy and (3) assessing dietary issues that may affect intake, e.g., food allergies or vegetarianism 13 . Data derived from these assessments can provide a focus for discussions with all adolescents throughout pregnancy. Adolescents, especially those younger than 15 years of age, are at high risk for inappropriate maternal weight gain, anemia, and more serious complications such as lung and renal disease. Maternal weight gain is reportedly more influential than age of mother on fetal birth weight 11, 14 . Given that fetal birth weight 3,000 g is related to increased infant morbidity and mortality, optimizing maternal weight gain should be...

Risk and Course of Bipolar Disorder During Pregnancy

Grof and colleagues (2000) presented findings suggestive of an apparent protective effect of pregnancy on the course of lithium-responsive type I BD. They described a benign course, and even improvement, during pregnancy, basing their results on comparisons made before and after pregnancy in women whose illness could be managed for prolonged periods without mood-stabilizing medication. Although these findings were proposed to support the view that pregnancy may prevent recurrences of BD, the sample may not have been representative of broader groups of women with BD (Viguera et al. 2002b). Moreover, other recent research and growing clinical experience suggest that pregnancy probably does not consistently protect against recurrences of mania or major depression in women with BD rather, it is often a time of substantial risk of relapse, particularly following discontinuation of ongoing mood-stabilizing maintenance treatment (Blehar et al. 1998 Finnerty et al. 1996 Viguera et al. 2000)....

99 nutrition intervention

The primary objective for AN is to gradually increase energy intake to support a positive energy balance to allow repletion of the mother while meeting fetal energy demands. An intake of 130 of estimated energy needs is initially recommended. Reaching this goal should be attained through incremental increases of 100-200 kcal per day approximately twice per week. In the first trimester, additional kilocalories are not needed to support fetal growth and development however, maternal weight gain of one to two pounds per week may be expected due to repletion of maternal energy stores. During the second and third trimesters, energy intake should increase beyond maternal repletion needs to supply requirements of the fetus (see Table 9.2). Frequent recalculation of estimated energy needs is necessary to adjust for changes in body composition, basal metabolic rate, and energy expenditure, including physical activity.

54 weight gain recommendations and consequences of noncompliance

Evidence is mounting that significant numbers of women, particularly overweight and obese women, are not adhering to IOM guidelines. In an investigation of over 120,000 women enrolled in Women, Infants, and Children (WIC) clinics over a 6-year period, Schieve et al. 55 found that the percentage of women reporting a pregnancy weight gain greater than the IOM recommendations increased significantly from 41.5 to 43.7 . In 2005, Jain et al. 56 examined data from the New Jersey Pregnancy Risk Assessment Monitoring System (n 7,661) and found that nearly 64 of overweight women and 78 of obese women were noncompliant with IOM recommendations (e.g., overgained). women who gained at the recommended level 60 . In a longer-term study, Rooney et al. 61 followed 540 women for 8 years after childbirth and found that women who gained more than the IOM recommended weight during pregnancy retained 2 kg above their prepregnancy weight more at 8 years postpartum compared with those who complied with...

Chapter References

Sady SP, Carpenter MW, Thompson PD, Sady MA, Heydon B, Coustan DR. Cardiovascular response to cycle exercise during and after pregnancy. J Appl Physiol 1989 66 336-341. 90. Clapp JF, Capeless E. The VO2 max of recreational athletes before and after pregnancy. Med Sci Sports Exer 1991 23 1128-1133.

3 Impact Of Psychotropic Medications On Offspring

All psychotropic medications diffuse readily across the placenta during pregnancy. Thus, the fetus is exposed to medication and its potential complications. Risks of medication exposure can include organ malformation (teratogenicity), obstetrical complications, perinatal syndromes (neonatal toxicity), and long-term postnatal behavioral sequelae (behavioral teratogenicity) (3). Teratogenicity is defined as an organ malformation congenital deformity that occurs with a significantly greater risk over the baseline risk of malformations. In the United States, the baseline risk of malformations (i.e., the risk in the population at large) is 2-3 (27). Obstetrical complications include preterm delivery, low birth rate, and delivery complications such as low Apgar scores. Perinatal syndromes (neonatal toxicity) include behavioral symptoms noticed shortly after birth such asjitteriness. Postnatal behavioral sequelae (behavioral teratogenicity) include long-term neurobe-havioral effects in...

Diab Care BIS for diabetes and pregnancy

One of the main recommendations of the St Vincent Declaration was the following 'Achieve pregnancy outcome in diabetic women that approximates to that of nondiabetic women'. In consequence, WHO IDF guidelines for care and management of pregnant diabetic women have been proposed by an invited group of international experts in the field.14 The document brought attention to the important differences in the provision of diabetes and obstetrical care in different European countries. Specifically, the relevance of intensive metabolic care before conception, during pregnancy and parturition, as well as the needs of special training and education of the diabetic women contemplating pregnancy, were addressed. For the purpose of developing the quality assurance program, a DiabCare BIS for diabetes and pregnancy was proposed by members of the WHO IDF Working Group on Pregnancy Outcomes in the Diabetic Woman (Figure 53.5), with data fields addressing diabetes diagnosis, past obstetrical history,...

41110 Estrogens gestagens and hormonal contraceptives

Pure gestagen preparations (mini-pills) are the oral contraceptive of choice during breastfeeding. If the mother does not tolerate them, then the low-dosage combination pills (ethinylestradiol plus gestagen), or gestagen depot preparations, are acceptable. If necessary, they can be started about 6-8 weeks after birth. There is no preparation among the well-established hormonal contraceptives which requires an interruption of breastfeeding.

Ascites In Small Babies

People With Caudal Regression Syndrome

Chest radiograph of an infant of a diabetic mother presenting with tachypnea. Note the enlarged cardiac shadow. Infants of diabetic mothers may have cardiac enlargement due to a transient septal hypertrophy. The majority of these infants are asymptomatic, and the thickening is detected only by an electrocardiogram or echocardiography. With very marked septal thickening, left ventricular outflow obstruction may lead to left heart failure in the first few days after birth. Figure 5.45. Chest radiograph of an infant of a diabetic mother presenting with tachypnea. Note the enlarged cardiac shadow. Infants of diabetic mothers may have cardiac enlargement due to a transient septal hypertrophy. The majority of these infants are asymptomatic, and the thickening is detected only by an electrocardiogram or echocardiography. With very marked septal thickening, left ventricular outflow obstruction may lead to left heart failure in the first few days after birth.

2157 Hyperthyroidism and thyrostatics

9.5 of in utero PTU-exposcd children developed hypothyroidism and 5.4 also developed goiter. Not all hypothyroid neonates demonstrated goiter directly after birth some were noted only at the screening control 2 weeks later. co-therapy increases the mother's thyrostatic needs. Fetal hypothyroidisms as a consequence of maternal antithyroid therapy as well as hyperthyroidism as a consequence of placental transfer of auto-antibodies In case of Graves' disease have been described. Therefore, the thyroid gland of the fetus should be monitored by ultrasound scan. The screening of thyroid parameters of the newborn is absolutely necessary, and this Is compulsory in many countries. A second evaluation of the thyroid status should be performed 2 weeks after birth in the case of Intrauterine exposure. Mild symptoms of hyperthyroidism with borderline laboratory parameters can be treated symptomatically without thyrostatics, for example with i-receptor blockers such as propranolol or metoprolol. If...

Antenatal screening tests

Dilated renal pelves are detectable using ultrasound and may be indicative of an abnormal urinary tract. In a study by Adra et al. (1995), renal pathology was confirmed at birth in 44 of pyelectasis cases identified antenatally, the most common features being ureteropelvic junction obstruction and vesicoureteral reflux. All cases of pyelectasis should be referred to a urologist for evaluation after birth.

Breast Feeding During Illness

Mothers with hepatitis B can breast-feed their infants if the infant receives the hepatitis B vaccine during the first few days after birth. There is no evidence that hepatitis C is transmitted by breast-feeding. Mothers with chronic hepatitis C are often advised that they can nurse their infants, but they should discuss this with their physician. Other types of infections need to be evaluated by the obstetrician and pediatrician, but nearly all are likely to be safe for breast-feeding.

Foreword to the first edition

Ms West is an acupuncturist and a midwife with 15 years' experience and therefore is uniquely placed to write about obstetrics. Her book is a lucid, coherent and practical guide to the care of pregnant women for acupuncturists. The book combines a comprehensive discussion of the acupuncture treatment of the pregnant mother before, during and after childbirth with possibly the most rigorous and detailed guidelines for administering acupuncture in childbirth ever published in the English language. The extensive chapters on the physiology and pathology of labour will give any acupuncturist complete confidence in assisting women during labour.

Vitamin F essential fatty acids

There are many fatty acids but research has identified two important ones for the development and functioning of the brain arachidonic acid (AA) and DHA (Crawford 1992). During the third trimester, the brain of the fetus increases 4-5 times in weight, using two-thirds of the energy supplied by the mother. Large amounts of AA and DHA are needed during this 'brain growth spurt' that occurs in the baby just before and just after birth (Crawford & Doyle 1989). They are used as components of the brain cell membranes and to ensure that messages are transferred efficiently between brain cells. They are also found in high concentrations in the eyes and are essential for eye development the eyes mature rapidly in the third trimester and during the first few months of life.

Intrauterine factors in metabolic syndrome The fetal origin of adult disease

In another study, Barker et al.22 observed that the effects of impaired fetal growth are modified by subsequent growth. As such, individuals who were small at birth but became overweight in adulthood were at the highest risk of heart disease and Type 2 DM (a physiological resistance to insulin action). This finding led to the second part of the hypothesis, the thrifty phenotype (Figure 41.1). The authors proposed that the process of adaptation to undernutrition in fetal life leads to permanent metabolic and endocrine changes. These are beneficial if the undernutrition persists after birth, but may predispose the individual to obesity and impaired glucose tolerance if it does not. The most unfavorable growth pattern is smallness and thinness at birth, continued slow growth in early childhood, followed by an acceleration of growth so that height and weight approach the population means, with a continued rise in body mass index above the mean. The growth pattern differs by sex6,23 and...

2143 Ergot alkaloids see also Chapter

Ergot alkaloids are used only after birth for postpartum uterine hypotonia. They are contraindicated during pregnancy. Accidental use during the first trimester does not automatically require termination of the pregnancy. Detailed ultrasound scanning can exclude morphologic developmental disorders. For other ergotamine derivatives, see Chapters 2.1,2,8 and 2.15,

Insulin resistance and hypertension in pregnancy

In normal pregnancy, insulin resistance results in a metabolic advantage for the fetus. The mother enters a state of accelerated starvation in which she increases her reliance on lipolysis and protein catabolism as a source of energy. Thus, glucose is reserved for the fetus, which uses it as its primary fuel.89 A steady supply of glucose is essential for the growing fetomater-nal unit normally, pregnant women are able to increase their insulin secretion to three times that of nonpregnant women.90 In GDM, however, there is no increase in maternal insulin secretion in reaction to the increasing insulin resistance.91 Some investigators believe this effect is due to a metabolically limited beta-cell reserve.92,93 In most women with GDM, insulin sensitivity is restored after pregnancy. However, some may later develop Type 2 DM. The reported cumulative incidence rate of Type 2 DM after GDM is approximately 50 after 5 years.94,95 It is even higher in women with excessive weight gain or with...

121 Macronutrients 1211 Energy

The additional energy requirements of pregnancy are small relative to the needs for many other nutrients. While an extra 340-450 kcal could be consumed by simply adding a glass of 2 milk and a small sandwich, this would not meet increased nutrient needs for pregnancy. The fact that the relative increase for many other nutrients is more dramatic than for energy indicates the importance of emphasizing nutrient-dense foods during pregnancy. Following the dictum of eating for two may result in excessive maternal weight gain. Further, for obese women, sedentary women, and women whose activity levels decline during pregnancy (e.g., bed rest) the recommendations of 340-450 kcal day may be too high. On the other hand, underweight women, young adolescent mothers who are still growing (

Womens rights and the antenatal environment

Ballantyne's approach was similar in many respects to that of another influential campaigner, Dr J.W. Sykes, best known for his connection with the St Pancras School for Mothers, founded in 1907. The St Pancras School had an influence out of all proportion to its size, becoming a model institution for the emergent infant welfare movement. Its influence was due in part to the eloquence and enthusiasm of Sykes, who was Medical Officer of Health for St Pancras, and in part to the publicity generated by prominent supporters of the school such as Mrs Humphry Ward, Lady Henry Somerset and Alys Russell. Its stated aim was to combat infant mortality by educating working-class mothers in nutrition, hygiene and domestic health the implicit assumption was that these mothers lacked knowledge rather than resources. However, when the School opened, its first practical step was to provide food for expectant and nursing mothers, and it was the nutritional help it offered which made it an immediate...

492 Tri and tetracyclic antidepressants

Clomipramine, half-life 32 hours, increases the prolactin levels and can stimulate lactation. The pharmacologically active metabolites are N-desmethylclomipramine and two hydroxy-metabolites - 8-OH-clomipramine and 8-OH-desmethylclomipramine. Based on seven published mother-child pairs, the average relative dosage is 1.3 (overview in Weissman 2004). After birth, 267 ig l were measured in the plasma of an infant who had been exposed prenatally (the mother took 125 mg clomipramine a day). From the seventh day postpartum, the dosage was increased to 150 mg daily. The maternal plasma concentration rose from 355 ig l on day 10 to 510 jig l on day 35. The milk concentration was between 270 and 624 ig l. In the same period of time, concentrations decreasing from 45 ig l to 9.8(ig l were measured in the infant's serum (this was due to the breakdown of the drug transferred prenatally). Assuming the highest value reported in the milk, the dosage for a fully breastfed baby -without considering...

Milk Synthesis and Maturational Changes

Arthur, Smith, and Hartmann (1989) and Hu-menick (1987) have proposed two different biological markers as objective measures to define stages of breastmilk maturation. Arthur, Smith, and Hartmann hold that in the first stage of lactogen-esis, average concentrations of lactose, citrate, and glucose are low. A sudden and rapid increase in concentrations of these components between 24 to 48 hours after birth heralds the transition from stage I to stage II lactogenesis. Stage II lactogen-esis markers (lactose, citrate, and total nitrogen) take an additional 24 hours to attain concentration in women who have insulin-dependent diabetes Humenick et al. (1994), on the other hand, consider the breakdown of an emulsion dependent on the ratio of sterols plus phospholipids to fat content of milk (maturation index of colostrum and milk MICAM ) as the biological marker for breastmilk maturation (Figure 4-1). Both of these methods appear to be valid in that they were positively related to greater...

35 Amount of medication in the milk and relative dose

The amount of milk produced daily is between 500 and 900 ml. This amount is achieved about 4 days after birth. In order to better compare the different medications, the average daily amount per kg bodyweight that the infant takes in, rather than the individual total amount of milk consumed, is used as a basis for calculation. It is presumed that an infant receives about 150 ml kg per day ( 0.151 kg per day).

Anatomical and Biological Imperatives

After pregnancy, the mother continues to nourish her child through breastmilk energy now synthesized and stored in the breast. Breastmilk, a living fluid that benefits infants, mothers, and society, changes throughout lactation to meet the infant's nutriment needs. No human-made substitute nourishes the infant as well.

Postpartum Mood Disorders

Although DSM-IV-TR defines postpartum psychiatric illness as an affective episode that has its onset within the first 4 weeks after delivery, other authors have described a broader period of risk for the onset of puerperal illness. Risk of postpartum psychiatric illness is the highest in the first month after childbirth however, several different studies have indicated that women remain at very high risk for affective illness during the first 3 months after delivery (Kendell et al. 1987 O'Hara 1995), and women remain at heightened risk up until 1 year after delivery (Kendell et al. 1987). Thus, the Marce Society, an international organization dedicated to the study of postpartum psychiatric disorders, defines postpar-tum psychiatric illness as any episode occurring within the first year after childbirth.

Daniel M Herron and Amy Fleishman

Summary The dramatic increase in the incidence of obesity has resulted in an overwhelming increase in the number of bariatric, or weight loss, operations performed in the United States. These operations induce long-term weight loss through a combination of volume restriction and malabsorption. As a result, bariatric surgery patients may suffer from nutritional deficiencies over the long term and need to be followed extremely closely before, during, and after pregnancy. Bariatric patients are given regimens of nutritional supplementation that are specific for their operation. This chapter describes the different types of bariatric surgery and the nutritional disturbances associated with each one. Additionally, the standard recommendations for supplementation and follow up are reviewed. Alterations to these regimens during pregnancy are discussed. Pregnancy outcomes after bariatric surgery are reviewed.

Support for the fetal insulin hypothesis from monogenic diabetes studies

There has been strong evidence for the principle that genes resulting in monogenic diabetes have a large impact on fetal growth. In addition to the observation of glucokinase, which acts on glucose sensing (see above), there is also greatly reduced birthweight in mutations that reduce insulin secretion or action. The impact n fetal growth on monogenic diabetes mutations are outlined in Table 61.3. When hyperglycemia is detectable soon after birth due to reduced insulin secretion (e.g. Kir6.2 neonatal diabetes) it is not surprising that there is also reduced insulin secretion in utero and hence low birth-weight.42 More striking is that mutations in HNF-1P are associated with a 800g reduction in birthweight despite diabetes not usually developing until early adult life (Edghill and Hattersley, personal communication). This observation is compatible with the role of HNF-1P in pancreatic stem cells43 which is supported by loss of function mutations resulting in reduced pancreatic size and...

Conception During Breast Feeding References

In 22 cases of amiodarone therapy during pregnancy, the antiarrhythmic was administered for maternal indications (1,2 and 3,5,7,8 and 9,11,12,13,14,15 and 16). One patient in the last 3 months of pregnancy was treated with 200 mg daily for resistant atrial tachycardia (1). She delivered a 2,780-g female infant at 40 weeks' gestation. Both the mother and the infant had a prolonged QT interval on electrocardiogram (ECG). A second woman was also treated by these investigators under similar conditions. Both infants were normal (infant sex, weight, and gestational age were not specified for the second case), including having normal thyroid function. In another report, a woman was treated at 34 weeks' gestation when quinidine failed to control her atrial fibrillation (2). After an initial dose of 800 mg day for 1 week, the dose was decreased to 400 mg day and continued at this level until delivery at 41 weeks' gestation. The healthy 3220-g infant experienced bradycardia during labor...