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Management of pregnancy

Prenatal care.
Nutrition.
Weight gain.
Medication.
Recreational drugs.
Exposure to toxins.
Death by violence.
Sexual activity.
Exercise.
Sleep.
Dental care.
Flying.
Pregnancy classes and birth plans.

Prenatal care

• Prenatal care is care that is provided to a woman or couple to discuss conception, pregnancy, current health issues, and recommendations for the period before pregnancy.

• High-risk women have better outcomes if they are seen regularly and frequently by a medical professional than women who are low risk

• The aim of good prenatal care is prevention, early identification, and treatment of any medical complications. A basic prenatal visit consists of measurement of blood pressure, fundal height, weight, and fetal heart rate, checking for symptoms of labor, and guidance for what to expect next.

Nutrition

• Nutrition during pregnancy is important to ensure the healthy growth of the fetus.

• here are increased energy requirements and specific micronutrient requirements.

• Nutrition and pregnancy refer to the nutrient intake and dietary planning that is undertaken before, during, and after pregnancy.

• the nutrition of the mother is important from before conception (probably several months before) as well as throughout pregnancy and breastfeeding.

• An inadequate or excessive amount of some nutrients may cause malformations or medical problems in the fetus, and neurological disorders and handicaps are a risk that is run by mothers who are malnourished.

• An estimated 24% of babies worldwide are born with lower than optimal weights at birth due to a lack of proper nutrition.

• Personal habits such as the consumption of alcohol or large amounts of caffeine can negatively and irreversibly affect the development of the baby, which happens in the early stages of pregnancy.

Weight gain

• Weight gain is related to the weight of the baby, the placenta, extra circulatory fluid, larger tissues, and fat and protein stores.

• The National Academy of Medicine recommends an overall pregnancy weight gain for those of normal weight (body mass index of 18.5–24.9), of 11.3–15.9 kg (25–35 pounds) having a singleton pregnancy. Underweight women (BMI of less than 18.5), should gain between 12.7 and 18 kg (28–40 lb), while those who are overweight (BMI of 25–29.9) are advised to gain between 6.8 and 11.3 kg (15–25 lb) and those who are obese (BMI ≥ 30) should gain between 5–9 kg (11–20 lb).

• During pregnancy, insufficient or excessive weight gain can compromise the health of the mother and fetus.

• Being overweight in pregnancy increases the risk of complications for the mother and fetus, including, gestational hypertension, shoulder dystocia, and macrosomia.

• Excessive weight gain can make losing weight after pregnancy difficult

• Some of these complications are risk factors for stroke.

• Around 50% of women of childbearing age in developed countries like the United Kingdom are overweight or obese before pregnancy.

• Diet modification is the most effective way to reduce weight gain and associated risks in pregnancy.

Medication

• Drugs used during pregnancy can have temporary or permanent effects on the fetus.

• Anything (including drugs) that can cause permanent deformities in the fetus is labeled as a teratogen.

• In the U.S., drugs were classified into categories A, B, C, D, and X based on the Food and Drug Administration (FDA) rating system to provide therapeutic guidance based on potential benefits and fetal risks. It is very important to read this article.

For example

Drugs, including some multivitamins, that have demonstrated no fetal risks after controlled studies in humans are classified as Category A. On the other hand, drugs like thalidomide with proven fetal risks that outweigh all benefits are classified as Category X.

Recreational drugs

• Alcoholic drinks consumed during pregnancy
•  can cause one or more fetal alcohol spectrum disorders creational drugs.

• Tobacco smoking during pregnancy can cause a wide range of behavioral, neurological, and physical difficulties, Smoking during pregnancy causes twice the risk of premature rupture of membranes, placental abruption, and placenta previa.

• Prenatal cocaine exposure is associated with premature birth, birth defects, and attention deficit disorder.

• Prenatal methamphetamine exposure can cause premature birth and congenital abnormalities.

• Cannabis in pregnancy is teratogenic in large doses in animals but has not shown any teratogenic effects in humans.

Exposure to toxins

Intrauterine exposure to environmental toxins in pregnancy has the potential to cause adverse effects on prenatal development and cause pregnancy complications.

Mercury

• Intrauterine exposure to environmental toxins in pregnancy has the potential to cause adverse effects on prenatal development and cause pregnancy complications.

• Elemental mercury and methylmercury are two forms of mercury that may pose risks of mercury poisoning in pregnancy. Methylmercury, a worldwide contaminant of seafood and freshwater fish, is known to produce adverse nervous system effects, especially during brain development.

• Eating fish is the main source of mercury exposure in humans and some fish may contain enough mercury to harm the developing nervous system of an embryo or fetus, sometimes leading to learning disabilities, Mercury exposure in pregnancy may also cause limb defects.

• The United States Food and Drug Administration and the Environmental Protection Agency advise pregnant women not to eat swordfish, shark, king mackerel, and tilefish and limit consumption of albacore tuna to 6 ounces or less a week.

Lead

• Adverse effects of lead exposure in pregnancy include miscarriage, low birth weight, neurological delays, anemia, encephalopathy, paralysis, and blindness.

• The developing nervous system of the fetus is particularly vulnerable to lead toxicity. 

• Neurological toxicity is observed in children of exposed women as a result of the ability of lead to cross the placental barrier.

•  A special concern for pregnant women is that some of the bone lead accumulation is released into the blood during pregnancy.

•  Several studies have provided evidence that even low maternal exposure to lead produces intellectual and behavioral deficits in children.

Dioxin

• Intrauterine exposure to dioxins and dioxin-like compounds has been associated with subtle developmental changes in the fetus.

• Dioxins and dioxin-like compounds persist in the environment for a long time and are widespread, so all people have some amount of dioxins in their bodies.
  

• Effects on the child later in life include changes in liver function, thyroid hormone levels, and decreased performance in tests of learning and intelligence

Air pollution

• Air pollution can negatively affect a pregnancy resulting in higher rates of preterm births, growth restriction, and heart and lung problems in the infant
• Compounds such as carbon monoxide, sulfur dioxide, and nitrogen dioxide all have the potential to cause serious damage when inhaled by an expecting mother
• Control of air pollution can be difficult. For example, in Los Angeles, regulations have been made to control pollution by imposing industrial and vehicle emissions rules. Improvements have been made to meet these regulations. Despite these improvements, the region still does not meet federal standards for ozone and particulate matter. 
• Approximately 150,000 births occur every year in Los Angeles. Thus, any effects air pollution has on human development in utero are of great concern to those who live in this region.

Benzenes

• BTEX (Benzene, toluene, ethylbenzene, xylenes).
• Benzene exposure in mothers has been linked to fetal brain defects, especially neural tube defects.
• Women with high exposure to toluene had three to five times the miscarriage rate of those with low exposure, and women with occupational benzene exposure have been shown to have an increased rate of miscarriages
• A 2011 study found a relationship between Neural Tube Defects and maternal exposure to benzene, a compound associated with natural gas extraction. The study found that mothers living in Texas census tracts with higher ambient benzene levels were more likely to have offspring with neural tube defects, such as spina bifida, than mothers living in areas with lower benzene levels.

Other toxins

• Heat and noise- have also been found to have significant effects on development.

• Carbon dioxide – decreased oxygen delivery to the brain, intellectual deficiencies.

• Ionizing radiation – miscarriage, low birth weight, physical birth defects, childhood cancers.

• Environmental exposure to perchlorate in women with hypothyroidism causes a significant risk of low IQ in the child.

Death by violence

• Pregnant women or those who have recently given birth in the U.S. are more likely to be murdered than to die from obstetric causes. These homicides are a combination of intimate partner violence and firearms.
• Health authorities have called the violence "a health emergency for pregnant women," but say that pregnancy-related homicides are preventable if healthcare providers identify those women at risk and offer assistance to them.

Sexual activity

Desire and frequency

• for a healthy pregnant woman, there is no single safe or right way to have sex during pregnancy.
• Most women can continue to engage in sexual activity, including sexual intercourse, throughout pregnancy.
• Research suggests that during pregnancy both sexual desire and frequency of sexual relations decrease during the first and third trimesters, with a rise during the second trimester.

Safety

sex during pregnancy is a low-risk behavior except when the physician advises that sexual intercourse be avoided, because it may, in some pregnancies, lead to serious pregnancy complications or health issues such as a high risk for premature labor or a ruptured uterus.

Benefits

 Sexual activity during pregnancy

Psychological usefulness

• Some studies in the 1980s and 1990s contend that it is useful for pregnant women to continue to be sexually active, specifically noting that overall sexual satisfaction was correlated with feeling happy about being pregnant, feeling more attractive in late pregnancy than before pregnancy, and experiencing orgasm.

• Sexual activity has also been suggested as a way to prepare for induced labor; some believe the natural prostaglandin content of seminal liquid can favor the maturation process of the cervix making it more flexible, allowing for easier and faster dilation and effacement of the cervix. However, the efficacy of using sexual intercourse as an induction agent "remains uncertain".

Prevention of pre-eclampsia

• Pre-eclampsia is a disorder of pregnancy characterized by the onset of high blood pressure and often a significant amount of protein in the urine.

• When it arises, the condition begins after 20 weeks of pregnancy. In severe cases of the disease, there may be red blood cell breakdown, a low blood platelet count, impaired liver function, kidney dysfunction, swelling, shortness of breath due to fluid in the lungs, or visual disturbances.

• There is tentative evidence for exposure to a partner's semen as prevention for pre-eclampsia, largely due to the absorption of several immune-modulating factors present in seminal fluid.

After pregnancy

• Sexual intercourse after giving birth can begin when the couple is both ready. However, most American couples wait six weeks, Ovulation and thus pregnancy can begin before a return to regular menses.

Exercise

• Regular aerobic exercise during pregnancy appears to improve (or maintain) physical fitness.

• Physical exercise during pregnancy appears to decrease the need for Caesarean section and even vigorous exercise carries no significant risks to babies and provides significant health benefits to the mother. Bed rest, outside of research studies, is not recommended as there is no evidence of benefit and potential harm.

• Although an upper level of safe exercise intensity has not been established, women who were regular exercisers before pregnancy and who have uncomplicated pregnancies should be able to engage in high-intensity exercise programs, without a higher risk of prematurity, lower birth weight, or gestational weight gain.

• The Clinical Practice Obstetrics Committee of Canada recommends that "All women without contraindications should be encouraged to participate in aerobic and strength-conditioning exercises as part of a healthy lifestyle during their pregnancy".

Sleep

It has been suggested that shift work and exposure to bright light at night should be avoided at least during the last trimester of pregnancy to decrease the risk of psychological and behavioral problems in the newborn.

Dental care

• The increased levels of progesterone and estrogen during pregnancy make gingivitis more likely; the gums become edematous, red in color, and tend to bleed.

• Maintaining healthy oral procedures and dental care to reduce the visit to the dentist, in order to avoid exposure to dental operations such as extraction or prescribing therapeutic medications, which may affect the mother and fetus.

Flying

• In low-risk pregnancies, most healthcare providers approve flying until about 36 weeks of gestational age.
• Many airlines require a doctor's note that approves flying, especially at over 28 weeks.
• Most airlines allow pregnant women to fly short distances at less than 36 weeks, and long distances at less than 32 weeks.
• During flights, the risk of deep vein thrombosis is decreased by getting up and walking occasionally, as well as by avoiding dehydration.

Pregnancy classes and birth plan

• Birthing classes are classes to help parents to prepare for the birth of a baby and the first care of a newborn, and a birth plan is a document created by a pregnant woman detailing her decisions and expectations regarding her labor and childbirth.

• To prepare for the birth of the baby, healthcare providers recommend that parents attend antenatal classes during the third trimester of pregnancy. Classes include information about the process of labor and birth and the various kinds of births, including both vaginal and cesarean delivery, the use of forceps, and other interventions that may be needed to safely deliver the infant.

• Types of pain relief, including relaxation techniques, are discussed. Partners or others who may plan to support a woman during her labor and delivery learn how to assist in the birth.

• It is also suggested that a birth plan be written at this time. A birth plan is a written statement that outlines the desires of the mother during labor and delivery of the baby. Discussing the birth plan with the midwife or other care provider gives parents a chance to ask questions and learn more about the process of labor.