Pregnancy, in particular a woman’s first pregnancy, can be both magical and overwhelming at the same time. This Reproductive Health Awareness Month, which is commemorated in February, a Johannesburg gynaecologist shares her insights to help guide expectant parents through the basics of health during pregnancy.
“While it is natural for parents-to-be to feel somewhat anxious, understanding some of the factors that can affect the health of mother and the unborn baby can greatly contribute in making this a most special time,” says gynaecologist, Dr Bronwyn Moore, who practises at Netcare Park Lane Hospital.
“Women who have chronic medical conditions, such as hypothyroidism, hypertension (commonly known as high blood pressure), diabetes or epilepsy prior to falling pregnant will need to consult a healthcare professional about how best to manage their condition during pregnancy.
“When falling pregnant, it is imperative that one does not just stop taking prescribed medication without the sanction of a healthcare professional, as this could place both the mother and her baby’s health at risk. The type of medicine may need to be adjusted, opting for drugs that are safer for pregnancy. Pre-existing health conditions often require close monitoring during pregnancy, so it is important to ensure there is on-going support from one’s healthcare professional,” Dr Moore notes.
Certain medical conditions can develop during pregnancy. Two examples that expectant mothers should be particularly aware of are gestational diabetes and gestational hypertension.
“Gestational diabetes occurs when a pregnant woman who was not diabetic before pregnancy develops high blood sugar during pregnancy, as the body is unable to manage glucose appropriately. The condition is more common in the second half of pregnancy, in women with a family history of diabetes and who start pregnancy overweight. Excessive weight gain in pregnancy is also a risk factor.
“Symptoms include thirst, fatigue and frequent urination, all of which are common symptoms in normal pregnancy. Urine testing performed regularly during pregnancy looks for warning signs of gestational diabetes and you may have to have a glucose tolerance test at the lab. Diagnosis and treatment are important as gestational diabetes can cause serious complications. Dietary changes and exercise can help to regulate blood sugar levels, and prescription medication is available to help manage the condition.”
Dr Moore warns that high blood pressure can also develop: by definition pregnancy induced hypertension starts after week 20 of the pregnancy. “Pregnancy-induced hypertension can lead to a condition known as preeclampsia, which may place the health of both mother and baby at significant risk. During your regular check-ups during pregnancy, your doctor will check your blood pressure and test your urine for any signs of the condition so that it can be appropriately managed should it develop. Be on the lookout for severe headaches, visual changes and excessive swelling as warning signs, and call in for advice should these occur.”
Women who are pregnant are particularly sensitive to heat, and they are advised to avoid taking hot baths, and spending long periods of time in hot closed environments. Both may lead to a drop in blood pressure, leaving the mom-to-be feeling faint, light-headed and nauseous.
A rise in core temperature caused by a fever or spending time in saunas or steam rooms can be harmful to the developing foetus. Use paracetamol and lukewarm baths to bring down a temperature and give the steam room a miss.
“Good nutrition and adequate hydration are essential for mother and unborn baby, although the old maxim that a pregnant woman is ‘eating for two’ should not be taken as licence to consume too many calories,” Dr Moore points out.
“During pregnancy, the volume of blood in the body increases and for this reason pregnant women require additional iron in their diets. Iron can be obtained either from a supplement or food sources, such as green leafy vegetables, red meat and beans. Most pregnancy multivitamins contain extra iron to meet the increased need. Consult your doctor before taking additional supplements because too much iron may be harmful.”
Dr Moore warns that pregnant women must not eat raw protein, including raw or undercooked meat or fish, and foods or condiments made using raw eggs, including homemade mayonnaise or ice cream.
“Eggs should be thoroughly cooked and firm. Women who are pregnant should avoid shellfish, herbal teas, certain soft cheeses and pâtés, as well as alcohol, during pregnancy. With the recent listeriosis outbreak in South Africa, it is even more important that proper food hygiene and hand hygiene be followed.
“Drink at least eight glasses of water every day. Fruit juices are high in sugar, and should only be consumed in moderation,” she adds.
“When a woman is pregnant, she needs to be hyper vigilant about what she consumes or comes into contact with, as there are a surprising number of substances that can be harmful at this time.”
Dr Moore recommends that pregnant women always consult a doctor before taking any medication including, but not limited to, so-called ‘natural’ or homeopathic remedies, over-the-counter medications, supplements or even using topical lotions.
According to Dr Moore, it is advisable to avoid unnecessary travel while pregnant, particularly in the first and third trimesters. “It is a good idea not to travel far away from your chosen place of delivery during the third trimester. If you do travel, consider that an unexpected preterm delivery may mean that your baby would require expert neonatal care. Make sure this care is available, that it will be funded by your medical aid or travel insurer, and realise that you may not be able to return home for a number of weeks.”
She notes that pregnant women should not undertake international air travel after 34 weeks or locally after 36 weeks. “Remember, you will need a letter from your doctor stating your fitness to fly once you are 28 weeks pregnant, and for long flights it is possible that you may require a blood thinning injection to reduce the risk of deep vein thrombosis.
“It is particularly important for pregnant women to avoid visiting countries where the Zika virus is present, as this can be detrimental to the development of the unborn baby. Malaria areas should also be avoided,” Dr Moore adds.
She cautions expectant mothers, especially those who have never had a cat before falling pregnant, against coming into contact with cat faeces in cat litter boxes or even in garden soil, as feline excrement carries a parasite that causes toxoplasmosis, a condition that can lead to miscarriage.
“Pregnancy should be a beautiful experience, and this time of preparation for motherhood is precious beyond measure. With a little caution, continuous support from your team of healthcare professionals and adequate rest, pregnancy need not be stressful. Enjoy this special time of closeness with your unborn baby, and take the time to prepare for the memorable day when you will take him or her home with you,” Dr Moore concluded.