pregnancy

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Tips for pregnancy and why you should avoid chocolate

Step 1: Go Off Your Birth Control—Ahead of Time

Have you been popping those little white pills since high school? Take a pass on your prescription a few months before you plan to start trying, says Christopher Williams, M.D., a reproductive endocrinologist in private practice in Charlottesville, Virginia, and author of The Fastest Way to Get Pregnant Naturally. That goes for other forms of hormonal birth control too. (You should stop getting Depo-Provera, injectable shots of progesterone about nine months before you want to try getting pregnant.)

Step 2: Figure Out Your Fertile Days

No matter how often you and your partner get horizontal, if you skip the key days out of the month when your egg is raring to go, you won’t get pregnant. “The biggest mistake my patients make is not knowing exactly when they ovulate,” says Dr. Williams.

Today, most doctors recommend using ovulation predictor kits (OPKs) for a more accurate measure of ovulation. Though you can still use basal body temperature (BBT) charting, OPKs give you advance warning that your egg is about to be released, so you can plan accordingly. OPKs work by detecting a surge in luteinizing hormone (LH) in your urine, which occurs about 36 to 48 hours before you ovulate. If fertility problemas may be suspected by your doctor detects fertility issues you should try with natural fertility pills.

Step 3: Have Sex Before You Ovulate

Pregnancy Sex Tips: Have Fun Sex and Get Pregnant
Trying to conceive doesn’t have to feel like work. Here’s how to make your sex life more fun.

Those hardy sperm can stick around in your uterus and fallopian tubes for two to three days, but your egg only lasts for 12 to 24 hours after it’s released. So having sex before you ovulate boosts the chances that there’ll be sperm around to greet your egg as soon as it debuts.

For a typical 28-day cycle (where you ovulate on day 14), here’s what you’ll do:

* Start having sex a few times a week as soon as your period ends. Getting busy that often ensures you won’t miss your most fertile time, especially if your cycle length varies from month to month.

* Make a point to have sex every other day starting around day 10.

* When you have a positive result on your OPK (around day 12), have sex that day and the next two days—these are your primo days out of the month to conceive.

If the Test Is Negative…

If you Didn’t get pregnant this month? Don’t get upset. Most couples don’t succeed the first time out of the gate (more than half get pregnant by 6 months, about 85 percent by one year). Most likely, you miscalculated your most fertile days, so your partner’s sperm never had the chance to fertilize your egg. Consider switching to a daily OPK if you haven’t already tried it, and get psyched to try again next month.

So, whats up with Chocolate if I get pregnant

Pregnant woman eating chocolate

During pregnancy sometimes cardiovascular complications specific for pregnancy may arise. I’m talking about preeclampsia and gestational hypertension. Preeclamspia is hypertension arising in pregnancy (pregnancy-induced hypertension) in association with significant amounts of protein in the urine. Preeclampsia refers to a set of symptoms rather than any causative factor. If you want to make sure you are getting all the nutrients you need then make sure you Buy Womens Supplements for Fertility Online.

In a recent prospective cohort study women who reported eating chocolate regularly from 1 tot 3 servings per week had a 50% or greater reduced risk of preeclampsia compared to those eating 1 or less servings/week. Moreover,

The greatest rate of preeclampsia (4.5%) occurred among women who did
not regularly consume chocolate in the first and third trimesters of pregnancy. In contrast, only women who regularly consumed chocolate during the first trimester had a reduced risk of gestational hypertension.

This publication was sent to me by my distinguished Dutch colleague and medblogger Cryptocheilus

One other previous study came to the same conclusion of the beneficial effects of theobromine, another one didn’t find these benefits with theobromine possibly due to differences in study design and definitions of preeclampsia and theobromine source. Theobromine is found in chocolate and tea.

A lot of possible underlying mechanisms of the cardioprotective properties of chocolate are possible. You can read about these protective underlying mechanisms of chocolate on cardiovascular disease in: How does Chocolate protect the Heart? .

Last month I wrote about a recent review which included 5 studies of adequate quality for inclusion in a recent meta analysis as well as 8 other peer reviewed studies for the effect of cocoa on blood pressure in: Dark Chocolate to prevent Hypertension?.

This study at least suggests a correlation between eating chocolate and the prevention of preeclampsia and gestational hypertension, it doesn’t prove causality. More protective studies are needed.

ResearchBlogging.org
Saftlas, A., Triche, E., Beydoun, H., & Bracken, M. (2010). Does Chocolate Intake During Pregnancy Reduce the Risks of Preeclampsia and Gestational Hypertension? Annals of Epidemiology, 20 (8), 584-591 DOI: 10.1016/j.annepidem.2010.05.010

 

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The Neuroscience of Pregnancy

pregnancy neuroscience

Pregnancy requires many adaptations to new situations. These changes are accompanied by massive neuroendocrine changes leading to adaptations organized by the mother’s brain. These changes are necessary for the different phases of pregnancy and motherhood.

First optimization is needed for the growth and protection of the fetus, next parturition has to be timely and uncomplicated, next maternal behavior such as caring and defending the young is important together with the start of lactation. It’s not easy to understand the complex interaction between female- and pregnancy hormones and their interaction with the maternal brain.

At the start of pregnancy the brain controls the increased appetite necessary for the pregnancy and the expansion of the blood volume as well as deeper breathing. The brain also prevents further ovulations through the pituitary gland.

The most important female hormones secreted in massive amounts during pregnancy are oestrogen en progesterone. They are very lipid soluble and easily penetrate the brain. Their ratio change the balance between inhibition and excitation. The stages of the pregnancy are signaled to the brain by the pattern of their secretion. Labor starts after the progesterone to oestrogen ratio strongly declines.

The fetus is during pregnancy protected from stress hormones such as cortisol by “in-built” mechanisms. The stress system (HPA-axis) activity is reduced during pregnancy, the responsiveness of the system to a wide range of physical and psychological stressors is reduced. If all this fails, the placenta produces an enzyme that acts as a barrier against maternal stress hormones. It converts these stress hormones (cortisol) to inactive metabolites.

The other most important female hormone for pregnancy and it’s effects on the brain is Oxytocine. When the ratio of progesterone to oestrogen drops, oxytocine is released and stimulates expulsive uterine contractions (labor), it reduces the anxiety of the first exposure to the screaming and noisy newborn, it encourages maternal behavior and the oxytocine pulses due to nipple sucking starts the breast feeding. Prolactin also increased at the end of pregnancy which is also important for breast feeding and maternal behavior.

This is just a short introduction to all the different complex systems and adaptations needed with pregnancy. If your interested the most extensive review was published in Neuroscience in January 2008. For a short and comprehensive explanation you can freely read online: 12. The maternal brain by Professor John A Russell, Laboratory of Neuroendocrinology, Department of Biomedical Sciences, University of Edinburgh.

ResearchBlogging.org
Brunton, P., & Russell, J. (2008). The expectant brain: adapting for motherhood Nature Reviews Neuroscience, 9 (1), 11-25 DOI: 10.1038/nrn2280

 

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Suicide During Pregnancy?

suicide pregnancy

True or false:

“ Pregnant women never commit suicide, they just don’t do it because it’s against human nature”

This is what experts declared to a murder trial jury in 1993 after the death of an 38 weeks pregnant woman. Because of this declaration, Eddy Gifoyle, who found his wife hanging in the garage is serving a life sentence for the murder of his pregnant wife.

This guest post was written by Veerle Bergink, psychiatrist, besides patient care especially perinatal psychiatry she is also busy on her PhD research project
Amazing that this actually happened in the UK, the cradle off perinatal psychiatry… Only 10 years later the article: suicide: the major cause of maternal death was published by Margeret Oates in the British Journal of Psychiatry.

More pregnant and postpartum mothers die because of suicide than die from infection, high blood pressure and hemorrhage combined. Furthermore depressive and anxiety states are very common during pregnancy.

In Rotterdam we do have a large in and outpatients clinic to treat all these perinatal conditions. Untreated depression and anxiety during pregnancy is not only harmful for the mother but also for the unborn child (it’s the potential next generation of patients suffering from psychiatric disorders).

Since recent a dutch website about perinatal psychiatry is available

This guest post is written by Veerle Bergink, psychiatrist, besides patient care especially in perinatal psychiatry, she is also doing her PhD research project

 

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ECT and Pregnancy

pregnancy ect

The last systematic review of this topic was in 1994. According to this recent review ECT does seem to be effective for treating mental illness during pregnancy and the risks of adverse events are low. It should be considered in pregnant women with severe mental illness such as psychotic symptoms, catatonia or strong suicidal urges.

Why is this important?

  • The most common mental illness during pregnancy is major depressive disorder. It is estimated that 9% of pregnant patients suffer from major depressive disorder
  • Untreated depression is linked to poor maternal and neonatal outcomes including poor weight gain during pregnancy, higher risk of alcohol and/or drug abuse, preterm birth, lower birth weight, preeclampsy, and hindered mother infant bonding
  • Elevated risk of suicide
  • ECT is efficacious for major depressive disorder and other severe mental disorders
  • Medications carry a potential risk for the fetus especially in the first trimester.

How was this study done?

English-language and English-language translated articles published since 1941 that included data on ECT in pregnancy were located in bibliographic databases, online sites, journal issues, and secondary sources, such as journal articles and book chapters. PubMed and PsycINFO were searched using the terms “ECT,” “electroshock,” “electroconvulsive” or “electroconvulsive shock,” and “pregnancy.”

The search yielded 57 articles that met the inclusion criteria and dated from 1942-2007. The total number of cases described was 339.

Results

  • The mean number of treatments was 10.8 (range 1-35). Gestational age was reported in 71 cases. Fifteen patients received ECT in the first trimester, 37 received ECT in the second trimester, and 19 in the third trimester.
  • Efficacy data were available on 68 of 339 cases. Of these 37 were diagnosed with either MDD or “depression” (with or without psychosis) and the rate of at least partial response was 84%. Twenty-one pregnant women were treated for schizophrenia or schizophreniform disorder and the rate of at least partial remission was 61%.
  • There were 25 of the 339 cases in which fetal or neonatal abnormalities were reported. death (n=11), transient fetal bradycardia and or decelerations (n=8), peritonitis (n=1), club foot (n=1), prematurity (n=1), congenital pulmonary cysts (n=2), congenital blindness (n=1), great vessel transposition (n=2), aorta coarctation (n=1), cortical infarcts (n=1), anencephaly (n=1), VATER syndrome (n=1), and mental retardation (n=1).
  • Of the 11 reported fetal or neonatal deaths, only one was believed to be the direct result of ECT, death followed an episode of status epilepticus in the mother secondary to ECT. The others were believed to be unrelated to ECT
  • Among the nonfatal complications only 8 cases of abnormal transient fetal arrhytmias and one case of multiple interhemispheric infarctions were believed to be related to ECT.
  • There were 18 of 339 maternal cases described with complications likely related to ECT.
  • Of the 8 fetal and 18 maternal cases describing complications likely related to ECT includes 4 cases that each have both a neonatal and maternal complication.

Conclusion (with my 2 cents added)
ECT is an option with severe mental health disorder during pregnancy. Some precautionary measures should be taken with ECT durnig pregnancy:

  • Positioning a woman during the latter stages of pregnancy to minimize aortocaval compression by elevating the right hip and displacing the uterus will also improve placental perfusion and minimize the risk of hypoxia in the fetus.
  • From the third trimester intubation is always necessary. The authors don’t mention this in their article but it should have
  • Tocodynamometry during ECT administration can be used for monitoring uterine activity. In the event of uterine contractions, tocolysis with alfa-2-adrenergic agonists like ritodrine can be administered.
  • Given the potential for general anesthesia to sedate the fetus, obstetric fetal monitoring is necessary during ECT. We don’t always do this, it depends on the trimester and growth of the fetus. We do it at least once every month during a ECT session.

no randomized, controlled trial has yet been conducted evaluating ECT efficacy for treating major mental illness during pregnancy.

Another limitation of this review is reporting bias. Adverse or unusual outcomes post treatment with ECT are much more likely to be reported than normal or uneventful outcomes. This review did not focus on long term outcome.

Obstretic fetal monitoring is one suggestion of debate, how often should this be done, every treatment, all trimesters? Nobody knows. Any idea anyone? Let me know your experiences with ECT during pregnancy in the comments.

Related post on this blog: Electroconvulsive therapy and pregnancy, a case report
Why pregnant women don’t tip over
ResearchBlogging.org
E. L. Anderson, I. M. Reti (2008). ECT in Pregnancy: A Review of the Literature From 1941 to 2007 Psychosomatic Medicine DOI: 10.1097/PSY.0b013e318190d7ca

 

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Why pregnant women don’t tip over


Women have some reinforcements in their backs that men lack. This is to compensate for the forward shift of the trunk’s centre of mass (COM) above the hips during pregnancy.
Isn’t nature beautiful?

reinforcements in their backs that men lack, including a lumbar (lower back) curve that spans three instead of two vertebrae and spinal joints that are 14 percent larger and positioned differently.

From Scientific American

bipedalism poses a unique challenge to pregnant females because the changing body shape and the extra mass associated with pregnancy shift the trunk’s COM anterior to the hips. Here we show that human females have evolved a derived curvature and reinforcement of the lumbar vertebrae to compensate for this bipedal obstetric load.

From Nature