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Pregnancy and Fertility Blog of Dr.Amos

Prevention of Travelers' Diarrhea

Thu, 03/20/2014 By Dr.Amos
Take two Pepto Bismol chewable tablets whose active ingredient is bismuth subsalicylate (BSS) 4-times a day to prevent travelers' diarrhea.

Studies have shown tthat it can reduce the incidence of travelers diarrhea by approximately 50%.

BSS should be avoided by travelers with

  • aspirin allergy
  • renal insufficiency
  • gout 
  • those taking anticoagulants, probenecid, or methotrexate. 

BSS is not generally recommended for children aged <12 years. Caution should be taken in administering BSS to children with viral infections, such as varicella or influenza, because of the risk for Reye syndrome. BSS is not recommended for children aged <3 years. Studies have not established the safety of BSS use for periods >3 weeks. Because of the number of tablets that need to be carried and the 4 times per day dosing, BSS is not commonly used as prophylaxis for TD.

Read more on the CDC website

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News of the Week: 1/13/2014

Mon, 01/13/2014 By Dr.Amos

Here are the News for the Week of 1/13/2014

 

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Omega 3 DHA and EPA Fatty Acids During Pregnancy and Fetal Development

Mon, 12/30/2013 By Dr.Amos

What are Omega-3 Fatty Acids?

Omega-3 fatty acids chemicals that are essential for the development of important body functions. Most omega-3 acids are consumed in the diet but they can also be added to the diet with supplements. During pregnancy, getting enough omega-3 fatty acids is crucial because these fatty acids are critical building blocks of the fetal brain and the retina, a part of the eye. In addition to affecting the fetus, omega-3 fatty acids may also play a role in determining the length of gestation and in preventing perinatal depression

There are two fatty acids that are especially important:

  • DHA: Docosahexaenoic acid (DHA) and
  • EPA: Eicosapentaenoic acid (EPA) 

In general, omega-3 fatty acids are associated with several different body functions suchas dilatation of vessels, preventing blood clots, and reduction in inflammation. DHA is also a fatty acid that is mostly located in the brain, and it especially increases in the brain of the fetus very quickly in the third trimester of the pregnancy.

Maternal nutrition has a significant effect on the developing fetus and having the proper amount of omega-3 affects the amount of DHA deposited in the growing brain.

How can you get these fatty acids?

In general, these fatty acids are found in plants such as walnuts and in oils made from soy, canola, and flaxseed. In addition, both DHA and EPA are found in fatty fish (salmon, tuna, trout, sardines, and mackerel) and in smaller amounts in lean fish and shrimp. Your diet should therefore be geared towards getting these food within a balanced diet.

Many seafoods are rich in Omega-3, however about 10 years ago the FDA advised all pregnant women to limit seafood consumption to 340 g (2 6-oz servings) per week to limit fetal exposure to trace amounts of potential toxins such as mercury. Pregnant women should continue to eat 2 servings of fish and seafood a week during pregnancy, but they should avoid consumption of swordfish, king mackerel, shark, and tilefish.

Observational studies have found that omega-3 fatty acid consumption during pregnancy either in the diet or via supplements is associated with improved neurodevelopmental outcomes in the child, but there is not enough data to recommend omega-3 fatty acid supplementation for the sole purpose of prolonging gestation or reducing the risk of preterm birth. In addition, some data have shown that low seafood intake during pregnancy correlates with higher levels of depressive symptoms during pregnancy. while more thorough randomized, controlled trials have failed to demonstrate a clear benefit to omega-3 fatty acid supplementation during pregnancy and postpartum to prevent depressive symptoms.

Recommendation

Omega-3 fatty acids are essential for the developing fetus. All pregnant women should try and eat the right amount of food to obtain omega-3 in pregnancy. The right food includes 2 servings of low mercury seafood, plants, or supplements. As a good alternative, especially if you cannot consume the recommended amount of seafood, you can get the right amount of omega-3 fatty acids from fish oil supplements which are sometimes contained in prenatal vitamins or as separate supplements. Because omega-3 supplements are usually made from low mercury fish oil they are safe augment omega-3 fatty acids in the diet.

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Follow the Mediterranean Diet and Improve Your Fertility

Fri, 10/18/2013 By Dr.Amos
It's a fact: If you watch your weight and closely follow a Mediterranean-style diet high in vegetables, vegetable oils, fish and beans then you may increase your chance of becoming pregnant.

One in 3 cases of female infertility is due to weight issues, either being overweight or underweight. Both weight issues cause shifts in hormones, which can affect ovulation. Reducing weight by even 5 percent can enhance fertility.

Here are some nutritional tips to improve your fertility and your chances getting pregnant:

  • Take a regular pregnancy multivitamin supplement
  • Reduce intake of foods with trans and saturated fats while increasing intake of monounsaturated fats, such as avocados and olive oil
  • Add more vegetable protein to your diet and lower intake of animal protein
  • Add more fiber to your diet by consuming whole grains, vegetables and fruit
  • Incorporate more vegetarian sources of iron such as legumes, tofu, nuts, seeds and whole grains
  • Consume high-fat dairy instead of low-fat dairy

Male Infertility

Approximately one-half of infertility issues are attributed to men.  Among them is low sperm count and poor sperm motility, which are common in overweight and obese men. Men who are looking to have a baby should also maintain a healthy body weight and consume a balanced diet, because male obesity may affect fertility by altering testosterone and other hormone levels.

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Is waterbirth a good idea?

Fri, 09/13/2013 By Dr.Amos

According to Wikipedia, a water birth refers to childbirth, usually human, that occurs in water.

There are some misunderstandings as to what exactly a waterbirth refers to, as it may refer to:

  1. Women laboring in water during the early part of labor, then push and deliver outside the water ("early water labor")
  2. Women laboring in water during the second pushing stage then deliver outside the water ("later water labor")
  3. Babies born under water then removed from the water shortly afterwards ("under waterbirth")

There is no major culture known that walks on earth including humans that routinely delivers a baby under water. The only land mammals known to mate and deliver under water are hippos.

The few scientific studies done on labor in water but not water birth itself have shown that women who labor during the early stages of labor need less pain control such as epidurals. So there appear to be some maternal benefits to laboring but not delivering in water.

  • Early water labor: OK
  • Waterbirth: NOT OK

Considering the many advances we have made over the last decades in improving the safety of childbirth, the main consideration when planning a water birth should be the safety for the newborn baby.

Is here an advantage to the baby from being born in water?

The answer is that there is no known advantage to the newborn baby from a water birth. None. Zero. Advantages of laboring but not delivering in water are only for the mother and none for the baby.

Is there a disadvantage to the baby from being born in water?

The answer is a clear YES. Delivering in water is very risky to the baby and it can kill the baby. Not only are there no scientifically known advantages for the baby, but there are numerous case reports of babies born with adverse outcomes after an actual water birth. The concerns for serious harm include:

  • serious infections,
  • aspiration of water by the baby,
  • seizures,
  • respiratory distress syndrome,
  • snapped umbilical cords, 
  • brain damage, and 
  • actual drownings of babies.

Women considering an actual delivery of the baby in or under water should be informed that there is no known advantage to the baby and that the safety to the baby of actual water births or under water births has not been scientifically proven and can be risky and kill babies. Women need to balance their own comfort laboring and delivering in water against the absence of known safety for the baby and the known potential risks to the baby from a water birth. 

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Drink more milk in pregnancy: It may make your child grow taller

Fri, 09/13/2013 By Dr.Amos

There is no question that drinking milk in pregnancy improves the growth of the developing fetus. But what about future growth? Does it affect the height of adults too?

A new study published online Sept. 4, 2013 in The European Journal of Clinical Nutrition shows that the amount of milk a pregnant woman drinks is not only growth-promoting ifor weight and length at birth but may have an effect into early adult age.

This is a prospective study where researchers followed 809 Danish pregnant women and checked the growth of the infants after 20 years (n=685). 

Maternal milk consumption of >=150 ml/day vs < 150 ml/day was associated with higher birth weights, birth length, and 20 years later more height and more insulin-like growth factor I.

The authors suggest that drinking more milk during pregnancy increases future height of adults. 

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Prenatal Testing: Testing for Down syndrome and other chromosomal issues

Wed, 09/04/2013 By Dr.Amos
Like most moms-to-be, you want assurances about your and the baby’s health and you want to have the right tests done to ensure you get the information you need. That's where prenatal testing comes in. Seeing your doctor during pregnancy involves many things, but more importantly it includes a whole list of tests to check on the mother's and the baby's health.

Prenatal testing can detect many, but not all, conditions and knowing about your baby before birth can be helpful in making decisions.

Around 11-13 weeks of the pregnancy a screening for Down’s syndrome is usually offered to all pregnant women. The test is known as the "first trimester screen" or nuchal translucency test.

This test consists of two parts:  

1. An ultrasound to measure the thickness of the back of the fetus' neck and 

2. A blood test that detects the presence of 2 markers in a blood sample in conjunction wit blood tests that measure levels of pregnancy-associated plasma protein-A (PAPP-A) and a hormone known as human chorionic gonadotropin (HCG).  

These three tests are then combined to calculate the risks of having a fetus with a chromosomal anomaly.  Abnormal levels of PAPP-A and HCG or an abnormally thick neck may indicate a problem with the baby. If the test shows an increased risk, additional tests such as CVS (chorionic villi sampling) or amniocentesis can be done to confirm a diagnosis.

The current nuchal screening test has a false positive rate (that is, the results suggest a problem when the fetus is in fact healthy) of around 3-4%. 

This means many women have invasive testing, using chorionic villus sampling (CVS) or amniocentesis. Both of these procedures carry a less than 1 in 2-500 risk of causing a miscarriage.

There is now a new screening technique which is a simple blood test that involves analyzing the small amounts of fetal DNA found in the mother’s blood stream,  circulating cell-free DNA extracted from a maternal blood sample. The test can be done as early as 10 weeks of the pregnancy. It takes about 2 weeks for results to be ready and as more companies offer the test, it has become more widely available.  The test detects the relative amount of 21, 18, 13, X and Y chromosomal material, so if you desire, you can find out the gender of the baby as early as 11 weeks.

After testing 1,005 women, researchers found the new technique had a much lower false positive rate (around 0.1%). This means many fewer normal pregnancies had an unnecessary invasive diagnostic test with the new test. However, in about 2% of women the new test did not produce a result, meaning that the conventional screening technique had to be used.

For now, most professional organization recommend it only for women at risk, such as when you are 35 years or older or have other risks.

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Effect of Timing of Umbilical Cord Clamping of Term Infants on Maternal and Neonatal Outcomes

Sun, 07/14/2013 By Dr.Amos
Content: 

It seems unthinkable to deliberately deprive a newborn baby of 30% to 40% of its blood supply but some delivery experts suggest we do exactly that when the umbilical cord is severed within a minute of its birth. A recently published report indicating a wait of just another minute or two delivers immediate benefits to the baby with no added risk to the mother's safety. 

The report -- Effect of Timing of Umbilical Cord Clamping of Term Infants on Maternal and Neonatal Outcomes -- was published online on July 11, 2013, by the Cochrane Pregnancy and Childbirth Group. Data was gleaned from 15 clinical trials that involved 3,911 mothers and their newborn babies. 

The widespread practice of immediate cord clamping is said to minimize the risk of the mother hemorrhaging but results of the Cochrane report suggest the benefit to the baby outweighs the minimal risk to the mom. Benefits include: 

  • Improved stores of iron to the baby within the first six months of life 
  • Higher hemoglobin levels 24 to 48 hours after birth 
  • Higher birth rate, thought to be a result of added blood volume from the mother at birth 
  • No increased risk of severe hemorrhage 
  • No increase in maternal blood loss 
  • No reduction in maternal hemoglobin levels 

Concerns to consider: 

  • 2% increased risk of jaundice in babies 
  • Newborn anemia is not common in the US 
  • Certain medical emergencies require immediate clamping 

To counter concerns over jaundice, delayed clamping should be done in medical facilities equipped to deal with the possibility. Because of a mother's increased risk of hemorrhaging during a C-section delivery, delayed clamping should be reserved for vaginal deliveries only. 

There are no long term studies of the effects of delayed clamping but Dr. Tonse Raju, a neonatologist not involved with the study, says theoretically that improved iron stores at birth and in the first few months of life could minimize the risk of cognitive delay and learning difficulties later on. Iron-deficiency anemia has been linked to learning difficulties in children of school age. 

Raju describes the delayed clamping as "a good chunk of blood the baby is going to get" that will help fill the baby's lungs. Raju is medical officer for the National Institute of Child Health and Human Development. 

Eileen Hutton describes the study's implications as "huge" and suggests we've deprived babies of a valuable blood supply "just because we've learned a practice that's bad." Hutton, a midwife, teaches obstetrics at Ontario (Canada) McMaster University. 

MedlinePlus / US National Library of Medicine: Umbilical Cord Care in Newborns 

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WebMD got it all wrong

Wed, 06/26/2013 By Dr.Amos

As my readers know, I like to point out ignorance of other websites.

Below is the WebMD fertility calculator as of today, Jun 26, 2013.

I entered a last period of 5/1/2013 with 29 cycle days. Everybody knows that ovulation happens 14 days before the next period. So, LMP 5/1 plus 29, that would make the next period 5/30. WebMD is correct. Everybody also knows that the luteal phase last on average 14 days, so ovulation happens 14 days before the next period. And that fertility ends on the day of ovulation. You just cannot get pregnant from making love the day after ovulation. Look below what WebMD calculated. They calculated the fertile days from 5/14 to 5/18. If ovulation happens on CD 16 or 5/16, and there are 5 fertile days, then how come WebMD says you are fertile until 5/18? And not fertile before 5/14?   The correct fertility for an ovulation day of 5/16 would be from 5/12 to 5/16. If you follow the WebMD calendar and make love on 5/18 then you cannot get pregnant. 

WebMD Fertility Calculator

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Chemical Exposure During Pregnancy and Dealing with Uncertainties

Sun, 06/09/2013 By Dr.Amos
This is an excerpt from a publication:

Chemical Exposures During Pregnancy:  Dealing with Potential, but Unproven, Risks to Child Health

Under normal lifestyle and dietary conditions, the level of exposure of most women to individual environmental chemicals will probably pose minimal risk to the developing fetus/baby. However, women who are pregnant are exposed to hundreds of chemicals at a low level. Potentially, this exposure could operate additively or interactively and raises the possibility of ‘mixtures’ effects. On present evidence, it is impossible to assess the risk, if any, of such exposures. Obtaining more definitive guidance is likely to take many years; there is considerable uncertainty about the risks of chemical exposure. The following steps would however reduce overall chemical exposure:

  • use fresh food rather than processed foods whenever possible
  • reduce use of foods/beverages in cans/plastic containers, including their use for food storage
  • minimise the use of personal care products such as moisturisers, cosmetics, shower gels and fragrances
  • minimise the purchase of newly produced household furniture, fabrics, non–stick frying pans and cars whilst pregnant/nursing
  • avoid the use of garden/household/pet pesticides or fungicides (such as fly sprays or strips, rose sprays, flea powders)
  • avoid paint fumes
  • only take over–the–counter analgesics or painkillers when necessary
  • do not assume safety of products based on the absence of ‘harmful’ chemicals in their
  • ingredients list, or the tag ‘natural’ (herbal or otherwise). 

It is unlikely that any of these exposures are truly harmful for most babies, but in view of current uncertainty about risks, especially those relating to ‘mixtures’, these steps will reduce environmental chemical exposures. 

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