KHAULA REHMAN MD

KHAULA REHMAN MD
FIRST TRIMESTER
The first 12 weeks of pregnancy
Fertilization
Implantation in the uterus wall
Placenta forms
Formation of all body systems
by the end of the first trimester, the fetus begins to move
and takes a recognizable human shape , will be about 3
inches (76 mm) long and will weigh approximately 1
ounce (28 g).
SECOND TRIMESTER
Weeks 13 to 28 of the pregnancy .
Once pregnancy moves into the second trimester, the
risks of miscarriage and birth defects drop drastically
Bodily changes are more apparent
The movement of the fetus is usually felt in 19- 21
week
Ultrasound can determine that baby is male or female
THIRD TRIMESTER
The fetus will be growing the most rapidly during this
stage, gaining up to 28 g per day.
This period of pregnancy can be uncomfortable,
causing symptoms like weak bladder control and
backache.
There is head engagement in the third trimester, that
is, the fetal head descends into the pelvic cavity
Embryo at 4 weeks after fertilization
Fetus at 8 weeks after fertilization
Fetus at 18 weeks after fertilization
Fetus at 38 weeks after fertilization
NUTRITION AND PREGNANCY
A balanced, nutritious diet ,including carbohydrates, fat,
and protiens.
eating a variety of fruits and vegetables.
Start prenatal vitamins.
Adequate peri-conceptional folic acid intake has been
proven to limit fetal neural tube defects, preventing spina
bifida a very serious birth defect. The neural tube develops
during the first 28 days of pregnancy.
NUTRITION AND PREGNANCY
Folic acid is abundant in green leafy vegetables as
spinach , salads, beets, broccoli, asparagus, citrus fruits
and melons, chickpeas and eggs.
In the United States and Canada, most wheat products
flour, noodles and cereals are fortified with folic acid.
Foods That should avoided
during pregnancy
Raw Meat: Uncooked seafood and rare or undercooked beef
or poultry should be avoided because of the risk of
contamination with coliform bacteria, toxoplasmosis and
salmonella.
Deli Meat: Deli meats have been known to be contaminated
with listeria, which can cause miscarriage. Listeria has the
ability to cross the placenta and may infect the baby leading to
infection or blood poisoning, which may be life-threatening. If
you are pregnant and you are considering eating deli meats,
make certain that you reheat the meat until it is steaming .
Foods That should avoided
during pregnancy
Raw Eggs: Raw eggs or any foods that contain raw eggs
should be avoided because of the potential exposure to
salmonella. Some homemade Caesar dressings, mayonnaise,
homemade ice cream or custards can have raw eggs. If the
recipe is cooked at some point, this will reduce the exposure to
salmonella. Commercially manufactured ice cream, dressings,
and eggnog are made with pasteurized eggs and do not increase
the risk of salmonella.
Foods That should avoided
during pregnancy
Un pasteurized Milk: Un pasteurized milk may contain a
bacteria called listeria, which can be life-threatening for the
baby. Make sure that any milk you drink is pasteurized.
Soft Cheese: You would need to avoid soft cheeses such as:
Brie, Camembert, Roquefort, Feta, Gorgonzola and Mexican
style cheeses that include queso blanco and queso fresco,
unless they clearly state that they are made from pasteurized
milk.
Foods That should avoided
during pregnancy
Unwashed Vegetables:
Vegetables are safe to eat. However, it is essential to make
sure they are washed to avoid potential exposure to
toxoplasmosis.
Foods That should avoided
during pregnancy
Caffeine: Although most studies show that caffeine intake in
moderation is OK, there are others that show that caffeine intake may
be related to miscarriages, premature birth, low birth weight, and
withdrawal symptoms in infants. The safest thing is to refrain from
consuming caffeine. If you cannot avoid it than it should be less than
200 mg per day during pregnancy.
Alcohol: There is NO amount of alcohol that is known to be safe
during pregnancy. It can cause fetal alcohol syndrome
Foods That should avoided
during pregnancy
Fish with Mercury: Fish that contain high levels of mercury should be
avoided. Mercury consumed during pregnancy has been linked to
developmental delays and brain damage. A sample of these types of fish
include: shark, swordfish, king mackerel, and tilefish. Canned, chunk light tuna
generally has a lower amount of mercury than other tuna, but still should only
be eaten in moderation. Certain types of fish used in Sushi should also be
avoided due to high levels of mercury.
Fish Exposed to Industrial Pollutants: Avoid fish from
contaminated lakes and rivers that may be exposed to high levels of
polychlorinated biphenyls. This is primarily for those who fish in local lakes
and streams. These fish include: bluefish, striped bass, salmon, pike, trout, and
walleye. Contact the local health department or Environmental Protection
Agency to determine which fish are safe to eat in your area. Remember, this is
regarding fish caught in local waters and not fish from your local grocery store.
WEIGHT GAIN AND
PREGNANCY
Caloric intake must be increased to ensure proper development
of the fetus. .
The Institute of Medicine recommends an overall pregnancy
weight gain for women starting pregnancy at a normal of 25–
35 pounds
Overweight women are advised to gain between 15–25 lbs,
Obese woman to gain between 11–20 lbs.
Doctors and dietitians may make different, or more
individualized, recommendations for specific patients, based on
factors including low maternal age, nutritional status, fetal
development, and morbid obesity.
WEIGHT GAIN AND
PREGNANCY
During pregnancy, insufficient or excessive weight
gain can compromise the health of the mother and
fetus. All women are encouraged to choose a healthy
diet regardless of pre-pregnancy weight.
Exercise during pregnancy, such as walking and
swimming, is recommended for healthy pregnancies.
Exercise has notable health benefits for both mother
and baby, including preventing excessive weight gain.
United States FDA Pharmaceutical
Pregnancy Categories
Pregnancy Category A
Adequate and well-controlled human studies have failed to demonstrate a risk to the fetus in the
first trimester of pregnancy (and there is no evidence of risk in later trimesters).
Pregnancy Category B
Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate
and well-controlled studies in pregnant women OR Animal studies have shown an adverse effect,
but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the
fetus in any trimester.
Pregnancy Category C
Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate
and well-controlled studies in humans, but potential benefits may warrant use of the drug in
pregnant women despite potential risks.
Pregnancy Category D
There is positive evidence of human fetal risk based on adverse reaction data from investigational
or marketing experience or studies in humans, but potential benefits may warrant use of the drug in
pregnant women despite potential risks.
Pregnancy Category X
Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive
evidence of human fetal risk based on adverse reaction data from investigational or marketing
experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential
benefits.
United States FDA Pharmaceutical
Pregnancy Categories
CATEGORY A
Vitamins
Levothyroxine (Used for Hypothyriodism)
United States FDA Pharmaceutical
Pregnancy Categories
CATEGORY B
Acetaminophen (Tylenol, Paracetamol)
Pepcid
Amoxicillin and Clavulanic acid
Cafotaxime
Rhinocort nasal spray
Glucophage (metformin) for diabetes
Some insulins used to treat diabetes such as regular and
NPH insulin.
United States FDA Pharmaceutical
Pregnancy Categories
CATEGORY C
Diflucan (fluconazole) for yeast infections
Ventolin (albuterol) for asthma
Allegra
Ciprofloxacin
Theophylline
Zoloft (sertraline) and Prozac (fluoxetine) for depression
Triamcinolone (skin)
Rifampicine
United States FDA Pharmaceutical
Pregnancy Categories
CATEGORY D
Aspirin
Paxil (paroxetine) for depression
Lithium for bipolar disorder
Dilantin (phenytoin) for epileptic seizures
Phenytoin
Tetracycline
Some cancer chemotherapy
United States FDA Pharmaceutical
Pregnancy Categories
CATEGORY X
non-contraceptive estrogens (estradiol, conjugated estrogen with
methyltestosterone or testosterone)
statins (lovastatin, atorvastatin, pravastatin, simvastatin, fluvastatin,
cirivastatin),
warfarin derivatives
quinine
Benzodiazepine sedatives (flurazepam, quazepam, temazepam, triazolam)
Xanax
non-oestrogen hormones (leuprolide, danazol, clomiphene),
vitamin A preparations (etretinate, isotretinoin, menadione, and vitamin A),
ribavirin, chenodiol, live vaccines (measles, mumps, rubella),
iodinated glycerol, aminopterin, and misoprostol.
Thalomide
HYPERTENSION AND
PREGNANCY
Chronic Hypertension (complicates 5% of all
pregnancies)
Pregnancy induced Hypertension ( usually in third
trimester)
COMPLICATIONS OF
HYPERTENSION IN PREGNANCY
MOTHER
Stroke, pre-eclampsia and eclampsia
BABY
Placenta Abruption
Abnormal development of placenta
Fetal growth retardation
TREATMENT OF HYPERTENSION
IN PREGNANCY
AVIOD
ACE- Inhibitors
Angiotensin enzyme inhibitors
Aldosterone receptor blockers
Diuretics
Can Take
methyl-dopa,
calcium channel blockers, and
labetalol.
SIGNS & SYMPTOMS WATCHED
DURING PREGNANCY
Check your BP regularly
If headaches, swelling of your hands, feet and legs
call your doctor
pay attention to the baby’s movements
ASTHMA AND PREGNANCY
Asthma affects over 20 million Americans and is one of the
most common potentially serious medical conditions to
complicate pregnancy.
Poorly controlled asthma can lead to serious medical problems
for pregnant women and their fetuses. Maternal asthma is
associated with increased risk of infant death, preeclampsia (a
serious condition marked by high blood pressure, which can
cause seizures in the mother or fetus), premature birth, and
low-birth weight.
Simply put, when a pregnant patient has trouble breathing, her
fetus also has trouble getting the oxygen it needs
NAEPP guidelines for treating
asthma during pregnancy
We cannot predict whose asthma will worsen during
pregnancy. Generally asthma in 1/3 of the women will
stay the same, in 1/3 it will improve and in 1/3 it will get
worse.
so the new guidelines recommend that pregnant patients
with persistent asthma have their asthma checked at least
monthly by a healthcare provider.
NAEPP guidelines for treating asthma
during pregnancy
Albuterol, a short-acting inhaled beta2-agonist, should be used
as a quick-relief medication to treat asthma symptoms.
Pregnant women with asthma should have this medication
available at all times.
Women who have symptoms at least two days a week or two
nights a month have persistent asthma and need daily
medication for long-term care of their asthma and to prevent
exacerbations. Inhaled corticosteroids are the preferred
medication to control the underlying inflammation in pregnant
women with persistent asthma. The guidelines note that there
are more data on the safety of budesonide use during
pregnancy than on other inhaled corticosteroids
NAEPP guidelines for treating asthma
during pregnancy
For patients whose persistent asthma is not well controlled
on low doses of inhaled corticosteroids alone, the
guidelines recommend either increasing the dose of
inhaled corticosteroid or adding another medication — a
long-acting beta agonist.
Oral corticosteroids may be required for the treatment of
severe asthma. The guidelines note that there are
conflicting data regarding the safety of oral corticosteroids
during pregnancy; however, severe, uncontrolled asthma
poses a definite risk to the mother and fetus; and use of
oral corticosteroids may be warranted.
ASTHMA AND PREGNANCY
prospective studies found no relation between taking
inhaled corticosteroids and congenital abnormalities or
other adverse pregnancy outcomes
leukotriene receptor antagonists, cromolyn, theophylline ,
and antihistamines should be avoided
Important aspects of asthma
management during pregnancy
Identifying and limiting exposure to asthma triggers
Women with other conditions that can worsen asthma, such as
allergic rhinitis, sinusitis, and gastro-esophageal reflux, should
have these conditions treated as well by their Physician.
Tobacco smoke or allergens like dust mites should be avoided
DIABETES AND PREGNANCY
Criteria for very high risk are:
Severe obesity
Prior history of GDM or delivery of large baby
Presence of glycosuria
Diagnosis of PCOS
Strong family history of type 2 diabetes
DIABETES AND PREGNANCY
High blood glucose levels before and during pregnancy can
worsen your long-term diabetes complications, such as vision
problems, heart disease, and kidney disease
Increase the chance of problems for your baby, such as being
born too early, weighing too much or too little, and having low
blood glucose or other health problems at birth
Increase the risk of your baby having birth defects
increase the risk of losing your baby through miscarriage or
stillbirth
However, research has shown that when women with diabetes
keep blood glucose levels under control before and during
pregnancy, the risk of birth defects is about the same as in
babies born to women who don't have diabetes.
DIABETES AND PREGNANCY
Plan your pregnancy. See your doctor. Get your diabetes under good control.
Monitor your blood sugar often. Pregnancy affects your blood sugar control. You will
probably need to check your blood sugar more often than when you are not pregnant. Talk
with your doctor about how often to check your blood sugar.
Take your medications on time. If medications are ordered by a doctor, take them as
directed.
Control and treat low blood sugar quickly. Having tight blood sugar control can lead
to a chance of low blood sugar at times. Keep a ready source of sugar, such as glucose tablets
or gel or hard candy, on hand at all times. Talk with your doctor about how to treat low blood
sugar.
Follow up with the doctor regularly. You will need to see your doctor more often than
a pregnant woman without diabetes. Together, you can work with your doctor to prevent or
catch problems early.
If you had gestational diabetes, talk with your doctor about getting your blood sugar
checked after delivery and every 1 - 3 years. About half of all women who had gestational
diabetes develop type 2 diabetes later.
PRE-ECLAMPSIA
Preeclampsia is a condition that typically starts after the 20th
week of pregnancy and is related to increased blood pressure
and protein in the mother's urine . Preeclampsia affects the
placenta, and it can affect the mother's kidney, liver, and brain.
When preeclampsia causes seizures, the condition is known as
eclampsia -the second leading cause of maternal death in the
U.S. Pre-eclampsia is also a leading cause of fetal
complications, which include low birth weight, premature
birth, and stillbirth
Who Is More Likely to Develop
Preeclampsia?
Women with chronic hypertension, Diabetes and kidney disease.
Women who developed high blood pressure or preeclampsia during a previous
pregnancy, especially if these conditions occurred early in the pregnancy.
Women who are obese prior to pregnancy.
Pregnant women under the age of 20 or over the age of 40.
Women who are pregnant with more than one baby.
SYMPTOMS OF PRE-ECLAMPSIA
Increased BP
Swelling
Protien in the urine
Headache
Abdominal pain
TREATMENT OF PREECLAMPSIA
The only cure is Delivery of the baby
Medications to lower blood pressure.
Corticosteroids. can temporarily improve liver and platelet
functioning to help prolong your pregnancy. Corticosteroids
can also help your baby's lungs become more mature in as little
as 48 hours — an important step in helping a premature baby
prepare for life outside the womb.
Anticonvulsive medications. If your preeclampsia is severe,
your doctor may prescribe an anticonvulsive medication, such
as magnesium sulfate, to prevent a first seizure.