Pregnancy Concerns

Overweight and pregnant

Management of childbirth in the excessively overweight patient was a topic pregnant scalesof discussion at a recent department meeting at one of the hospitals I attend.

Obesity is increasing in incidence in the community. Now approximately 50 per cent of women who become pregnant are overweight. Being excessively overweight has considerable implications for a pregnant woman. It is one of the most important and most difficult challenges in pregnancy and childbirth care.

Body mass index (BMI) is the index used medically to establish whether or not someone is of an appropriate weight for their height.

You can check your BMI at the National Heart Foundation of Australia website.

Risks of being overweight and pregnant

Pregnancy

Being of considerable excessive size

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Posted by Dr Gary Sykes on -

Overweight and pregnant

Obesity is increasing in incidence in the community. Now approximately 50 per cent of women who become pregnant are overweight. Being excessively overweight has considerable implications for a pregnant woman. It is one of the most important and most difficult challenges in pregnancy and childbirth care.

Body mass index (BMI) is the index used medically to establish whether or not someone is of an appropriate weight for their height.bmi

You can check your BMI at the National Heart Foundation of Australia website.

Risks of being overweight and pregnant

Pregnancy

Being of considerable excessive size (BMI ≥ 40) (called ‘morbid obesity’) is associated with an increased incidence of subfertility and miscarriage. As well, there is an increased risk in pregnancy of diabetes, pre-eclampsia, thrombosis, sleep apnoea, excessive growth of the baby (called ‘macrosomia’) and maternal death. Ultrasound imaging of the baby in the uterus and monitoring of the baby’s growth and wellbeing with ultrasound scans is

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Vitamin D deficiency

I have Vitamin D deficiency. Is this a problem in pregnancy?

More Vitamin D deficiency is being diagnosed in the community. This is due a combination of more doctors checking Vitamin D levels in “well” people and also an increased incidence with people being encouraged to say out of the sun, to cover up and to use strong sun screens to help prevent the sun causing skin cancers especially malignant melanoma.

Vitamin D helps to develop your baby’s bones. If you have a very significant Vitamin D deficiency it can result in a reduced the amount of calcium your baby's bones and in very severe cases can cause a bone deformity called "rickets".  Personally I have never delivered a baby with rickets, even though I have delivered thousands of babies.

For the large majority of pregnant women Vitamin D deficiency is a long term rather than a pregnancy-only consideration. Vitamin D helps to maintain your muscle and bone strength, helps your body absorb calcium from food and may also protect you against developing diabetes, heart disease and some types of cancer. But a recent study by Prof Ian R Reid reported in the Lancer Medicla Journal found the widespread use of vitamin D for osteoporosis prevention in community-dwelling

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Weight Gain in Pregnancy

What is normal weight gain in pregnancy?iStock_000005174065XSmall_thumb

The usual weight gain in pregnancy is 10-12 kg, which works out to approximately one kg and a bit every month of pregnancy.

Weight gain patterns vary considerably though. Larger women tend to gain less weight in pregnancy than this.

Excess weight gain

Excess weight gain has an association with a having larger baby, gestational diabetes and hypertension in pregnancy. But for most women there are no pregnancy concerns.

The good reason for watching your weight gain in pregnancy is because the more weight you put on the more weight you have to take off to get back to your pre-pregnancy weight once the pregnancy is over. There has been many a woman who has ‘lost her figure’ because of excess weight gain in pregnancy

It is also known that women who gain excessive weight during pregnancy are at higher risk of having overweight or obese children. Childhood obesity is on the increase and is associated with many health and psychological challenges for the child. As well if you don’t learn how to eat healthy before you are pregnant what hope do you

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Varicose Veins

I think I have varicose veins!

Varicose veins are twisted, enlarged, palpable veins near the surface of the skin. varicose-veinsThey most commonly develop in the legs and ankles. In pregnancy they can also occur in the vulval area (vulval varicosities).

They are common in pregnancy because of hormone changes affecting the circulation, gravity (hence they are common in the legs) and pressure effect of the uterus and later the baby's head in the pelvis on blood circulation.

Varicose veins often run in families and so there is often an inherited weakness in the venous circulation.

Besides the adverse cosmetic effect they can cause aching pain and discomfort. Occasionally there is superficial thrombophlebitis in varicose veins. This implies infected clot formation. It is unusual to be associated with the more serious condition deep vein thrombosis.

Spider veins are common, mild varicose veins they look like short, fine lines, "starburst" clusters, or a web-like maze and are usually not palpable. Spider

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Vaginal Discharge

Why do I have so much discharge?

It is common to have more vaginal discharge in pregnancy. It is due to the impact of hormones on the skin of the vagina and cervix. It is clear to yellow in colour and there is no irritation or significant odour. The amount varies from one woman to another.

If there is an irritation or odour then you could have a vaginal infection. The most common is due to Candida albicans (thrush).

If you have a very watery clear vaginal loss and especially if it has a fishy smell then you could have rupture of the membranes. The loss is usually considerable but sometimes is not.

What can be done?

Nothing can be done in pregnancy about the physiological increase in discharge in pregnancy, as it is part of pregnancy changes. It will settle after the pregnancy. Use pads and not tampons and change them frequently. If it doesn't settle after you have your baby it may be because you may have a cervical ectropion (excessive glands on your cervix). Cervical diathermy after your pregnancy is over will most likely result in you having markedly less discharge. Ask me about this if it is relevant for you.

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Urinary Frequency

Why am I going to the toilet so often?Foam-born baby

Urinary frequency is common even from conception. It can be one of the first symptoms of pregnancy.

It is related to hormone changes and the increase in blood volume that occurs in pregnancy. As well pregnant women are encouraged to drink more. The pressure of the pregnant uterus on the back of the bladder and in advanced pregnancy the baby's head in the pelvis will exacerbate the problem.

What can be done?

It is part of pregnancy, sorry!

It will self correct after you have your baby. It may be worst immediately after deliver especially if you have significant fluid retension.

Be aware of discomfort with passing urine as this could be due to a urinary tract infection. Urinary tract infections are more common in pregnancy. If this happens let me know

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Tiredness

Why am I so tired?

Tiredness is very common. Tiredness tends to be more iStock_000003906161XSmall_thumbof a problem in the first and third trimesters. In the first trimester it is the body getting used to pregnancy while in the third trimester it has to do with being advanced in pregnancy and the body coping with your extra pregnancy size. Most women feel quite good in the second trimester.

What can be done?

In the first trimester women may not yet show or may not want people to yet know, and so often will try to be as active as they would be if they were not pregnant. It doesn't work! You will need to rest more and have some early nights. If the tiredness continues you may need extra help around the house. Your body is saying "slow down". Listen to it. It always wins! Some will even need to stop working earlier than planned if they are not coping. It

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Swelling

Why am I so swollen?

Swelling is due to fluid retension in the body in pregnancy. It is due to hormone changes of pregnancy and is common. It usually occurs in the feet / ankles and hands / wrists. swollen_ankles_thumbIt can also be noticed in the vulval area, in the face and in the general body. Historically excessive swelling has been used as a sign of preeclampsia though it usually does not indicate this. Also preeclampsia often occurs without significant swelling.

Swelling usually gets worst in advanced pregnancy and can be even more marked immediately after delivery.

Fluid retension in the hands can result in carpal tunnel syndrome. This is due to fluid causing pressure on the median nerve as it travels through the carpal tunnel at the base of the hand. This may result in pain, weakness, tinging or numbness in the hand and wrist, radiating up the arm.

As well as not being attractive swelling can cause considerable discomfort and numbness.

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Stabbing Pains in my Pelvis

I have stabbing pains in my pelvis. Is that ok?iStock_000007120272XSmall pain_thumb

Usually the answer is yes but you should bring it to my attention to check.

It is more common in advanced pregnancy and especially if your baby’s head is engaged in your pelvis, if you have had an advanced pregnancy and especially vaginal birth before, or if you have a large baby on board.

It can be due to the pressure of your baby’s head in your pelvis. It can happen without your baby’s head being engaged and due to tension on pelvic ligaments that have been stretched from your previous pregnancies.

What can be done about it?

  • Let me know so I can determine all is normal
  • Rest as much as possible. Try to minimise heavy house work, walking and lifting any toddler you may have
  • Sometimes wearing a Velcro belt when up and about can help as it will give you extra
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