GROUP 2

Topics:Hematologic Disorders and

Pregnancy

Renal and Urinary Disorders and Pregnancy

Neurologic Disorders and Pregnancy

Cancer and Pregnancy

Members:

Aragon, John Cedric

Decena. Kimberly Jo – Ann

Francia, Diana Marie

Jainal, Elham

Nobi, Anita

Noritomi, Irene

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Tuazon, Czarina Isabela - Leader

Hematologic Disorders

and

Pregnancy

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Anemia in Pregnancy

When you're pregnant, you may develop anemia. When you have anemia, your blood doesn't have enough healthy red blood cells to carry oxygen to your tissues and to your baby.During pregnancy, your body produces more blood to support the growth of your baby. If you're not getting enough iron or certain other nutrients, your body might not be able to produce the amount of red blood cells it needs to make this additional blood.It's normal to have mild anemia when you are pregnant. But you may have more severe anemia from low iron or vitamin levels or from other reasons.Anemia can leave you feeling tired and weak. If it is severe but goes untreated, it can increase your risk of serious complications like preterm delivery.

Types of Anemia During Pregnancy

Several types of anemia can develop during pregnancy. These include:

Iron-deficiency anemiaFolate-deficiency anemia

Vitamin B12 deficiency

Here's why these types of anemia may develop:

Iron-deficiency anemia

This type of anemia occurs when the body doesn't have enough iron to produce adequate amounts of hemoglobin. That's a protein in red blood cells.It carries oxygen from the lungs to the rest of the body.In iron-deficiency anemia, the blood cannot carry enough oxygen to tissues throughout the body.

Iron deficiency  is the most common cause of anemia in pregnancy.

Folate-deficiency anemia

Folate, also called folic acid, is a type of B vitamin. The body needs folate to produce new cells, including healthy red blood cells.During pregnancy, women need extra folate. But sometimes they don't get enough from their diet. When that happens, the body can't make enough normal red blood cells to transport oxygen to tissues throughout the body.Folate deficiency can directly contribute to certain types of birth defects, such as neural tube abnormalities (spina bifida) and low birth weight.

Vitamin B12 deficiency

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The body needs vitamin B12 to form healthy red blood cells. When a pregnant woman doesn't get enough vitamin B12 from her diet, her body can't produce enough healthy red blood cells. Women who don't eat meat, poultry, dairy products, and eggs have a greater risk of developing vitamin B12 deficiency, which may contribute to birth defects, such as neural tube abnormalities, and could lead to preterm labor.

Risk Factors for Anemia in Pregnancy

All pregnant women are at risk for becoming anemic. That's because they need more iron and folic acid than usual. But the risk is higher if you:

Are pregnant with multiples (more than one child)Have had two pregnancies close togetherVomit a lot because of morning sickness

Are a pregnant teenagerDon't eat enough foods that are rich in ironHad anemia before you became pregnant

Symptoms of Anemia During Pregnancy

The most common symptoms of anemia during pregnancy are:

Pale skin, lips, and nailsFeeling tired or weak

Dizziness

Shortness of breathRapid heartbeatTrouble concentrating

In the early stages of anemia, you may not have obvious symptoms. And many of the symptoms are ones that you might have while pregnant even if you're not anemic. So be sure to get routine blood tests to check for anemia at your prenatal appointments.

Risks of Anemia in Pregnancy

Severe or untreated iron-deficiency anemia during pregnancy can increase your risk of having:

A preterm or low-birth-weight babyA blood transfusion (if you lose a significant amount of blood during delivery)

Postpartum depression A baby with anemiaA child with developmental delays

Untreated folate deficiency can increase your risk of having a:

Preterm or low-birth-weight baby

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Baby with a serious birth defect of the spine or brain (neural tube defe Treatment for Anemia

If you are anemic during your pregnancy, you may need to start taking an iron supplement and/or folic acid supplement in addition to your prenatal vitamins. Your doctor may also suggest that you add more foods that are high in iron and folic acid to your diet.

In addition, you'll be asked to return for another blood test after a specific period of time so your doctor can check that your hemoglobin and hematocrit levels are improving.

To treat vitamin B12 deficiency, your doctor may recommend that you take a vitamin B12 supplement.

The doctor may also recommend that you include more animal foods in your diet, such as:

Untreated vitamin B12 deficiency can also raise your risk of having a baby with neural tube defects.

meateggs

dairy products

Your OB may refer you to a hematologist, a doctor who specializes in anemia/ blood issues. These specialist may see you throughout the pregnancy and help your OB manage the anemia.

Preventing Anemia

To prevent anemia during pregnancy, make sure you get enough iron. Eat well-balanced meals and add more foods that are high in iron to your diet.

Aim for at least three servings a day of iron-rich foods, such as:

lean red meat, poultry, and fishleafy, dark green vegetables (such as spinach, broccoli, and kale)iron-enriched cereals and grains

beans, lentils, and tofunuts and seedseggs

Foods that are high in vitamin C can help your body absorb more iron. These include:

citrus fruits and juicesstrawberrieskiwis

tomatoesbell peppers

Try eating those foods at the same time that you eat iron-rich foods. For example, you could drink a glass of orange juice and eat an iron-fortified cereal for breakfast.

Also, choose foods that are high in folic acid to help prevent folate deficiency. These include:

leafy green vegetablescitrus fruits and juices

fortified breads and cerealsdried beans

Follow your doctor's instructions for taking a prenatal vitamin that contains a sufficient amount of iron and folic acid.

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Vegetarians and vegans should talk with their doctor about whether they should take a vitamin B12 supplement when they're pregnant and breastfeeding.

Thalassaemia in pregnancy

What is thalassaemia?

Thalassaemia is an inherited (genetic) blood disorder. It happens when mutated genes affect the body’s ability to make healthy haemoglobin, the iron-rich protein found in red blood cells. Haemoglobin carries oxygen to all parts of the body, and carbon dioxide to the lungs to be exhaled. When genes are mutated it means that they are permanently altered. So thalassaemia is a lifelong condition.

What types of thalassaemia are there?

There are different types of thalassaemia, depending on which part of the haemoglobin is affected. Haemoglobin is made up of matching chains of proteins: the alpha chains and the beta chains. The symptoms of thalassaemia vary widely from mild to severe. It depends on which genes are mutated, and whether it is the alpha haemoglobin or beta haemoglobin that is affected. The terms thalassaemia minor (or thalassaemia trait), thalassaemia intermedia and thalassaemia major are used to describe the severity of the symptoms. Thalassaemia minor, or trait, carries no symptoms. Thalassaemia intermedia can cause problems, for example, some patients may need blood transfusions, either occasionally or regularly. The most severe form of the disease is thalassaemia major.

Alpha thalassaemia

A mutation in the alpha haemoglobin chains causes alpha thalassaemia. The alpha chains are produced by four genes. 

If one gene is mutated, there are rarely any symptoms.If two genes are mutated, it may result in mild anaemia. This is called alpha thalassaemia trait.If three genes are mutated, it results in a condition called haemoglobin H disease (HbH).Mutation of all four alpha genes causes the most severe form of the condition. This is called alpha thalassaemia major (Hb Bart’s syndrome). Sadly, few babies with alpha thalassaemia major survive beyond pregnancy or birth.

Beta thalassaemia

A mutation in the beta haemoglobin chains causes beta thalassaemia. The beta chains are produced by two genes: 

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If one gene is mutated, it results in symptoms of usually very mild anaemia (beta thalassaemia trait). It may also cause a more complex set of anaemia symptoms, ranging from mild to severe (beta thalassaemia intermedia). It all depends on the intricate interactions of the affected genes.If both genes are mutated, it results in the more serious beta thalassaemia major (Cooley’s anaemia).

How do I find out if my unborn baby has thalassaemia?

Thalassaemia is passed down through families and is carried on a recessive gene. This means that your baby won't automatically inherit thalassaemia. 

If you or your partner is a thalassaemia carrier, your baby has a one in two chance of inheriting the gene defect and being a carrier like one of his parents. 

If both you and your partner are thalassaemia carriers, your baby has a: 

one in four chance that he will be neither a carrier, nor have the diseaseone in two chance of being a symptom-free carrierone in four chance of having the more severe thalassaemia major

If you and your partner have been diagnosed with thalassaemia trait, a diagnostic test will tell you for sure whether your baby has inherited it. You may be offered one of the following tests: 

Chorionic villus sampling involves taking a small sample of the placenta for DNA testing at about 11 weeks to 14 weeks of pregnancy.Amniocentesis, in which the amniotic fluid surrounding your baby is tested at between 15 weeks and 18 weeks of pregnancy.Fetal blood sampling, during which a blood sample is taken from the umbilical cord between 18 weeks and 21 weeks.

When a baby is affected by alpha thalassaemia major and has a very low chance of survival, some parents consider ending the pregnancy. This is because, very sadly, the baby may not have a good quality of life, even if they have complex treatments. 

An early diagnosis will be better for you and your family, to give you time to make your decision. The results are confidential, and if they are positive, a counsellor will explain your options before you and your partner decide what to do. 

I have thalassaemia. How will it affect my pregnancy?

If you have thalassaemia, your GP should refer you to a doctor who specialises in blood disorders (haematologist) for assessment. Depending on the type of thalassaemia you have, you may be cared for by a specialist team throughout your pregnancy. 

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Whether you have thalassaemia or are a carrier, your baby will benefit if you take 5mg of folic acid daily throughout your pregnancy. This is because thalassaemia may increase the risk of your baby developing a neural tube defect, such as spina bifida. Taking a high dose of folic acid daily reduces this risk. 

Taking folic acid every day helps your blood to stay healthy too. Having thalassaemia can lead to anaemia during pregnancy. If you have beta thalassaemia minor, your doctor will recommend you have extra tests to check your iron levels before you're offered iron tablets. Beta thalassaemia minor can affect blood test results during pregnancy and indicate that your iron stores are low when they're not. 

Alpha thalassaemia minor can also cause anaemia, particularly if you carry two mutated genes. 

Alpha thalassaemia HbH disease can cause mild to severe anaemia and may mean you require blood transfusions during pregnancy. 

Beta thalassaemia major makes it more likely that you will have complications during your pregnancy. Your organs, which are already under strain, will have the extra demands of growing a baby. Your transfusion and medication needs will probably change as your pregnancy progresses.

Will having thalassaemia affect my baby's birth?

Your doctor will advise you to book a hospital birth if thalassaemia has led to complications, such as anaemia. 

Beta thalassaemia major can affect how your bones grow, which could make a vaginal birth difficult. So, again, your doctor will advise a hospital birth, in case you need a caesarean.

Treatment for thalassaemia

The most common treatment for beta thalassaemia major (BTM) is to have regular blood transfusions every four-to-six weeks to top-up haemoglobin in the body. This treatment can raise iron levels in the body too high, risking heart, liverand hormone problems. Chelation may be given to reduce iron levels.

Malaria

What is malaria?

Malaria is a disease of the blood that is caused by the  Plasmodium parasite, which is transmitted from person to person by a particular type of mosquito.Derived from the Italian word for "bad air

There are more than 100 types of Plasmodium parasites,which can infect a variety of species. Scientists have identified four types that specifically infect humans, they are:

Plasmodium falciparumPlasmodium Vivax

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Plasmodium ovalePlasmodium malaria

Causes of malariaMalaria is caused by the bites from the female Anopheles mosquito, which then infects the body with the parasitePlasmodium. This is the only mosquito that can cause malaria.

Symptoms of malaria

According to the CDC, malaria symptoms can be classified in two categories, uncomplicated and severe malaria.

Uncomplicated malaria is diagnosed when symptoms are present, but there are no clinical or laboratory signs to indicate the severity or vital organ dysfunction. Individuals suffering from this form, can eventually develop severe malaria if the disease is left untreated, or if they suffer from poor to no immunity against the disease.

Severe malaria is defined by clinical or laboratory evidence of vital organ dysfunction. This form has the capacity to be fatal if left untreated. A general overview of the symptoms are:

Fever and chills

Impaired consciousness

Prostration

Multiple convulsions

Deep breathing and respiratory distress

Abnormal bleeding, such as anemia

Clinical jaundice and evidence of vital organ dysfunction.

Management

If malaria is suspected in a pregnant patient, refer immediately to secondary/tertiary care where

infectious disease, obstetric and neonatal care is on hand, together with intensive care facilities,

if needed.

Drugs should be used at adequate doses and according to clinical condition and local

resistance patterns. Whilst a Cochrane review pointed to the lack of quality data,

particularly with regard to drug safety in pregnancy, several innovations have since

improved the risk-benefit ratio:

o Chloroquine and quinine can be used safely in any part of the pregnancy

but resistance is common.

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o Studies of pregnant women with malaria in Thailand found that artemisinin-

combination therapy (treatment in which artemisinin is combined with other

antimalarials) were safe in  the first, second and third trimesters and provided

fewer treatment failures than other commonly used regimes.

o Mefloquine and pyrimethamine/sulfadoxine are safe in the second and third

trimesters.

o A Gambian study recommended quinine plus clindamycin for seven days as the

first-line treatment for uncomplicated malaria and artesunate plus clindamycin for

seven days if this treatment fails. Treatment, however, should not be delayed and

should be started with the most readily available drug.

o Primaquine, tetracycline, doxycycline and halofantrine are contra-

indicated. Current UK treatment guidelines suggest the use of quinine and

clindamycin in place of doxycycline.

Recurrence of malaria is common in pregnancy and resistance frequently reduces the

usefulness of antimalarials. The WHO recommended a regimen of seven days of

artesunate (2 mg/kg/day or 100 mg daily for seven days) and clindamycin (450 mg three

times daily for seven days). Atovaquone-proguanil-artesunate and dihydroartemisinin-

piperaquine have been used in pregnant women with multiple recurrent infections to

good effect in the UK.[14]

Fluid replacement needs to be very carefully monitored to prevent pulmonary oedema.

If anaemia requires transfusion (Hb <7-8 g/dL) then packed cells are preferred to avoid

fluid overload.

The complications of malaria should be carefully and aggressively managed.

Involve the obstetric team early in case of premature labour.

Maternal complications

In endemic/high-transmission areas for malaria, baseline immunity to malaria is decreased by

pregnancy. Sufferers are more likely to experience severe anaemia. A non-immune pregnant

woman (or one with low immunity from a low-transmission area) is likely to develop a severe

form of the illness and complications.

Anaemia  tends to occur between 16-29 weeks - due to haemolysis of parasitised cells

and increased demands of pregnancy ± folate/iron deficiency. 5-10% of pregnant African

women have severe anaemia, of which 26% are thought to be attributable to malaria.[

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Severe anaemia eliminates any physiological reserve to cope with haemorrhage, making

women more likely to die in childbirth.

An Indian study reported that pregnant women with malaria are at increased risk of

hypoglycaemia, cerebral malaria, renal failure, hepatic failure and hypotension.

Acute pulmonary oedema  occurs much more commonly in pregnant women and may be

the presenting feature. It carries a high mortality and is typically seen in the second and

third trimesters.

Disseminated intravascular coagulation  can occur and carries a high mortality risk.

Fetal complications

Both P. falciparum and Plasmodium vivax can cause complications that affect the fetus. Fetal

mortality is estimated at 15% for P. vivax and around 30% for P. falciparum. Common problems

for the fetus include

Spontaneous abortion

Premature delivery  

Stillbirth

Intrauterine growth restriction

Low birth weight - common

Intrauterine fetal death

Maternal infection can also be associated with missed abortion, preterm labour, intrauterine

growth restriction and intrauterine fetal death.[20] 

 Neonatal and infant problems related to malaria include:

Increased mortality rates

Congenital malaria

Anaemia

Increased rates of other infections

Undernutrition

Coagulation

What Is Coagulation?

Coagulation is the body’s first reaction to any damage to blood vessels, such as a wound or an internal rupture of a blood vessel. Damage to a blood vessel exposes platelets (cells in blood that create clots) to proteins in the wall of the vessel that are normally not exposed to blood. This exposure causes changes in platelets and, rather than flowing normally, they begin to form a plug at the site of the injury. This process is called primary hemostasis.

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Secondary hemostasis occurs simultaneously. Proteins in the blood change and begin to form strands, called fibrin strands, which strengthen the platelet plug.

What are Coagulation Disorders?

Coagulation disorders are disruptions in the body’s ability to control blood clotting. They can result in either hemorrhage (increased risk of bleeding) or thrombosis (clots that obstruct blood flow). These disorders can be acquired or inherited.

What Are the Different Types of Coagulation Disorders?

Von Willebrand Disease

The most common inherited coagulation disorder is von Willebrand disease. This disease takes its name from a protein in the blood called von Willebrand factor. You can learn about von Willebrand disease on our hemophilia page.

Hemophilia

Another common hereditary coagulation disorder is hemophilia. Children with hemophilia have low levels of more than one of the blood proteins (called factors) that are necessary for clotting.

Factor V Leiden Thrombophilia

Thrombosis is excessive clotting. In this inherited coagulation disorder, a blood protein that aids in clotting, factor V Leiden, becomes overactive and clots too often or too much. It can cause disabling or life-threatening clots.The factor V Leiden mutation is relatively common, occurring in approximately five percent of Caucasian people. Although this mutation can be very dangerous, most of those who have it do not develop abnormal clotting. Clots caused by factor V Leiden are relatively rare in children.

What Causes Coagulation Disorders?

Major causes of coagulation disorders include:

Disseminated intravascular coagulation (overactive clotting that obstructs blood vessels)Genetic inheritance from parentsLiver disease

Overdevelopment of circulating anticoagulants (this creates a condition with symptoms similar to those of hemophilia)Vitamin K deficiency

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Von Willebrand disease, hemophilia and factor V Leiden are inherited diseases. To develop these disorders, a child must have a mutated gene inherited from one or both parents.

Renal andUrinary

Disorders

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and Pregnancy

Urinary Tract Infection

Urinary Tract Infections During Pregnancy

A urinary tract infection is rather common so don’t be surprised if you get urinary tract infections during pregnancy. This infection is further classified into simple and complex. Prevention is a matter of getting enough water, not withholding the urge to use the bathroom and wiping yourself in the proper manner. Using cotton innerwear can also aid in prevention of urinary tract infections or UTIs.

Symptoms of Urinary Tract Infections during Pregnancy

With a urinary tract infection, urine appears to burn you. This is to say that you

experience this highly uncomfortable burning sensation when you attempt to urinate. It

could hit you even just after you have finished urinating. Look for color changes and the

presence of blood. The problem is that frequent urination is one of the most common

features of a pregnancy so it makes UTIs harder to discover. A urinary tract infection in

the third trimester requires medical attention.

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Causes of Urinary Tract Infections when Pregnant

Urinary tract infection in pregnant women can result from the usual causes. These

include inadequate intake of drinking water, improper hygiene and aggravating the

bladder. Wrong clothing, such as synthetic materials used and tight clothes can lead to

UTIs. Cystitis is a common cause of a UTI. It is also linked to several conditions

including kidney stones, catheterization and, of course, pregnancy.

Treatment for Urinary Tract Infections during Pregnancy

For a urinary tract infection cranberry juice is widely recommended as it is a very

effective natural remedy against (UTIs) and can even prevent UTIs altogether, in some

cases. This simple natural remedy is a great choice for those pregnant women who want

to avoid regular medications. Since blueberries, another great natural choice, hail from

the same plant family, try its juice or eat them plain. However, remember that you will

probably have to take whatever antibiotics your doctor prescribed, along with these

juices. There are a number of other things you can use to supplement treatment such as

augmenting your intake of water and Vitamin C. When it comes to urinary tract infection

and pregnancy antibiotics are usually safely prescribed. You don’t want to leave this

untreated as it can lead to a more dangerous kidney infection. Now this infection is

linked to problems like early labor. Low birth weight is another worrying risk associated

with kidney infections.

Chronic Renal Disease

Kidney Failure During Pregnancy

All the systems in the body undergo a lot of change once a woman gets pregnant. One

of the many changes that happen is changes to the kidney and the renal system. The

kidney grows about 1 to 1.5 centimeters. The renal plasma flow also increases

considerably in the first two trimesters. Women with chronic kidney problems should be

aware that there are all kinds of risks for them when they get pregnant. Chronic health

problems like diabetes and hypertension can often lead to kidney problems, especially in

pregnant women as the body is working harder to provide for baby. A poor diet,

smoking, drinking, excess use of antibiotics and illegal drugs, all can lead to kidney

problems during pregnancy.

During the constant excess fluid in the mother’s body, she could have high blood

pressure through the pregnancy. Acute renal failure is a real threat for pregnant women

with chronic kidney disease.

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Kidney failure while pregnant can be quite painful. Kidney failure is quite rare in pregnant

women and if it happens, it can occur during early or late pregnancy. Different disorders

are responsible for kidney failure depending on which stage of the pregnancy it occurs.

Renal failure in early pregnancy can be caused by prerenal azotemi a, acute tubular

necrosis and renal cortical necrosis all of which can cause spontaneous abortion.

Kidney failure in late pregnancies is usually caused by preeclampsia and other

eclampsia related disordres. Other causes include acute tubular necrosis which also

causes kidney failure in early pregnancies and acute fatty liver which can lead to a

kidney failure in pregnancy. Pregnancies in women with existing chronic kidney disease

can also lead kidney failure.

Signs of kidney failure during pregnancy can be monitored with signs of preeclampsia

like headache, abdominal pain, chest pain and visual differences. Other signs include fever and kidney stones. Kidney stones, blood clots, and other infections can block the flow of urine from the kidney. But drugs are not always a possible treatment for kidney stones during pregnancy. Sometimes doctors use stents to allow flow of urine from around the blockage. This is a relatively new treatment for kidney failures during pregnancies where doctors insert a stent in the path of the urine. Kidney failure can affect the immune system and all your levels like mineral, creatine, protein along with blood pressure are constantly monitored through your pregnancy along with your cholesterol and urine levels.

Kidney Changes During Pregnancy

The kidney, along with all organs and organ systems in a woman’s body, goes through

changes during pregnancy. All the systems in the body undergo a lot of change once a

woman gets pregnant. One of the many changes that happen is changes to the kidney

and the renal system. The kidney grows about 1 to 1.5 centimeters through the

pregnancy. The renal plasma flow also increases considerably in the first two trimesters.

Women with chronic kidney problems should be aware that there are all kinds of risks in

pregnancies. For women with chronic kidney problems or diseases that can lead to

kidney problems, the women can face different.

Treating chronic kidney problems before getting pregnant helps the woman and gives

her higher odds of successfully carrying the baby to term without added complications.

Some of the many complications of kidney disease during pregnancy include

preterm labor, low amniotic fluid, low birth weight, thyroid disease and

fibromyalgia. Symptoms generally include protein in urine, swelling or numbness

of hand or feet, loss of appetite, nausea, fatigue, cramps and eventually kidney

failure.

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How To Prevent Causes & Symptoms of Kidney Infection During Pregnancy

Kidney infection usually begins due to the growth of bacteria in your urethra that travels through the urinary tract and ultimately affects the kidneys. Kidney infection is very common and can occur in anyone, albeit pregnant women can be more prone to a kidney infection due to the following reasons:

Causes for Kidney Infection During Pregnancy

The growing size of the uterus puts pressure on the urinary bladder, thereby restricting

the flow of urine. This can lead to the infection of urinary tract and kidneys.

Some women are unable to empty their bladder completely, again due to the pressure

on the ureter, and this can lead to kidney infections.

These are the most common causes of kidney infection during pregnancy. Sometimes, it

becomes a little difficult to identify the symptoms of a kidney infection during pregnancy.

The reason is that some of the symptoms of a kidney infection during pregnancy are

identical to the symptoms generally seen in a normal pregnancy. The most common

kidney infection symptoms during pregnancy are as follows:Symptoms of Kidney Infection in Pregnancy

Frequent urge for urination, but inability to pass the urine completely. This happens

due to pressure exerted on the bladder by the growing uterus.

Pain and burning sensation while urinating. This can cause severe discomfort to the

pregnant women.

Change in color and smell of the urine. Sometimes, in case of severe infection, some

traces of blood can also be seen in the urine.

Back pain in the waist region or lower back on both sides.

Nausea and vomiting.

Mild to high fever.How to Prevent Kidney Infection in Pregnancy

For preventing kidney infection during pregnancy, you should do the following.

Drink lot of water.

Do not stop the urge to urinate.

Keep your genitals clean and dry.

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Neurologic

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disorders and

pregnancy

Seizure Disorders

Seizure disorders: One of a great many medical conditions that are characterized by episodes of uncontrolled electrical activity in the brain (seizures). Some seizure disorders are hereditary, but others are caused by birth defects or environmental hazards, such as lead poisoning. Seizure disorders are more likely to develop in patients who have other neurological disorders, psychiatric conditions, or immune-system problems. In some cases, uncontrolled seizures can cause brain damage, lowered intelligence, and permanent mental and physical impairment. Diagnosis is by observation, neurological examination, electroencephalogram (EEG), and in some cases

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more advanced brain imaging techniques. Treatment is usually by medication, although in difficult cases a special diet or brain surgery may be tried

Seizure Disorders During Pregnancy

Most women who have a seizure disorder are able to safely give birth to a healthy baby.

However, women who have seizures are slightly more likely to

Develop preeclampsia (a type of

high blood pressure that develops

during pregnancy—

see Preeclampsia and Eclampsia)

Have a stillbirth

Have a fetus who does not grow as

much as expected

Seizures during pregnancy can cause:

Fetal heart rate deceleration

Fetal injury, premature separation of the placenta from the uterus (placental abruption)

or miscarriage due to trauma experienced during a seizure

Preterm labor

Premature birth

On the other hand, taking anticonvulsants increases the risk of birth and may slightly

reduce intelligence in the baby. However, these risks may be increased by the seizure

disorder as well as by the use of anticonvulsants.

What does my seizure disorder mean for my baby?

Beyond the effects of medications, babies born to mothers who have epilepsy also have

a slightly higher risk of developing seizures as they get older.

What should I do to prepare for pregnancy?

Before you try to conceive, schedule an appointment with the health care provider who'll

be handling your pregnancy. Also meet with other members of your health care team,

such as your family doctor or neurologist. They'll evaluate how well you're managing

your epilepsy and consider any treatment changes you might need to make before

pregnancy begins.

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Take your anti-seizure medication exactly as prescribed. Don't adjust the dose or stop

taking the medication on your own. Remember, uncontrolled seizures likely pose a

greater risk to your baby than does any medication.

It's also important to make healthy lifestyle choices. For example:

Eat a healthy diet

Take prenatal vitamins

Get enough sleep

Avoid smoking, alcohol and illegal

drugs

What if I have a seizure when I'm pregnant?

Seizures can be dangerous, but many mothers who have seizures during pregnancy

deliver healthy babies. Report the seizure promptly to your health care provider. He or

she might adjust your medication to help prevent other seizures. If you have a seizure in

the last few months of your pregnancy, your health care provider might monitor your

baby at the hospital or clinic.

How can I make sure my baby is OK?

Your health care provider will closely monitor your baby's health throughout the

pregnancy. Frequent ultrasounds might be used to track your baby's growth and

development. Your health care provider might recommend other prenatal tests,

depending on the circumstances. What you find out might help you understand the odds

and make important decisions about your pregnancy.

What about labor and delivery?

Most pregnant women who have epilepsy deliver their babies without complications.

Women who have epilepsy might use the same methods of pain relief during labor and

delivery as other pregnant women.

Seizures don't commonly occur during labor. If you do have a seizure during labor, it

might be stopped with intravenous medication. If the seizure is prolonged, your health

care provider might deliver the baby by C-section. If you have frequent seizures during

your third trimester, your health care provider might recommend an elective C-section to

avoid the risk of a seizure during labor.

If your anti-seizure medication dosage is altered for pregnancy, talk to your health care

provider about returning to your pre-pregnancy levels shortly after delivery to continue

keeping your seizures under control and your medication at safe levels.

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Vaginal delivery is usually possible. Cesarean delivery is done only if women have

repeated seizures during labor or other problems develop and require it.

Will I be able to breast-feed my baby?

Breast-feeding is encouraged for most women who have epilepsy, even those who take

anti-seizure medication. Discuss any adjustments you'll need to make with your health

care provider ahead of time. Sometimes a change in medication is recommended.

Multiple Sclerosis

What Is Multiple Sclerosis?

Multiple sclerosis, or MS, is a long-lasting disease that can affect yourbrain, spinal cord, and the

optic nerves in your eyes. It can cause problems with vision, balance, muscle control, and other

basic body functions.

The effects are often different for everyone who has the disease. Some people have mild

symptoms and don’t need treatment. Others will have trouble getting around and doing daily

tasks.

MS happens when your immune system attacks a fatty material called myelin, which wraps

around your nerve fibers to protect them. Without this outer shell, your nerves become

damaged. Scar tissue may form.

The damage means your brain can’t send signals through your body correctly. Your nerves also

don’t work as they should to help you move and feel. As a result, you may have symptoms like:

Trouble walking

Feeling tired

Muscle weakness or spasms

Blurred or double vision

Numbness and tingling

Sexual problems

Poor bladder or bowel control

Pain

Depression

Problems focusing or remembering

Before Pregnancy

Talk to your doctor. If you want to start a family, or add to it, let your doctor know.

Many MS medications -- like glatiramer acetate (Copaxone), interferons

(Avonex, Betaseron, Rebif) and natalizumab(Tysabri), and others -- aren't safe for your

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baby. You'll need to stop taking them before you try to get pregnant. Some others, like

teriflunomide (Aubagio), are risky even for men who want to father a child.

During Pregnancy

Appreciate the benefits. Pregnancy naturally seems to ease MS symptoms for many

women, especially in the third trimester. So if you get a reprieve, enjoy it.

Get treatment if you need it. Let your doctor know if you don't feel good or have

problems. Being pregnant can be uncomfortable for anyone. If you have an issue, don't

ignore it.

If you have a hard time getting around, it may get even tougher late in your pregnancy. A

cane or other device may help you.

Plan for delivery. Most women with MS give birth just like anyone else. But

muscle weakness can come into play. You may have a higher likelihood of needing a C-

section. If your condition has caused a loss of feeling in your pelvis, you may need to be

watched more closely the last month of your pregnancy.

After Your Baby's Birth

Think abou tbreastfeeding. It has no effect on MS symptoms. It's perfectly safe, as

long as you feel up to it. But you'll have to stay off interferons and other disease-

modifying drugs while you do it. They're risky for your baby. You and your doctor will

decide what's best.

Take care of yourself. Any new mom needs to get plenty of rest. It's even more

important if you have multiple sclerosis. Focus on caring for yourself and your baby.

Take advantage of offers for help. When possible, let others shop, clean, and do the

laundry.

MS is unpredictable, so it can be hard to plan ahead. Don't let that worry you. Deciding

to have a child is always a leap of faith. If you still feel ready after you talk to your partner

and your doctor, don't let MS stop you.

Myasthenia Gravis

What is Myasthenia Gravis

Myasthenia gravis is a complex autoimmune disorder. It causes antibodies to destroy the connections between your muscles and nerves. This causes muscle weakness and tiredness.

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Only about 20 out of 100,000 people get this disorder. In young people, myasthenia gravis happens more in women than in men. Some people just have weakness in the eye muscles. Others have weakness in the face, arms, and legs.Myasthenia gravis may be of special concern during pregnancy. Some women with the disease have breathing problems (myasthenic crisis) while pregnant. In other women, the disease may go into remission. This is when some or all symptoms go away. Pregnancy does not seem to make the disease worse.

What Causes Myasthenia GravisMyasthenia gravis is an autoimmune disorder. This means the body makes antibodies that attack its own tissues. People get myasthenia gravis when their body’s immune system attacks the connections of the nerves and muscle cells. It is not clear why people get autoimmune disorders. It’s likely a mix of your genes, things in the environment, and allergies.

Symptoms of Myasthenia GravisThe main symptom of myasthenia gravis is weak muscles. Muscles get weaker with activity and better with rest. Affected muscles are usually in the eyes, face, jaw, neck, arms and legs, and muscles used to breathe. People also get very tired. Pregnant women with myasthenia gravis often have more weakness and are more tired. This is because of the added weight and effort of pregnancy. Some women who get very weak and tired may have a myasthenic crisis. Their breathing muscles can’t work properly, and they have respiratory failure. The main symptom of myasthenic crisis is more problems with breathing. You may be more likely to have a myasthenic crisis when you are in labor.

During pregnancy You may need to:

Change the type of medicine you take and the amount you take

Avoid emotional and physical stress

Check for signs of myasthenic crisisYou may also have:

Ultrasound. This imaging test uses high-frequency sound waves and a computer to

create images of blood vessels, tissues, and organs. Your healthcare provider uses

ultrasound to look at organs and the blood flow through blood vessels, and to watch the

growth of your developing baby.

Fetal monitoring. This is done to look for signs of muscle weakness that may show that

the fetus has myasthenia gravis.

Other fetal testing. This includes using Doppler flow studies to watch blood flow in the

uterus and umbilical cord. Your provider will also watch for signs of  preeclampsia and

fetal growth problems.You can increase your chances of having a healthy pregnancy by getting early prenatal care and working with your healthcare providers to manage your disease.

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What are the complications of Myasthenia Gravis

Myasthenic crisis and respiratory failure are the major complications of myasthenia gravis, even when you are not pregnant.

But when you are pregnant, there are other concerns. These complications of pregnancy may be more likely when you have myasthenia gravis:

Preterm labor. This is labor before 37 weeks of pregnancy. It may be because of certain medicines used to treat myasthenia gravis.Difficult delivery. Myasthenia gravis does not affect the muscles of the uterus. But the muscles needed for pushing can be affected. This may make forceps and vacuum-assisted deliveries more likely.Baby born with myasthenia gravis. Between 12% and 20% of babies born to women with myasthenia gravis may have the infant form of the disorder (neonatal myasthenia gravis). It happens when antibodies common in myasthenia gravis cross the placenta to the fetus. These babies may be weak, with poor suck, and they may have breathing problems. This condition is usually temporary, lasting only a few weeks.Women with myasthenia gravis should not use the medicine magnesium sulfate. This medicine is commonly used to treat high blood pressure and preterm labor. This medicine blocks the nerve-muscle connections and can make muscle weakness worse.

Key poinst on Mysthenia Gravis

Myasthenia gravis is a complex autoimmune disorder. It causes antibodies to destroy

the connections between your muscles and nerves. This causes muscle weakness and

tiredness.

Myasthenia gravis may be of special concern during pregnancy. It can make

complications more likely.

If you have myasthenia gravis when you are pregnant, you will need to be closely

monitored.

You can raise your chances for a healthy pregnancy by getting early prenatal care and

working with your healthcare providers to manage your disease.

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Cancer

and

Pregnancy

Cancer During Pregnancy

Cancer during pregnancy is rare.

Some cancer treatments are safe to use during pregnancy, while others can harm the fetus (unborn baby).

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It is important to talk with your doctor to learn the risks and benefits of specific diagnostic tests and treatment options for cancer if you are pregnant.Cancer during pregnancy is uncommon, occurring in approximately one out of every 1,000 pregnancies. Because of this, both doctors and women were often unsure about how to deal with cancer during pregnancy for many years. However, as more women with cancer are deciding with their doctors to start or continue treatment while pregnant, more information about treating and living with cancer during pregnancy is available than ever before.Most importantly, a pregnant woman with cancer is capable of giving birth to a healthy baby because cancer rarely affects the fetus directly. Although some cancers may spread to the placenta (a temporary organ that connects the mother to the fetus), most cancers cannot spread to the baby. However, being pregnant with cancer is extremely complicated for both the mother and the health care team. Therefore, it is important to find a doctor who has experience treating pregnant women with cancer. Learn more about finding an oncologist.

Diagnosis

Being pregnant often delays a cancer diagnosis because some cancer symptoms, such as abdominal bloating, frequent headaches, or rectal bleeding, are common during pregnancy and are not considered suspicious. On the other hand, pregnancy can sometimes uncover cancer that has previously gone undetected. For example, a Pap test done as part of standard prenatal care can detect cervical cancer. Similarly, an ultrasound performed during pregnancy can find ovarian cancer that might otherwise go undiagnosed.The cancers that tend to occur during pregnancy are those that are more common in younger people, such as cervical cancer, breast cancer, thyroid cancer, Hodgkin lymphoma, non-Hodgkin lymphoma, and melanoma, as well as gestational trophoblastic tumor, which is a rare cancer that occurs in a woman's reproductive system.The most common cancer in pregnant women is breast cancer, which affects approximately one in 3,000 pregnancies. Pregnancy-related breast enlargement may make it difficult to detect small breast tumors, and most women do not have a mammogram while pregnant. As a result, researchers have estimated that pregnant women with breast cancer are often diagnosed two to six months later than non-pregnant women.If cancer is suspected during pregnancy, women and their doctors may be concerned about diagnostic tests such as x-rays. However, research has shown that the level of radiation in diagnostic x-rays is too low to harm the fetus. Computed tomography (CT) scans are similar to x-rays because they use ionizing radiation. However, CT scans are much more accurate than x-rays at outlining internal organs and structures and can be very helpful in making a diagnosis of cancer or determining whether the cancer has spread. CT scans of the head or the chest are generally considered safe during pregnancy as there is no direct radiation exposure to the fetus. When possible, women may use a lead shield that covers the abdomen (stomach) for extra protection during both x-rays and CT scans. CT scans of the abdomen or pelvis should be done only if

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absolutely necessary and after discussion with the medical team. Other diagnostic tests—such as magnetic resonance imaging (MRI), ultrasound, and biopsy—are also considered safe during pregnancy because they don't use ionizing radiation.

Treatment

When making treatment decisions for cancer during pregnancy, the doctor considers the best treatment options for the mother and the possible risks to the developing baby. The type of treatment chosen depends on many factors, including the gestational age of the fetus (stage of the pregnancy); the type, location, size, and stage of the cancer; and the wishes of the expectant mother and her family. Because some cancer treatments can harm the fetus, especially during the first trimester (the first three months of pregnancy), treatment may be delayed until the second or third trimesters. When cancer is diagnosed later in pregnancy, doctors may wait to start treatment until after the baby is born, or they may consider inducing labor early. In some cases, such as early-stage (stage 0 or IA) cervical cancer, doctors may wait to treat the cancer until after delivery.

Some cancer treatments may be used during pregnancy but only after careful consideration and treatment planning to optimize the safety of both the mother and the unborn baby. These include surgery, chemotherapy, and rarely, radiation therapy.

Surgery.

Surgery is the removal of the tumor and surrounding tissue during an operation. It poses little risk to the developing baby and is considered the safest cancer treatment option during pregnancy. In some cases, more extensive surgery can be done to avoid having to use chemotherapy or radiation therapy.

Chemotherapy.

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells' ability to grow and divide. Chemotherapy can harm the fetus, particularly if it is given during the first trimester of pregnancy when the fetus' organs are still developing. Chemotherapy during the first trimester may cause birth defects or even the loss of the pregnancy (miscarriage).

During the second and third trimesters, some types of chemotherapy may be given without necessarily harming the fetus. The placenta acts as a barrier between the mother and the baby, and some drugs cannot pass through this barrier, or they pass through in very small amounts. If the planned chemotherapy includes a drug that is not safe during any stage of pregnancy, the doctor can sometimes substitute another drug.

Although chemotherapy in the later stages of pregnancy may not directly harm the developing baby, it may cause side effects like malnutrition and anemia (a low red blood cell count) in the mother that may cause indirect harm. In addition, chemotherapy given

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during the second and third trimesters sometimes causes early labor and low birth weight, both of which may lead to further health concerns for the mother and the baby. The baby may struggle to gain weight and fight infections, and the mother may have trouble breastfeeding.

Radiation therapy.

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. Because radiation therapy can harm the fetus, particularly during the first trimester, doctors generally avoid using this treatment. Even in the second and third trimesters, the use of radiation therapy is uncommon, and the risks to the developing baby depend on the dose of radiation and the area of the body being treated.

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