May 23, 2012
Should All Pregnant Women be Tested for STDs?
While the topic of sexually transmitted diseases (STD) is not pleasant, it certainly is essential, especially for pregnant women. A recent medical study reports that only 59% of pregnant women are tested for Chlamydia and Gonorrhea. That is absurd. Both the Center for Disease Control (CDC) and the American Congress for Obstetrician/Gynecologists (ACOG) recommend that all pregnant women be screened for STDs during their first prenatal visit.
Untreated STDs can cause havoc during pregnancy. From preterm labor to newborn blindness, STDs are not a nice thing to have. But the good news is, they’re curable provided you know that you have one. One of my former patients complained about “breaking her water” although she was only 26 weeks pregnant. When I checked her, she did indeed rupture her membranes but also had an STD called Trichomonas which I ultimately treated. Had I not checked her, we would never have known about the premature rupture of membranes as well as the STD. The patient was sent to a specialty hospital where she remained for the next 11 weeks until she had her baby.
In our present healthcare climate, time equals money. The more patients a provider sees the more money he or she makes so there is the temptation to cut corners. Every pregnant woman should have an initial PAP smear at her first prenatal visit. Most PAP smears have the ability to detect cervical cancer as well as the Human Papilloma Virus (HPV) in addition to Trichomonas and Bacterial Vaginosis. Both of these infections need to be treated in order to reduce the risk of developing preterm labor and your partner needs to be treated for Trichomonas as well. If your partner is not treated and you have sex, consider yourself reinfected.
Unlike men, women rarely have symptoms so it is important to be tested for Chlamydia because if untreated, there is a risk of going blind. All pregnant women should be tested for Chlamydia and then retested after receiving treatment to make certain the infection is gone. The same principle holds true for Gonorrhea.
All foul-smelling vaginal discharges need to be checked by your provider. No exceptions. Some providers will not examine the patient but give her a prescription for a “yeast” infection. All vaginal discharges cannot be attributed to a yeast infection and needs further evaluation.
All pregnant women need to be tested for STDs, not a mere 59%. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
April 18, 2012
Pregnant and Unmarried? You’re Fired!
The Center for Disease Control (CDC) recently published a study revealing 27 percent of babies are born to unmarried couples who live together in the U.S. This is a three-fold increase from 1985 and it’s not a trend just limited to the U.S. This phenomenon is happening through the entire industrialized world including countries such as Iceland and Sweden where 66 and 55 percent of babies are born to unmarried parents. While the stigma of having a “baby out of wedlock” appears to have declined, Cathy Samford, a teacher at the Heritage Christian Academy in Rockwall, Texas might not agree.
Samford was a popular volleyball coach and science teacher at Christian Academy for approximately three years. When she was originally hired, she signed a contract stating that she would exhibit “good Christian behavior.” However, when it was discovered that Samford, who has two children was pregnant with her third and unmarried, she was summarily fired from her job. Samford asserted that she was in a committed relationship and she had planned to get married before the end of the summer but “a series of events” had delayed the event. Both she and her fiancé stated that they would change their plans to get married sooner in an attempt to avoid Samford’s termination but to no avail. The school stated it didn’t matter. They weren’t going to change their decision because “It doesn’t change that her behavior was out of wedlock.” Samford was in shock. When she lost her job, she also lost her medical benefits and is rightfully concerned about her future and the future of her children. She is presently living off her tax refund. She hired an attorney and has filed a discrimination suit against the school. The school asserts that they were within their right to terminate Samford because they are a private school.
If Jesus the Christ were the headmaster of Heritage Christian Academy, do you think he would fire Samford? Probably not. Maybe the school administrators should put down their stones.
November 2, 2011
Violence is #1 Killer of Pregnant Women
In a recent medical study, violent deaths of pregnant women outnumber traditional causes of maternal deaths such as post partum hemorrhage or pre-eclampsia . I am not surprised. In September 2010, I wrote an article entitled 7 Reasons Why Pregnancy Becomes a Deadly Affair after an 18 year old college student almost lost her life at the hands of her football-playing boyfriend because she became pregnant. Pregnancy is not a benign act and 50% of them are unplanned.
Dr. Christie Palladino, an ob-gyn physician at the Georgia Health Sciences University and main researcher of the study, looked at data from 17 states and found 94 pregnancy-related suicides and 139 homicides from 2003-2007. Approximately 45 % of suicides occur during pregnancy, often precipitated by a domestic dispute. Palladino addresses the problem by focusing on identification and treatment of pregnant women who have depression by obstetricians or women’s health providers. While it is a noble ideal it only scratches the surface. There is an association between the “depressed” pregnant woman and relationships that usually involves the father of the baby. It is not enough to put prescribe antidepressants and not provide professional counseling. Most obstetricians do not feel comfortable treating depression if the truth be told. It is neither their specialty nor area of expertise. And God help the patients who are on Medicaid. The challenge to find a psychiatrist that will accept them will be daunting. Palladino mentions more research for future studies. We don’t need more data. We don’t need another American Congress of Obstetrician-Gynecologist (ACOG) task force. We need action plans that include:
- Formal collaborations between mental health workers and obstetricians for proper referrals and treatments including case management meetings during the patient’s prenatal care
- Group therapy and individualized sessions conducted by licensed psychologists and social workers
- Collaboration of social work schools and public health departments or community health clinics that could provide psychotherapy for indigent or Medicaid pregnant patients. Social work students could perform counseling under the supervision of a licensed preceptor
- Home visits (through the use of Home Visit Grants) for at-risk-women by doulas or community health workers
I would also encourage pregnant women who are in abusive relationships to review the 7 warning signs of a potentially deadly affair.
Suicides and homicides are preventable. Let’s roll up our sleeves and get busy.
October 26, 2011
Warning: Stay Away From Plastics If You Are Pregnant with a Girl
Plastic and BPA. We can’t seem to get away from it. But perhaps we should, especially if you’re pregnant. Bisphenol a (BPA) is an organic compound found in food packaging, plastic bottles, the lining of cans, baby bottles and even dental fillings. It has been around for more than 40 years and has generated safety issues in the past regarding consumer exposure. Why? Because it is an endocrine disrupter which means that it can interfere with the human body’s hormone or endocrine system. These disruptions can cause cancer, birth defects and learning disabilities. Any system in the body that’s controlled by hormones can be damaged. BPA can even mimic the body’s own hormones, specifically estrogen.
A recent article in USA Today quoted a medical study that states girls exposed to high levels of BPA before birth are at greater risk for behaviors such as anxiety, depression and hyperactivity by age 3. Boys’ behavior is not affected by exposure to BPA according to the study that states 244 Cincinnati mothers and their 3 year olds were tracked looking at behavioral problems. Mothers with high levels of BPA in their urine reported their daughter’s significant problems. Although the federal government has previously maintained that low doses of BPA were safe, the Federal Drug Administration (FDA) is now taking a closer look at the possibility of harmful effects through additional research. It is also recommending that the plastics industry stop putting BPA in infant bottles and feeding- cups. The National Institute of Health (NIH) has invested $30 million dollars to perform further research. This should give us all reason to pause.
In light of the above, pregnant women should read labels carefully and avoid all products that contain BPA. In addition, according to the FDA, plastic containers have recycle codes on the bottom. In general, plastics that are marked with recycle codes 1, 2, 4, 5, and 6 are very unlikely to contain BPA. Some, but not all, plastics that are marked with recycle codes 3 or 7 may be made with BPA.
Additional information regarding BPA may be obtained at this Center for Disease Control (CDC) website http://www.cdc.gov/exposurereport/BisphenolA_FactSheet.html.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
October 3, 2011
Just Had a Baby? Should You Leave the Hospital With Birth Control or Wait?
image from http://www.blisstree.com
It depends on the method and whether the mother plans to breast feed. Ideally, it is recommended that women abstain from sexual relations for at least 4 to 6 weeks after having a baby to reduce the risk of developing vaginal infections and of course, becoming pregnant.
Pregnant women have an increased risk of developing blood clots because of hormonal changes. This is commonly referred to as a hypercoagulable state. Birth control pills that contain both estrogen and progestin (aka combination pills) are not recommended for the first 42 days after the delivery because they increase the risk of blood clots in the legs (Deep Venous Thrombosis, aka DVT) and also decrease breast milk production. The vaginal ring and patch are also not recommended. However, birth control pills that only contain progestin are safe to take immediately after delivery because they don’t increase the risk of developing blood clots nor do they reduce the amount of breast milk production. The Depo- Provera injection may also be given as well because it is a progestin-only product. What women are at increased risk for developing a DVT? Women who are
- Over 35
- Had previous DVTs
- Obese
- Had a history of postpartum hemorrhage
According to the Center for Disease Control (CDC), a woman may use combination birth control pills 21 days after having a baby if she is not breastfeeding.
Can a woman have an intrauterine device (aka IUD) inserted after she delivers a baby? Only if it can be inserted during the first 10 minutes after the placenta has been delivered. According to a recent article in OBGManagement, the FDA has approved immediate placement of the copper IUD (aka Paragard) after a delivery. Why can’t the IUD be placed after the first 10 minutes? Because the chances that it will be expelled or fall out of the cervix are increased by at least 12 to 24 percent if it is inserted between 10 and 48 hours after delivery.
So, is it safe to use a birth control method immediately after having a baby? Yes, provided those methods are
- Progestin only products which include pills, the Depo-Provera shot and progestin implants
- Condoms
- Tubal ligation which is a permanent method of sterilization
- The IUD if it is inserted within the first 10 minutes after the placenta is delivered
There are approximately 4 million babies born each year in the U.S. According to CDC, half of them are unintended. A pregnancy that occurs less than six months from the last increases the risk of complications to the mother. Therefore, choose wisely and choose safely. A discussion with your healthcare provider before your baby is born is probably not a bad idea.
August 3, 2011
Dr. Linda Cares: Why are More Pregnant Women Having Strokes?
According to CDC, there has been a 54 percent increase in the number of pregnant women who’ve had strokes in 1995 to 1996 and in 2005 to 2006. While this may surprise some researchers, it certainly would not surprise clinicians who take care of pregnant women who have risk factors such as obesity, chronic hypertension or a lack of prenatal care. Ten percent of strokes occur in the first trimester, 40 percent during the second trimester and more than fifty percent occur during the post partum period and after the patient has been discharged home. Hypertension was the cause of one-third of stroke victims during pregnancy and fifty percent in the post partum period. Hypertension accounted for one-third of stroke cases during pregnancy and fifty percent in the post partum period. Many stroke cases might be prevented if blood pressure problems were treated appropriately during pregnancy.
Pregnant women who have high blood pressure during the first trimester are treated with medication and are classification as having chronic hypertension. The problem occurs when patients begin their prenatal care late and have high blood or when a diagnosis of pre-eclampsia is missed. Pre-eclampsia is a clinical condition that includes high blood pressure, protein in the urine and swelling of the hands, face, ankle or feet. Should patients be treated with medication or should their babies be delivered? The diagnosis may not be straight forward. The patient’s blood pressure could be high but there’s no protein in the urine. Or the patient may have high blood pressure that returns to normal with bed rest. Or the patient is only 26 or 27 weeks but has high blood pressure and a diagnosis of pre-eclampsia but the practitioner is hesitant to deliver the baby based on its prematurity. Or the patient is hospitalized for high blood pressure and then the blood pressure returns to “normal” so the healthcare provider inadvertently sends the patient home. Or the patient had high blood pressure, delivered a baby, is sent home and then has a seizure and ultimately a stroke.
What should a pregnant mom do to prevent a stroke? If you have blood pressure problems during your pregnancy, insistent on obtaining a consultation from a high-risk obstetrician (aka maternal fetal medicine specialist) even if you think your present obstetrician or midwife is managing your prenatal care appropriately. A second opinion never hurts and in some cases, it can save a life. Two heads are always better than one.
November 29, 2010
Are Airport Body Scans Safe for Pregnant Women?
While it is important to support our country’s national security, there has to be a voice of reason. In Christmas of 2009, a 23-year-old terrorist hid an explosive device in his underpants that went undetected because of its nonmetallic ingredients and the world was never the same again. The Department of Homeland Security shipped 385 full-body scanners to 68 U.S. airports this year with 1,000 more projected for 2011. Perhaps this decision was premature. At the center of the controversy is whether these scanners are safe, especially for pregnant women, the elderly and children despite claims to the contrary made by federal officials.
Physics professors and scientists from universities in California and Arizona have purported that the radiation of body-scanners is 10 times greater than what the TSA estimates and will increase the risk of cancer to children and other vulnerable populations. At question is whether the airport scanners will dump large amounts of radiation into the skin and tissue resulting in undesired side effects. Although the scanners were FDA-approved, the machines passed a test developed by the very companies that manufactured them thereby suggesting a possible conflict of interest. And if the pictures of the scans are not clear, will the untrained TSA workers simply raise the dose, thus placing passengers at a greater risk for radiation exposure?
The Allied Pilots Union has rejected the use of body scanners thus making the issue as clear as mud. If the pilots don’t want to use the body scanner, why should pregnant women? The Center for Disease Control (CDC) has published helpful facts about radiation and pregnancy:
- Radiation exposure before birth can increase a person’s risk of getting cancer later in life
- Unborn babies are especially sensitive to the cancer-causing effects of radiation
- If the radiation dose to the fetus was roughly equivalent to 500 chest xrays, the increase in lifetime cancer risk would be less than 2% above the normal lifetime cancer risk of 40 to 50%
- During the first 2 weeks of pregnancy, the radiation-related health effect of greatest concern is the death of the baby. The fetus is made up of only a few cells during the first 2 weeks of pregnancy. Damage to one cell an cause the death of the embryo before the mother even knows she’s pregnant.
- Large radiation doses to the fetus during the more sensitive stages of development (between 2 and 15 weeks of pregnancy) can cause birth defects, especially to the brain
- Between the 16th week of pregnancy and birth, radiation-induced health effects are unlikely unless the fetus receives large doses of radiation
- After 26 weeks, the radiation sensitivity of the fetus is similar to that of a newborn. This means that birth defects are not likely to occur and only a slight increase in the risk of having cancer later in life is expected.
The bottom line? Pregnant women should NOT be subjected to body scans at airports. The risks far outweigh the perceived benefits. We need a voice of reason to protect pregnant women and their unborn. I hope the American Medical Association, the American Congress of Obstetrician-Gynecologists and the American Board of Obstetrician-Gynecologists are listening.
May 1, 2009
Swine Flu and Pregnancy: Reasons to be Calm
As we all know by now, CDC has implemented an emergency response because of the H1N1 viral outbreak that has infected one hundred and nine people and caused one death of a 23-month toddler in Texas who was visiting from Mexico. The virus was first identified in April 2009 and is easily transmitted to humans. Although one might be tempted to respond with panic, it is much more productive to remain calm.
The good news is that a full-court press effort has been initiated bringing together CDC scientists to exchange pertinent information with public health emergency response partners. An international committee is also involved because of the potential of the viruses’ transmission through visitors and travelers. According to CDC, emergency medications and personnel can be transported across the country within two hours of notification and within six hours for an international flight. All 50 U.S. states and territories have already received the necessary medication and protective equipment in the event of an outbreak. At last count, there were no cases reported of infected pregnant women.
Helpful Recommendations
Although pregnant women and children are particularly susceptible to infections, the following CDC recommendations will help you stay healthy:
- Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
- Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleansers are also effective because they immediately reduce the number of germs
- Avoid touching your eyes, nose or mouth.
- Stay home if you are sick. Stay home from work or school and limit contact with others to keep from infecting them.
- Store a supply of food, medicines, facemasks, alcohol-based hand rubs and other essential supplies.
Flu Symptoms
A cough, sore throat, running nose, muscle aches and a temperature of 100°F or greater always needs further evaluation. These symptoms usually resolve within three to five days however, if these symptoms become rapidly worse, testing for the swine flu should be done immediately by a state public health laboratory.
The current treatment for the swine flu are antiviral medications called zanamivir and oseltamivir and should be started within 48 hours of suspected infection. As a precaution, pregnant women are sometimes admitted in the hospital for a minimum of five days.
The most reliable source of information regarding this outbreak is not what you will hear or see in the media but what’s on the CDC website. I encourage everyone to visit http://www.cdc.gov/swineflu for further information and will continue to provide updates through my blog until this crisis is over.
