Posts Tagged ‘diseases’
Wednesday, November 3rd, 2010
 Can you believe that flu season has arrived again? Any one of us can be infected, but pregnant women, as stated in our previous articles, are considered to be in the “high risk” group for complications from acquiring the seasonal flu virus. This is due to a suppression of the normal immune system during pregnancy.
Therefore, I want to personally remind all my pregnant readers, regardless of trimester, to get vaccinated prior to the January peak of the flu season. Postpartum women should definitely get vaccinated as well.
The vaccine is safe and serves as a protection both for mother and for the newborn during the first 6 months of life. Children under six months of age are ten times more susceptible to respiratory infections requiring hospitalization compared to older children. By vaccination of mom, maternal antibodies are formed which cross the placenta or appear in breast milk and prevent infection in the newborn. Newborns have a 41% reduction in the risk of acquiring influenza when mothers are vaccinated according to studies from Johns Hopkins.
It is a common misconception that vaccination during pregnancy is not safe. In addition many women view the flu virus as mild, not needing the protection offered by vaccination. Both these facts are misconceptions and have resulted in a poor acceptance of vaccination during pregnancy. Of all the deaths from the influenza virus last year, a disproportionate number were pregnant women. Health care providers in obstetrics have an obligation to educate their patients to accept vaccination since the majority of pregnant women have regular contact with caregivers. In addition, prior vaccination in 2009 does NOT afford protection against this years flu virus and revaccination must occur since new flu virus strains appear each year.
Pregnant women can receive the flu shot only, but breast feeding women are able to receive either the shot or the nasal spray (live weakened virus). Rather than receiving 2 separate shots, this year’s vaccine is a combination of 3 strains—an H3N2 virus, an influenza B virus, and last years H1N1 swine flu. If one should contract a flu virus other than that created for the vaccine, it will most likely result in a milder course.
It should be remembered that allergy to chicken eggs, those that have had a severe reaction to a prior flu shot or developed Guillain-Barre syndrome (type of paralysis after an infectious process) should not receive the vaccine. In addition, it best to wait till after any cold has subsided before vaccinating.
Should pregnant woman contract the flu, treatment with one of the antiviral agents, such as Tamiflu is recommended as soon as you suspect disease. Taking the medication on a full stomach can reduce the most common side effects which are mild nausea and vomiting within the first 2 days of treatment. Tamiflu, given for 5 days, will shorten the duration of the disease and help prevent the serious complications that can occur in pregnant women.
In the meantime, pregnant women should avoid people that are sick, wash their hands often and GET VACCINATED.
Tags: diseases, flu antibodies, flu shot, flu vaccine, postpartum, pregnancy, vaccination, vaccination clinic
Posted in Sickness During Pregnancy | No Comments »
Tuesday, July 6th, 2010
 This week, let’s pretend we have a different 26 year old, newly-pregnant woman sitting on the exam table in her obstetrician’s office. She is also excited about her pregnancy but she is more verbal and is telling her physician about the terrible nausea and vomiting, anxiety, difficulty sleeping, and general fatigue. The obstetrician can easily see that she seems to be suffering the normal symptoms of pregnancy but is also a bit worried that it may be something else. Even if nausea and vomiting occur in 50–80% of all pregnant women, especially between the 5th and 13th week, a good obstetrician will go a bit further to make sure it is not something more serious before suggesting a medication, or a supplement, to reduce the symptoms of nausea and vomiting.
Is it possible that this woman is experiencing something more severe than the normal, early pregnancy symptoms? Could it be hy-PO-thyroidism?
Quick Review:
As I wrote in my last blog, one of the great masqueraders for pregnant women is thyroid disease. Many of the symptoms that women experience in the early stages of pregnancy are the exact symptoms that occur with thyroid problems. Women will commonly experience fatigue, weight gain, constipation, insomnia, and lethargy. Health care providers will often reassure patients that this is normal and these symptoms are due to the hormonal and physiological changes that one expects with the early stages of a healthy pregnancy. However, one must be on the alert that these same symptoms could be representative of a much more serious underlying problem; one that could have major, negative ramifications on the pregnancy and the newborn infant. Left undiagnosed and untreated, hypothyroidism (low thyroid hormone) could result in serious, high-risk conditions during the pregnancy. Prematurity, preeclampsia, placental separation (abruption), and/or serious consequences in the child such as congenital cretinism (mental retardation, deafness, muteness).
This weeks blog will focus only on hy-PO-thyroidism. (when you have too little thyroid hormone) and its effects on pregnancy.
Just as HYPERthyroidism can be the great masquerader, so too can hy-PO-thyroidism. Symptoms often mimic a normal early pregnancy, such as weight gain and lethargy with a decrease in exercise ability. Hypothyroidism is defined as the inability to manufacture thyroid hormone by the thyroid gland. Missing this diagnosis can have grave irreversible neurological consequences for the fetus.
How frequent is HYPOthyroidism in pregnancy?
Hypothyroidism occurs in .1 to .3% of pregnancies. It can be associated with other autoimmune disorders such as diabetes. It is often a cause of difficulty in conceiving since women with this condition have difficulty ovulating.
What are the symptoms of hypothyroidism?
- fatigue
- constipation
- intolerance to cold
- muscle cramps
- hair loss
- dry skin
- carpel tunnel syndrome
- weight gain
- intellectual slowness
- voice changes (hoarseness)
- goiter
- insomnia
- lethargy or decrease in exercise capacity
- prolonged relaxation of deep tendon reflexes
- concentration difficulties
What are the dangers to the mother and fetus with untreated hypothyroidism?
- preeclampsia
- low birth weight
- placental abruption
- intrauterine growth restriction
- congenital cretinism (growth failure, mental retardation, deafness, muteness)
- miscarriage
- prematurity
- stillbirth
- postpartum hemorrhage
What are some of the causes of hypothyroidism?
The most common cause of hypothyroidism in pregnancy in the United States is Hashimoto’s thyroiditis. This is when the body produces antibodies against the thyroid gland rendering it unable to manufacture the hormone. However, the most common cause of hypothyroidism world wide is iodine deficiency. Iodine is essential for the manufacture of the hormone.
Other causes include subacute thyroiditis (viral illness of the thyroid gland), certain drugs (ferrous sulfate, phenytoin, rifampin), pituitary or hypothalamic disease, or prior treatment with radioactive iodine to treat Graves Disease (see previous blog).
How is hypothyroidism diagnosed?
The diagnosis of primary hypothyroidism in pregnancy is made by an elevated TSH (made by the pituitary) and a corresponding low thyroid hormone level (T4). One can also measure antibody levels in the thyroid hormones (antithyroglobulin, antithyroid peroxidase). Measurement of antibody levels is important because women who have antibodies are at increased risk of pregnancy complications and also increased risk of postpartum thyroid dysfunction. Women can have a goiter or large swelling in the neck area. Having one autoimmune disease increases the chance of developing another. Women with type I diabetes have a 5 to 8% chance of developing hypothyroidism during pregnancy and a 25% chance of developing postpartum thyroid disease.
How do you treat hypothyroidism?
The treatment of this disease is to replace the thyroid hormone with levothyroxine till the TSH levels are normal. Generally levels are followed each trimester of the pregnancy since the demands of pregnancy may necessitate an increase in dosage. If the cause of the hypothyroidism is due to iodine deficiency, replacement with iodine is essential not only during pregnancy but also after birth. Also, women who take iron during pregnancy due to anemia will have difficulty absorbing their thyroid hormone so these medications should be spaced at least 4 hours apart.
What is subclinical hypothyroidism?
This is a subgroup of thyroid impairment found in 2–5% of pregnant women. Generally the T4 is normal but the TSH is elevated. Subclinical hypothyroidism has been linked to faulty placental development. There is a three fold increased risk of abruption, higher miscarriage rate, and a two fold increase in the incidence of preterm birth leading to impaired neurodevelopment in the child. There is currently a great debate on whether women who present with this condition should be treated since studies have not shown a benefit with replacement. These patients should be followed after delivery because of the increased incidence of developing overt thyroid disease postpartum.
What course does pregnancy have on a women with already diagnosed thyroid disease prior to becoming pregnant?
Pregnancy has a beneficial effect on women with preexisting thyroid disease. Due to the suppression of the immune system, the antibodies found in Hashimoto’s disease decline but, immediately postpartum, there can be a resurgence with marked worsening of the condition. There can be a noticeable reduction in goiter size during the pregnancy.
What is the importance of fetal and neonatal hypothyroidism?
Congenital hypothyroidism occurs in one in 4,000 births. There can be multiple etiologies from genetic, immunologic, environmental, and drug induced causes. It is critically important not to miss this diagnosis in the infant since developmental retardation can occur if the condition goes untreated. Often infants appear normal at birth but deteriorate over several months. Infants can have severe retardation, deafness and muteness. This is the most common cause of mental retardation worldwide. If delay in treatment of congenital hypothyroidism is beyond 3 months, the chance of normal development is low. Currently there is mass neonatal screening programs for all babies in all 50 states prior to leaving the hospital.
Summary:
Hypothyroidism in pregnancy is a condition that should be recognized and treated so severe maternal and fetal complications can be avoided. If thyroid disease exists prior to pregnancy, women should be followed closely and adjustments made to medication throughout the pregnancy. Care should be taken not to miss postpartum thyroid problems which can be transient but have a tendency to reoccur in subsequent pregnancies. Thyroid dysfunction during pregnancy both overt and sub-clinical can predict later thyroid disease. There is also a corresponding six fold risk of diabetes later on in life. Please see my blog on crystal balls in pregnancy for more information on this.
On the other hand, most pregnant women and their babies will not experience significant problems if the hypothyroidism is mild to moderate and, if properly treated, the pregnancy can be expected to progress normally. When treatment is complete, most women feel much better than before their treatment and are able to do more and to enjoy the activities of their daily lives.
Tags: diseases, healthy baby, hormone, hyperthyroidism, Hypothyroidism, morning sickness, nausea and vomiting, predictor, thyroid medication
Posted in Conditions & Diseases | 2 Comments »
Wednesday, June 30th, 2010
A 26 year old, newly-pregnant woman sits on the exam table in her obstetrician’s office. She is excited about her pregnancy and does not want to complain about her nausea, vomiting, weight loss, anxiety, difficulty sleeping, and fatigue. The obstetrician can tell just by looking at her that she seems to be suffering the normal symptoms of pregnancy and is not overly worried. After all, nausea and vomiting occur in 50–80% of all pregnant women, especially between the 5th and 13th week. The doctor reassures the patient that this is normal, and encourages her to hydrate and rest. Sometimes the physician will suggest a medication, or a supplement, to reduce the symptoms of nausea and vomiting.
Is it possible that this woman is experiencing something more severe than the normal, early pregnancy symptoms?
One of the great masqueraders for pregnant women is thyroid disease. Many of the symptoms that women experience in the early stages of pregnancy are the exact symptoms that occur with thyroid problems. Women will commonly experience fatigue, weight gain, constipation, insomnia, and lethargy. Health care providers will often reassure patients that this is normal and these symptoms are due to the hormonal and physiological changes that one expects with the early stages of a healthy pregnancy. However, one must be on the alert that these same symptoms could be representative of a much more serious underlying problem; one that could have major, negative ramifications on the pregnancy and the newborn infant. Left undiagnosed and untreated, hypothyroidism (low thyroid hormone) could result in serious, high-risk conditions during the pregnancy. Prematurity, preeclampsia, placental separation (abruption), and/or serious consequences in the child such as congenital cretinism (mental retardation, deafness, muteness).
This weeks blog will focus only on hy-PER-thyroidism (when you have too much thyroid hormone.)
Next week we will review hyp-O-thyroidism. (when you have too little thyroid hormone) and its effects on pregnancy.
Who should get screened for thyroid disease in pregnancy?
The current American College of Obstetrics and Gynecology guidelines state that thyroid functions should be checked only in women with a personal history of thyroid disease or symptoms of thyroid disease. It is NOT universally recommended to test all pregnant women even though there are cases of women who have disease that do not have symptoms (subclinical cases).
How does maternal thyroid hormone effect the fetus?
The fetal brain is completely dependent on maternal thyroid hormone until about 12 weeks gestation. At that time, the fetus is able to manufacture its own thyroid hormone in conjunction with the maternal hormone that crosses the placenta. Diminished levels of thyroid hormone in the mother impair fetal brain development. Elevated levels can also cross the placenta and cause excessive production in the fetus. (Graves disease.)
What is hyperthyroidism?
The thyroid is an endocrine gland located in the neck that controls metabolism. It receives a message (TSH) from an area in the brain called the pituitary which releases thyroid hormone (T4).
When the gland produces more hormone than it is supposed to, hyperthyroidism is diagnosed (elevated thyroid hormone T4 and low TSH.) This can occur in about .2% of all pregnancies. The most common form of the disease is Graves disease where certain antibodies are made by the body that stimulate thyroid hormone production. Other causes can be multinodular goiter, subacute thyroiditis, an extra thyroid source of hormone production (certain tumors of the ovary or pituitary), thyroid adenoma.
What are the symptoms of hyperthyroidism?
- nervousness
- tremors
- tachycardia
- frequent stool
- excessive sweating
- heat intolerance
- weight loss
- goiter
- insomnia
- palpitations
- hypertension
- eye changes-lagging of the eyelid and retraction of the eye lid
What are the risks to the mother and the fetus if hyperthyroidism is left untreated?
If left untreated, hyperthyroid can cause:
- preterm delivery
- severe preeclampsia
- heart failure
- fetal loss
- low birth weight infants
- stillbirth
- fetal hyperthyroidism
How do you treat hyperthyroidism in the mother?
A classification of drugs called thioamides are used to treat hyperthyroidism.
These drugs prevent the manufacture of the thyroid hormone by preventing a needed substrate iodine from attaching to the thyroid molecule and it also blocks the the manufacture of of another active form of the hormone T3.
These drugs do cross the placenta and can effect the fetal thyroid, although it is generally transient. Generally, these drugs are safe to use in pregnancy but rare side effects of the drug can include fever, sore throat, hepatitis, rash, nausea, loss of taste and smell, loss of appetite and a very serious and rare side effect called agranulocytosis (less than 1%) which is an abnormal condition of the blood characterized by a severe reduction of white blood cells (fever, prostration and bleeding ulcers of rectum, mouth, and vagina.)
Infants must be observed carefully after birth with mothers on antithyroid medication since newborns have been known to have neonatal hypothyroidism and goiter in mothers who have been treated. Babies are ultrasounded during pregnancy looking for fetal goiter and growth problems which can present problems at delivery due to the hyperextension of the neck.
It is generally considered safe to breast feed on these medications.
Other drugs used to treat hyperthyroidism are beta-blockers (propranolol) which act to reduce the rapid heart rate that can occur. Side effects from this drug can include growth retardation in the fetus, fetal bradycardia (slowed heart rate) and hypoglycemia in the infant (low blood sugar).
Radioactive iodine is never used in pregnancy since it can ablate the fetal thyroid. A patient was treated with radioactive iodine prior to becoming pregnant, should avoid becoming pregnant for at least 4 months. If all medications fail, or allergy to the medications exist, thyroidectomy, or surgical excision of the thyroid is recommended.
What is subclinical hyperthyroidism?
In about 1.7% of women there are asymptomatic women with normal thyroid hormone but a low TSH. This condition generally has been found to have no effect on the pregnancy since it is the maternal T4 level that is critical for fetal brain development, regardless of what the TSH level is. However, these women should be observed for osteoporosis, cardiovascular morbidity and progression to overt disease or thyroid failure in the future.
What is thyroid storm?
Thyroid storm is an acute obstetrical emergency that occurs in about 10% of women with hyperthyroidism. Symptoms include a change in mental status, seizures, nausea, diarrhea, and cardiac arrythmias. Patients are placed in the intensive care unit for constant monitoring and observation since there is a high risk of maternal heart failure. Thyroid storm can be precipitated by an acute surgical emergency, infection, diabetes. anesthesia, and noncompliance with thyroid medications. In addition to the usual treatment of hyperthyroidism as described above, steroids are commonly given.
Can thyroid disease present itself right after delivery?
About 6 to 9% of women with no history of thyroid disease can present with disease after delivery, generally within the first year postpartum. This is common in women that have previously known thyroid antibodies that are not activated until after the delivery, or women with a strong family history of diabetes or other autoimmune disorders. Most women have transient hyperthyroidism which then converts to hypothyroidism requiring treatment. About 77% of women will completely recover but 30% will continue with thyroid disease permanently. Many women that recover will develop this disorder again with subsequent pregnancies.
Summary:
Because of the close similarity of symptoms that occur with a normal early pregnancy, be sure to ask your health care providers if you should be screened for thyroid disease. Discovery and correction of this condition can have beneficial ramifications to ensure a happy, healthy mother and baby. As stated in many previous blogs, pregnancy can be the crystal ball of future medical conditions and by being vigilant, pregnancy can help a woman avoid diseases and conditions from surfacing later in life.
If it’s actually Morning Sickness you have, Beauté de Maman Nausea Supplement can help! With Ginger, Vitamin B6, Vitamin D and Lime, morning sickness will be a thing of the past… Try it now!
Tags: depression, diseases, hyperthyroidism, Hypothyroidism, morning sickness, mother, Nausea & Morning Sickness, obstetrician
Posted in Conditions & Diseases | 6 Comments »
Monday, June 14th, 2010
 I’m terribly sorry if anyone is offended by this photo of a horse with a bad set of choppers, but because a whopping 30% of pregnant women get periodontal disease, I simply couldn’t risk losing your attention. As they say, you can lead a horse to water, but you can’t make it brush its teeth.
While periodontal disease may seem like a boring and unglamorous topic for us to be discussing, it’s so important that I even decided to post two articles in a row about proper dental care during pregnancy.
My pregnancy article last week focused on dental changes, good oral hygiene and recommended dental health guidelines. This week’s pregnancy article will concentrate on the specific risks of periodontal disease. It’s not a pretty picture but please read all the way to the end to make sure you understand what you can do to stay out of the 30% and prevent this ugly and damaging syndrome.
What is periodontal disease?
Periodontal disease begins as gingivitis, or inflammation of the soft tissue that supports the teeth. This inflammation is caused by a specific oral bacteria named gram negative anaerobic bacteria. In combination with the elevated hormones during pregnancy that increase blood volume and capillary fragility, these bacteria give rise to redness, increased sensitivity, bleeding and pain. Left untreated, these conditions can predispose a pregnant woman to more serious problems down the road.
Why can periodontal disease lead to more serious problems during pregnancy?
If left untreated, the inflammation previously described can lead to the formation of pockets around the teeth. Within these pockets potential deep infections can occur and as pregnancy progresses, pocket depth has been shown to increase. These pockets are actually the separation of the teeth from the gums and, if left untreated, these teeth can separate from the surrounding supporting structure, named the periodontal ligament and cementum. This separation can eventually lead to the loss of the affected teeth.
What is the incidence of periodontal disease in pregnancy?
Approximately one third of all pregnant women have periodontal disease. Although the disease is measured differently in varying studies it is generally defined as 15 or more tooth sites with greater than 4 mm loss of attachment when probing.
Why is the presence of periodontal disease so important in pregnancy?
Periodontal disease has been associated with preterm delivery (before 37 weeks), low birth weight (less than 2500 grams), poor obstetrical outcomes, pregnancy loss, late miscarriage and preeclampsia, especially in populations comprised of people who have very limited access to dental care. Preterm birth rate has been reported to be 11.2% in women without periodontal disease compared to 28.6% in women with moderate to severe disease (Offenbacher, 2006). Similarly, progression of periodontal disease is also associated with a higher risk of preterm birth (6.4% vs 1.8% by same author). Most studies confirm these findings although some fail to show this association.
How can you explain this association of periodontal disease with poor obstetrical outcome?
- One explanation is that bacteria or infection from the mouth enter the bloodstream and eventually reach the placental membranes causing inflammation and damage resulting in preeclampsia or labor.
- Other explanations behind the results are that the specific bacteria and toxins identified in periodontal disease (Treponema denticola, Campylobacter rectus, Porphyromonas gingivalis to name a few) cause elevations in “inflammatory factors” or cytokines in the maternal blood (tumor necrosis factor-alpha, interleukin-8 (IL-8) and IL-1B) and it is these factors that have been found to increase the substances that stimulate the uterus to contract, such as prostaglandins (PGE-2), which cause the induction of labor.
- Supporting this theory is the finding that blood from pregnant moms who have an increase in antibodies (reactive substances) to some of these bacteria found in the mouth have also been found to have a higher incidence of preterm birth and low birth weight infants. These same elevated antibodies have been found in amniotic fluid and in fetal cord blood samples of infants delivered preterm or of low birth weight.
- Studies have shown that treatment for periodontal disease, through plaque control, scaling, and daily antibacterial rinsing reduced the risk of preterm births. Some studies however, have not been as consistent.
How does periodontal disease relate to other conditions in life?
After pregnancy, chronic exposure to these inflammatory blood substances from bacteria in the mouth may cause a three to four times greater risk later in life to cardiovascular disease, atherosclerosis, stroke, and diabetes compared to the general population. The mechanism is believed to be due to bacteria, toxins and platelets sticking together, along with circulating inflammatory factors which cause clots to form.
Children exposed to these inflammatory factors may also have added risk of cardiovascular disease and diabetes later in life. Other diseases associated with these inflammatory mediators include Crohn’s disease and Alzheimer’s disease as adults.
Summary
Periodontal disease is a curable problem. Treatment may not only help save your teeth, but will support the prevention of perinatal mortality and morbidity. If mothers are educated to realize that there might be a link between preventing periodontal disease and improving the health and well-being of their infant, not to mention their own health, more women will seek preventative dental care during pregnancy. Studies that are more conclusive with controls for socioeconomic status, smoking and study size have yet to be performed. However, even if the associations with these other factors are found not to be a factor in getting the disease, treating periodontal disease in pregnancy is safe and effective and, at the very least, may prevent unpleasant symptoms and appearance. It may also prevent the need for costly treatment and potential tooth loss later in life.
You may want to stick my photo of the gingivitic horse on your refrigerator as a reminder to always take good care of your teeth, especially while you are pregnant. Please share this article with everyone you know who is pregnant or may get pregnant. We have provided some sharing links below.
As I mentioned last week… no one has ever regretted taking good care of their teeth!
Tags: dental care, diseases, gingivitis, mother, Oral Hygiene, periodontal disease, pregnancy
Posted in Oral Hygiene | No Comments »
Wednesday, June 2nd, 2010
 Last week I wrote about diabetes during pregnancy and how this gestational disorder can predict the development of the full blown disease later in life. A few weeks before this article, I wrote about preeclampsia, another pregnancy specific disease characterized by sudden onset of hypertension, protein in the urine and swelling. I stressed how preeclampsia can be associated with an increased future risk of hypertension and heart disease.
Now that you understand (from these previous blogs) that pregnancy sometimes serves as a “crystal ball” of future diseases in the mother, I want to give you another heads up. This time it’s about thyroid disease.
Thyroid disease is an endocrinological disorder that often manifests itself initially during pregnancy. It is the second most common endocrine disorder for women of childbearing age. In the general population, approximately 4% to 10% of non-pregnant women have sub-clinical hypothyroidism.
What is subclinical hypothyroidism?
The production of thyroid hormone is regulated by the pituitary gland in the brain which secretes thyroid stimulating hormone (TSH). This hormone travels to the thyroid gland and stimulates the production of thyroid hormone. When a patient has increased TSH in conjunction with a thyroid hormone level within the normal range, this is often referred to as “subclinical hypothyroidism.” It is generally considered to be an early stage of hypothyroidism. Overt hypothyroidism develops when a patient develops low thyroid hormone levels along with an elevated TSH level. The stress that pregnancy places on the entire body can cause a an improvement of an existing thyroid condition or cause a “silent” thyroid disease to reach a level at which it needs attention. This is often caused by antibodies developed by the body (auto-antibodies) against the organ. We are immediately concerned about this because women with latent thyroid disease during pregnancy have a higher risk of miscarriage in both the first and second trimester. Minor decreases in maternal thyroid levels have been associated with a lower IQ in the offspring. In addition, an association exists between pre-term delivery and thyroid abnormalities.
What are the changes that occur in pregnancy?
The thyroid gland sometimes increases in size during pregnancy. Iodide levels decrease during pregnancy because of fetal use of iodide. Therefore, it is recommended by the World Health Organization that pregnant women take 200 micrograms per day as a replacement.
The level of thyroid stimulating hormone is generally decreased in the first trimester, which has minimal clinical effects. TSH levels then normalize by second trimester.
How does preeclampsia effect the thyroid gland?
There is new consideration being given to the possibility that vascular damage after preeclampsia may affect the thyroid gland causing subclinical hypothyroidism. It has been proposed that this may be independent of the autoimmune process to which hypothyroidism is usually attributed.
In preeclampsia, the serum concentration of thyroid stimulating hormone is increased. This may cause subclinical hypothyroidism. Studies have shown that TSH levels sometimes increase 2.42 times above baseline in women with preeclampsia. Studies of women with preeclampsia have shown that those women are also more likely than a control group of women who do not have preeclampsia, to develop a raised TSH concentration about 20 years later. This raises the possibility that subclinical hypothyroidism is more common after preeclampsia and that women with a history of preeclampsia may even have an elevated risk of reduced thyroid function as they get older.
These thyroid findings may also contribute to the hypertension and coronary artery disease that has been found to occur in people who have had preeclampsia. Treatment with thyroxine may possibly reduce future cardiovascular risk. It may be advisable to screen women who have had preeclampsia for thyroid function after they deliver, with ongoing follow-ups. Treatment with thyroxine may prove to be beneficial in the prevention of early cardiovascular disease in affected women.
SUMMARY:
Preeclampsia can cause reduced thyroid function during pregnancy and can be an indicator of which women would be more prone to developing reduced thyroid function in later years. Women who have had preeclampsia are advised to be followed by the their physicians after their pregnancy has ended.
Stay healthy, all you mothers out there! Pay attention to what your pregnancy tells you.
Tags: diseases, Hypothyroidism, mother, predictor, Preeclampsia, pregnancy
Posted in Conditions & Diseases | 3 Comments »
Wednesday, May 26th, 2010
 At this point in my life, I have had the honor of helping many women have happy, healthy pregnancies. Good maternity care is essential, but sometimes pregnancy itself acts like a crystal ball.
Okay. This may sound a bit like voodoo, but please hear me out.
Scientists have known for some time that high blood pressure in some pregnancies can be a predictor of future heart issues in certain women. Now it seems that gestational diabetes can also be an indicator of who will get the full blown diabetes disease later in life.
Best of all, if it can be predicted… we may be able to avert the onset of this terrible disease.
Is it possible that those unique nine months of unprecedented nausea, hormonal changes, and emotional roller coaster rides, will hold even more clues to help save women’s lives? Think about this as you kiss and hug your newborn as a new mother… or as you watch your own mother play with her grandchildren, hopefully as a still-vibrant and healthy senior. It goes without saying that the health of mothers is incredibly vital to the health and well being of their offspring.
What is Gestational diabetes?
Gestational diabetes is defined as any type of glucose impairment that is initially detected during pregnancy. The incidence of Gestational Diabetes in the United States is about 4% and rates are increasing over the last few years. High risk factors for the development of the condition include:
What are the risk factors for Gestational diabetes?
- Age over 25 years
- Obesity
- Family history of diabetes
- Previous history of gestational diabetes
- Certain ethnic groups (Hispanic, American Indian, Asian, African-American)
What are the screening recommendations for Gestational diabetes?
The American College of Obstetrics and Gynecology recommends that all pregnant women be screened for gestational diabetes. The most common diagnostic test is the 50 gram 1-hour glucose challenge test that is given between 24 and 28 weeks of gestation. An abnormal result is defined as blood glucose of 130 mg/dl or greater or 140 mg/dl or greater, depending upon the criteria used. If abnormal, the patient then undergoes a 100 g 3-hour oral glucose tolerance test in which 2 or more abnormal values confirm the diagnoses.
What are the treatment options for Gestational diabetes?
Various treatments during pregnancy including dietary modifications directed by a certified nutritionist who specializes in diabetes, physical activity and possibly medications, depending upon the level of severity. The medications may include oral hypoglycemic agents or insulin, depending upon the glucose values obtained as the pregnancy progresses. Increased resistance to insulin occurs as pregnancy progresses, stressing the pancreas and making more demands on the pancreas to manufacture insulin.
Why is it advisable to treat gestational diabetics?
Controlling glucose levels in pregnancy reduces the risk of congenital anomalies, miscarriage, pre-eclampsia, preterm delivery, macrosomia (large babies), polyhydramnios (excessive amniotic fluid), stillbirth, Cesarean sections, difficult or traumatic delivery, and infections postpartum.
Immediately after delivery, miraculously the diabetes disappears!!! Resistance to insulin resolves within hours and patients often return to their pre-pregnancy normal state.
Does the end of pregnancy close the chapter on Gestational diabetes?
Some women, whose diabetes was not diagnosed prior to the pregnancy, have been found to have long standing diabetes that was uncovered with the routine screening that is performed during pregnancy. Even if it is a new onset of disease, detected during pregnancy, it is a known fact that women who have had gestational diabetes are at major risk for developing Type II diabetes later on in life. Some articles (Callaghan, 4/10) report that approximately one-third of women with gestational diabetes continue to have evidence of diabetes immediately postpartum. Other estimates range at about 50% chance of developing diabetes in the ten years following the pregnancy.
How should these women be followed after their pregnancy ends?
- All women who have had gestational diabetes should have a repeat oral glucose tolerance test (75 gm 2 hour test) at their 6 to 12 week postpartum visit or after breast feeding has been discontinued.
- Even if the values are normal, annual screening with a fasting glucose and/or HbA1C blood test has been suggested. However, at minimum, screening at least every 3 years is advisable.
- Encourage diabetes prevention education by encouraging exercise, weight loss, and proper diet.
- Women with pre-diabetes should consider medication regimens and lifestyle changes that prevent the chances of progression of their disease.
In Summary
Women have a distinct advantage of having a unique “window in time” in their life during pregnancy when potentially later in life disease complications might appear which the stress of pregnancy can unmask. If taken seriously, this can serve as an early marker of future disease and with proper monitoring and intervention can allow for possible opportunities for reversal.
Tags: diabetes, diagnostics, diseases, mother
Posted in Conditions & Diseases | 1 Comment »
|
